Case Of Intestinal Obstruction Research Articles

Su1319 Intestinal Adverse Outcomes With Pancreatic Enzymes: An Analysis of the Food and Drug Administration Adverse Event Reporting System

Background: There are over 30,000 patients with cystic fibrosis and about 80,000 diagnosed each year with pancreatitis in the United States. Pancreatic enzyme products (PEPs) containing the active ingredient pancrelipase, a mixture of the digestive enzymes amylase, lipase, and protease are frequently prescribed to both groups. Case reports of fibrosing colonopathy with pancreatic enzyme supplements have been reported in children with cystic fibrosis and rarely in adults. We sought to identify adverse events affecting small and large intestines with the use of pancreatic enzyme supplements reported to a pharmacovigilance database using the Food and Drug Administration Adverse Event Reporting System (FAERS). Methods: More than 3.1 million files between January 2003 and June 2012 were downloaded from the FAERS and analyzed using SPSS 20 (IBM Co. Armonk, NY). They were queried for Primary Suspect (PS) reports of adverse events with PEPs, using both trade and generic names. All approved indications were used, and the Medical Dictionary for Regulatory Activities (version 15.1 September 2012) was used to identify all primary and lower-level search terms. All reactions, after querying for indication and drug, were then hand searched for intestinal adverse events. Results: There were 114 PS cases (table 1) of small and large intestinal adverse events identified with PEPs. A total of 38 cases were associated with cystic fibrosis, 27 with pancreatitis, and 49 associated with unspecified pancreatic indications (pancreatic insufficiency, neoplasm of the pancreas, pancreatic operations, pancreatic disorders not otherwise specified). A majority of intestinal adverse events were found in females (52.2%). Average age of cases by indication of usage was 16±14 years for those with cystic fibrosis, 64±18 years for those with pancreatitis and 52±28 years for those with unspecified pancreatic indications. Diarrhea was the most common adverse reaction. We identified 17 cases of small or large intestinal obstruction. Three of the 17 obstruction cases had a concomitant medication which may have led to the obstruction (1 on meloxicam and 1 on loperamide leading to an intestinal obstruction, and 1 on oxycodone leading to a colonic obstruction). This results in an intestinal obstruction rate of 1.47 cases per year and a colonic obstruction rate of 0.32 cases a year, within the context of cases reported to the FDA. Conclusion: Diarrhea is most likely related to the underlying disease state. Serious complications such as small and large intestinal obstructions are rarely reported with PEPs in context of the large number of patients who are prescribed these drugs. More research is warranted to identify the at-risk patient population for serious intestinal adverse events associated with PEPs. Table 1: Small and large intestinal adverse reactions associated with pancrelipase tablets and delayed release capsules

Metastatic Small Bowel Tumours Causing Intestinal Obstruction: A Report of Two Cases

Small bowel metastases arising from hematogenous seeding of primary tumours are rare. We report on two cases of subacute intestinal obstruction arising from lung and skin adnexal metastases, and review the literature on diagnostic and treatment modalities for these lesions.

A case of intestinal obstruction due to ileocecal tuberculosis

A case of intestinal obstruction due to ileocecal tuberculosis

A rare case of intestinal obstruction as a result of phytobezoar

Intestinal obstruction (ileus) due to bezoar is a rare condition. Its combined prevalence among all cases of intestinal obstruction varies from 0.5 to 1%. An observed case is reported. A patient was admitted at the emergency ward with abdominal pain,nausea, bloating, and constipation. At examination - bloating, abdominal distention, moderate abdominal muscular defense at palpation, paraumbilical tenderness. Colon cleansing was started with a good effect. Gastrointestinal fluoroscopy: at 4 and 8 hours after introduction of barium contrast it is located in the dilated loops of small bowel with persisting air fluid levels. The diagnosis of unresolved intestinal obstruction was set up. The midline laparotomy, small bowel decompression by Abbott-Miller, peritoneal drainage with two tubes were performed. Final diagnosis: «Intestinal obstruction (phytobezoar), non-infected peritonitis».

Laparoscopic management of intestinal obstruction and perforation of Meckel's diverticulum by a button battery

We describe a case of intestinal obstruction and peritonitis secondary to an ingested button battery impacted and eroded in a Meckel's diverticulum. The patient had an uneventful recovery following a laparoscopic assisted retrieval of the button battery and Meckel's diverticulectomy with primary small bowel anastomosis. Impaction of a button battery in Meckel's diverticulum with small bowel obstruction and perforation of the diverticulum, is rare but potentially life threatening. Laparoscopy is very useful, safe and effective diagnostic and therapeutic tool.

Obstrucción intestinal por oblito quirúrgico.

The abdominal oblito that can be formed in an involuntary way after making an invasive procedure abdominal constitutes a serious problem that is not very analyzed in the medical literature. The purpose in the presentation of this case of intestinal obstruction by oblito is to aid the support of the concept that all has not still been said about the ways of presentation of the abdominal oblito. Also to insist in the importance of the prevention and the inform of the personnel of the surgical room. The daily chore confirms that this topic is a taboo issue and that it generates dilemmas in diverse planes which magnitude is as enough as to be discussed.

Jejunal mesenteric cyst presenting as a case of intestinal obstruction in a newborn

Jejunal mesenteric cyst presenting as a case of intestinal obstruction in a newborn

Meckel憩室が原因であった腸閉塞に対して腹腔鏡下手術が有用であった１例

症例は30歳代男性．腸閉塞の診断で入院となった．腸閉塞で３回の入院歴があるが，開腹歴はない．long tubeを留置し，保存的加療で改善した．繰り返す腸閉塞の原因精査のために，小腸内視鏡検査を施行した．回腸に狭窄部位を認めたが，粘膜面には異常はなく，内視鏡の通過は可能であった．狭窄の原因が不明であったため，診断と治療の目的で，腹腔鏡下手術を施行した．回腸末端から約150cmの小腸にMeckel憩室が存在し，後腹膜と腸間膜に癒着していたことから，Meckel憩室の炎症性癒着による腸閉塞と診断した．Meckel憩室を含めた小腸部分切除術を小開腹下に施行した．術後経過は良好であり，その後腸閉塞の再発は認めていない．繰り返す腸閉塞症例ではMeckel憩室も鑑別におくべきであり，本疾患に対して，腹腔鏡下手術は有用である．

A Case of Ileus Caused by Accidental Ingestion of a Foreign Body Which Showed the Target Sign Indicating Invagination

A Case of Ileus Caused by Accidental Ingestion of a Foreign Body Which Showed the Target Sign Indicating Invagination

腹腔鏡下調節性胃バンディング術後に胃バンドが迷入し腸閉塞を発症した1例

33歳，女性，韓国人．母国で病的肥満に対し約1年前に腹腔鏡下調節性胃バンディング術（laparoscopic adjustable gastric banding，LAGB）を実施．術後半年で腹腔鏡下胃バンド（gastric band，GB）摘出術を実施するも，GBが胃内腔へ迷入していたために摘出できず経過観察となっていた．腹痛で当院救急外来受診し，緊急造影CT検査で小腸拡張と腸管内異物を認めた．異物嵌頓による腸閉塞と診断し緊急開腹手術となった．異物摘出後，経過良好で術後4日目に退院．LAGBは手術手技の簡便性と短期的な手術合併症が少ないとされているが，長期的な手術合併症が報告されるようになっている．今回，われわれはGBが腸管内へ迷入するband migration後，腸閉塞を発症した症例を経験した．われわれが調べた限り，本邦報告例はなく本症例が初めての報告である．

Obturator hernia: a rare case of acute mechanical intestinal obstruction.

Obturator hernia is a rare type of pelvic hernia which generally occurs in elderly patients with accompanying diseases. Because it is difficult to diagnose before surgery, the morbidity and mortality rates for obturator hernia are high. The most common symptom is strangulation combined with mechanical intestinal obstruction.

Ileo-ileal Intussusception in an Adult Caused by Vanek’s Tumour: A Rare Case Report

Adult intussusception is relatively rare in patients with bowel obstructions. Adult invagination is mostly caused by benign tumours. Intussusceptions caused by inflammatory fibroid polyps (IFPs) are uncommon. IFPs are rare, localized, non-neoplastic lesions originating in the submucosa of the gastrointestinal tract. We are reporting a rare case of intestinal obstruction caused by an ileo-ileal intussusception, caused by an IFP, a rare but peculiar and always benign tumour.

結節形成による腸閉塞を生じたMeckel憩室の1例

結節形成による腸閉塞を生じたMeckel憩室の1例

腸閉塞を合併した毛髪胃石の1例

症例は22歳，女性．自閉症で精神科通院中．平成22年6月中旬，腹痛にて当院の救急外来受診．腹部CTおよび上部消化管内視鏡にて毛髪塊を認めた．内視鏡的摘出を試みたが困難なため，後日，外科紹介予定とし，外来フォローとなった．その4日後，腹部膨満，発熱で救急外来を再診．腹部CTで小腸拡張の増悪を認め，イレウスの診断にて緊急開腹術となった．小腸内および胃内にある，合計800gの毛髪塊を摘出し，暗褐色で動きの悪い小腸は部分切除を行った．毛髪胃石と腸閉塞が同時に存在した症例は1984年～2012年までで自験例を含め22例が報告されている．全例が女性で，10代以下の若年者がほとんどであった．多量の毛髪胃石の自然排出は期待できず，内視鏡的に摘出が困難な場合は，早急に外科的摘出を考慮すべきと考えられた．また毛髪胃石の多くが精神的要因に起因し，海外では再発例もあり，精神科の継続的なフォローが必要である．

Rectal endometriosis –rare case of intestinal obstruction. Case report

The study presented a case of a 32-year old female patient admitted to the department of surgery with symptoms of abdominal pain and retention of gas and stool. The abdominal X-ray examination showed signs of intestinal obstruction. Abdominal CT suggested the possibility of a cancerous lesion located in the colon. The patient was qualified for surgical intervention. An anterior rectal resection was performed. The histopathological examination revealed the presence of colorectal endometriosis. After two months the patient was subject to gastrointestinal continuity restoration. Endometriosis is a rare cause of intestinal obstruction, considering patients hospitalized in the department of general surgery.

Intestinal obstruction during pregnancy

This is a review of literature concerning intestinal obstruction in pregnant women. Approximately 50-90% and 30% of pregnant women, respectively suffer from nausea and vomiting, mostly during the first trimester. There is also increased risk of constipation. During the perioperative period, the administration of tocolytics should be considered only in women showing symptoms of a threatening premature delivery. Intensive hydration should be ordered to sustain uterine blood flow. The incidence of intestinal obstruction during pregnancy is estimated at 1:1500-1:66431 pregnancies and is diagnosed in II and III trimester in most cases. However, it can also occur in the I trimester (6%) or puerperium. Symptoms of intestinal obstruction in pregnancy include: abdominal pains (98%), vomiting (82%), constipation (30%). Abdominal tenderness on palpation is found in 71% and abnormal peristalsis in 55% of cases. The most common imaging examination in the diagnosis of intestinal obstruction is the abdominal X-ray. However ionizing radiation may have a harmful effect on the fetus, especially during the first trimester. X-ray is positive for intestinal obstruction in 82% of pregnant women. Ultrasonography and magnetic resonance imaging are considered safe and applicable during pregnancy. Intestinal obstruction in pregnant women is mostly caused by: adhesions (54.6%), intestinal torsion (25%), colorectal carcinoma (3.7%), hernia (1.4%), appendicitis (0.5%) and others (10%). Adhesive obstruction occurs more frequently in advanced pregnancy (6% - I trimester 28% - II trimester; 45% - III trimester 21% - puerperium). Treatment should begin with conservative procedures. Surgical treatment may be necessary in cases where the pain turns from recurrent into continuous, with tachycardia, pyrexia and a positive Blumberg sign. If symptoms of fetal anoxia are observed, a C-section should be carried out before surgical intervention. The extent of surgical intervention depends on the intraoperative evaluation. Intestinal torsion during pregnancy mostly occurs in the sigmoid colon and cecum. Small bowel torsion secondary to adhesions is diagnosed in 42% of pregnant women with intestinal obstruction. The risk of intestinal torsion is higher in the 16-20 and 32-36 weeks of pregnancy and during puerperium. Intestinal torsion results in vessel occlusion which induces more severe symptoms and makes urgent surgical intervention necessary. The overall prognosis is poor--during II and III trimester the fetal mortality rate reaches 36% and 64%, respectively while the risk of maternal death is 6%. Acute intestinal pseudoobstruction can be diagnosed during puerperium, especially following a C-section. Diagnosis is made on the basis of radiological confirmation of colon distension at the cecum as > 9cm, lack of air in the sigmoid colon and rectum, exclusion of mechanical obstruction. In most cases, the treatment is based on easing intestine gas evacuation and administering neostigmine. The authors point out the need for multi-specialty cooperation in the diagnostic-therapeutic process of pregnant women suspected with intestinal obstruction, since any delay in making a correct diagnosis increases the risk of severe complications, both for the woman and the fetus.

S状結腸腹膜垂による腸閉塞の1例

S状結腸腹膜垂による腸閉塞の1例

A Case of Ileus due to Ileal Stenosis caused by Oral Intake of Calcium Polystyrene Sulfonate

症例は75歳，男性．慢性腎不全，高カリウム血症で6年前よりポリスチレンスルホン酸カルシウム（calcium polystyrene sulfonate：CPS）を内服していた．腹痛・嘔吐で近医を受診し，イレウスの診断で紹介された．回腸に5cm長の狭窄と口側の腸管拡張を認め，減圧の後に回腸部分切除術を施行した．切除標本で狭窄部に腫瘍や癒着はなく，炎症細胞浸潤，線維化，肉芽，粘膜下層にCPSと考えられる好塩基性異物と異物型巨細胞を認め，CPSの腸管への沈着により狭窄・イレウスを来した稀な一例と考えられた．

Postoperative intestinal obstruction caused by Meckel’s diverticulitis after appendectomy

Surgical treatment of the complications associated with Meckel’s diverticulum is widely accepted, but surgical management of an asymptomatic diverticulum found incidentally during laparotomy for other reasons is controversial. Appendectomy is the most common reason for laparotomy in many pediatric surgery clinics. The most common causes of an intestinal obstruction in the early period after appendectomy are an intra-abdominal abscess, adhesive small bowel obstruction and invagination. Obstruction due to Meckel’s diverticulum is reported rarely. In this study, we present 2 cases, five and eleven years old, with an asymptomatic Meckel’s diverticulum where appendectomy was performed due to acute and perforated appendicitis and obstruction developed due to Meckel’s diverticulitis in the postoperative early stage. Meckel’s diverticulitis must be considered in intestinal obstruction cases developing in the early stages after appendectomy although quite rare.

A rare presentation of midgut malrotation as an acute intestinal obstruction in an adult: Two case reports and literature review

INTRODUCTIONMidgut malrotation is a congenital anomaly presenting mainly in the childhood. Its presentation as an acute intestinal obstruction is extremely rare in adults usually recognized intra-operatively, therefore a high index of suspicion is always required when dealing with any case of acute intestinal obstruction. PRESENTATION OF CASEWe report two cases of young adults who presented with symptoms of acute intestinal obstruction and were diagnosed intra-operatively as cecal volvulus and paraduodenal hernia, respectively, caused by midgut malrotation. Post-operative CT scan confirmed these findings. DISCUSSIONMalrotation of the intestinal tract is a product of an aberrant embryology. The presentation of intestinal malrotation in adults is rare (0.2–0.5%). Contrast enhanced CT can show the abnormal anatomic location of a right sided small bowel, a left-sided colon and an abnormal relationship of the superior mesenteric vein (SMV) situated to the left of the superior mesenteric artery (SMA) instead of to the right. CONCLUSIONAnomalies like midgut malrotation can present as an operative surprise and awareness regarding these anomalies can help surgeons deal with these conditions.