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INTRODUCTION AND IMPORTANCE: Obesity is a global epidemic, and bariatric surgery is an effective treatment. During this surgery, rare abnormalities in the small intestine, like ectopic pancreas (EP), can be found. CASE PRESENTATION: A 16-year-old male presented at the surgical clinic with a complaint of morbid obesity, weighing 140 KG. Since he was unable to commit to a diet, bariatric surgery was performed. During the surgery, the gastrointestinal tract was examined, and an incidental finding was noted in the wall of the proximal jejunum. The histopathology report revealed that the excisional biopsy was a complete EP in the proximal jejunum. The patient was discharged from the hospital on the first postoperative day, and his condition remained stable. CLINICAL DISCUSSION: Our case of EP stood out due to its larger size, measuring 3.5 cm in diameter, while EP lesions are typically smaller, despite its size, the patient did not experience any symptoms. EP is more commonly found in individuals between 40 and 50 years old, with a higher incidence in males. However, our patient is only 16 years old. CONCLUSION: Surgical resection is the most effective treatment, preventing malignant transformation and future complications. To the best of our knowledge, this is the first documented case of incidentally detected heterotopic pancreatic tissue in jejunum during a bariatric procedure in Syria, and it is also the fourth case in the medical literature.

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Introduction and importance: Duplications are the abnormal portion of the intestine, either externally attached to the intestine or intrinsically placed within the bowel lumen. Their prevalence is noted to be around one in 25 000 deliveries. The rare gastrointestinal tract duplication may be located in any part of the gastrointestinal system from the oral cavity to the anus. The most common site of enteric duplication cyst (DC) is the terminal part of the ileum. Hence, duplications in jejunum are rare. Case presentation: Hereby, the authors report a case of jejunal DC in a female neonate which was managed successfully via surgery and adequate post-operative care without any complications. Clinical discussion: Duplications are more frequently single. They are usually located in the mesenteric border of the associated native bowel and may vary in shape and size. Most of them are cystic, followed by tubular and mixed type, with or without other congenital anomalies. More than 80% of the cases present before the age of 2 years as an acute abdomen or bowel obstruction, but many duplications remain silent unless complications occur, and therefore may not be diagnosed until adulthood. Complications of enteric DC include volvulus, bleeding, and, rarely, malignant degeneration. Conclusion: It is important for paediatric surgeons to include DC in the differential diagnosis if a neonate presents with features of intestinal obstruction.

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Objectives: Capsule endoscopy (CE) has been shown to have poor diagnostic performance when the capsule passes quickly through the small bowel, especially the proximal jejunum. This study aimed to evaluate the diagnostic yield of proximal jejunal lesions with third-generation CE technology. Methods: We retrospectively examined 138 consecutive patients, 76 (55.0%) of whom were men. The patients' median age was 70 years, and proximal jejunal lesions were detected by CE and/or double-balloon endoscopy at Hiroshima University Hospital between January 2011 and June 2021. We analyzed the diagnostic accuracy of CE for proximal jejunal lesions and compared the characteristics of the discrepancy between the use of CE and double-balloon endoscopy with Pillcam SB 2 (SB2) and Pillcam SB 3 (SB3). Results: SB2 and SB3 were used in 48 (35%) and 90 (65%) patients, respectively. There was no difference in baseline characteristics between these groups. Small-bowel lesions in the proximal jejunum comprised 75 tumors (54%), 50 vascular lesions (36%), and 13 inflammatory lesions (9%). The diagnostic rate was significantly higher in the SB3 group than in the SB2 group for tumors (91% vs. 72%, p < 0.05) and vascular lesions (97% vs. 69%, p < 0.01). For vascular lesions, in particular, the diagnostic rate of angioectasia improved in the SB3 group (100%) compared with that in the SB2 group (69%). Conclusions: SB3 use improved the detection of proximal jejunal tumors and vascular lesions compared with SB2 use.

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INTRODUCTION: Very-short proximal jejunal stump anastomosis leak has been a major problem in surgery and it causes high postoperative morbidity and mortality. However, using a Bishop-Koop Modification technique anastomosis with decompression and nutrition tube, we can completely cure the patient with this case. PRESENTATION OF CASE: A 61-year-old man came to the emergency room with generalized peritonitis and sepsis, on emergency laparotomy we found a perforation from solid tumor located in the proximal jejunum, 20 cm distal to ligament of Treitz. Free purulent exudate and diffuse inflammatory reaction of the peritoneum were also found in the abdominal cavity. We resected the jejunum together with the mass and anastomosis using Bishop-Koop technique with the decompression and nutrition tube. The patient completely recovered and left the hospital after a total stay of 30 days. DISCUSSION: Surgery-associated-anastomotic leak has been a major complication in performing anastomosis on the very-proximal jejunum especially in septic condition. The decompression after anastomosis is important, because of the high excretion of Brunner gland, bile, pancreas, duodenum, and jejunum juice and also the paralytic bowel condition in septic condition can make fluid accumulation in jejunum. It was impossible to decompress the anastomosis by performing an external jejunostomy because the proximal stump was too close to the ligament of Treitz. Using Bishop-Koop anastomosis technique, we were able to decompress the anastomosis and to give early nutrition using tubes at the same time. CONCLUSION: Bishop-Koop anastomosis modification with decompression and nutrition tube is a safe procedure for anastomosing on the very-proximal jejunum.

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BACKGROUND: The foregut theory posits that the proximal small intestine plays an important role in the improvement of type 2 diabetes (T2D) after Roux-en-Y gastric bypass (RYGB). OBJECTIVE: To study the possible role of proximal jejunum in the treatment of T2D after RYGB via the analysis of DNA methylation and transcriptome. SETTING: Laboratory of Shanghai Diabetes Institute, China. METHODS: Two batches of T2D rats undergoing surgeries (RYGB and a sham operation as control) were established independently. The proximal jejuna from one batch were used for the methylated DNA immunoprecipitation sequencing and transcriptome sequencing. Those from another batch were used for DNA methylation analysis via a MassARRAY (Agena Bioscience, San Diego, CA, United States) platform and quantitative polymerase chain reaction to verify the results of high-throughput sequencing analysis. RESULTS: The transcriptome sequencing results showed that the genes differentially expressed (P < .05) in the RYGB- and sham-operated groups were significantly enriched in the gene ontology biological processes associated with fatty acid metabolism and lipid transport. The methylated DNA immunoprecipitation sequencing analysis showed that there were 1973 genes with significantly differentially methylated CpG sites located within gene promoters between the 2 groups (P < .05 and fold change > 2). The Mogat3 in the proximal jejunum after RYGB was hypermethylated in the promoter region and its transcription level was significantly reduced. The results of the high-throughput sequencing were validated via methylation quantitative analysis and quantitative polymerase chain reaction in a new set of samples. CONCLUSIONS: RYGB could change DNA methylation and gene expression profiles in the proximal jejunum in T2D rats. Mogat3 potentially contributes to the beneficial effects caused by RYGB.

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INTRODUCTION: Gastrointestinal stromal tumors (GISTs), with a primary occurrence in the duodenum and proximal jejunum, are rare and treatment is poorly understood. This study aimed to evaluate the main factors influencing the prognosis of GIST resection in this complex anatomical structure. MATERIALS AND METHODS: This retrospective study included 47 patients who underwent surgery for primary GIST of the duodenum (20) and proximal jejunum (27) between 2012 and 2017. Perioperative clinical data as well as relapse and survival information were collected. RESULTS: All patients underwent negative margin resection (R0) of duodenal and proximal jejunum GISTs. Complications occurred more frequently in treatment of duodenal GISTs than proximal jejunum GISTs (p = 0.003). GISTs in D3 (the 3rd portion of duodenum) were related to larger tumor size (p = 0.001), higher probability of severe complication rate (p = 0.042), longer hospital stays (p = 0.023) and fasting time (p = 0.020). More complications were found for patients with digestive reconstruction than limited resection (p = 0.010). Additionally, patients with a tumor mass larger than 5 cm or a mitotic index greater than 5 mitoses/50 HPFs showed poorer therapeutic outcomes. The 1- and 3-year overall survival was 97.9% and 86.1%, respectively and were not influenced by operation type (p = 0.061) or GIST position (p = 0.447). CONCLUSION: With negative operational margins, limited resection is a safe and feasible procedure for duodenal and proximal jejunum GIST patients and unnecessary digestive reconstruction should be avoided. Considering the severe complication rate, resection for GISTs in D3 should be performed with care.

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SCOPE: Hesperetin-7-O-rutinoside (hesperidin) reduces blood pressure in healthy volunteers but its intestinal absorption and metabolism are not fully understood. Therefore, we aimed to determine sites of absorption and metabolism of dietary flavanone glycosides in humans. METHODS AND RESULTS: Using a single-blind, randomized crossover design, we perfused equimolar amounts of hesperetin-7-O-rutinoside and hesperetin-7-O-glucoside directly into the proximal jejunum of healthy volunteers. We assessed the appearance of metabolites in the perfusate, blood and urine, to determine the sites of metabolism and excretion, and compared this to oral administration. The glucoside was rapidly hydrolyzed by brush border enzymes without any contribution from pancreatic, stomach, or other secreted enzymes, or from bacterial enzymes. Only ∼3% of the dose was recovered intact in the perfusate, indicating high absorption. A proportion was effluxed directly back into the perfused segment mainly in the form of hesperetin-3'-O-sulfate. In contrast, very little hydrolysis or absorption of hesperetin-7-O-rutinoside was observed with ∼80% recovered in the perfusate, no hesperetin metabolites were detected in blood and only traces were excreted in urine. CONCLUSION: The data elucidate the pathways of metabolism of dietary hesperidin in vivo and will facilitate better design of mechanistic studies both in vivo and in vitro.

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Congenital anomalous bands at the proximal jejunum resulting in obstruction have been described sporadically in the literature and are otherwise rare. We present a case of an 8 year-old girl with a nine-month history of intermittent vomiting and no history of prior surgery. The imaging workup includes an abdominal ultrasound, a single contrast upper gastrointestinal series, and a dual contrast computed tomography of the abdomen and pelvis. Surgical intervention revealed the presence of dense bands at the proximal jejunum without evidence of malrotation. Our report reviews the embryology and radiologic findings of this entity using different imaging modalities.