Acute Small Intestinal Obstruction Research Articles

Prevalence of an empty colon in patients with acute and chronic small intestinal mechanical obstruction: A retrospective radiographic study in 100 dogs and cats

Small intestinal mechanical obstruction (SIMO) is a common clinical condition, with radiographic studies typically focusing on the small intestine. However, the colon's appearance in SIMO has not been extensively studied. This retrospective study aimed to determine the prevalence of an empty colon on radiographs of dogs and cats with confirmed SIMO. Pre-surgical abdominal radiographs of 100 patients (68 dogs and 32 cats) with surgically confirmed mechanical ileus and a control group of 30 dogs and 20 cats with non-obstructive gastrointestinal (GI) disease and one without GI disease, respectively, were evaluated. The colon was assessed for content (none/collapsed, gas, faeces) and segmental distribution (ascending, transverse, descending colon) and correlated to the duration of clinical signs (acute, chronic). A colon was classified as empty when ≥2/3 was collapsed and/or gas-filled. The overall prevalence of an empty colon in cases of mechanical ileus was 61% (p=0.028), with 49/68 in dogs (72.1%) and 12/32 in cats (37.5%), p=0.001 between dogs and cats. Clinical signs duration did not influence the prevalence 28/61 (45.9%) acute, 33/61 (54.1%) chronic, p=0.522. However, acute cases had more empty colon segments (2/3 segments: 6/28, 21.4%; 3/3 segments: 22/28, 78.6%) than chronic cases (2/3 segments: 23/33, 69.7%; 3/3 segments: 10/33, 30.3%; p≤0.001). In the control groups, the prevalence of an empty colon was 64% (p=0.048) with and 38%, p=0.048) without GI disease, with no statistical difference between dogs and cats. An empty colon can be a supporting radiographic finding in diagnosing patients with GI disease, including SIMO, in addition to other established characteristic features. Dogs are more likely to have an empty colon in the presence of mechanical ileus.

Acute Small-bowel Obstruction: An Appraisal of Common Etiology and Management at the Federal Medical Centre, Keffi, North-central Nigeria.

Acute small intestinal obstruction is a common surgical emergency in the sub-Saharan region. Over the decades, complicated inguinal hernias have been identified as a leading cause. However, we observed from our clinical practice that complicated inguinal hernias were not the most common etiology. This study aimed to evaluate the common etiology of acute small bowel obstruction in the study center and compare our findings with that from other centers and existing literature. This was a retrospective, cross sectional study carried out over a period of five years (January 2017 to December 2021). This study looked at the patients presenting with acute, mechanical, small bowel obstruction that did not respond to conservative treatment in our hospital facility. Relevant information were extracted from patients' clinical details and entered into the proforma prepared for this study. A total of 147 patients were recruited into this study out of which 85(57.8%) were males and 62 (42.2%) were females (M:F=1.44:1). Majority (80.3%) of the patients that presented with post-operative bowel adhesion had previous appendectomy. Simple bowel obstruction was seen in 93 (63.3%) patients while strangulated obstruction and gangrenous bowel were seen in 26 (17.7%) patients and 22 (15.0%) patients respectively. Majority (47.6%) of the patients had adhesiolysis done while others had bowel resection. The common cause of acute small bowel obstruction as observed in this study is post-operative adhesions arising from previous appendectomy and laparotomies.

Mini-invasive technologies in the treatment of patients with acute adhesion small intestinal obstruction

Modern technologies in surgery lead to an increase in the number of surgical interventions, which in turn increases the number of patients with peritoneal adhesions disease. Patients with acute adhesive small intestinal obstruction make up to 70 %. Acute adhesion small intestinal obstruction takes the leading place among mechanical forms of intestinal obstruction and reaches 63–80 %, and the mortality rate is 5.1–8.4 %.
 The aim. Improvement of minimally invasive technologies in the treatment of patients with adhesive small intestinal obstruction.
 Materials and methods. The main group – 99 (58.6 %) patients with adhesions of the small intestine, who underwent minimally invasive treatment technologies. The comparison group included 70 (41.4 %) patients with acute adhesion small intestinal obstruction, who were treated with traditional methods.
 Results. Based on clinical laboratory and instrumental research results, 21 (12.4 %) patients out of 169 patients underwent emergency surgery: 7 (10.0 %) patients of the comparison group and 14 (14.1 %) patients of the main group. Minimally invasive surgical intervention was performed in 45 (45.5 %) patients of the main group with viscerolysis in 29 (29.3 %) patients and conversion was performed in 16 (16.2 %) patients. Median laparotomy was performed in 54 (54.5 %) patients of the main group and in 70 (100.0 %) patients of the comparison group.
 The complications of acute adhesive small intestinal obstruction and the complications of the postoperative period in the comparative analysis of the results of the treatment of patients were taken into account. The grading of postoperative complications was carried out in accordance with the classification of P. A. Clavien and D. Dindo (2009), according to which a statistically significant difference is noted in the studied groups: 14 (14.1 %) of the main group and 23 (32.8 %) of the comparison group, III, IV and V degrees of complications were preferred. Relaparotomy was performed in 5 (7.1 %) patients of the comparison group and in 2 (2.0 %) patients of the main group. Mortality decreased from 6 (8.5 %) in the comparison group to 2 (2.0 %) in the main group.
 Conclusions. The use of an improved approach in diagnostics and treatment of patients with acute adhesion small intestinal obstruction ensured improved results of surgical treatment. The use of mini-invasive technologies in diagnosis and treatment made it possible to reduce the frequency of postoperative complications from 32.8 % to 14.1 %, the mortality rate from 8.5 % to 2.0 %, which confirms the effectiveness of the use of mini-invasive technologies in the treatment of patients with acute adhesion small intestinal obstruction.

Morphofunctional changes in the small intestine in acute adhesive small bowel obstruction

Aim: To study the features of morpho-functional changes in the small intestine mucosa in acute adhesive small bowel obstruction.Material and methods. The results of a comprehensive study of morphological and functional changes in the small intestine’s mucous membrane in 20 patients out of 50 with acute adhesive small intestinal obstruction were analyzed. Patients underwent resection of the small intestine with a biopsy from the mucous membrane, followed by a pathomorphological and biochemical examination of biopsy specimens.Results. The study results show that more pronounced pathomorphological changes in the mucous membrane of the small intestine were observed in patients with acute adhesive small intestinal obstruction with widespread (multiple) adhesions compared with limited (single) adhesions. In the study of biochemical parameters in the small intestine mucosa in patients with acute adhesive small intestinal obstruction with the presence of multiple (widespread) adhesions, there was a significant and critical increase in lipid peroxidation and proinflammatory cytokines, a decrease in antioxidant protection compared to the patient group with the presence of single (limited) adhesions. There was also a decrease in the concentration of serotonin in the mucosa of the small intestine. In the presence of single (limited) adhesions in these patients, it decreases to 0,50±0,3 units, and in patients with multiple (common) adhesions - to 0,20±0,2 arb. units.Conclusion. The severity of morpho-functional changes in the mucosa of the small intestine directly correlates with the severity of the development of the adhesive process and acute adhesive small bowel obstruction.

A rare type of postoperative abdominal herniation

Resume. Postoperative abdominal hernia is considered the most common complication in abdominal surgery. Aim. To acquaint medical practitioners with the clinical case of diagnosis and treatment of impaired postoperative contraperture true abdominal hernia on the background of a closed abdominal injury. Materials and methods. We present a clinical case of our own observation of the clinical course, diagnosis and treatment of impaired postoperative contraperture true abdominal hernia with necrosis of the loop of the small intestine and necrosis of the large omentum, acute strangulation small intestinal obstruction, general serous-fibrinous peritonitis, adhesive peritoneal disease of the 2nd degree at patient with closed abdominal trauma. Results. The patient with a closed abdominal injury, the results of the examination and treatment of which are given in the article, in the anamnesis - cholecystoectomy 39 years ago. The preliminary diagnosis: closed abdominal trauma, peritonitis. Intraoperatively, a case of true postoperative abdominal hernia of rare localization - contraperture hernia. It was taking into account the patient's complaints, medical history, results of physical examination, the results of laboratory and instrumental methods of research available at the time of examination. The clinical interest is not only the rarity of the birth of this pathology, but also the history of the disease, diagnostic search, clinical picture and treatment tactic. Conclusions. In this case, the patient was probably a hernia carrier for many years, and the injury only provoked the infringement. The patient sought medical help late, as result of which the picture of peritonitis was obvious. This made it possible to quickly decide on the need for surgical treatment. Otherwise, the likelihood of a tactical error is not excluded. We believe this case is interesting because one should always remember about the possible surgical pathology against the background of a closed abdominal trauma.

INCORRECT REPOSITIONING OF ENTRAPPED INGUINAL HERNIA

The case presents entrapped inguinal hernia and its incorrect repositioning with resulted strangulation of small intestine. The purpose of the work. Prevention of such cases in surgery and observance of strict rules of classical canons in the surgical environment, which remain relevant today. Patient M., 45 years old, was urgently hospitalized with complaints of intense, intractable, painful protrusion in the hernia in the right groin. From the anamnesis – suff ers from right inguinal hernia for 3 years. The day before, during exercise, an intractable, painful protrusion appeared at the site of the hernia, which began to increase. When examining the abdomen in the projection of the outer ring of the right inguinal canal there is a hernial protrusion, which does not disappear and does not change in size when changing body position. The protrusion is tense, dense, painful, the symptom of «coughing» in the area of protrusion is not transmitted, and coughing increases the pain. No free air and Kloiber’s bowls were found in the abdomen. According to laboratory and instrumental examination and objective signs, the diapatient was diagnosed with strangulated right inguinal hernia. During the examination of the patient, the hernial protrusion was exercised, so the patient was dynamically monitored. The next day the patient left the surgical department due to family circumstances. After 3 days, the patient again went to the surgical department with complaints of thirst and abdominal pain, vomiting with small intestine content and no discharge of gases and no bowel movements for 5 days. On examination, the patient’s condition is moderate. Taking into account the anamnesis, clinical evolution of the disease, laboratory and instrumental examination data and objective signs, it was concluded that the patient has acute surgical pathology. Diagnosed with: Acute small intestinal obstruction. The clinical case shows a misalignment of a strangulated inguinal hernia. After self-repositioning of the hernia, patients should be hospitalized to the surgical department for an elective surgery.

P53 First Reported Case of Successful Non-Surgical Management for Acute Small Intestinal Obstruction Caused by Enterolith as A Rare Complication of Jejunal Diverticulosis

IntroductionEnterolith ileus is a rare complication of jejunal diverticulosis, which in itself is a rare entity. Here we report a rare case of enterolith ileus as a complication of jejunal diverticulosis which is successfully managed conservatively.Case ReportA 75-year-old female presented with a 7- day history of “gripey” abdominal pain with intermittent vomiting. She was able to pass flatus and had open bowel with small amount of loose stool. Patient was previously fit and well with no significant past medical history and had not undergone previous abdominal surgery. On admission, patient was in no acute distress and was afebrile. On examination, she had a very distended tympanic abdomen with left-sided tenderness but no palpable mass. Bowel sounds were present. Laboratory investigations revealed a white cell count of 22.6 x109/L, C-reactive protein of 26 mg/L and haemoglobin of 144 g/L. Abdominal X-rays revealed distended loops of small bowel indicating small bowel obstruction. CT images did not reveal pneumobilia which would be suggestive of gallstone ileus but showed intraluminal small bowel obstruction secondary to an enterolith in the terminal ileum. The scan also showed an inflamed jejunal diverticulum with fat stranding around but no perforation nor abscess was seen. The working diagnosis was acute intestinal obstruction caused by jejunal enterolith expulsed from jejunal diverticulum. Since no perforation nor abscess was noted, this patient was treated conservatively. Patient recovered uneventfully and was discharged with an MRI scheduled in 4-6 weeks for follow-up. The follow-up MRI was completely normal and patient has recovered uneventfully with conservative management.DiscussionAcute intestinal obstruction caused by jejunal enterolith expulsed from jejunal diverticulum is rare. However, it is important to diagnose jejunoileal diverticulosis timely as they may lead to acute complications which can be life- threatening and may even cause death.ConclusionMany cases have reported jejunoileal diverticulosis being overlooked or misdiagnosed for other acute abdominal conditions. It is important to have a clinical awareness of this condition as although rare, it can lead to life-threatening complications.

Modern aspects of surgical treatment of patients with adhesive small bowel obstruction

Despite the ongoing preventive measures aimed at reducing the formation of adhesions in the abdominal cavity with an increase in the number of surgical interventions on the abdominal organs, the number of patients admitted to surgical hospitals with adhesions of the small intestine is also increasing. It should be noted that annually about 12% of previously operated patients undergo treatment in surgical departments while the exceptional fact is that 5070% are patients with acute adhesive ileus of the small intestine and the mortality rate in this group ranges from 13 to 55%. In recent years the literature has been actively discussing the advantages of minimally invasive technologies in the treatment of adhesive small bowel obstruction since the use of traditional methods often leads to the development of complications with repeated (in 60% of cases) surgical interventions. The purpose of this study was the development and implementation of an improved therapeutic and diagnostic algorithm in patients with adhesive small bowel obstruction which made it possible to improve the results of treatment. A comparative analysis of 338 patients with adhesive small bowel obstruction who were treated in the surgical departments of the St. Elizabeth Hospital in St. Petersburg in the period from 2016-2019 was carried out. All the patients were divided into 2 groups: the main (I) group (2018-2019), which consisted of 198 patients who received the improved diagnostic and treatment algorithm as well as the comparison group (II) (2016-2017) which included 140 cases these are patients examined according to the standard protocol and operated on in the traditional way. Moreover, in 98 cases, it was possible to resolve acute adhesive small intestinal obstruction in a conservative way, and 240 patients underwent surgical treatment. The developed diagnostic algorithm is based on the consistent application of the most informative diagnostic methods. At the same time the indications and the sequence of their application were established which ultimately made it possible to shorten the preoperative time interval as well as to determine the optimal treatment strategy with the choice of the type of surgical treatment (laparotomy or laparoscopy). The proposed treatment and diagnostic algorithm allowed to reduce the complication rate from 46.5% (53) to 22.2% (28) (р 0,001), and the mortality rate from 14.9% (17) to 3.9% (5) (p 0,01).

Breast Carcinoma Presentation as Acute Small Intestinal Obstruction: Carcinoma of Unknown Primary

Cancer of unknown primary (CUP) is a relatively common clinical entity accounting for 4 to 5% of cancers (Scoggins et al., The American Surgeon 65(1):1, 1999). Adenocarcinoma and undifferentiated carcinomas account for 75% of CUPs. The diagnosis of CUP is mainly done by immunohistochemistry (IHC). Some of the important biomarkers used for the differentiation of the tumor lineage in CUP for breast primary are GATA3, ERM GCDFP-15, TFF1, and MGB (Thomas et al., Eur J Nucl Med Mol Imaging 37(3):635–644, 2010 Mar). We highlight the importance of mammaglobin (MGB) as a diagnostic marker in metastatic breast carcinoma. We present a 55-year-old lady who had presented with acute small bowel obstruction. Computer tomography (CECT) had revealed a stricture involving the mid ileum. Laparotomy with resection and anastomosis was done. The histology was a poorly differentiated adenocarcinoma. Six months later, she had presented with a lump in the right breast and trucut histology had shown an invasive lobular carcinoma. IHC was positive for estrogen (ER), progesterone (PR), and mammaglobin receptor. With a high index of suspicion, the previously reported poorly differentiated adenocarcinoma of the small bowel was reviewed and IHC for mammaglobin was positive. This was consistent with a metastatic carcinoma of the small bowel with the primary being breast. She is on tamoxifen and doing well on short follow-up.

Changes in Metabolic Processes in The Gastric Mucosa in The Pathogenesis of the Formation of Acute Ulcers in Acute Small Intestinal Obstruction

Changes in Metabolic Processes in The Gastric Mucosa in The Pathogenesis of the Formation of Acute Ulcers in Acute Small Intestinal Obstruction

PREVALENCE, DISTRIBUTION AND DETERMINANTS OF INTESTINAL TUBERCULOSIS IN ADULT INDOOR PATIENTS WITH ACUTE SMALL INTESTINAL OBSTRUCTION IN POPULATION OF PESHAWAR DIVISION, PAKISTAN

Background: Acute small intestinal obstruction (ASIO) is one of the commonest causes of emergency hospital admissions, morbidity and mortality. Intestinal tuberculosis (ITB) is common cause of ASIO in developing countries leading to significant morbidity and mortality. Our objectives were to determine prevalence, distribution and determinants of ITB in adult indoor patients with ASIO in population of Peshawar Division, Pakistan.Materials Methods: This cross-sectional study was conducted at Department of Surgery Peshawar Medical College, Peshawar, Pakistan from January 2019 to June 2020. The data was collected from its three affiliated hospitals; Mercy Teaching Hospital, Kuwait Teaching Hospital Prime Teaching Hospital, Peshawar. 207 ASIO subjects were selected from population at risk consecutively. Sex, age groups and presence of ITB were variables. Prevalence and distribution were described by count, percentage and confidence intervals for proportion for population. Hypotheses for distribution were tested by chi-square goodness of fit and of association by chi-square test of association.Results: Out of 207 patients with ASIO, 128 (61.84%) were men and 79 (38.16%) women, 87 (42.03%) were in age group 18-40 and 120 (57.97%) in 41-60 years. Out of 207 patients with ASIO, 41 (19.81%) had ITB, while 166 (80.19%) had no ITB. Out of 41 ITB patients, 25 (12.08%) were men and 16 (7.73%) women, 17 (8.21%) in age group 18-40 and 24 (11.60%) in 41-60 years. The prevalence of ITB was similar to expected (p=.5695). The distribution across sex (p=.00001) was different and across age groups (p=.12501) was similar to expected. Presence of ITB was not associated to sex (p=.8992) and age groups (p=.9347).Conclusion: Prevalence of intestinal TB in adult indoor acute small intestinal obstruction (ASIO) population of Peshawar Division, Pakistan was 19.81%. Prevalence was higher in men than women and higher in 41-60 years than 18-40 years age group population. Overall prevalence of intestinal TB was similar to expected. Observed distribution across sex was different and across age groups was similar to expected. Presence of intestinal TB was not associated to sex and age groups respectively.

Acute Small Intestinal Obstruction Caused by Ectopic Pancreas. A Clinical Case Report

Introduction. An ectopic pancreas is an abnormality in which pancreatic tissue has grown outside its normal location with its own blood supply and ducts while having no anatomical, vascular or innervation connections with the pancreas situated normally. The accessory pancreas is the most frequent congenital disorder of this gland. The pancreatic tissue can be found in the walls of stomach, intestine, gallbladder, Meckel’s diverticulum, the liver, spleen and, seldom, in other organs having no contact with the pancreas. Currently the ectopic pancreas incidence is on the rise and amounts up to 0.2% on average in abdominal surgeries and is reported in 0.5–13% of autopsy cases. Most frequently the aberrant pancreas is located in the gastroduodenal zone (63–70% of all the heterotopic pancreas cases); most often it is found in the pylorus and antrum (85–95% of all the gastric ectopic pancreas cases).Materials and methods. This paper presents a case of a successful treatment of a 39 year old male with an acute small intestinal obstruction caused by ectopic pancreatic tissue in the intestinal wall. The patient received a diagnostic laparoscopy and a mid-midline laparotomy with the wedge resection of the small intestine.Results.The postoperative period was recorded as uneventful; the patient was discharged home on day nine following the surgery after removal of cutaneous sutures. The pathology of the small intestinal fragment with the polyp-like neoplasm identified heterotypic pancreatic foci (with acini and ducts) located between muscular bands, with extensive areas of haemorrhaging and necrosis.Conclusion.The diagnosis of the ectopic pancreas tissue in intestinal wall is an extremely complex issue in abdominal surgery; this diagnosis is normally made only when complications occur. Pathomorphological verification is of paramount importance to make the final diagnosis of this disease, making it possible to identify correctly the cause and mechanism of the development of an acute surgical disorder.

Оптимізація діагностичної програми у хворих на гостру непрохідність тонкої кишки

Метою роботи: розробка ефективної і доступної діагностичної програми у хворих на ГНТК для покращення результатів їх хірургічного лікування.Матеріали і методи. У 221 пацієнта проведено комплексне обстеження з визначенням індексу коморбідності, функціонального стану хворих і ступеня операційно-анестезіологічного ризику. Ретроспективний аналіз проведено у 30 хворих із несприятливими наслідками.Результати досліджень та їх обговорення. Рентгенологічне дослідження виконано в 96,67 % померлих хворих і у всіх пацієнтів зі сприятливим перебігом захворювання. УЗД органів черевної порожнини виконано в 33,33 % і 49,77 % випадків, відповідно. Звернено увагу на значення кожного з цих методів під час обстеження хворих. При досліджені моторно-евакуаторної функції травного каналу було виявлено, що задовільна перистальтика ТК була тільки в 8 (3,62 %) випадках, її підсилення спостерігалося у 78 (35,29 %) хворих, пригнічення – у 103 (46,61 %) пацієнтів та її відсутність – у 32 (14,48 %) госпіталізованих. У хворих із несприятливим перебігом захворювання в одному випадку характер перистальтичних звуків був ритмічний, непідсилений, в 36,67 % – спостерігалося їх підсилення, пригнічення та її відсутність – в 60 % хворих. При дослідження ЛІІ та ПЛІ виявлено, що при несприятливому перебізі ГНТК ЛІІ склав (3,99 ± 0,84) од., ПЛІ – (1,21±0,33) од., у хворих при сприятливому перебізі хвороби – (4,06± 0,24) од. і (0,82 ± 0,07) од., відповідно. У 146 (66,06 %) випадках функціональний стан хворих був компенсованим і в 75 (33,94 %) випадках – декомпенсованим. Індекс коморбідності в цих хворих був наступним: до 59 роки – 1,03, у віці 60–74 роки – 4,82 і у віковій групі 75–89 роки – 6,0. У хворих з несприятливим перебігом захворювання індекс коморбідності був значно вищим, що вказувало на важливе значення супутніх захворювань у перебігу ГНТК. Запропоновано діагностичний алгоритм у хворих на ГНТК, який дозволяє проводити моніторинг перебігу захворювання і забезпечує оптимізацію хірургічної допомоги таким пацієнтам.

интубация тонкой кишки как компонент лечения острой странгуляционной тонкокишечной непроходимости

Objective: Improving the results of treatment of patients with acute strangulated intestinal obstruction (ASIO). Methods: Analyzed the results of complex diagnostics and surgical treatment of 49 patients with ASIO. In 20 (40.8%) observations, the cause of ASIO was the acute adhesive small intestinal obstruction, 12 (24.5%) – intussusception, 10 (20.4%) – nodulation and 7 (14.3%) – volvulus of small intestine. Results: Established that as the syndrome of enteric insufficiency progresses, observed an increase in endotoxemia levels. Thus, with the syndrome of enteric insufficiency of II and III degrees, the leukocyte index of intoxication (LII) was 6.23±1.16 units and 8.62±2.51 units, respectively, medium-mass molecules (MMM) – 0.587±0.25 conv. units and 0.838±0.06 conv. Units, respectively, and blood lactate levels were 2.8±0.04 μmol/l and 3.1±0.06 μmol/l, respectively. At a severe and extremely severe increase in intra-abdominal pressure, the level of MMM reached 0.1104±0.53 conv. units and 0.1274±0.78 conv. units, respectively, blood lactate – 2.5±0.02 μmol/l and 3.1±0.04 μmol/l, respectively, and LII – 6.24±1.18 units, and 8.60±2.53 units, respectively. Performed various kinds of surgery with intubation of the small intestine with subsequent decompression and gut lavage, which effectively reduced endotoxemia and indices of intra-abdominal pressure, and also reduced the incidence of enteroenteroanastomosis insufficiency. Four observations have suppuration of the laparotomic wounds, in 2 patients – subhepatic abscess and in 1 – entero-enteroanastomosis nsufficiency. Two elderly patients died of peritonitis (n=1) and acute myocardial infarction (n=1). Conclusion: Intubation of the small intestine with the implementation of hypothermic sanation allows effective removal of toxic intestinal content and prevents the risk of entero-enteroanastomosis nsufficiency. Keywords: Acute intestinal obstruction, enteral insufficiency, intubation of intestine.

The Use of Antihypoxant and Antioxidant Therapy in Comprehensive Treatment of Acute Small Intestinal Obstruction

Indices of lipid peroxidation (LPO), middle weight molecules (MWM), and changes in the structure of the liver and the impact of Reamberin solution on them were analyzed in 202 patients with acute small intestinal obstruction (ASIO) and model of small intestinal obstruction (SIO) in 40 Vietnamese pigs. Endogenous intoxication indices were established to increase along with the increase in enteral deficiency. In case of ASIO increase in lipid peroxidation products, MWM in serum, and decrease in ceruloplasmin securities, significant changes in the liver (destruction of granular and smooth endoplasmic reticulum, mitochondria, hepatocytes nuclei) were observed. Surgical resolution of ASIO leads to further temporary deterioration of liver structure, increase in MWM, and indices of lipid peroxidation and decrease in ceruloplasmin levels. Prescription of antioxidant therapy in the postoperative period promotes reparative processes in hepatocytes and leads to normalization of endogenous intoxication indices in blood serum and helps reduce postoperative mortality.

MDCT Diagnosis of Symptomatic Incarceration of the Right Ileocecocolic Mesentery Within a Complete 360-Degree Whirl of the Great Omentum: Follow the Vessels!

Case Report A 74-year-old female was referred to the emergency department with persistent abdominal pain. Five months earlier, she had experienced acute small bowel intestinal obstruction necessitating emergency laparotomy. This occlusion was caused by anterior parietal adherences related to recurrent previous abdominal surgery. Contrast-enhanced MDCT excluded now significant dilatation of the gut but demonstrated an unusual accumulation of abdominal fat incarcerating mesenteric vessels and bowel segments in the midline of the anterior mesogastrium (Figure 1, white arrows). Careful multiplanar analysis (Figure 2A, B, C shows the antero-posterior coronal MPR views, and Figure 2D shows the axial oblique MPR view) revealed the omental nature of the encircling fatty structure through the clear delineation of the encircling omental vessels (white arrows). This 360-degree whirl of the greater omentum was incarcerating the right ileocecocolic mesenteric vessels (white star); the two incarcerated and compressed bowel segments were identified as the terminal ileum and the transverse colon (black arrows). Selective volume-rendering reconstruction confirmed the whirl (Figure 3). Despite the fact that there was no critical dilatation nor suffering signs of the gut at the time of MDCT, the risk of occlusion was nevertheless considered important, and it seemed unlikely that this complete omental whirl would resolve spontaneously. This caution justified laparotomy.

Intensity indicators of bacterial translocation in experimental acute obstruction of small and large intestine

Intensity indicators of bacterial translocation in experimental acute obstruction of small and large intestine

A study of preoperative predictive factors of strangulation in acute small intestinal obstruction

Background: Acute small intestinal obstruction is a common surgical emergency where outcomes are often influenced by the presence of strangulation. Identification of criteria which can predict strangulation among patients presenting with acute small intestinal obstruction can help in early decision making regarding management and thereby can ensure better outcomes. A prospective observational study was carried out among 54 patients presenting with acute small intestinal obstruction to document clinically the signs and symptoms which can predict strangulation early along with laboratory parameters and findings on imaging using ultrasound and color doppler. Methods: A delayed presentation beyond 72 hours with bleeding per rectum and fever along with marked tachycardia with hypotension were the significant criteria observed among patients with strangulated obstruction. Results: On laboratory evaluation, leukocytosis with an elevated serum lactate was significant in strangulated obstruction whereas on imaging ultrasound abdomen supplemented with a color doppler proved to be an investigation of choice in predicting strangulation. Conclusions: A combination of clinical, laboratory and imaging criteria can be useful in predicting strangulation among patients presenting with acute small intestinal obstruction thereby ensuring an early surgical intervention and better outcomes.

Pathogenetic Meaning Of The Violation Of The Metal-Protein Homeostasis In Increasing Bacterial Aggression And Intensification Of Endotoxicosis In The Organism With Acute Small Intestinal Obstruction

Pathogenetic Meaning Of The Violation Of The Metal-Protein Homeostasis In Increasing Bacterial Aggression And Intensification Of Endotoxicosis In The Organism With Acute Small Intestinal Obstruction

Acute small intestinal obstruction-an unusual complication of capsule endoscopy.

We report a case of endoscopic capsule impaction causing acute small intestinal obstruction in a patient with Crohn's disease (CD), having obscure gastrointestinal bleeding. A 57-year old female presented with features of acute small bowel obstruction 2days after capsule endoscopy elsewhere for the evaluation of intermittent bleeding per rectum and iron deficiency anemia. Patient underwent an exploratory laparotomy with right hemicolectomy for the diseased ileocecal region which mimicked malignancy. The capsule was found to be impacted in the strictured lumen of the terminal ileum. Post operative histopathological examination revealed it to be Crohn's disease.