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Steatosis of the liver is a harmless symptom of disturbed lipid metabolism but not a disease. The cause of the steatosis, and not the fat accumulation by itself, produces cirrhosis. There is no evidence so far in man that cirrhosis may be caused by nutritional deficiencies alone. Even cirrhosis after small bowel bypass procedures seems to be result from metabolic rather than nutritional disturbances.
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BACKGROUND/AIMS: Small bowel bacterial overgrowth (SBBO) is defined as an abnormal increase in the number of bacteria in the small intestine, and may be occult in older adults. The aim of this study was to determine whether small bowel bacterial overgrowth (SBBO) is found in healthy older people as a concomitant of normal aging or is seen only in disabled or frail older people, excluding patients with intestinal disease and those who had undergone upper intestinal or gastric surgery. METHODOLOGY: Forty-one relatively healthy older people, aged 74.6 +/- 1.7 (mean +/- SE) years, who engage in regular exercise, and 42 variously disabled older people, average age 78.8 +/- 1.1 years, who commute to a day-care center participated in this study. SBBO was determined by a breath hydrogen (H2) test after ingestion of 50g of glucose solution dissolved in 200mL of water. Physical activity was judged from the number of steps walked per day as measured by a pedometer. Food intake was assessed by an interview. RESULTS: No SBBO-positive subject was seen among the healthy, while 11 (25.6%) of the disabled older adults were positive. The number of steps/day taken by the disabled subjects was extremely low, only 22.3% of that of the healthy (P<0.001). No significant difference was seen between the groups in food intake. The mean age of the SBBO-positive patients was relatively high, 81.5 +/- 2.2 years, and 5 (45.4%) of them were underweight, with a BMI<18.5. CONCLUSIONS: Our results and previous studies indicate that SBBO is seen only in patients with intestinal disease and disabled or frail older people.
A rare late complication of side-to-side anastomosis; perforation of a blind loop with subsequent localized inflammation of the abdominal wall is presented. Operative intervention with resection of the blind loop and the establishment of an end-to-end anastomosis is recommended.
The authors report 3 cases of intestinal bleeding either micro- or macroscopic induced by ulcers in blind loops. The blind loops developed in all 3 cases on side-to-side ileocolic anastomoses. In one of the patients, the ulcers were demonstrated by colonoscopy. The 3 cases reported are quite comparable to the 18 cases found in the world literature. These hemorrhages may become severe by their abundance or repetition, but a cure is easily obtained by resection of the intestinal blind loops and restoration of the continuity by end-to-end anastomosis.
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A certain amount of relaparotomies after small bowel surgery is caused by technical failures, such as the technique of suturing the anastomosis and the kind of re-establishing the continuity of the bowel. An end-to-end-anastomosis with sufficient vascularisation at the cut ends, tension free, and without an overdone inversion will guarantee a more successful suturing of the bowel than a side-to-side-anastomosis. At first the whole small bowel should be explored to recognize multiple lesions. Postoperative malabsorption due to the exclusion of more less extended segments of the bowel--by bypass anastomoses or construction of blind loops--can be repaired successfully by corrective laparotomies. Special problems in operative tactics and technique of Crohn's disease are discussed.
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