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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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7.2.6 Graft-Versus-Host Disease (GVHD)
(A) Grade 1 GVHD with a patchy distributed edematous mucosa and loss of
vasculature
(B) Grade 2 GVHD with diffuse edematous mucosal changes, granularity, and
pale exudate
(C) Grade 3 GVHD with marked diffuse edematous mucosal change accompanied
by multiple erythema and deep erosions
(D) Grade 4 GVHD with multiple supercial ulcerations covered with whitish exu-
date and necrotic debris.
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7.2.7 Cytomegalovirus (CMV) Enteritis
(A) Erythematous and edematous mucosal changes in the jejunum of a leukemia
patient treated with bone marrow transplantation. Detection of CMV via
immunohistochemistry
(B) Shallow well-demarcated ulcerations with exudate in a patient treated with che-
motherapy for metastatic colorectal cancer
(C) Geographically shaped ulcerations with an irregular border and base in a patient
with glomerulonephritis treated with systemic glucocorticoids (positive CMV
immunohistochemistry)
(D) CMV co-infection in ileal ulcers in patients with Crohn’s disease (positive
CMV immunohistochemistry)
(E) CMV jejunitis in a 64-year-old immunocompetent patient without underlying
diseases other than diabetes. Note that the diffuse erythematous and edematous
mucosal changes with geographic ulceration with indistinct borders from the
proximal to the distal jejunum
(F) CMV ileitis in an 80-year-old immunocompetent patient with well-dened bor-
ders and deep ulcerations leading to strictures.
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7.2.8 Eosinophilic Enteritis
(A) Edematous and hyperemic mucosal change with granularity and fragility in the
ileum (eosinophils 50 per high power eld (HPF))
(B) Diffuse edematous mucosal change with mild ulceration (eosinophils 30
per HPF)
(C) Eosinophilic enteritis presented with the presence of swollen, bumpy patches.
7.2.9 Radiation Enteritis
(A) Acute radiation enteritis with diffuse erythematous and edematous mucosal
changes with supercial ulceration after radiotherapy of lymph node metastases
in the aortic bifurcation
(B) Chronic radiation enteritis with multiple telangiectasias after radiotherapy for
hepatocellular carcinoma.
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a
7.2.10 Henoch-Schönlein Purpura
(A), (B) Small bowel involvement in Henoch-Schönlein purpura with multiple well-
demarcated edema, severe erythema, and ulceration in the duodenum and the
jejunum.
a
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7.3 Small-Bowel Vascular Lesions
7.3.1 Endoscopic Classification ofSmall-Bowel Vascular Lesion
(Yano-Yamamoto Classification) [6]
(A) Yano-Yamamoto type IA small-bowel vascular lesions. Small punctate ery-
thema (< 1mm), indicating angioectasia
(B–E) Yano-Yamamoto type IB small bowel vascular lesions. Patchy erythema
(2–5mm), indicating a large angioectasia.
(F), (G) Yano-Yamamoto type IIA small bowel vascular lesions. Small punctate
lesions (< 1mm) with active bleeding, indicating Dieulafoy’s lesions.
(H), (I) Yano-Yamamoto type IIB small-bowel vascular lesions. Pulsatile red protru-
sions without surrounding venous dilatation, indicating Dieulafoy’s lesions.
(J) Yano-Yamamoto type III small-bowel vascular lesions. Pulsatile red protrusion
accompanied by a surrounding venous dilatation, indicating arteriovenous
malformations
(K) Yano-Yamamoto type IV small-bowel vascular lesions. An unclassied vascular
lesion that does not t into the other categories.
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7.3.2 Lymphangiectasia
(A), (B) Whitish dilated lymphangiectasia measuring approximately 5mm in the
proximal jejunum
(C–E) Diffusely distributed whitish dilated lymphangiectasia in the duodenum and
the jejunum in a patient with lymphangiectasia leading to protein-losing
enteropathy
(F) Lymphangiectasia associated with angioectasia.
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7.4 Diverticular Lesions
7.4.1 Meckel’s Diverticulum [7]
(A–C) Two-lumen sign appearing to divide the ileum into two at 100cm from the
ileocecal valve, indicating Meckel’s diverticulum.
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(D–F) Ulceration in the ectopic gastric tissue in the Meckel’s diverticulum.
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