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The presence of incomplete upper gastrointestinal obstruction in childhood is a rare condition and usually indicates congenital anomaly. We reported a case of incomplete duodenal obstruction in a 16-year-old girl due to a congenital duodenal diaphragm. A duodenal diaphragm with an eccentric aperture was found by upper gastrointestinal series and endoscopic examination in the second part of the duodenum. The patient made an uncomplicated recovery with relief of the symptoms after duodenotomy and excision of the diaphragm. This case underlines that congenital duodenal diaphragm should be kept in mind as a possibility whenever chronic obstruction of the duodenum in childhood is diagnosed. The prognosis of congenital duodenal diaphragm is usually good after excision of the diaphragm, when not associated with other congenital anomalies. [ABSTRACT FROM AUTHOR]

Background: Post-operative enteral nutrition via gastric or jejunal feeding tubes is a common and standard practice in managing the critically ill or post-surgical patient. It has its own set of complications, including obstruction, abscess formation, necrosis, and pancreatitis. We present here a case of small bowel obstruction caused by enteral nutrition bezoar. It is the second recorded incidence of this complication after pancreaticoduodenectomy in the medical literature., Case Summary: The 70-year-old female presented to our institution for a pancreaticoduodenectomy (Whipple's procedure) for pancreatic adenocarcinoma. On day 5 post-operative, having failed to progress and developing symptoms of small bowel obstruction, she underwent a computed tomography scan, which showed features of mechanical small bowel obstruction. Following this, she underwent an emergency laparotomy and small bowel decompression. The recovery was long and protracted but, ultimately, she was discharged home. A literature search of reports from 1966-2020 was conducted in the MEDLINE database. We identified eight articles describing a total of 14 cases of small bowel obstruction secondary to enteral feed bezoar. Of those 14 cases, all but 4 occurred after upper gastrointestinal surgery; all but 1 case required further surgical intervention for deteriorating clinical picture. The postulated causes for this include pH changes, a reduction in pancreatic enzymes and gastric motility, and the use of opioid medication., Conclusion: Enteral feed bezoar is a complication of enteral feeding. Despite rare incidence, it can cause significant morbidity and potential mortality., Competing Interests: Conflict-of-interest statement: The authors declare no conflicts of interest., (©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.)

Body packing was first described in 1973 and refers to the intracorporeal concealment of illegal drugs, which are swallowed or placed in anatomical cavities and/or body orifices. The body packer can be asymptomatic or can have signs of systemic drug toxicity (neurological, cardiac, abdominal, renal and cutaneous) due to rupture of the packet(s) or symptoms of gastrointestinal obstruction or perforation. The diagnosis is established based on a suggestive history, findings on physical examination and laboratory findings and/or imaging. The vast majority of patients are asymptomatic and are treated conservatively. However, complex situations may require surgical intervention. We present a case of a 50-year-old man who was admitted in the emergency department with a generalized tonic-clonic seizure and vomiting with plastic film, which raised the suspicion of foreign body ingestion, confirmed by imaging and laboratory tests. He underwent exploratory laparotomy to remove the packages., Learning Points: Body packing is a potentially lethal activity.Body-packers can be asymptomatic, or have signs/symptoms of systemic drug toxicity or gastrointestinal obstruction or perforation.It is essential to recognize this condition so that the correct clinical approach, diagnosis and management can be established., Competing Interests: Conflicts of Interests: The Authors declare that there are no competing interests., (© EFIM 2020.)

Treats are important contributors to the economics of the U.S. pet product industry. Not only do pet owners use them to build an emotional bond or interact with their pets, but treats also can deliver functional or health benefits. The objective of this study was to evaluate the digestion and safety of selected commercial treats by measuring their in vitro dry matter disappearance (DMD) using the modified in vitro method of Boisen and Eggum, which was developed to simulate in vivo digestibility of nonruminant animals. Twenty-five commercial treats were classified into six categories based on their appearance, size, and functionality. These categories included biscuit, chew, dental, meat product, rawhide, and cat treat. Each commercial product was analyzed in triplicate and in vitro DMD was calculated after enzymatic digestion and incubation. A wide variation in DMD was observed among and within different treat categories in both gastric and gastric + small intestinal phases of digestion. For the gastric phase, DMD ranged from 8.40% to 92.20%, whereas intestinal phase digestion had a DMD range of 35.10-100% ( P < 0.05). In general, treats from meat products, dental, chew, biscuit, and cat treat categories had a high DMD (>85%) after the intestinal phase, whereas DMD of rawhide treats varied from 35.10% to 95.70%. Principal component analysis, in addition, has visually shown that rawhide treats displayed the largest portion of variation from the other treats. A low DMD at gastric phase is a concern because it may pose a risk for gastrointestinal blockage and intolerance, particularly for treats of large size that remained intact during this phase. In vitro DMD results can be used as a potential predictor of in vivo digestibility, facilitate recommendations about pet treat safety for professionals and manufacturers in the pet industry, and assist pet owners in the treat selection process and with treat purchasing decisions., (© The Author(s) 2020. Published by Oxford University Press on behalf of the American Society of Animal Science.)

Background: Digestive tumours are among the leading causes of morbidity and mortality. Many cancer patients cannot maintain oral feeding and develop malnutrition. The authors aim to: review the endoscopic, radiologic and surgical techniques for nutritional support in cancer patients; address the strategies for nutritional intervention according to the selected technique; and establish a decision-making algorithm to define the best approach in a specific tumour setting., Summary: This is a narrative non-systematic review based on an electronic search through the medical literature using PubMed and UpToDate. The impossibility of maintaining oral feeding is a major cause of malnutrition in head and neck (H&N) cancer, oesophageal tumours and malignant gastric outlet obstruction. Tube feeding, endoscopic stents and gastrojejunostomy are the three main nutritional options. Nasal tubes are indicated for short-term enteral feeding. Percutaneous endoscopic gastrostomy (PEG) is the gold standard when enteral nutrition is expected for more than 3-4 weeks, especially in H&N tumour and oesophageal cancer patients undergoing definite chemoradiotherapy. A gastropexy push system may be considered to avoid cancer seeding. Radiologic and surgical gastrostomy are alternatives when an endoscopic approach is not feasible. Postpyloric nutrition is indicated for patients intolerant to gastric feeding and may be achieved through nasoenteric tubes, PEG with jejunal extension, percutaneous endoscopic jejunostomy and surgical jejunostomy. Oesophageal and enteric stents are palliative techniques that allow oral feeding and improve quality of life. Surgical or EUS-guided gastrojejunostomy is recommended when enteric stents fail or prolonged survival is expected. Nutritional intervention is dependent on the technique chosen. Institutional protocols and decision algorithms should be developed on a multidisciplinary basis to optimize nutritional care., Conclusions: Gastroenterologists play a central role in the nutritional support of cancer patients performing endoscopic techniques that maintain oral or enteral feeding. The selection of the most effective technique must consider the cancer type, the oncologic therapeutic program, nutritional aims and expected patient survival., Competing Interests: The authors have no conflicts of interest to declare., (Copyright © 2019 by S. Karger AG, Basel.)

Superior mesenteric artery (SMA) or Wilkie's syndrome is a rare clinical entity of partial or complete duodenal obstruction. The pathogenic mechanism is an acute angulation of the SMA which leads to compression of the third part of the duodenum between the SMA and the aorta. This is commonly due to loss of fatty tissue as a result of a variety of debilitating conditions. Its treatment is initially conservative and in case of failure, surgical therapy is unavoidable. We present a case of a 68-year-old female patient who presented in our Department with symptoms of dehydration after persistent vomiting for months. After complete radiologic workup, SMA syndrome was diagnosed and was successfully treated operatively. SMA syndrome might be a diagnostic challenge and must be always included in the differential diagnosis of upper gastrointestinal obstruction. Consequently, this paper aims to increase the awareness of a rare entity of duodenal obstruction. [ABSTRACT FROM AUTHOR]

An ectopic pancreas, also known as pancreatic rest or heterotopic pancreas, consists of pancreatic tissue found in a location with no continuity with the anatomic pancreas. This lesion can occasionally cause gastrointestinal obstruction, ulceration or become inflamed and cause ectopic pancreatitis. We present the case of a 29-year-old immunocompromised female patient due to a previous kidney transplant. She presented with nausea and vague abdominal discomfort and was admitted for investigation and treatment of an acute kidney injury. A small bowel mass of unknown etiology was incidentally found on abdominal computed tomography imaging. Due to the high suspicion of a post-transplant lymphoproliferative disease, a surgical exploration took place and revealed the presence of a pancreatic rest with chronic pancreatitis. Ectopic pancreas diagnosis is challenging and surgical exploration is warranted when a neoplastic process is suspected. [ABSTRACT FROM AUTHOR]

Objectives: Patients with advanced cancer often suffer from severe malnutrition and gastrointestinal obstruction. This population could benefit from home parenteral nutrition (HPN). The aim of this study was to observe the outcome of patients with advanced cancer patients who were eligible for HPN., Methods: All patients in the nutrition clinic who received HPN over the past 7 y were included in the present study. We compared patients with advanced cancer with the noncancer population in terms of hospitalization rate and mortality., Results: Of 221 advanced cancer patients, 153 who had no oral/enteral intake and who received HPN survived. Of these, 35% survived for 6 mo, 27% for 1 y, 18.9% survived 2 y, and 3.9% survived for the 7 y of the follow-up. Hospitalization rate was not significantly different from the noncancer population., Conclusion: These results show that HPN is a relevant palliative therapy for patients with advanced cancer patients without oral or enteral feeding access., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Multiple magnet ingestion is an unexpected health hazard in children that can lead to significant gastrointestinal morbidity. The magnets are attracted to each other across the bowel wall and this may lead to pressure necrosis, resulting in perforation, fistula formation, and/or intestinal obstruction. We report herein a case of small bowel obstruction following ingestion of two magnets. The public and clinicians should be aware of the health hazard of such devices. [ABSTRACT FROM AUTHOR]

Brunner's gland hamartomas are small benign lesions that are most commonly found in the bulb of the duodenum. They are very uncommon, and most are found incidentally during upper gastrointestinal series or esophagogastroduodenoscopy. The lesions tend to be asymptomatic, but patients may present with symptoms of duodenal obstruction or hemorrhage secondary to ulceration. Histologically, a Brunner's gland hamartoma consists of the components of Brunner's gland cells, as well as glandular, adipose and muscle cells. In this study, we report the case of a 30-year-old man who presented with upper gastrointestinal bleeding and obstructive symptoms due to a giant Brunner's gland hamartoma in the duodenal bulb. The hamartoma was successfully removed by endoscopic resection. No significant complications were observed. Microscopically, the lesion was found to be entirely composed of variable Brunner's glands and adipocytes., Competing Interests: The authors have no financial conflicts of interest.

We present three cases of self-expandable metallic stent (SEMS) placement using a balloon enteroscope (BE) and its overtube (OT) for malignant obstruction of surgically reconstructed intestine. A BE is effective for the insertion of an endoscope into the deep bowel. However, SEMS placement is impossible through the working channel, because the working channel of BE is too small and too long for the stent device. Therefore, we used a technique in which the BE is inserted as far as the stenotic area; thereafter, the BE is removed, leaving only the OT, and then the stent is placed by inserting the stent device through the OT. In the present three cases, a modification of this technique resulted in the successful placement of the SEMS for obstruction of surgically reconstructed intestine, and the procedures were performed without serious complications. We consider that the present procedure is extremely effective as a palliative treatment for distal bowel stenosis, such as in the surgically reconstructed intestine.