Adhesive Obstruction Research Articles

A CASE REPORT: SMALL BOWEL OBSTRUCTION DUE TO OBTURATOR HERNIA

Introduction: The obturator hernia is an uncommon cause for small bowel obstruction. It is classically described in thin elderly women. Delay to diagnosis may result in strangulation and gangrenous bowel at subsequent laparotomy The classically described signs, whilst useful when present, are absent in greater than 50% of cases, and preoperative diagnosis is made on radiological imaging. A 79-year-old female presented Case report: to hospital with a 2 – days history of vomiting, generalized dull aching abdominal pain and enable to pass stool for 2 days. Past medical history included scoliotic deformity in lumbar spine and previously operated for tubal ligation before 32 years. Laparotomy, bowel resection and suture hernia repair were undertaken. A subsequent presentation of small bowel obstruction was due to recurrence of the obturator hernia. However, resolved without operative management. A very high index of suspicion is required when Discussion: presented with the case of small bowel obstruction in an elderly female patient. One must therefore, also consider that any subsequent presentations of small bowel obstruction may be due to recurrence of the obturator hernia, the differential being adhesive bowel obstruction, and delay to denitive treatment is associated with poorer prognosis. A high index of suspicion is required to diagnose an obturator hernia clinicall Conclusion: y. Failure to do so results in greater mortality and morbidity. Early cross-sectional imaging can make the diagnosis and lead to earlier surgical repair. A diagnostic challenge, an obturator hernia is a rare cause of small bowel obstruction. Delay in diagnosis is associated with adverse outcome. Computed tomography scan has proved invaluable to early detection and repair.

25, 50 and 75 years ago

25, 50 and 75 years ago

Short-term outcomes of deeper intubation technique of ileus tube for different types of acute intestinal obstruction patients: A retrospective multicenter study.

Our previous research reported a novel deeper intubation technique (DIT) of the ileus tube for acute bowel obstruction patients. The present study was designed to evaluate the effect of this novel technique on the clinical outcomes of patients with obstruction using a large cohort. The detailed clinical data were analyzed retrospectively from 496 obstruction patients who underwent intubation technique from 2014 to 2019 in five hospitals. The patients were divided into either the DIT group or the traditional intubation technique (TIT) group. The groups were matched in a 1:1 ratio using propensity scores, and the primary outcome was the short-term clinical outcomes for patients. The baseline characteristics were similar between the DIT group and the TIT group after matching. Compared with the TIT group, the DIT group had a significantly deeper intubation depth, with shorter hospital days, shorter time to first flatus and defecation, lower pain score, increased drainage volume, and lower emergency surgery rate. Importantly, the inflammatory factors such as white blood cell, C-reactive protein, and procalcitonin levels were significantly lower in the DIT group. In addition, the DIT treatment was significantly useful for adhesive obstruction patients. The DIT procedure led to better short-term clinical outcomes compared with the TIT procedure, indicating that DIT is a safe and feasible technique for the treatment of intestinal obstruction that is worthy of further popularization and clinical application.

Rehabilitation of patients with peritoneal adhesive disease

Adhesive disease is a syndrome caused by the presence of adhesions in the abdominal cavity, formed due to various reasons, and characterized by frequent bouts of relative intestinal obstruction.Purpose. Determine the complex of rehabilitation measures for adhesive disease.Material and methods. Patients with the following forms were observed: a) with pain syndrome (84.1%); b) with periodically recurring attacks of intestinal obstruction; c) there may also be asymptomatic SB (not found in observations). All patients had the following symptoms as pain, thirst, nausea (sometimes vomiting that does not bring relief), a feeling of heaviness in the abdomen, tachycardia, discomfort, flatulence, arterial hypertension. Ultrasound of the abdominal organs and laparoscopy, MSCT of the abdominal organs and plain radiography of the abdominal cavity and electrogastroenterography were performed to detect violations of the motor function of the gastrointestinal tract.Results and discussion. The complex of rehabilitation measures included the following rehabilitation. Outside the attack of adhesive disease (an attack of intestinal obstruction) and with adhesive dynamic obstruction, patients were treated conservatively; surgical rehabilitation was prescribed for an attack of adhesive mechanical obstruction. Conservative rehabilitation included exercise therapy, diet, folk remedies, medical correction.

Paediatric adhesive bowel obstruction: A review of a case of congenital surgery and its sequelae

Paediatric adhesive bowel obstruction: A review of a case of congenital surgery and its sequelae

Clinical efficacy of acupuncture in patients with adhesive intestinal obstruction: A meta-analysis.

Background:Adhesive intestinal obstruction (AIO) is a common surgical emergency. Surgical exploration has a considerable risk of intestinal injury, and surgical treatment may greatly reduce the quality of life after surgery and cause AIO after re-operation. The nonsurgical treatment is effective for approximately 70% to 90% of patients with adhesive small bowel obstruction (ASBO). However, the high recurrence (30%) and mortality (2%) rates of ASBO are concerning. Moreover, the ideal management method of ASBO remains debatable. Studies have shown that acupuncture can also promote postoperative gastrointestinal function recovery and prevent postoperative complications such as nausea, vomiting, and visceral pain.Aim:We aimed to evaluate the effectiveness of acupuncture in the treatment of AIO.Methods:Randomized controlled trials investigating the effectiveness of acupuncture for adhesive bowel obstruction published until November 2021 were identified by searching 8 comprehensive databases. Data analysis was performed using RevMan v. 5.4 and Stata software v. 16.0. The random-effects model and the fixed-effects model were used to perform the meta-analysis on the experimental group and control group.Results:Twelve studies with a total of 892 participants were included. The results showed that the experimental group had a significantly higher effective rate (relative risk: 1.20; 95% confidence interval (CI): 1.11–1.28; P < .00001) and a markedly shorter time of the first defecation (mean difference: −11.49, 95% CI: −19.31 to −3.66; P = .004) than the control group. The experimental group also showed a reduction in the duration of abdominal pain, and the reduced length of hospital stay. However, no statistical differences were observed between the 2 groups in terms of the surgery conversion rate.Conclusion:Acupuncture is effective in the treatment of AIO. It can remarkably alleviate some clinical symptoms in patients with AIO.

Establishment of an early diagnosis model of colon cancerous bowel obstruction based on 1H NMR.

To prospectively establish an early diagnosis model of acute colon cancerous bowel obstruction by applying nuclear magnetic resonance hydrogen spectroscopy(1H NMR) technology based metabolomics methods, combined with machine learning. In this study, serum samples of 71 patients with acute bowel obstruction requiring emergency surgery who were admitted to the Emergency Department of Sichuan Provincial People's Hospital from December 2018 to November 2020 were collected within 2 hours after admission, and NMR spectroscopy data was taken after pretreatment. After postoperative pathological confirmation, they were divided into colon cancerous bowel obstruction (CBO) group and adhesive bowel obstruction (ABO) control group. Used MestReNova software to extract the two sets of spectra bins, and used the MetaboAnalyst5.0 website to perform partial least square discrimination (PLS-DA), combining the human metabolome database (HMDB) and the Kyoto Encyclopedia of Genes and Genomes (KEGG) to find possible different Metabolites and related metabolic pathways. 22 patients were classified as CBO group and 30 were classified as ABO control group. Compared with ABO group, the level of Xanthurenic acid, 3-Hydroxyanthranilic acid, Gentisic acid, Salicyluric acid, Ferulic acid, Kynurenic acid, CDP, Mandelic acid, NADPH, FAD, Phenylpyruvate, Allyl isothiocyanate, and Vanillylmandelic acid increased in the CBO group; while the lecel of L-Tryptophan and Bilirubin decreased. There were significant differences between two groups in the tryptophan metabolism, tyrosine metabolism, glutathione metabolism, phenylalanine metabolism and synthesis pathways of phenylalanine, tyrosine and tryptophan (all P<0.05). Tryptophan metabolism pathway had the greatest impact (Impact = 0.19). The early diagnosis model of colon cancerous bowel was established based on the levels of six metabolites: Xanthurenic acid, 3-Hydroxyanthranilic acid, Gentisic acid, Salicylic acid, Ferulic acid and Kynurenic acid (R2 = 0.995, Q2 = 0.931, RMSE = 0.239, AUC = 0.962). This study firstly used serum to determine the difference in metabolome between patients with colon cancerous bowel obstruction and those with adhesive bowel obstruction. The study found that the metabolic information carried by the serum was sufficient to discriminate the two groups of patients and provided the theoretical supporting for the future using of the more convenient sample for the differential diagnosis of patients with colon cancerous bowel obstruction. Quantitative experiments on a large number of samples were still needed in the future.

Necrotizing Enterocolitis as a Possible Manifestaion of Multisystem Inflammatory Syndrome in Neonates Related to SARS-CoV-2

Background: Multisystem inflammatory syndrome in neonates (MIS-N) is hypothesized to be caused either following transplacental transfer of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) antibodies or antibodies developed in the neonate after infection with SARS-CoV-2. The common clinical manifestations include fever, respiratory distress, shock, and encephalopathy. Gastrointestinal manifestations include vomiting, diarrhea, bloody stools, and gastric residues. Necrotizing enterocolitis (NEC) has not been described before in MIS-N. Clinical Description: We report a term neonate presenting on day 10 of life with 2 days history of fever, abdominal distension, vomiting, reduced feeding, and not passing stool. He had tachycardia, tachypnea, a distended tense and tender abdomen with absent bowel sounds, and excessive irritability. Salient investigation results were anemia, neutrophilic leukocytosis, hyponatremia, metabolic acidosis, and elevated inflammatory markers. Dilated bowel loops on abdominal radiograph and thickening of bowel wall on abdominal ultrasonography were consistent with NEC. In view of the unusual presentation of NEC, the elevated biomarkers and setting of the pandemic, MIS-N was suspected, investigated, and the diagnostic criteria were found to be satisfied. Management: The baby received supportive care. Methylprednisolone, intravenous immunoglobulin, aspirin, and enoxaparin were started resulting in defervescence and decline in inflammatory markers. However, he developed fixed bowel loops and underwent an exploratory laparotomy. This revealed stricture and extensive necrosis of the terminal ileum with adhesive obstruction. The affected segment was excised, and loop ileo-colostomy was done. He gradually improved and was discharged on the 11th postoperative day on enteral feeds. The infant was thriving on follow-up. Conclusion: NEC may be a possible manifestation of MIS-N.

Одвічна проблема хірургії - апендицит: його ускладнення та результати лікування хворих

Purpose - to improve the treatment of patients with appendicitis on the basis of the introduction of the latest imaging methods and surgical technologies. Materials and methods. In the clinic of the surgery center of the Kyiv City Clinical Hospital No. 1 from 2006 to 2019, 30,627 patients were treated, of which acute appendicitis with various forms of inflammation in 2697 (49.18%). The age of the patients ranged from 16 to 92 years old. Depending on the time of the hospitalization (by year), the patients were divided into two groups: the control group (2006-2012) - 1379 (51.13%) patients; the studied group (2013-2019) - 1318 (48.87%) patients. The reason for division into groups was the use of modern technologies for diagnostics (visualization) of the disease and improved methods of surgical treatment in the studied group. Results. Surgical access in 1846 (68.45%) cases was laparotomy, in 851 (31.55%) cases laparoscopic of which 69 (8.10%) cases had a conversion. Appendix location: typical in 692 (25.66%) cases, pelvic in 986 (36.56%) cases, retrocaecal in 293 (10.86%) cases, retroperitoneal in 277 (10.27%) cases, subhepatic in 228 (8.45%) cases, medial in 221 (8.19%) cases. In the postoperative period, complications from the abdominal cavity were established in 89 (3.30%) cases and wounds in 125 (4.63%) cases. 6 patients (0.22%) died, out of 1379 patients of the control group in 4 (0.29%) cases, and among 1318 patients of the study group 2 (0.15%) cases. Early adhesion obstruction in 18 (0.67%) cases, and subsequently the disease was found in 72 (2.67%) patients, which was restored surgically, as well as concomitant hernias in 45 (1.67%) cases. Conclusions. The use of modern imaging and treatment technologies has improved the results and reduced postoperative mortality from 0.29% to 0.15% with an average of 0.22%. According to the results of the study, it was found that the quality of life after laparoscopic appendectomy is statistically significantly (p&lt;0.01) higher than in patients operated on by the open method. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Keywords: appendicitis, adults, adolescents, open appendectomy, laparoscopic appendectomy, adhesive obstruction, hernias.

Травма прямої, товстої кишки та промежини в дітей

Purpose - to improve the treatment of children with traumatic injuries of the rectum, perineum and intestines. Materials and methods. In the clinic of the Department of Pediatric Surgery of the Shupyk National Healthcare University of Ukraine for 30 years, 9 children with traumatic injuries of the rectum, perineum and colon were treated. The age of the patients ranged from 1.5 to 16 years. There were 2 female patients (22.23%) and 7 male patients (77.77%). Results. The study found that among 9 patients who had damage to the rectum, concomitant damage to the descending colon in 1 (11.11%), sigmoid in 1 (11.11%), penetrating into the abdominal cavity in 3 (33.33%), urinary bladder in 1 (11.11%), vagina in 2 (22.22%). In 1 (11.11%) patient, a traumatic injury to the rectal wall was noted. Thus, among 9 patients fatigue was used in 8 (88.89%) children, of which in 3 (33.33%) double-barreled fatigue was initially imposed, requiring the distal colon to be turned off. Primary reconstructive surgeries were performed in 8 (88.89%) patients, and in 1 (11.11%) child with a delay of 2 weeks due to an inflammatory process in the rupture of the rectum and vagina in a 1.5-year-old child. Our own research has shown that the use of suspended or split fatigue on a spur is not an effective method of disconnecting the injured both colon and rectum from the contents. Traumatic damage to the rectum and vagina with rupture of the sphincter apparatus was found in 2 (22.22%) patients. Adhesive obstruction was found in 1 (11.11%) patient. All patients were discharged from the clinic. Conclusions. Visualization of the damage volume should be complete and performed under general anesthesia in the operating room. Surgical treatment of traumatic damage to the perineum of the rectum and colon requires an individual and should be phased: the imposition of a separate or final colostomy, as well as reconstructive and restorative surgery of the perineum, sphincter apparatus with mandatory electromyoidentification of the sphincter apparatus. Treatment of patients with perineal injury due to sexual abuse requires psychological and social rehabilitation. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Keywords: children, trauma, rectum, perineum, vagina, colon.

SURGICAL TREATMENT OF ACUTE ADHESIVE SMALL INTESTINE OBSTRUCTION

Abstract. The purpose of the study: to study and evaluate the results of surgical treatment of acute adhesive obstruction of the small intestine.&#x0D; Material and methods. Of the 49 patients with acute adhesive small intestine obstruction in the past, 83,7 % underwent 1 operation, 14,3 % — 2.&#x0D; Results and discussion. After laparotomy, 75,5 % of patients crossed adhesions, 4,1 % had small bowel + bicuspid end ileostomy, 18,4 % had small bowel resection, 2 % had ileotransversoanastomosis, and 18,4 % had simultaneous surgery. Intubation of the small intestine according to the indications.&#x0D; Iatrogenic injuries occurred in 12,2 % of patients, postoperative complications - in 18,4 %. 3 (6,1 %) patients died: sepsis (1), multiple organ failure (1), COVID-19 associated pneumonia (1).&#x0D; Conclusions. Acute adhesive obstruction of the small intestine is 3,8 % of all acute surgical diseases of the abdominal cavity. The scope of the operation depended on the viability of the small intestine, the possibility of separation of the conglomerate or infiltrate, the choice of method of incubation of the intestine, the presence of simultaneous pathology. This surgical tactic led to 18,4 % of postoperative complications, 4,1 % — relaparotomies, 6,1 % — mortality.

ADHESIVE OBSTRUCTION OF THE SMALL INTESTINE: FEATURES OF DIAGNOSIS AND TREATMENT IN THE CONTEXT OF MINIMALLY INVASIVE TECHNOLOGIES: review

The review presents a modern view on the features of the course and treatment of adhesions of the small intestine, based on modern epidemiological data, accepted guidelines for the diagnosis and nature of the treatment of different categories of patients. It is noted that adhesive intestinal obstruction is a symptom complex due to violation of the movement of contents through the intestines due to the presence of adhesions in the abdominal cavity after operations and injuries. Attention is drawn to the peculiarities of diagnostics of various forms of the disease, which include the leading clinical symptoms, data of X-ray methods (X-ray and CT of the abdominal cavity), MRI, assessment of various biomarkers, indicators of the severity of the patient's condition. It is noted that at present the primary task in solving this problem is to study several controversial issues in this area. The main provisions of measures for the treatment of adhesive obstruction of the small intestine, based on the principles of non-surgical treatment in a certain category of patients, the use of surgical interventions strictly according to indications, especially in patients who need to perform repeated operations, were highlighted. Among them, special attention is paid to the features of open and minimally invasive surgical interventions. It is emphasized that at present, minimally invasive surgical interventions perform the main tasks of surgical treatment for adhesive ileus of the small intestine and significantly reduce surgical trauma in comparison with "open" methods of treatment, but these interventions have not widespread in the world yet.

Adhesive small bowel obstruction in octogenarians: A 6-year retrospective single-center analysis of clinical management and outcomes

BackgroundFew evidences are available on adhesive bowel obstruction (ASBO)management and outcomes in geriatric patients. MethodsOne-hundred-twenty-eight patients aged 65–79 years were retrospectively compared to 77 patients aged ≥80 years. Aim of this study was to compare ASBO management and in-hospital course between patients aged 65–79 years and those over 80 years. ResultsUpfront surgery in octogenarians related with a higher rate of major complications (23.7%vs4.9%; p = 0.009) and longer hospitalization (8.8vs7.3 days; p = 0.01). No difference according to age was noted in terms of clinical outcomes when the non-operative management (NOM) was employed. Patients aged ≥80 years managed conservatively presented shorter hospitalization (7.3vs8.8 days; p = 0.04), lower rate of intensive care unit (ICU)admission (0vs18.4%; p = 0.005) and cumulative major complications (2.6%vs23.7%; p = 0.007) as compared to ≥80 years old patients treated with upfront surgery. In this same group, NOM failure did not lead to worse outcomes in comparison to upfront surgery. ConclusionsNOM in≥80 years patients is associated with better in-hospital course. The acceptable clinical outcomes in case of NOM failure further support NOM as first treatment strategy to employ in this same subset of patients.

Surgical Treatment of Wilkie's Syndrome by Vascular Transposition.

IntroductionSuperior mesenteric artery syndrome (SMAS), also called mesenteric duodenal compression syndrome, Wilkieʼs syndrome, chronic duodenal ileus or cast syndrome, is a rare clinical condition defined as a compression of the third portion of the duodenum in between the SMA and abdominal aorta (AA), due to narrowing of the space between them. SMAS is primarily attributed to loss of the intervening mesenteric fat pad, leading to partial or complete duodenal obstruction. Its manifestations are complex and non-specific, including postprandial epigastric pain, nausea, vomiting, early satiety, weight loss and anorexia. SMAS may present as an acute syndrome, or it may have an insidious onset with chronic symptoms. SMAS mainly affects females between 10 and 40 years of age. This study aims to discuss the safety and efficacy of vascular decompression of the duodenum by infrarenal transposition of SMA.MethodsThis single-centre prospective clinical study analysed 37 patients with Wilkie’s syndrome who underwent infrarenal transposition of the SMA between January 2012 and December 2021. The indications for the surgery were severe weight loss, uncontrolled upper abdominal pain, vomiting and other gastrointestinal (GI) symptoms that were severely debilitating to patients’ daily lives, along with radiological findings such as aortomesenteric angle < 25°, aortomesenteric distance <8 mm and distention of proximal part of the duodenum and the stomach. Ten patients (27%) concurrently had Nutcracker syndrome and seven patients (18.9%) had Dunbar syndrome (median arcuate ligament syndrome). Three female patients (8.1%) had all three above-mentioned vascular compression syndromes, which were treated in the same surgery. One male patient (2.7%) was after a laparoscopic duodenojejunostomy with symptoms that relapsed three months postoperatively, which was cured after the infrarenal transposition of SMA.ResultsTechnical operative and clinical success were achieved in all patients. There were no cases of anastomotic failure, SMA thrombosis or intestinal ischemia. All of the patients are currently living symptom-free. One patient (2.7%), four days postoperatively, had a lymphocele formed in the retroperitoneum, which was successfully drained by a CT-guided percutaneous pigtail catheter. Another patient (2.7%) after three months of surgery needed a re-laparotomy for adhesive obstruction of the second part of the duodenum and was treated by adhesiolysis and omentoplasty. One patient (2.7%), 2-year postoperatively, had a proximal SMA stenosis up to 60% where drug-eluting balloon percutaneous transluminal angioplasty (DEB PTA) was performed successfully. Finally, the upper GI symptoms were resolved in all 37 patients (100%).ConclusionWilkie’s syndrome, although rare, is frequently late-diagnosed or underdiagnosed. In cases of failure of conservative therapy, infrarenal transposition of the SMA can be considered a safe and feasible surgical option with more physiologically favourable outcomes comparable to gastrointestinal bypasses, especially in patients concurrently suffering from Nutcracker syndrome. Simultaneously, it also restores physiologic duodenal passage of gastroduodenal content without the need of creating a digestive tract anastomosis. To our best knowledge, we have the highest number of SMA transposition surgeries performed in a single centre for the treatment of Wilkie’s syndrome.

PATTERN, MANAGEMENT AND OUTCOME OF ACUTE INTESTINAL OBSTRUCTION AT CHITWAN MEDICAL COLLEGE TEACHING HOSPITAL

Background: Acute intestinal obstruction is one of the commonly encountered emergencies in surgical practice. Gynecological surgery, especially adnexal surgery and hysterectomy has a higher incidence of bowel obstruction as compared to bowel surgery. Conservative management can be done in patients with post-operative adhesive bowel obstruction if there is no evidence of ischemia, bowel necrosis, or perforation. Therefore, a correct diagnosis is essential for appropriate management. We conducted a study to evaluate the etiology, clinical presentation as well as management and outcome of patients presenting with Acute intestinal obstruction at our center. Methods: This was a retrospective study of all the patients with a diagnosis of Acute intestinal obstruction from January 2015 to December 2019. The diagnosis of Acute intestinal obstruction was made by a combination of clinical and radiological parameters. The data were analyzed using Statistical Package for Social Sciences (SPSS) for Windows version 16. The data were expressed in number and percentage. Results: During the study period, 178 patients were admitted with the diagnosis of Acute intestinal obstruction. Abdominal pain and vomiting were the main complaints seen in 98.3% (n=175) and 84.8% (n=151) respectively. Hernia (n=49, 27.5%) was the most common cause of acute intestinal obstruction in adults, and Intussusception (n=15, 8.4%) was the leading cause of Acute intestinal obstruction in a pediatric age group. Majority of the patients’ needs (n=148,83.1%) operative intervention to relieve the obstruction. The overall mortality rate was 6.7% (n=12). Conclusions: Hernia was the most common cause of Acute intestinal obstruction in adults while intussusception was the commonest in the pediatric age group.

Laparoscopic-assisted Soave procedure for Hirschsprung disease: 10-year experience with 106 cases

BackgroundThe purpose of this study was to summarize the clinical experience and 10 year follow-up results of laparoscopic assisted Soave procedure for the treatment of long-segment Hirschsprung disease (HD).MethodsFrom January 2010 to February 2020, 106 children with long-segment HD participated in this study. The laparoscopic-assisted Soave procedure was performed for the treatment of long-segment HD. The follow-up time was two weeks, one month, and three months after the operation, and then every six months to one year.ResultsThe operation was successful for all 106 children. All patients were discharged 5–7 days after the operation. The median time in surgery was 150 (100–190) minutes, and the median volume of bleeding was 6 (3–10) ml. The short-term postoperative daily defecation frequency was 4–11 times, 3–7 times within 6 months, and 2–3 times after 6–12 months. Postoperative complications included anastomotic leakage in two cases, perianal dermatitis in 13 cases, anastomotic stenosis in four cases, adhesive bowel obstruction in two cases, enterocolitis in 16 cases, soiling in 11 cases, and constipation recurrence in three cases.ConclusionsThe laparoscopic-assisted Soave procedure is a safe and effective surgical method for treating long-segment HD, and it causes little trauma or bleeding and has a fast postoperative recovery. Yet some complications may occur. Preoperative diagnosis, intraoperative and postoperative standardized processing can reduce the postoperative complications.

Enhanced-view totally extraperitoneal repair in a patient with incisional hernia after robot-assisted laparoscopic radical prostatectomy: a case report

BackgroundAlthough laparoscopic incisional hernia repair, especially laparoscopic intraperitoneal onlay mesh, is a widely used technique, it can cause serious complications, including mesh erosion, adhesive bowel obstruction, and chronic pain. The enhanced-view totally extraperitoneal (eTEP) technique has been reported to prevent such complications by placing the mesh in the retrorectus space. Here, we report the case of a patient with post-robot-assisted laparoscopic radical prostatectomy (RARP) incisional hernia repaired using the eTEP technique.Case presentationA 67-year-old man, who underwent RARP for prostate cancer 4 years ago developed an incisional hernia. Abdominal computed tomography showed the presence of an epigastric incisional hernia measuring 4 cm long and 3.7 cm wide. We performed an eTEP repair. We closed the hernia defect using a 0 barbed suture and placed a self-gripping mesh measuring 20 cm long and 15 cm wide in the developed retrorectus space with no fixation. There were no postoperative complications, and the patient was discharged on postoperative day 2.ConclusionseTEP repair is considered an extremely effective surgical treatment option for incisional hernias because of its few resulting postoperative mesh-and-tacker-related complications.

АНАЛИЗ ЛЕТАЛЬНОСТИ ПРИ СПАЕЧНОЙ БОЛЕЗНИ ОРГАНОВ БРЮШНОЙ ПОЛОСТИ

Adhesive disease of the abdominal cavity is currently an important medical and social problem, characterized by frequent relapses, decreased ability to work and the quality of life. The aim of the study was to analyze the patterns of development of adhesive disease of the abdominal organs on the basis of autopsy protocols. As a result of the study, it was proved that the likelihood of an unfavorable outcome is significantly influenced by the age and time of seeking medical care from the moment of the onset of the disease. While the older the patient, the later he seeks medical help and the longer he is in hospital; surgical treatment of adhesive intestinal obstruction in comparison with planned adhesiolysis is associated with an increase in the likelihood of complications, in particular: early adhesive obstruction by 88.9%, perforation of the hollow organ by 73.9%, peritonitis by 72.7%, which proves the presence of a syndrome of mutual burden, progression of multiple organ failure and the need for an integrated approach to patient treatment. In the pathological diagnosis of the abdominal adhesions, 29% of the deceased were noted, while 71% of the surgical procedures mentioned it, which indicates the prevalence of this disease.

Right Paraduodenal Hernia Causing Small Bowel Obstruction in an Adult with Down Syndrome: A Rare Case Report

Out of all internal hernias, Paraduodenal Hernia (PDH) is the variety but in PDH right sided one is not that common. In down syndrome, morgagni hernias are often seen as compared to right PDHs. This is a known case of down syndrome presented with chief complaints of abdominal pain, nausea, vomiting and abdominal distension since 2 days. Patient was surgically managed for the right PDH and later re-explored for adhesive intestinal obstruction on postoperative day 12 and later presented with small bowel obstruction symptoms due to adhesions and hence, relaprotomy for postoperative adhesive obstruction was performed. Right PDH is a rare entity encountered in down syndrome which makes it even rare.

Duodenal and Pyloric Web in Children: Clinical Presentation and Management.

Background:Duodenal and pyloric web (DW/PW) can present at any age, symptoms depend upon the location of the web along with the presence and size of the opening in the web. The surgical management is not straightforward always. Here, in this study, we aim to assess clinical characteristics, management, and outcome of children with DW/PW.Materials and Methodology:This was a retrospective study from 2005 to 2019, and data were collected from record registers. All children of DW/PW presented between this duration were included in this study.Results:A total of 45 patients (age range = 1 day to 11 years) included in the study, 40 had DW while 5 had PW. Seven patients were diagnosed antenatally and 20 patients had associated congenital anomalies. Most patients presented with vomiting either bilious or nonbilious. Plain X-ray was sufficient for the diagnosis in 60% of patients, the rest diagnosed on contrast study. The web excision and pyloroplasty were done for PW. The web excision and Heineke-Mikulicz type enteroplasty was the preferred surgery for DW but some patients were required Kimura's duodeno-duodenostomy. For postoperative nutrition, enteral feeding was established through the placement of a feeding tube beyond anastomosis. Ten patients died due to septicemia and associated anomalies. Four patients had a minor leak which was managed by conservative means. Four patients required redo surgery, adhesive obstruction was the most common indication. During follow-up, all 35 patients were doing well with no major complaints.Conclusion:DW/PW has different presentations as compared to other intestinal atresia and can present at any age. A contrast study confirms the diagnosis when plain X-ray is inconclusive. Associated anomalies and septicemia are the poor prognostic indicators. Postoperative enteral feeding helps in maintaining adequate nutrition and improves the outcome even in children with a minor anastomotic leak.