Case Of Small Bowel Obstruction Research Articles

Non-operative management of small bowel obstruction in virgin abdomen: a systematic review.

The aim of this study was to systematically review the feasibility and safety of non-operative management of small bowel obstruction (SBO) in virgin abdomen. A systematic review was performed through December 2019. The primary outcome was the resolution of non-operative management of SBO in virgin abdomen. Secondary outcomes were the etiology of SBO and findings of exploratory laparotomy. Six studies were included in the analysis. Of the 442 patients, 2 with metastatic cancer received palliative care, and the management in 26 was not reported, so these patients were excluded. A total of 414 patients were ultimately analyzed, including 203 patients (49%) who were managed non-operatively and 211 (51%) who underwent surgical management. Of the 203 managed non-operatively, the condition of 194 (96%) was resolved without further intervention. The remaining 9 (5%) patients failed non-operative management and ultimately required surgery. Of the 211 patients who underwent surgical exploration, only 137 had their intraoperative findings reported. Adhesions (n = 67; 49%) were the main cause, followed by malignancy (n = 14; 10%) and others (n = 33; 24%). No cause was found in 23 patients (17%). In highly select cases of SBO with virgin abdomen, non-operative management can be attempted if patients are clinically stable and computed tomography does not demonstrate concerning features or obvious pathology. Further well-designed prospective studies will be required prior to the introduction of this concept in clinical practice, as current evidence remains heterogeneous.

Foodborne botulism presenting as small bowel obstruction: a case report

BackgroundSmall bowel obstruction is one of the leading reasons for accessing to the Emergency Department. Food poisoning from Clostridium botulinum has emerged as a very rare potential cause of small bowel obstruction. The relevance of this case report regards the subtle onset of pathognomonic neurological symptoms, which can delay diagnosis and subsequent life-saving treatment.Case presentationA 24-year-old man came to our Emergency Department complaining of abdominal pain, fever and sporadic self-limiting episodes of diplopia, starting 4 days earlier. Clinical presentation and radiological imaging suggested a case of small bowel obstruction. Non-operative management was adopted, which was followed by worsening of neurological signs. On specifically questioning the patient, we discovered that his parents had experienced similar, but milder symptoms. The patient also recalled eating home-made preserves some days earlier. A clinical diagnosis of foodborne botulism was established and antitoxin was promptly administered with rapid clinical resolution.ConclusionsThough very rare, botulism can mimic small bowel obstruction, and could be associated with a rapid clinical deterioration if misdiagnosed. An accurate family history, frequent clinical reassessments and involvement of different specialists can guide to identify this unexpected diagnosis.

Intracorporeal Esophagojejunostomy during Reduced-port Totally Robotic Gastrectomy for Proximal Gastric Cancer: a Novel Application of the Single-Site® Plus 2-port System

PurposeIntracorporeal esophagojejunostomy during reduced-port gastrectomy for proximal gastric cancer is a technically challenging technique. No study has yet reported a robotic technique for anastomosis. Therefore, to address this gap, we describe our reduced-port technique and the short-term outcomes of intracorporeal esophagojejunostomy.Materials and MethodsWe conducted a retrospective review of patients who underwent a totally robotic reduced-port total or proximal gastrectomy between August 2016 and March 2020. We used an infra-umbilical Single-Site® port with two additional ports on both sides of the abdomen. To transect the esophagus, a 45-mm endolinear stapler was inserted via the right abdominal port. The common channel of the esophagojejunostomy was created between the apertures in the esophagus and proximal jejunum using a 45-mm linear stapler. The entry hole was closed with a 45-mm linear stapler or robot-sewn continuous suture. All anastomoses were performed without the aid of an assistant or placement of stay sutures.ResultsAmong the 40 patients, there were no conversions to open, laparoscopic, or conventional 5-port robotic surgery. The median operation time and blood loss were 254 min and 50 mL, respectively. The median number of retrieved lymph nodes was 40.5. The median time to first flatus, soft diet intake, and length of hospital stay were 3, 5, and 7 days, respectively. Three (7.5%) major complications, including two anastomosis-related complications and a case of small bowel obstruction, were treated with an endoscopic procedure and re-operation, respectively. No mortality occurred during the study period.ConclusionsIntracorporeal esophagojejunostomy during reduced-port gastrectomy can be safely performed and is feasible with acceptable surgical outcomes.

A Case of Small Bowel Obstruction Caused by a Vegetable

A Case of Small Bowel Obstruction Caused by a Vegetable

A case of small bowel obstruction occurring secondarily after uterine compression suture for intractable uterine bleeding during cesarean section due to adherent placenta

A case of small bowel obstruction occurring secondarily after uterine compression suture for intractable uterine bleeding during cesarean section due to adherent placenta

A Case of Small Bowel Obstruction due to Peritoneal Suture Dehiscence after Laparoscopic Hernia Repair

A Case of Small Bowel Obstruction due to Peritoneal Suture Dehiscence after Laparoscopic Hernia Repair

Small Bowel Obstruction Induced by Phytobezoar: A Case Report in Innocent Abdomen and Literature Review

Introduction: Small bowel obstruction (SBO) is defined as a complete and persistent cessation of the transit of materials and gases. It occurs in a segment of the digestive tract located between the pylorus and the colorectal junction. Herein, we report a case of small bowel obstruction (SBO) following excessive consumption of wild grapes with no previous abdomen medical or surgical history. Presentation of case: A 65-year-old male farmer presented with cessation of materials and gas associated with vomiting of food and then bilious. The abdomen was bloated and painful on palpation with a moving, painful mass in the left iliac fossa. The hypothesis of acute occlusion of the colon was retained and confirmed on the X-Ray which showed a dilation of small bowel with air-fluid levels. The diagnostic of acute SBO was retained. We performed urgently a median laparotomy. We found the dilation of the loops from the jejunum to the sigmoid colon with a compact mass at the sigmoid colon of 15 cm in length and 6 cm in diameter. We proceeded to crush the mass that was made up with wild grape seed fecal, and push it back to the rectum. The phytobezoar made up with wild grape seeds was extracted through the anus with the fingers after anal dilation. After extraction of the bezoar, the patient’s complaints completely subsided. Discussion: SBO is a frequent emergency surgical pathology. SBO induced by phytobezoar often occurs in patients with abdomen surgery history. However, it is particularly rare in virgin abdomen. Conclusion: This case report aims to raise awareness of phytobezoar as a cause of SBO in elderly even though without abdomen surgery history.

Small bowel obstruction of barium for gastric cancer screening.

We report a case of small bowel obstruction without perforation and peritonitis caused by inspissated barium sulfate for gastric cancer screening and surgically treated 26hours after the onset of abdominal pain.

An Unusual Case of Small Bowel Obstruction

An Unusual Case of Small Bowel Obstruction

S2803 Bizarre Bariatric Complication With Small Bowel Obstruction in a COVID-19 Patient With Acute Abdomen

INTRODUCTION: Gastrointestinal emergencies in the novel coronavirus pandemic present as acute abdomen in 4-5% of patients as gathered from emerging studies. Nausea, abdominal pain, diarrhea, rectal bleeding, dysgeusia, anorexia and jaundice have been recorded in these patients. Additionally there are cases with hemorrhagic gastritis, ischemia of bowel, and hepatitis often due to systemic immune complex phenomenon and thrombosis. We report a rare case of small bowel obstruction in a Covid-19 patient with a dislodged and migrated EG junction stent, initially placed to circumvent a leak at a prior gastrojejunal (GJ) bypass surgical revision, and then presenting to the emergency room with acute abdomen. CASE DESCRIPTION/METHODS: A 54 year old woman underwent a routine laparoscopic GJ revision in 2/2020 after which she developed a GJ leak 2 weeks later warranting an esophageal stent placement . She was then discharged home, at the height of the Covid-19 outbreak in a pandemic hotspot. She developed a small intra abdominal abscess post op 2 weeks warranting hospitalization for drainage and discharged on antibiotics. 2 months later, she presented with nausea, malaise, vomiting and diarrhea followed by worsening RLQ pain. An Abdominal CT w/ contrast revealed an impacted stent in the distal ileum with localized perforation and obstruction. After reporting generalized body aches and malaise at presentation, PCR testing revealed a positive Covid19 status. She underwent a successful emergency laparoscopic stent retrieval and repair, with no post op complications. DISCUSSION: Covid19 gastrointestinal emergencies are common, and varied with a favorable prognosis in respect to initial presentation. Our patient had subtle nausea, emesis and enteritis, as noted in 10–20% of patients with similar Covid presentation, which likely led to stent dislodgement and distal migration with subsequent bowel obstruction. Fortunately, her clinical course was mild so she was managed with optimal laparoscopic retrieval and supportive medical therapy after which she was successfully discharged from the hospital. Our case is unique in that an acute Covid19 case presenting concomitantly with post bariatric stent migration and bowel obstruction was successfully managed in a standard fashion during the height of a pandemic in a hotspot with stifling restrictions in place for routine emergencies. Though the exposure risk is high for medical staff, all such patients should be optimally managed like any Covid negative patients for optimal outcomes.Figure 1.: Migrated esophageal stent in the right lower quadrant.

Between a rock and a hard place: retained appendicolith causing a mechanical small bowel obstruction

Here we report an unusual case of small bowel obstruction, preluded by an unremarkable presentation of appendicitis. The small bowel obstruction subsequently diagnosed involved deposition of an appendicolith within the small bowel. Radiographic features of this incident are discussed along with its pathomechanics. Surgical management was carried out and is detailed along with advice for the management of retained appendicolith.

Gastrointestinal obstruction secondary to enteral nutrition bezoar: A case report.

BACKGROUNDPost-operative enteral nutrition via gastric or jejunal feeding tubes is a common and standard practice in managing the critically ill or post-surgical patient. It has its own set of complications, including obstruction, abscess formation, necrosis, and pancreatitis. We present here a case of small bowel obstruction caused by enteral nutrition bezoar. It is the second recorded incidence of this complication after pancreaticoduodenectomy in the medical literature.CASE SUMMARYThe 70-year-old female presented to our institution for a pancreaticoduodenectomy (Whipple’s procedure) for pancreatic adenocarcinoma. On day 5 post-operative, having failed to progress and developing symptoms of small bowel obstruction, she underwent a computed tomography scan, which showed features of mechanical small bowel obstruction. Following this, she underwent an emergency laparotomy and small bowel decompression. The recovery was long and protracted but, ultimately, she was discharged home. A literature search of reports from 1966-2020 was conducted in the MEDLINE database. We identified eight articles describing a total of 14 cases of small bowel obstruction secondary to enteral feed bezoar. Of those 14 cases, all but 4 occurred after upper gastrointestinal surgery; all but 1 case required further surgical intervention for deteriorating clinical picture. The postulated causes for this include pH changes, a reduction in pancreatic enzymes and gastric motility, and the use of opioid medication.CONCLUSIONEnteral feed bezoar is a complication of enteral feeding. Despite rare incidence, it can cause significant morbidity and potential mortality.

A rare case of superior ileocecal recess hernia

Internal hernias are a rare cause of small bowel obstruction, and one such internal hernia is superior ileocecal recess hernia, the subtype of pericycle hernia. The present study reports a case of small bowel obstruction due to superior ileocecal hernia for which laparotomy was performed. The surgery achieved a good outcome.

A Case of Small Bowel Obstruction During Labour: Diagnostic and Therapeutic Challenges in a Resource-limited Setting: A Case Report and Review of Management

Background: Small bowel obstruction (SBO) is defined as the partial or complete interruption of intestinal content progression in the oral to the aboral sense. It is the third leading cause of non-obstetrical surgical condition on pregnancy. It is a real emergency that requires early diagnosis and adequate management to reduce maternal and foetal morbidity and mortality, which remain high in developing countries. Case Presentation: This is the case of a 32-year-old black female refugee. She had a history of abdominal surgery indicated for splenic rupture during a road accident some 10years ago. She was admitted to the emergency unit for abdominal pain, vomiting and constipation persistent 4 hours after home delivery. On admission, the patient was hemodynamically unstable with abdominal distention. Abdominal ultrasonography revealed dilated loops. After intensive fluid resuscitation, the patient underwent an emergency laparotomy. Results: The findings were a small bowel adhesion obstruction. The postoperative evolution was good. Conclusion: Intestinal obstruction on pregnancy is usually diagnosed late. This delays its management and thus increases the rate of fetal and maternal mortality. The presentation of this case should appeal to clinicians in emergency rooms (ED) who receive pregnant women to think about nonobstetrical surgical conditions on pregnancies.

Computed Tomography Findings Predicting the Need for Surgery in Cases of Small Bowel Obstruction: Emphasis on Duodenal Distension.

The aim of the study is to retrospectively evaluate the utility of computed tomography (CT) findings, especially newly defined duodenal distension, for predicting the need to operate on small bowel obstruction (SBO) cases. During a 51-month period, 228 patients (100 women and 128 men; mean age, 55 years) were included in this study, among 438 patients who were hospitalized with a prediagnosis of SBO. The final study population was then divided into 2 groups: a surgery group (n = 76) and a conservative group (n = 152). The CT findings of the SBO patients whose treatment decisions and outcomes were unknown were examined by 2 gastrointestinal radiologists with consensus. Statistical analyses were conducted using univariate and binary logistic regression analyses. According to the univariate analysis, the degree of obstruction (P = 0.001), small bowel diameter (P = 0.014), and presence of mesenteric fluid (P < 0.001), intraperitoneal free fluid (P = 0.04), intra-abdominal free gas (P < 0.001), and duodenal distension (P < 0.001) showed statistically significant differences between the surgery and conservative groups. However, there were no statistically significant group differences regarding the presence of a transition point, small bowel feces or mesenteric congestion. According to the binary logistic regression analysis, the degree of obstruction (P = 0.012), presence of mesenteric fluid (P = 0.008), intra-abdominal free gas (P = 0.019), and duodenal distension (P < 0.001) were significant predictors of the need for surgery in SBO cases. Duodenal distension as a CT finding predicted the need for surgery in SBO cases.

A Rare Case of Large Impacted Stone in Jejunum Causing Obstruction in a Patient of Gallstone Ileus

Gallstone ileus is a rare complication of cholelithiasis that occurs as a result of occlusion of the intestinal lumen by a large sized gallstone accounting for 1-4% cases of small bowel obstruction. The aim of this work is to introduce a case report that emphasize the diagnostic and therapeutic management of gallstone ileus with an enterolith impacted in jejunum (an uncommon site).

Early Versus Routine Stoma Closure in Patients With Colorectal Resection: A Meta-Analysis of 7 Randomized Controlled Trials.

Background. A substantial proportion of patients undergoing colorectal surgery receive a temporary stoma, and the timing for stoma closure remains unclear. The aim of this study was to evaluate the safety and feasibility of early stoma closure (ESC) compared with routine stoma closure (RSC) after colorectal surgery. Methods. We comprehensively searched PubMed, Embase, and the Cochrane Library for randomized controlled trials that compared ESC and RSC after colorectal surgery. Results. A total of 7 randomized controlled trials with 814 enrolled patients were identified for this meta-analysis. There were no significant differences between the ESC and RSC groups regarding the complications of stoma closure (26.8% and 16.6%, respectively; odds ratio [OR]: 1.30; 95% confidence interval [CI]: 0.89-1.90; P = .17). A subgroup analysis was conducted by Clavien-Dindo grade of complication, and no significant difference was observed in any subgroup (P > .05). However, the ESC group had a significantly higher risk of wound complications than the RSC group (17.6% and 7.8%, respectively; OR: 2.61; 95% CI: 1.43-4.76; P = .002), and the RSC group had more cases of small bowel obstruction than the ESC group (3.1% and 8.4%, respectively; OR: 0.37; 95% CI: 0.15-0.87; P = .02). Conclusions. ESC is a safe and effective therapeutic approach in patients who have undergone colorectal surgery; it is associated with a reduced risk of bowel obstruction but a higher risk of wound complications.

A Case of Small Bowel Obstruction Caused by Intersigmoid Hernia Treated by Laparoscopic Surgery

A Case of Small Bowel Obstruction Caused by Intersigmoid Hernia Treated by Laparoscopic Surgery

Multidetector Computed Tomography Findings of Adhesive Internal Hernias.

To identify multidetector computed tomography (MDCT) findings of surgically confirmed adhesive internal hernias (IHs). Two gastrointestinal radiologists performed blinded, independent, and retrospective reviews of MDCT findings from a consecutive cohort of 35 adhesive IH and 41 adhesive small-bowel obstruction cases that had undergone surgery within 48 hours after MDCT. Univariate statistical analyses were performed to assess CT signs of adhesive IHs and CT findings of intestinal necrosis in patients presenting with adhesive IHs. Dislocated cluster of the intestine (P = 0.005), 2 transitional zones (P = 0.002), and presence of fat in the center sign (P = 0.001) were key CT outcomes that were significantly associated with adhesive IHs. Additionally, intramural hemorrhage was found the MDCT feature indicative of intestinal necrosis (P = 0.028). This study illustrates specific MDCT findings of IHs, and these observations may help guide early clinical management of the condition.

2576 Terminal Ileitis: A Rare Gastrointestinal Complication of 5-Fluorouracil Therapy

INTRODUCTION: Ileitis is often seen in Crohn's disease and infection. Less often, it is associated with other conditions, including vasculitides, neoplasia, ischemia and medication-related complications. Ileitis typically presents with right lower quadrant abdominal pain and diarrhea; in some cases, it causes a small bowel obstruction (SBO). There are very few case reports of 5-fluorouracil associated ileitis and it is not well-described in literature. CASE DESCRIPTION/METHODS: A 66-year-old male with stage IV gastroesophageal junction adenocarcinoma was started on radiation therapy to the upper esophagus along with continuous infusion of fluorouracil (5FU). On day four of 5-FU, the patient developed severe mucositis causing dysphagia and odynophagia, requiring hospitalization and PEG-tube placement. With initiation of tube feeds, patient developed nausea, vomiting and watery nonbloody diarrhea. CT abdomen/pelvis showed SBO, with thickening of the distal small bowel thickening suggestive of terminal ileitis (Figure 1). Despite cessation of tube feeds, he continued to have diarrhea. C. difficile PCR, enteric pathogen panel, GI pathogen panel, and Yersinia culture were negative. He remained afebrile and without leukocytosis. Colonoscopy revealed inflammation of the terminal ileum characterized by erythema and ulceration (Figure 2). Biopsies of the terminal ileum showed chronic active inflammation (Figure 3). The terminal ileitis was attributed to treatment with 5-FU. With supportive care, the patient's diarrhea resolved and he was discharged home. 5-FU was held and patient received radiation therapy alone. Repeat colonoscopy 2 months later showed endoscopically normal mucosa. Biopsies showed nonspecific chronic inactive ileitis. DISCUSSION: We report a case of diarrhea and SBO associated with terminal ileitis, which was likely related to 5-fluorouracil therapy. Histology showed chronic inflammation with crypt architectural distortion, which are similar to the findings associated with radiation induced enteritis. However, this patient received only radiation therapy to the upper esophagus, none to the abdomen or lower abdomen. Infectious etiologies of ileitis were ruled out, and the ileitis resolved with discontinuation of 5-FU. Terminal ileitis may be an important diagnostic consideration in patients receiving 5-FU. We suggest that colonoscopies performed for diarrhea associated with 5-FU should include intubation into the terminal ileum when possible.