Acute Small Bowel Obstruction Research Articles

Peutz-Jeghers Syndrome: A Case Report

Peutz-Jeghers syndrome (PJS) is a rare autosomal dominant disorder characterized by hamartomatous gastrointestinal polyposis and mucocutaneous pigmentation. We report here the case of a 28-year-old young woman presenting with PJS revealed by an acute small bowel obstruction at the MED VI University Hospital of Marrakech. Surgical exploration revealed hamartomatous polyps necessitating segmental resection. Anatomopathological examination confirmed the diagnosis. Postoperative recovery was uneventful. Surveillance revealed no abnormalities.

Management of rare complications in obese patients after laparoscopic gastric bypass

The complications resulting from laparoscopic gastric bypass can be categorised into two main groups: early (within 30 days after surgery) and late (after 30 days following surgery). Bleeding, marginal ulcers, and failure of the suture line occur most often. Stenosis of the anastomotic areas, adhesive small bowel obstruction, incarceration of Petersen’s space hernia, gastrogastric fistula, and hemobezoar‑induced small bowel obstruction are less often observed. Objective —  to improve the management of rare complications in obese patients after laparoscopic gastric bypass. Materials and methods. The study includes a retrospective analysis of patients who underwent laparoscopic gastric bypass in the Department of General Surgery No. 2 at Bogomolets National Medical University from 2011 to 2023. Patients aged 25 to 59 who met the IFSO criteria for obesity participated in the research. The minimum observation period was 12 months. All patients underwent a laparoscopic Roux‑en‑Y Gastric Bypass. Results. The study included a cohort of 348 patients who underwent laparoscopic gastric bypass. The majority of them were female, including 189 individuals (54.3%). A total of 6 patients (1.72%) were identified with rare problems, consisting of 2 women and 4 men. Two patients were diagnosed with acute small bowel obstruction caused by a hemobezoar, one patient with gastrogastric fistula, one patient with acute adhesive small bowel obstruction, one patient with a marginal ulcer of the «large» stomach complicated by perforation, and one patient with a pinched Petersen’s space hernia. All complications were class IIIb, according to the Clavien‑Dindo classification, and required surgical treatment. In the early period, 3 (50%) cases were diagnosed: acute adhesive small bowel obstruction (2 days postoperatively ) and acute small bowel obstruction caused by a hemobezoar (2—3 days postoperatively). Conclusions. We found that the incidence of rare complications among obese individuals after laparoscopic gastric bypass was 1.72%. Specifically, 1.14% of patients experienced small bowel obstruction, 0.29% had a marginal ulcer of the «large» stomach complicated by perforation, and 0.29% had a pinched Petersen’s space hernia. Each case of a rare complication requires an individual approach to its management.  

Ileo-ileal knot causing acute gangrenous small bowel obstruction: a case report

BackgroundIleo-ileal knotting is a very rare cause of small bowel obstruction, and only a few reports have been published. Small bowel obstruction (SBO) is one of the most common emergency surgical conditions that require urgent evaluation and treatment and is one of the leading causes of emergency surgical admission. There are many causes of SBO that are known in general surgical practice, and these causes are different in the developing and developed worlds.Clinical presentationIn this article, we present a case of acute gangrenous SBO secondary to ileo-ileal knotting in a 37-year-old Ethiopian female patient after she presented with severe abdominal cramp, vomiting, and abdominal distension of 4 hours duration. The patient was operated on intraoperatively; she had gangrenous small bowel obstruction caused by ileo-ileal knotting. Later, the patient was discharged and improved after 12 days of hospital stay.ConclusionIleo-ileal knotting should always be considered in the differential diagnosis of acute small-bowel obstruction. The diagnostic difficulty and the need for urgent treatment of this condition to yield optimal results are discussed.

Acute Small Bowel Obstruction with Gangrenous Bowel due to Entrapment of Fallopian Tube-A Rare Case of Acute Abdomen

Acute Small Bowel Obstruction with Gangrenous Bowel due to Entrapment of Fallopian Tube-A Rare Case of Acute Abdomen

Deep learning using computed tomography to identify high-risk patients for acute small bowel obstruction: development and validation of a prediction model : a retrospective cohort study.

To build a novel classifier using an optimized 3D-convolutional neural network for predicting high-grade small bowel obstruction (HGSBO). Acute SBO is one of the most common acute abdominal diseases requiring urgent surgery. While artificial intelligence and abdominal computed tomography (CT) have been used to determine surgical treatment, differentiating normal cases, HGSBO requiring emergency surgery, and low-grade SBO (LGSBO) or paralytic ileus is difficult. A deep learning classifier was used to predict high-risk acute SBO patients using CT images at a tertiary hospital. Images from three groups of subjects (normal, nonsurgical, and surgical) were extracted; the dataset used in the study included 578 cases from 250 normal subjects, with 209 HGSBO and 119 LGSBO patients; over 38000 CT images were used. Data were analyzed from 1 June 2022 to 5 February 2023. The classification performance was assessed based on accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve. After fivefold cross-validation, the WideResNet classifier using dual-branch architecture with depth retention pooling achieved an accuracy of 72.6%, an area under receiver operating characteristic of 0.90, a sensitivity of 72.6%, a specificity of 86.3%, a positive predictive value of 74.1%, and a negative predictive value of 86.6% on all the test sets. These results show the satisfactory performance of the deep learning classifier in predicting HGSBO compared to the previous machine learning model. The novel 3D classifier with dual-branch architecture and depth retention pooling based on artificial intelligence algorithms could be a reliable screening and decision-support tool for high-risk patients with SBO.

Intensive care in severe acute bowel obstruction (clinical lecture)

Most patients with severe acute small bowel obstruction in the early postoperative period require treatment in the intensive care unit. The main principles of intensive care are identifying major vital function disorders, their rapid correction, as well as supporting the functions of the affected organs and systems. The leading pathophysiological disorders that require intensive correction during small bowel obstruction are impaired intestinal barrier function (for bacteria and toxins), hypovolemia, hypotension and microcirculation disorders, primarily in the abdominal organs, fluid and electrolyte and acid-base disorders. Such disorders, in turn, could cause repeated development of intra-abdominal hypertension with impaired perfusion of the abdominal organs. Thus, the efficiency of intensive care for dynamic acute bowel obstruction primarily depends on the speed of correction of fluid and electrolyte disorders and restoration of intestinal blood flow, normalization of gut parietal digestion rather than on the quantity of the drugs that stimulate bowel movement. The primary method of gut microcirculation restoration is the ROSE approach to fluid resuscitation. The main criteria of the intensive care efficiency should be control of intra-abdominal pressure and timely treatment of intra-abdominal hypertension.

S3901 Trichobezoar Presenting with Acute Pancreatitis, Biliary, and Small Bowel Obstruction in a Child: A Case of Rapunzel Syndrome

S3901 Trichobezoar Presenting with Acute Pancreatitis, Biliary, and Small Bowel Obstruction in a Child: A Case of Rapunzel Syndrome

Ileoileal Knotting as a Rare Cause of Acute Small Bowel Obstruction: Report of a Case with Review of Literature

Ileoileal Knotting as a Rare Cause of Acute Small Bowel Obstruction: Report of a Case with Review of Literature

“Choice of surgical approach for the treatment of acute small bowel obstruction: A retrospective analysis from a high-volume single center in Milan, Northern Italy”

“Choice of surgical approach for the treatment of acute small bowel obstruction: A retrospective analysis from a high-volume single center in Milan, Northern Italy”

ThTP5.12 Assessment of malnutrition and nutritional interventions in patients presenting with acute small bowel obstruction – are we ‘getting it right first time’?

Abstract Aims High levels of morbidity and mortality are associated with small bowel obstruction (SBO), a common general surgical emergency. Assessment of malnutrition and introduction of early nutritional interventions are of paramount importance in the management algorithm of these patients. We audited our practice of managing acute small bowel obstruction at a busy district general hospital comparing our practice against National Audit of Small Bowel Obstruction (NASBO) recommendations. Methods Data were gathered for all patients presenting with bowel obstruction to our Trust between 01/08/2022 and 30/11/2022. In depth review of patient case records was undertaken using electronic patient record systems (e-Track and Evolve). Results 195 patients were admitted with acute bowel obstruction. 68 patients (35%) had acute SBO (M: F; 34:34). 58 (85%) had no documentation of duration for which they had been ‘nil by mouth’ (NBM) prior to hospitalisation. Malnutrition universal screening tool score (MUST score) was completed in 29 (43%) patients. 59% of patients had an emergency computed tomography (CT) which confirmed diagnosis of SBO. 60% of patients were managed non-operatively. On an average, patients were kept ‘NBM’ for two days (range; 1-16 days). Average waiting time for peripherally inserted central catheter (PICC) was 9.6 days. Conclusions Evaluating our practice of managing patients with acute SBO has highlighted multiple areas for improvement to ‘get it right first time’. We have included stakeholders; nursing staff, dieticians, surgeons, junior doctors and vascular access team to implement action plan to optimise management in this cohort of patients in line with NASBO guidelines.

Commentary on 'A new clinical severity score for the management of acute small bowel obstruction in predicting bowel ischemia: a cohort study' [Int J Surg 2023; 109:1620-28].

Commentary on 'A new clinical severity score for the management of acute small bowel obstruction in predicting bowel ischemia: a cohort study' [Int J Surg 2023; 109:1620-28].

Internal Herniation of Small Bowel Underneath Iliac Vascular Axis After Pelvic Surgery: A Systematic Review.

Internal abdominal hernias are rare entities that most commonly present with acute small bowel obstruction. These hernias can be congenital or acquired. While congenital hernias are considered the most common type, acquired hernias are becoming more common. Recently, a rare type of internal herniation has been reported underneath iliac vasculature in patients who have undergone pelvic lymph node dissection in the past. This study was carried out to assess the prevalence of this rare type of internal hernia. Two reviewers searched the literature in three online databases using the Cochrane methodology for systematic reviews. The search of databases yielded 70 articles. The studies which reported internal herniation underneath iliac vasculature were included. Studies that reported herniation underneath other pelvic organs or vasculature were excluded. After screening, 17 articles were deemed suitable and selected. All 17 cases reviewed underwent pelvic lymph node dissection in the past. The median latency period between index surgery and clinical presentation with the incarcerated hernia was 20 months. All 17 cases were managed surgically with small bowel resection carried out in 13 cases. Eleven authors reported closing the hernia defect with various techniques, while five decided not the close it. All 17 cases were alive at the time of discharge from the hospital, with a mean hospital stay of 12.7 days. Given our findings, there should be a high index of suspicion of internal hernia in patients presenting with small bowel obstruction with a history of pelvic lymph node dissection. In our review, internal herniation was always preceded by pelvic lymph node dissection, so the closure of the peritoneum should be considered while pelvic lymph node dissection is carried out.

Laparoscopic treatment of complicated obturator hernia: A case series of 6 patients

Abstract Obturator hernia (OH) is a rare type of abdominal hernia. Preoperative diagnosis of OH is often challenging because of nonspecific signs and symptoms, leading to late diagnosis and increased mortality. Laparoscopic repair has been suggested as one of the alternative options for complicated inguinal hernias. We describe a case series of 6 consecutive patients diagnosed with complicated OH and treated by laparoscopic repair. All patients were females, aged 81 to 90 years. Most of them were underweight (body mass index, <18.5 kg/m2). All cases presented with acute small bowel obstruction. All cases were unilateral OH. Concomitant femoral hernia existed in 3 cases (50%). Bowel resection was required in 2 cases because of bowel ischemia and perforation. Four of 6 cases were repaired using synthetic mesh, and the 2 remaining patients were treated with peritoneal closure and medial umbilical fold flap reinforcement. There were no postoperative deaths. Laparoscopic repair seems to be a safe and effective option for the treatment of complicated OH.

Predicting of intestinal ischemia in patients with adhesive small bowel obstruction

Aim. To detect intestinal ischemia promptly in patients with acute adhesive small bowel obstruction.Methods. A total of 124 patients with acute adhesive small bowel obstruction were studied. Logistic regression analysis was performed to determine the most significant prognostic factors for intestinal ischemia. The derived regression coefficient indicators were utilized in a scoring system.Results. Six independent prognostic factors of intestinal ischemia were identified: age, duration of pain, body temperature, white blood cell count, reduced intestinal wall contrast, and localized mesenteric edema visible on a CT scan. Regression coefficient scores were attributed to each variable associated with intestinal ischemia. The predicted occurrence of bowel ischemia was computed as a sum of scores ranging from 0 to 24. A threshold of 6 points was used to define the low-probability group (risk of bowel ischemia was 1.13%). A score between 7 and 15 determined the intermediate-probability group (the risk of intestinal ischemia was 44%). A score of ≥16 defined the high-probability group (all patients in this group had intestinal ischemia).Conclusions. The risk prediction assessment of bowel ischemia was performed with high accuracy (above 90%). This evaluation is reliable and reproducible, hence it may aid the surgeon to differentiate patients with intestinal ischemia for surgical intervention. Since ischemic disorders may be reversible, this could prevent the development of intestinal necrosis.

The role of computed tomography in the diagnosis of acute adhesive small bowel obstruction

Purpose of the study: to determine the role of multislice computed tomography (MSCT) in the diagnostic algorithm for the management of patients with acute adhesive small bowel obstruction.Materials and methods. The study included 168 patients undergoing inpatient treatment from 2015 to 2019 with a diagnosis of acute small bowel obstruction. The obturation form of acute adhesive small bowel obstruction (AASBO) was detected in 151 patients, while 17 patients have strangulation form of obstruction. The study compared two groups of patients who differ in the examination algorithm:Group I – “traditional” approach – 74 patients who used X-ray (plain radiography, with passage assessment) and ultrasound to diagnose intestinal obstruction.Group II – “proposed” algorithm, included 94 patients whose diagnostic complex, in addition to the methods described above, was supplemented with MSCT with enterography.Results. In the group of "proposed" algorithm, the sensitivity, specificity and accuracy of MSCT was 99.7%, 86.6%, 97.8%, respectively, in the diagnosis of the obturation AASBO, and the resolution of the obstruction was detected significantly earlier than in the "traditional" group (p = 0.0081).Conclusion. Computed tomography is the most accurate method of diagnosing the presence, cause and level of intestinal obstruction; in addition, it is the most effective way to evaluate the efficacy of conservative therapy.

Small bowel transmural necrosis secondary to acute mesenteric ischemia and strangulated obstruction: CT findings of 49 patients

Rationale and objectivesTransmural bowel necrosis (TBN) is an uncommon surgical emergency that represents an endpoint of occlusive acute mesenteric ischemia (AMI), nonocclusive AMI and small bowel obstruction (SBO). According to limited evidence, each etiology of TBN might demonstrate a different CT finding. This investigation aimed to 1) identify overall CT findings of TBN, and 2) compare CT findings of TBN in each etiology. Materials and methodsForty-nine consecutive adults (mean age, 64.6 years; 26 men) with occlusive AMI, nonocclusive AMI or SBO, and pathologically proven TBN were enrolled. All had a CT scan within 24 h before surgery. Clinical information was compiled from medical records. CT examinations were re-reviewed by two radiologists with disagreements resolved by the third radiologist. Data were analyzed and compared. ResultsTransmural bowel necrosis were secondary to arterial AMI, venous AMI, combined arterial and venous AMI, nonocclusive AMI, and SBO in 6, 5, 2, 10, and 26 patients, respectively. The CT findings were ascites (93.9%), abnormal wall enhancement (91.8%), bowel dilatation (89.8%), mesenteric fat stranding (89.8%), abnormal wall thickness (71.5%), pneumatosis (46.9%) and intrinsic hyperattenuation of bowel walls (22.5%). Portovenous gas, mesenteric venous gas, and pneumoperitoneum were present in 4 patients (8.2%). Bowel wall thickness was the only CT findings that showed a statistically significant difference among the 5 etiologies of TBN (P = 0.046). ConclusionsMost common CT findings of TBN were ascites, abnormal bowel wall enhancement, dilatation, and mesenteric fat stranding. Wall thickness differentiated five etiologies, being most thickened in venous AMI and normal in arterial AMI.

Small-Bowel Obstruction Secondary to Trichobezoar in Young Children: A Case Report

Background: The term bezoar refers to an intraluminal masse in the gastrointestinal system caused by the accumulation of indigestible ingested materials. Trichobezoar is a compact conglomeration of swallowed hair and constitutes less than 6% of all bezoars. The stomach is the common site of occurrence and many patients may remain asymptomatic or present a mild form of the disease. Intestinal obstruction due to trichobezoar is an extremely rare complication. The clinical findings of bezoar-induced ileus do not differ from those of mechanical bowel obstruction due to other causes and they are rarely reported in the pediatric age group. Case presentation: we report a case of acute small-bowel obstruction due to trichobezoar in a three years old boy with no history of eating disorder which presented an abdominal distention. Conclusion: This case serves to raise awareness of trichobezoar as a diagnosis in young children who present with abdominal pain, palpable mass, and signs of acute small-bowel obstruction

A new clinical severity score for the management of acute small bowel obstruction in predicting bowel ischemia: a cohort study.

Small bowel obstruction (SBO) is a common hospital admission diagnosis. Identification of patients who will require a surgical resection because of a nonviable small bowel remains a challenge. Through a prospective cohort study, the authors aimed to validate risk factors and scores for intestinal resection, and to develop a practical clinical score designed to guide surgical versus conservative management. All patients admitted for an acute SBO between 2004 and 2016 in the center were included. Patients were divided in three categories depending on the management: conservative, surgical with bowel resection, and surgical without bowel resection. The outcome variable was small bowel necrosis. Logistic regression models were used to identify the best predictors. Seven hundred and thirteen patients were included in this study, 492 in the development cohort and 221 in the validation cohort. Sixty-seven percent had surgery, of which 21% had small bowel resection. Thirty-three percent were treated conservatively. Eight variables were identified with a strong association with small bowel resection: age 70 years of age and above, first episode of SBO, no bowel movement for greater than or equal to 3 days, abdominal guarding, C-reactive protein greater than or equal to 50, and three abdominal computer tomography scanner signs: small bowel transition point, lack of small bowel contrast enhancement, and the presence of greater than 500ml of intra-abdominal fluid. Sensitivity and specificity of this score were 65 and 88%, respectively, and the area under the curve was 0.84 (95% CI: 0.80-0.89). The authors developed and validated a practical clinical severity score designed to tailor management of patients presenting with an SBO.

Acute Small Bowel Obstruction Caused by Trans Epiploic Hernia in a Young Man: A Case Report

Introduction: A strangulated hernia is a surgical emergency. Hernia strangulation is manifested by a hard, painful and irreducible inguinal swelling and requires emergency surgical treatment. In some cases, it can be revealed by pathology; hence its name of hernia symptom and the diagnosis will only be rectified by gesture. Observation: We report the case of 50 year old men with no particular pathological history, admitted to the emergency for management of a strangulated right inguinal hernia and whose surgical exploration revealed appendicular peritonitis Conclusion: The diagnosis of strangulated inguinal hernia is a clinical diagnosis that most often does not require any additional examination. But in some cases it can be revealed by another pathology mimicking a strangulated hernia, the diagnosis of which is corrected during surgery.

Small Bowel Obstruction due to the Impaction of an Intragastric Balloon

We report the case of a 42 year old patient who was admitted to the emergency room for acute small bowel obstruction due to the impaction of an intragastric balloon, previously placed endoscopically for morbid obesity. The patient had surgical extraction through a laparoscopic enterotomy. No postoperative follow-up was noted. We performed an overall review of the results and complications of the endoscopic intragastric balloon as a therapeutic option in patients with severe obesity.