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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5540_Библиотеки_им_академика_М_И_Перельмана.pdf
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7.1.7 Hemangioma
(A) Proximal jejunal capillary hemangioma measuring 8mm with supercial punc-
tate dilated capillaries, (B) intermittent bleeding
(C) Cavernous hemangioma with a bluish nodular protruding mass measuring
15mm on the jejunum and a dilated vascular structure on the surface of the lesion
(D) Cavernous hemangioma with a 2-cm Isp-shaped, polypoid, bluish nodular pro-
truding mass with supercial erythema in the fourth portion of the duodenum.
7.1.8 Ectopic Pancreas
(A) Slightly elevated white-yellowish and inltrative lesion with indistinct borders
in the proximal jejunum. A small, depressed structure suspected to be a pancre-
atic duct orice
(B) Slightly elevated inltrative lesion with a nodular surface with indistinct borders
in the proximal jejunum and a central depression suspected to be a pancreatic
duct opening
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(C) Slightly elevated inltrative lesion with indistinct borders in the fourth part of
the duodenum
(D) Isp-type nodular whitish-yellowish protruding subepithelial lesion with an
overlying normal mucosa in the proximal jejunum.
7.1.9 Lipoma
(A) A 1.5-cm yellowish Isp-type subepithelial tumor in the ileum that was soft and
compressible when pressed with biopsy forceps (positive pillow sign)
(B) A 2-cm Isp-type subepithelial tumor in the jejunum that was soft and compress-
ible when pressed with biopsy forceps (positive pillow sign).
(C) A large lipoma with supercial ulceration caused by recurrent transient intus-
susception in the proximal jejunum, lling almost the whole lumen of the
intestine
(D) Yellow adipose tissues in the resected section after endoscopic mucosal resec-
tion (naked fat sign).
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7.2 Inflammatory Lesions
7.2.1 Small-Bowel Crohn’s Disease [4, 5]
(A–D) Longitudinal ulcers located asymmetrically at the mesenteric border of the
small intestine
(E), (F) Eccentric longitudinal ulcer with shortening of the mesenteric border with
luminal narrowing and ulcerative scar and saccular dilatation with antimesen-
teric border
(G) Longitudinally arranged aphthous ulcers
(H) Cobblestone appearance of the small intestinal mucosa with ulceration
(I–L) Inammatory stricture with transverse circular ulceration
(M) Web-like brotic stricture
(N) Eccentric brotic stricture with an eccentric longitudinal ulcer scar
(O), (P) Endoscopic balloon dilation using balloon-assisted enteroscopy for small-
bowel stricture in a patient with Crohn’s disease.
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* Tips for diagnosis: On balloon-assisted enteroscopy, small-bowel Crohn’s disease is characterized by non-contiguous longitudinal ulcers, longitudinally arranged
aphthous ulcers, and a cobblestone appearance. In addition, transverse circular
ulcers are often observed, resulting in inammatory strictures of the small bowel.
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7.2.2 Small-Bowel Tuberculosis
(A), (B) Small-bowel tuberculosis identied as segmental ileal strictures with
edematous mucosa and ulceration (no evidence of pulmonary tuberculosis;
chronic active ileitis with caseating granulomas on histological examination and
Mycobacterium tuberculosis isolated in the acid-fast bacteria culture)
(C, D) Small-bowel tuberculosis diagnosed in a patient with pulmonary tuberculo-
sis. Luminal narrowing with segmental ulceration in the ileum accompanied by
edematous and erythematous mucosal changes.
7.2.3 Intestinal Behçet’s Disease
(A) Single aphthous ulcers in the terminal ileum of a patient with Behçet’s disease
(B) Multiple small aphthous ulcers diffusely distributed in the ileum of a patient
with Behçet’s disease
(C) Whitish exudates covering a geographically shaped discrete ulcer in the distal
ileum of a patient with Behçet’s disease
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(D) Deep ulcer with a raised margin, folds convergence, and luminal narrowing in
the distal ileum of a patient with Behçet’s disease.
7.2.4 Nonsteroidal Anti-inflammatory Drug (NSAID)-Induced
Small-Bowel Ulcer andEnteropathy
(A) Deep discrete ulceration of the distal ileum after the prolonged use of NSAIDs
(B) A healed scar 6months after the discontinuation of NSAIDs
(C–F) Multiple web-like strictures in the jejunum in a patient with chronic
NSAID use
(G), (H) NSAID-induced small-bowel stricture treated with endoscopic balloon
dilation using balloon-assisted enteroscopy.
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7.2.5 Ischemic Enteritis
(A) Acute ischemic enteritis developed after angiographic embolization for proxi-
mal jejunal angioectasia, with a well-demarcated ulcer with necrotic debris
clearly demarcated from the normal mucosa
(B), (C) Chronic ischemic enteritis caused by superior mesenteric artery occlusion,
with a diffuse well-demarcated supercial ulcer with luminal narrowing and
clear demarcation from the normal mucosa
(D) Single-balloon endoscopy after the resolution of the superior mesenteric artery
occlusion, showing a large resolved ulcerative lesion of the small intestine.