Small bowel obstruction is a frequent medical condition with various causes, the most common being postoperative adhesions, volvulus, intussusception, hernias, and tumors. A bezoar-induced blockage of the small intestine is a rare condition that accounts for approximately 4% of all small bowel obstruction cases. Herein, we present the case report of a 71-year-old patient with diffuse abdominal pain caused by a small bowel obstruction due to a calcified bezoar (bezoar egg) resulting from a post-radiation intestinal stricture. The patient underwent a small bowel excision with the extraction of the bezoar, after which a full recovery was made.

The incidence of tuberculosis (TB) worldwide is still significantly high, with India contributing a high global TB burden. This case study features a 49-year-old male who had complaints of pain and abdominal distention for one and a half months. An erect abdominal radiograph showed features suggesting small bowel obstruction. Contrast-enhanced computed tomography (CT) of the abdomen was done. It showed multiple strictures involving the distal jejunum and ileum, causing small bowel obstruction. There was mesenteric and retroperitoneal lymphadenopathy with central necrosis and ascites. The patient was operated on for a small bowel obstruction. The resected intestine showed four strictures, tiny nodules on the serosal surface, and many enlarged lymph nodes. Representative tissue from these areas showed the typical picture of multiple caseating granulomas and fibrosis. Ziehl-Neelsen (ZN) staining highlighted the acid-fast bacilli (AFB). The suspicion index for intestinal tuberculosis (ITB) should be kept high while evaluating patients with intestinal obstruction presenting in endemic areas and high-risk populations, such as HIV-infected, undernourished, immunocompromised, and those with diabetes, smoking, and alcohol addiction.

Intestinal stricture remains one of the most intractable complications in Crohn\'s disease (CD), and the involved mechanisms are poorly understood. Accumulating evidence suggests that the gut microbiota contributes to the pathogenesis of intestinal fibrosis. In this study, we investigated specific mucosa-associated microbiota related to intestinal strictures and their role in predicting postoperative disease course. Twenty CD patients who had undergone operative treatments were enrolled and followed up. Intestinal mucosa and full-thickness sections from stenotic and non-stenotic sites were sterilely collected. DNA extraction and bacterial 16s rRNA gene sequencing were conducted. Radiological and histological evaluations were performed to assess fibrosis. Microbial alpha diversity was significantly decreased in stenotic sites (p = 0.009). At the genus level, Lactobacillus, Oscillospira, Subdoligranulum, Hydrogenophaga, Clostridium and Allobaculum were decreased in stenotic segments (p < 0.1). The difference in Oscillospira sp. (stenotic vs. non-stenotic) was negatively correlated with the erythrocyte sedimentation rate (correlation coefficient (CC) -0.432, p = 0.057) and white blood cell count (CC -0.392, p = 0.087) and positively correlated with serum free fatty acids (CC 0.575, p < 0.05). This difference was negatively associated with intestinal fibrosis evaluated by imagological and histological methods (CC -0.511 and -0.653, p < 0.05). Furthermore, CD patients with a higher abundance of Oscillospira sp. in the residual intestine might experience longer remission periods (p < 0.05). The mucosa-associated microbiota varied between stenotic and non-stenotic sites in CD. Most notably, Oscillospira sp. was negatively correlated with intestinal fibrosis and postoperative disease course. It could be a promising biomarker to predict post-operative disease recurrence and a microbial-based therapeutic target.

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A 44-year-old man presented to our hospital with lower gastrointestinal bleeding. We performed balloon-assisted enteroscopy, which revealed diverticulum and stricture at the ileum. The patient underwent segmental small bowel resection and diagnosed with Meckel\'s diverticulum. We should keep in mind the possibility of intestinal stricture due to Meckel\'s diverticulum.

OBJECTIVE: The standard therapies for benign gastrointestinal stenosis are endoscopic balloon dilation or surgery; each have their advantages and disadvantages. In contrast, radial incision and cutting (RIC) is a novel approach for such stenosis. This study aimed to investigate the feasibility, safety, and effectiveness of RIC.
METHODS: We enrolled 20 patients with benign stenosis of the lower gastrointestinal tract developed by various causes and conducted RIC. We evaluated the re-intervention free rate 52 weeks after RIC, technical success rate, adverse events, procedure time, and improvement of symptoms using a visual analog scale.
RESULTS: We performed 20 sessions of first RIC for 20 lesions and seven sessions of additional RIC due to re-stenosis. The cumulative re-intervention-free survival rate 52 weeks after the first RIC was 55.8%. The technical success rate of the first RIC was 100% (20/20) while that of the additional RIC was 85.7% (6/7). One case developed perforation during the additional RIC and urgent surgery was performed. The additional RIC tended to show worse results in adverse events and procedure time compared with the first RIC. The patients\' symptoms including abdominal bloating and dyschezia were significantly improved.
CONCLUSIONS: Although RIC demonstrated a higher technical success rate for lower gastrointestinal stricture and subsequent improvement of patient symptoms, several issues including preventing delayed bleeding, perforation, and the long-term prognosis should be solved and clarified in further investigations.

<br><b>Introduction:</b> The prevalence of Crohn\'s disease amounts to 5.9 cases per 100,000 population. Complications such as intestinal strictures usually occur within a long course of Crohn\'s disease. Intestinal resection for stricture does not prevent a stricture recurrence and the need for repeated resections, which in turn leads to the formation of short intestine syndrome. The advantage of endoscopic balloon dilatation is organ preservation and a quick clinical therapeutic effiect. However, the frequency of recurrences after conventional endoscopic balloon dilatation of the intestinal stricture in Crohn\'s disease is still at a relatively high level and amounts to 59%, which justifies the need to improve the endoscopic dilatation technique.</br> <br><b>Aim:</b> The aim of this study to improve the treatment effectiveness for intestinal strictures in Crohn\'s disease using endoscopic balloon dilatation combined with prednisolone injection in the stricture area.</br> <br><b>Materials and methods:</b> Endoscopic treatment for intestinal strictures in Crohn's disease was performed in 64 patients. Depending on the endoscopic technique, patients were randomized into 2 groups. The first group consisted of 32 (50%) patients who underwent conventional endoscopic balloon dilatation of strictured areas. The second group consisted of 32 (50%) patients in whom an endoscopic balloon dilatation in combination with submucosal injection of prednisolone to the area of stricture after dilatation was performed. Patient groups were comparable in age, sex and length of stricture.</br> <br><b>Results and conclusions:</b> The results showed that endoscopic balloon dilatation with administration of 40 mg of prednisolone in group II patients was more effective compared to conventional balloon dilatation. The recurrence rate was reduced from 34.4% to 9.3%. The risk of recurrence of intestinal stricture in group I during the first year of observation was found to be 4.5 times higher - HR = 4.5 (1.6-12.9); P = 0.010. The effectiveness of advanced endoscopic balloon dilatation for intestinal strictures was confirmed by colonoscopy with patomorphological examination of the intestinal mucosa 6 months after dilation in patients of both groups.</br>.

BACKGROUND: Patients with Crohn\'s disease can develop intestinal strictures, containing various degrees of inflammation and fibrosis. Differentiation of the main component of a stricturing lesion is the key for defining the therapeutic management.
OBJECTIVE: We assessed for the first time the accuracy of magnetic resonance elastography in detecting intestinal fibrosis and predicting clinical course in patients with Crohn\'s disease.
METHODS: This was a prospective study of adult patients with Crohn\'s disease and magnetic resonance imaging examination, including magnetic resonance elastography, between April 2019 and February 2020. The association between the bowel stiffness value and the degree of fibrosis was evaluated. The relationship between the stiffness value and the occurrence of clinical events was also investigated.
RESULTS: A total of 69 patients were included. The stiffness value measured by magnetic resonance elastography was correlated with the degree of fibrosis (p < 0.001). A bowel stiffness ≥ 3.57 kPa predicted the occurrence of clinical events with an area under the curve of 0.82 (95% CI 0.71-0.93). Bowel stiffness ≥ 3.57 kPa was associated with an increased risk of clinical events (p < 0.0001).
CONCLUSIONS: In Crohn\'s disease, magnetic resonance elastography is a reliable tool for detecting intestinal fibrosis and predicting a worse disease outcome.

UNASSIGNED: Self-expandable metal stents are used for malignant duodenal obstruction. Outcomes between stents placed above and below the papilla of Vater differ, and no study has investigated these differences. We evaluated the efficacy and adverse events of stent placement in these two locations and reported our experience with self-expandable metal stent placement in patients.
UNASSIGNED: We retrospectively analyzed the data of patients with unresectable metastatic cancers (n = 101), who underwent successful duodenal self-expandable metal stent placement between 2008 and 2018. Patients were divided into above and below the papilla of Vater groups. Patient demographics, technical and clinical outcomes, post-procedural morbidity, and stent patency were analyzed.
UNASSIGNED: Overall, 71 and 30 patients had intestinal obstruction above (including the papilla itself) and below the papilla of Vater and underwent successful stenting. Common bile duct obstruction was more common in the above-papilla group. Procedure time was similar between the groups, if an appropriate endoscope could facilitate stent placement in the below-papilla group. Both groups achieved symptomatic relief. Median stent patency duration was not significantly different between the groups; three patients had severe gastrointestinal bleeding due to postoperative vascular-enteric fistula.
UNASSIGNED: Self-expandable metal stents can effectively relieve symptoms of duodenal obstructions located above and below the papilla of Vater. Duodenoscopes could facilitate stent placement if the obstruction is located below the papilla of Vater; if gastrointestinal bleeding occurs postoperatively, the possibility of vascular-enteric fistula formation should be considered.

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