Blind intestinal loops

Fistulae occur in 17%-82% of CD patients. They are a transmural extension of the disease, often resulting from intestinal stenosis (Oberhuber et al. 2000), which ends blindly in the surrounding mesentery or connects intestinal loops or adjacent organs. Depending on their site and extension, abdominal fistulae are commonly subdivided into external or internal (enteroenteric,enteromesenteric). 

Search for fistula, large or multiple small intestinal diverticula, and an enlarged surgical blind loop (X-ray) or confined segment of intestine... 

Di Stefano M, Pezzimenti D, Veneto G, Missa-nelli A, Corazza GR Absorbable vs. nonabsorbable antibiotics in the therapy of small intestine bacterial overgrowth (SIBO) in patients with blind loop syndrome. Dig Liver Dis 2001 33 A93. 

Structural disease Crohn s disease Post-gastric surgery Intestinal resection Blind loops with bacterial overgrowth Infection... 

Deconjugation of bile acids may become excessive when bacterial overgrowth occurs in the small intestine. This condition is referred to as the stagnant loop or blind loop syndrome and is characterized by diarrhea, often accompanied by steatorrhea because of a decrease in the effective concentration of conjugated bile salts and a reduction in the fat-absorptive capacity of the small intestine. 

Intestinal malabsorption due to parasites (fish tapeworm, a.k.a. Dinhvllabothrium latum), bacteria (blind-loop syndrome), or Crohn s disease of ileum... 

The normal appendix can be detected on US in more than 80% of asymptomatic patients (Rioux 1992 WiERSMA et al. 2005). It may be identified as a tubular, mobile and blind-ended structure, measuring 6 mm or less in the anteroposterior diameter (Jeffrey et al. 1988 Vignault et al. 1990). As with any intestinal bowel loop, five concentric layers that are alternately hyperechoic and hypoechoic can be identified corresponding from inner to outer hyperechoic mucosal surface, hypoechoic mucosa, hyperechoic submucosa (due to vessels, connective tissue and fat content), hypoechoic muscular, and hyperechoic serosa sometimes in smooth continuity with the hyperechoic periappendicular fat (Kimmey et al. 1989) (Fig. 1.57). The most prominent layer of the normal appendix in children is the hypoechoic mucosa due to the follicular lymphoid tissue of the mucosal lamina propria (Spear et al. 1992). 

The serum bile salt pattern is altered in patients with bacterial proliferation in the small intestinal content (stagnant loop or blind loop syndrome). Bacterial deconjugation of bile salts in the lumen of the small intestine per-... 

B. Altered Intestinal Microflora, Blind-Loop Syndrome... 

The pathophysiology and clinical setting of the blind-loop syndrome have been reviewed recently by Donaldson (30). It is clear that a resident bacterial flora in the proximal small intestine has a major role in the development of the absorptive and luminal defects which have been observed repeatedly in these patients (20,31-35), who have a variety of basic illness, and in experimental animals (31,36) in which an antiperistaltic pouch has been constructed either in the proximal or middle jejunum. However, the presence and extent of the absorptive defects, i.e., vitamin B12, folate, xylose, and lipid, as well as the extent of luminal metabolic alteration of bile salts have varied in individual patients. This variability is probably related to... 

When bacteria invade the upper intestine, as in an intestinal blind loop, they deconjugate bile. The deconjugated bile is not absorbed, and instead of being absorbed normally, lipids are excreted in the feces (steatorrhea). 

Megaloblastic anemia may follow operations or diseases which lead to stenosis or blind loops in the small intestine, or anastomosis of the small with the large bowel. The essential feature in most cases is an area of stagnation in the small intestine. Experimental anemia in the rat (Watson et al., 1948) and a hypothesis are discussed on page 143. In the rat antibiotics were effective, and so was folic acid, but not vitamin B12. 

Malabsorption associated with (a) a deficiency of pancreatic enzymes or bile, (b) infiltration of the small intestine by the cancer, (c) gastric hypersecretion as in the Zollinger-Elli-son syndrome, (d) blind loop syndrome caused by obstruction in upper part of the small intestine, or (e) hypopitisia— regression of the villi of the small intestine. 

Lincomycin 4.280) from Streptomyces lincolnensisy and its derivative clindamycin (4,28b)y are given orally for resistant strains of Gram-positive cocci, and also for intestinal anaerobes, such as Bacteroides which builds up in postoperative blind-loops. It inhibits peptidyl transferase on the SoS ribosomal subunit, much as chloramphenicol does (Smithers, Bennett, and Struck, 1969). The principal side-effects are diarrhoea, and even colitis. 

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