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Ileal Blind Loop in Childhood

Ileal Blind Loop in Childhood Abstract A child had two stagnant loops of the terminal part of the ileum, resulting from a bypass operation in infancy for ileal atresia. The patient had an iron deficiency anemia that was shown at operation to be due to mucosal ulceration within the terminal part of the ileum. Diffuse nodular lymphoid hyperplasia was also demonstrated within the blind loop, and the mucosal ulceration and nodular lymphoid hyperplasia may be a response of the ileal mucosa to the increased counts of aerobic and anaerobic bacteria and to deconjugated intraluminal bile salts. Deconjugated bile salts and bacteria with deconjugating properties were also found in the upper part of the small intestine, showing that lesions of the terminal part of the ileum may be associated with metabolic abnormalities within the upper part of the small intestine. References 1. Badenoch J: The blind loop syndrome , in Jones FA (ed): Modern Trends in Gastroenterology . London, Butterworth & Co, 1958, pp 231-242. 2. Donaldson RM Jr: Normal bacterial populations of the intestine and their relation to intestinal function . N Engl J Med 270:938-945, 994-1000, and 1050-1056, 1964.Crossref 3. Benson CD: Resection and primary anastomosis of the jejunum and ileum in the newborn . Ann Surg 142:478-485, 1955.Crossref 4. Mason-Brown JJ: Small intestinal obstruction in the newly born . Ann R Coll Surg Engl 20:280-297, 1957. 5. Swain VAJ, Peonides A, Young WF: Prognosis after resection of small bowel in the newborn . Arch Dis Child 38:103-113, 1963.Crossref 6. Bayes BJ, Hamilton JR: Blind loop syndrome in children . Arch Dis Child 44:76-81, 1969.Crossref 7. Tabaqchali S, Booth CC: Bacteria and the small intestine , in Card WI, Creamer B (eds): Modern Trends in Gastroenterology , ed 4. New York, Appleton-Century-Crofts Inc, 1970, pp 143-179. 8. Anderson CM, et al: Unusual causes of steatorrhoea in infancy and childhood . Med J Aust 2:617-622, 1961. 9. van de Kamer JH, ten Bokkel Huinink H, Weyers HA: Rapid method for determination of fat in feces . J Biol Chem 177:347-355, 1949. 10. Challacombe DN, Richardson JM, Anderson CM: The bacterial microflora of the upper gastrointestinal tract in infants without diarrhoea . Arch Dis Child 49:264-269, 1974.Crossref 11. Cowan ST, Steele KJ: Manual for the Identification of Medical Bacteria . London, Cambridge University Press, 1965. 12. Panveliwalla D, et al: Determination of individual bile acids in biological fluids by thin-layer chromatography and fluorimetry . J Clin Pathol 23:309-314, 1970.Crossref 13. Hill MJ, Drasar BS: Degradation of bile salts by human intestinal bacteria . Gut 9:22-27, 1968.Crossref 14. Clawson DK: Side-to-side intestinal anastomosis complicated by ulceration, dilatation, and anemia. Physiologically unsound procedure. Review of literature and presentation of case . Surgery 34:254-257, 1953. 15. Hertzberg J: Anaemia associated with dilated blind segments of the small intestine after side-to-side anastomosis . Acta Chir Scand 120:376-379, 1961. 16. Schultz RP, Mark JBD: Massive gastrointestinal hemorrhage following side-to-side intestinal anastomosis . Arch Surg 92:399-402, 1966.Crossref 17. Botsford TW, Gazzaniga AB: Blind pouch syndrome: A complication of side-to-side intestinal anastomosis . Am J Surg 113:486-490, 1967.Crossref 18. Estes WL, Holm CE: The fate of the obstructed loop in intestinal obstruction following an anastomosis around the obstruction without resection . Ann Surg 96:924-929, 1932.Crossref 19. Ament ME, et al: Pathogenesis of steatorrhea in three cases of small intestinal stasis syndrome . Gastroenterology 63:728-747, 1972. 20. Tabaqchali S, Hatzioannou J, Booth CC: Bile salt deconjugation and steatorrhoea in patients with the stagnant loop syndrome . Lancet 2:12-16, 1968.Crossref 21. Low-Beer TS, Schneider RE, Dobbins WO: Morphological changes of the small intestinal mucosa of guinea pig and hamster following incubation in vitro and perfusion in vivo with unconjugated bile salts . Gut 11:486-492, 1970.Crossref 22. Hermans PE, et al: Dysgammaglobulinemia associated with nodular lymphoid hyperplasia of small intestine . Am J Med 40:78-89, 1966.Crossref 23. Milano AM, Lawrence LR, Horowitz L: Nodular lymphoid hyperplasia of the small intestine and colon with giardiasis . Am J Dig Dis 16:735-737, 1971.Crossref 24. Ajdukiewicz AB, Youngs GR, Bouchier IAD: Nodular lymphoid hyperplasia with hypogammaglobulinaemia . Gut 13:589-595, 1972.Crossref 25. Garbutt JT, et al: Increased ratio of glycine to taurine conjugated bile salts in patients with ileal disorders . Gastroenterology 56:711-720, 1969. 26. Garbutt JT, Lack L, Tyor MP: The enterohepatic circulation of bile salts in gastrointestinal disorders . Am J Med 51:627-636, 1971.Crossref 27. McLeod GM, Wiggins HS: Bile salts in small intestinal contents after ileal resection and in other malabsorptive syndromes . Lancet 1:873-876, 1968.Crossref 28. Abaurre R, et al: Fasting bile salts, pool size and composition after ileal resection . Gastroenterology 57:679-688, 1969. 29. Poley JR, et al: Bile acids in infants and children . J Lab Clin Med 63:838-846, 1964. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

Ileal Blind Loop in Childhood

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References (30)

Publisher
American Medical Association
Copyright
Copyright © 1974 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1974.02110300129020
Publisher site
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Abstract

Abstract A child had two stagnant loops of the terminal part of the ileum, resulting from a bypass operation in infancy for ileal atresia. The patient had an iron deficiency anemia that was shown at operation to be due to mucosal ulceration within the terminal part of the ileum. Diffuse nodular lymphoid hyperplasia was also demonstrated within the blind loop, and the mucosal ulceration and nodular lymphoid hyperplasia may be a response of the ileal mucosa to the increased counts of aerobic and anaerobic bacteria and to deconjugated intraluminal bile salts. Deconjugated bile salts and bacteria with deconjugating properties were also found in the upper part of the small intestine, showing that lesions of the terminal part of the ileum may be associated with metabolic abnormalities within the upper part of the small intestine. References 1. Badenoch J: The blind loop syndrome , in Jones FA (ed): Modern Trends in Gastroenterology . London, Butterworth & Co, 1958, pp 231-242. 2. Donaldson RM Jr: Normal bacterial populations of the intestine and their relation to intestinal function . N Engl J Med 270:938-945, 994-1000, and 1050-1056, 1964.Crossref 3. Benson CD: Resection and primary anastomosis of the jejunum and ileum in the newborn . Ann Surg 142:478-485, 1955.Crossref 4. Mason-Brown JJ: Small intestinal obstruction in the newly born . Ann R Coll Surg Engl 20:280-297, 1957. 5. Swain VAJ, Peonides A, Young WF: Prognosis after resection of small bowel in the newborn . Arch Dis Child 38:103-113, 1963.Crossref 6. Bayes BJ, Hamilton JR: Blind loop syndrome in children . Arch Dis Child 44:76-81, 1969.Crossref 7. Tabaqchali S, Booth CC: Bacteria and the small intestine , in Card WI, Creamer B (eds): Modern Trends in Gastroenterology , ed 4. New York, Appleton-Century-Crofts Inc, 1970, pp 143-179. 8. Anderson CM, et al: Unusual causes of steatorrhoea in infancy and childhood . Med J Aust 2:617-622, 1961. 9. van de Kamer JH, ten Bokkel Huinink H, Weyers HA: Rapid method for determination of fat in feces . J Biol Chem 177:347-355, 1949. 10. Challacombe DN, Richardson JM, Anderson CM: The bacterial microflora of the upper gastrointestinal tract in infants without diarrhoea . Arch Dis Child 49:264-269, 1974.Crossref 11. Cowan ST, Steele KJ: Manual for the Identification of Medical Bacteria . London, Cambridge University Press, 1965. 12. Panveliwalla D, et al: Determination of individual bile acids in biological fluids by thin-layer chromatography and fluorimetry . J Clin Pathol 23:309-314, 1970.Crossref 13. Hill MJ, Drasar BS: Degradation of bile salts by human intestinal bacteria . Gut 9:22-27, 1968.Crossref 14. Clawson DK: Side-to-side intestinal anastomosis complicated by ulceration, dilatation, and anemia. Physiologically unsound procedure. Review of literature and presentation of case . Surgery 34:254-257, 1953. 15. Hertzberg J: Anaemia associated with dilated blind segments of the small intestine after side-to-side anastomosis . Acta Chir Scand 120:376-379, 1961. 16. Schultz RP, Mark JBD: Massive gastrointestinal hemorrhage following side-to-side intestinal anastomosis . Arch Surg 92:399-402, 1966.Crossref 17. Botsford TW, Gazzaniga AB: Blind pouch syndrome: A complication of side-to-side intestinal anastomosis . Am J Surg 113:486-490, 1967.Crossref 18. Estes WL, Holm CE: The fate of the obstructed loop in intestinal obstruction following an anastomosis around the obstruction without resection . Ann Surg 96:924-929, 1932.Crossref 19. Ament ME, et al: Pathogenesis of steatorrhea in three cases of small intestinal stasis syndrome . Gastroenterology 63:728-747, 1972. 20. Tabaqchali S, Hatzioannou J, Booth CC: Bile salt deconjugation and steatorrhoea in patients with the stagnant loop syndrome . Lancet 2:12-16, 1968.Crossref 21. Low-Beer TS, Schneider RE, Dobbins WO: Morphological changes of the small intestinal mucosa of guinea pig and hamster following incubation in vitro and perfusion in vivo with unconjugated bile salts . Gut 11:486-492, 1970.Crossref 22. Hermans PE, et al: Dysgammaglobulinemia associated with nodular lymphoid hyperplasia of small intestine . Am J Med 40:78-89, 1966.Crossref 23. Milano AM, Lawrence LR, Horowitz L: Nodular lymphoid hyperplasia of the small intestine and colon with giardiasis . Am J Dig Dis 16:735-737, 1971.Crossref 24. Ajdukiewicz AB, Youngs GR, Bouchier IAD: Nodular lymphoid hyperplasia with hypogammaglobulinaemia . Gut 13:589-595, 1972.Crossref 25. Garbutt JT, et al: Increased ratio of glycine to taurine conjugated bile salts in patients with ileal disorders . Gastroenterology 56:711-720, 1969. 26. Garbutt JT, Lack L, Tyor MP: The enterohepatic circulation of bile salts in gastrointestinal disorders . Am J Med 51:627-636, 1971.Crossref 27. McLeod GM, Wiggins HS: Bile salts in small intestinal contents after ileal resection and in other malabsorptive syndromes . Lancet 1:873-876, 1968.Crossref 28. Abaurre R, et al: Fasting bile salts, pool size and composition after ileal resection . Gastroenterology 57:679-688, 1969. 29. Poley JR, et al: Bile acids in infants and children . J Lab Clin Med 63:838-846, 1964.

Journal

American Journal of Diseases of Children – American Medical Association

Published: Nov 1, 1974

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