Carcinoid tumor is a rare but interesting tumor. Gastrointestinal tract and its adjacent organs is the most common primary site for this tumor followwed by bronchopulmonary system. They are able to secret a variety of amin and protein products according to their neuroendocrine origin. The case of a male patient is reported who suffered from vague abdominal pain with weight loss whose radiologic findings were in favor of a terminal ileum tumor Lapartomy and resection of the tumor revealed carcinoid tumor.The tumor is classified based on its anatomic and embryologic origin to foregut, midgut and hindgut. Most of the tumors arise from ileum, appendix and cecum. Their clinical presentations, if any, depend on the tumor location and consist of vague abdominal pain, anorexia and weight loss. Surgery is the best therapeutic measure.Carcinoid syndrome is rarely seen and is mostly accompanied with liver metastases. CT, MRI and SPECT are radiologic methods to find primary tumors and their metastasis.

Intestinal lipomatosis also known as lipohyperplasia is a rare disease. Diffuse infiltration of the fatty tissue mainly in the submucosal layer is characteristic. It is usually asymptomatic and found incidentally. We report a case of lipomatosis in the terminal ileum and ileocecal valve. Multidetector computed tomography (MDCT) with contrast enhancement showed fatty infiltration of the terminal ileum and ileocecal valve.

Background: Total colectomy is used in children with total colonic aganglionosis, Ulcerative colitis (UC) and familial adenomatous polyposis (FAP). The purpose of this study was to maintain ileocecal valve and rectal-sparing surgery for the prevention of fecal incontinence in these children.Methods: From1990 to 2011, 14 children with diagnosis of UC, FAP and Hirschsprung’s disease were operated. Total colectomy was done with the preservation of patch of cecum with ileocecal valve and half of the rectum with ileocecorectal anastomosis. Distal ileum designed as S shape pouch and ileocecal valve were preserved. In Hirschsprung’s disease, posterior rectal myotomy was established. The data were collected and analyzed.Results: The mean age of the patients was 54 months (ranged from 2 months to 18 years). Ten patients were male. Among 14 patients, Hirschsprung’s disease, ulcerative colitis and FAP were seen in 10, 3, and one case, respectively. They were followed up annually. Clinical and endoscopic examinations were performed to evaluate the function of ileocecorectal anastomosis. They followed from 2 to 24 years. At first year, the patients experienced four to six bowel movements during the day and one at night. This frequency decreased over time. The main postoperative complications included recurrent enterocolitis (n=2), perianal fistula (n=2). Only 2 patients were suffering from some degree of fecal soiling.Conclusion: The results show that the Ileocecal patch- low rectal anastomosis in total colectomy leads to low complications and prevent fecal frequency and incontinence. It also increases absorptive function of ileum in children.

To investigate the prevalence of Mycobacterium paratuberculosis (M. avium subsp. paratuberculosis) infection among cattle slaughtered in Ahvaz abattoir, samples were taken from 250 cattle. Before slaughter, sex and age were assessed. Thereafter, samples were taken from ileocecal valve, rectum mucosa, ileocecal lymph node and stool. All smears which taken from these samples were stained by Ziehl-Neelsen method and examined by light microscopy. At first, ileocecal samples were examined; other samples were examined when ileocecal sample was positive. Out of the 250 cattle, 5 (2%) were positive. With the exception of one sample in which the organism was observed in both ileocecal valve and ileocecal lymph node, in other positive samples the bacteria was observed in only ileocecal valve smear.

In order to investigate the prevalence of Mycobacterium avium paratuberculosis infection among slaughtered sheep and goats in Ahwaz abattoir, samples were taken from 208 sheep and 208 goats, Sex, body condition and age. (By use of dental formula) were assessed before slaughter, thereafter smears were taken from terminal ileum mucosa, ileocecal valve, ileocecal node, rectum mucosa, and stool. All smears were stained by Ziehl-Neelsen technique and examined by light microscopy. At first, ileocecal samples were examined but the other samples were examined when ileocecal sample was positive. Out of the 208 sheep and 208 goats, 2(0.9%) and 3(1.4%) were positive respectively, based on the examination of ileocecal sample. In positive samples, there was no isolation from either part of the intestine, ileocecal lymph node and stool. The results of this study indicate that Mycobacterium avium paratuberculosis infection is common in Ahwaz and its prevalence is almost similar to other studies.      

Background: This study compared the early success, complication and patient satisfaction rates of modified extraperitoneal radical cystectomy (Mainz II urinary diversion) with standard intraperitoneal radical cystectomy (continent ileocecal urinary diversion) in a group of patients with muscle invasive urothelial carcinoma of the urinary bladder.Methods: From September 2009 until November 2013, this randomized study enrolled 60 patients with muscle invasive transitional cell carcinoma of the urinary bladder who underwent radical cystectomy and urinary diversion. The patients were randomly allocated to two groups via block randomization. Group A included 30 patients (28 men and 2 women) who underwent modified small incision extraperitoneal radical cystectomy with a Mainz II urinary diversion. Group B included 30 patients (27 men and 3 women) who had classic intraperitoneal radical cystectomy and ileocecal continent diversion. The data were extracted and analyzed. The patients were followed for one year after surgery.Results: Group A patients had a mean age of 61.47±8.63 years. Group B patients had a mean age of 60.77±6.82 years. There were no statistically significant differences in blood loss, electrolyte and acid-base abnormalities, and early post- operative complication rates between the two groups. However, surgical and hospitalization times were significantly shorter in group A (P<0.001). In addition, patients were mobilized earlier and had shorter nothing by moth time. Patient satisfaction rate was significantly more in group A.Conclusion: Small incision extraperitoneal radical cystectomy and Mainz II urinary diversion is a safe, less complicated, effective and more rapid technique with excellent short term outcome. It seems this technique is a reliable alternative for continent urinary diversion in selected bladder cancer patients, mainly in those with urethral involvement.

Introduction: Immunosuppression conditions are the leading risk factors for opportunistic fungal infections. The clinical manifestation is related to the site of infection. Gastrointestinal (GI) mucormycosis is a rare form of this disease, even in immunosuppressed patients. Case Presentation: We report rare cecum necrosis with terminal ileum perforation resulting from infi, ltration of mucormycosis in the cecum wall and terminal ileum mesentery in a patient with diabetes mellitus and acute myeloid leukemia (AML). During chemotherapy for AML, the patient presented diarrhea followed by constipation, severe progressive abdominal pain, and fecaloid peritonitis. Perforation of the terminal ileum was observed during the surgery. Ileostomy, right hemicolectomy, and resection of necrotic tissue were performed, and bowel mucormycosis was confi, rmed on histologic examination. Unfortunately, the patient expired fi, ve days after surgery. Conclusions: Gastrointestinal mucormycosis is an uncommon infection with symptoms like abdominal pain, nausea, vomiting, and melena. The mortality of GI involvement is due to perforation, peritonitis, and GI bleeding.

Introduction: We report a new modified technique of unaltered appendix transfer to ileal pouch and preserving ileocecal segment. This modification enables us to use ileum as the popular type of enteric segment instead of ileocecal segment while using appendix as a catheterizable stoma.Materials and Methods: Forty-five patients (30 men) who needed reconstruction of the lower urinary tract were enrolled for using appendix as a catheterizable stoma. Reservoir was reconstructed using ileal segment.The appendix was circumcised from its base over its pedicle. The spatulated appendix tip was exteriorized as a catheterizable stoma to the skin, preferably umbilicus, and its base was implanted to the ileal pouch.Results: Follow-up records of 38 of 45 patients were available. The median follow-up period was 29 months. The mean intermittent catheterization interval was 4.19 ± 1.6 hours. Urodynamic parameters were evaluated for 18 out of 38 patients. The median maximal pouch capacity determined as 380 mL. The median appendiceal closure pressure was 61 cm H2O. No pouch perforation occurred. Stomal stenosis occurred in 3 patients. They did not catheterize their appendiceal stoma because they restarted catheterization through the urethra.Conclusion: This novel approach enabled us to use ileum as today’s more popular type of bowel segment to reconstruct enteric pouch rather than using ileocecal segment, while using appendix as a catheterizable stoma. One of the unique advantages of this technique is that the postponement of clean intermittent catheterization will not result in pouch perforation since the urine will leak when the pouch become overfill.

The differential diagnosis of acute abdominal pain is a challenging task for medical doctors working in the department of gastroenterology. It is clear that acute abdominal pain may be associated with a number of pathologic conditions. We report an unusual case of an unnoticed swallowed wooden toothpick stuck in the ileocecal area of a young man with right lower abdominal pain who was misdiagnosed as acute appendicitis. However, an abdominal computed tomography scan showed an elongated foreign body stuck in the ileocecal area. The elongated foreign body was identified as a wooden toothpick, which was then grasped with a foreign body forceps and successfully removed through colonoscopy. The patient’ s abdominal pain was significantly relieved within 2 days following treatment. On the basis of the case report, we suggest the importance of abdominal computed tomography scans for the differential diagnosis of acute abdominal pain and highlight the need for extra vigilance in excluding the diagnosis of foreign bodies in the gastrointestinal tract of patients with acute abdominal pain.