Case Of Bowel Obstruction Research Articles

Successful Management of Early Postoperative Small Bowel Obstruction Using Steroid: a Case Report

Background: Early Postoperative Small Bowel Obstruction (EPSBO) is a primary factor contributing to death and morbidity after pelvic and abdominal surgery. Although it is frequently regarded as a surgical emergency, the most recent research indicates that non-operative management is always preferable unless there are complications.Case: A 53-year-old woman came with symptoms of small bowel obstruction and a history of hysterectomy three weeks earlier. The patient refused surgical intervention, so a conservative approach was taken. She was given methylprednisolone 500 mg/day in two doses daily for three consecutive days, in addition to nasogastric tube insertion and symptomatic therapy. After three days of follow-up, the patient showed symptoms improvement, and the abdominal X-Ray and CT Scan showed no abnormal findings.Discussion: The majority of Early Postoperative Small Bowel Obstruction (EPSBO) cases, according to the most recent research, may be managed without surgery. Additionally, due to their anti-inflammatory properties, some medications, like corticosteroids, have been found to be beneficial and effective for EPSBO. This is because they may help resolve the obstruction and lessen the edema and fibrin deposition associated with EPSBO following abdominal surgery.Conclusion: Conservative therapy with steroids appears promising due to its lower risk profile and greater patient comfort. However, the exact mechanism and its efficacy in treating EPSBO have yet to be fully concluded, so further research is still needed.Keywords: Corticosteroids, non-operative intervention, small bowel obstruction

Outcomes of ingested superabsorbent polymers ("water beads"): A poison center study.

Superabsorbent polymers (SAPs) are hydrophilic polymers that expand many-fold from their original size after contact with water. Ingestions of "water beads" by young children have been reported to cause bowel obstruction however, the incidence of bowel obstructions is unknown. We conducted a retrospective study analyzing ingestions reported to our regional poison center from January 1, 2002 to April 25, 2023. The primary outcome was development of bowel obstruction. Secondary outcomes included development of symptoms, imaging, interventions, disposition, and outcome. Of 256 cases reviewed, 217 met inclusion criteria, with 84% of ingestions occurring in children under six years of age. Of the 217 analyzed cases, no patients developed bowel obstruction. No clinical effects were reported in 54.8%, while 4.1% had minor effects, and less than 1% were coded with moderate effects. There were no cases coded with major effects or death. Fourteen patients underwent imaging which showed no abnormalities, and no patients were admitted to the hospital. Most patients (83.4%) were monitored at home. Follow-up attempts were made in 53% of cases, with an average of 45h of follow-up time. None of the patients reported to our poison center had abnormal imaging, required admission, developed a bowel obstruction, or required a procedure for foreign body removal. Though cases of bowel obstruction have been reported in literature, the incidence appears to be rare. In our study, no bowel obstructions, admissions, or severe or fatal outcomes were documented, indicating a generally favorable outcome from SAP ingestions. Given reports of serious outcomes in literature, clinicians should continue to use clinical judgement to evaluate patients on a case-by-case basis for potential complications.

070. Total Bowel Obstruction and Secondary Renal Impairment Following Bajakah Root Ingestion: Case Report

Background: Total bowel obstruction is a critical condition often caused by malignancies and adhesions or rare caused by foreign bodies. The bajakah root is a herbal medicine in Dayak community (Central Kalimantan), traditionally used to treat any diseases. This report presents a unique case of bowel obstruction due to bajakah root, and renal impairment as a complication. Case: A 62 years old female without any psychiatric disorders with history bajakah root consumtion complaint difficult defecation and green vomiting. Physical examination showed abdominal distention with collapsed rectal ampulla. Laboratory results revealed renal impairment. Imaging studies confirmed total bowel obstruction. Exploratory laparotomy identified ileoileal and ileo-omental adhesions with 0.5x0,5 cm ileum perforation 120 cm distal to the ligament of Treitz and a 2x2 cm wooden foreign body 10 cm distal from the perforation site. Surgical management included adhesiolysis, wedge excision of the ileum, foreign body extraction and anastomosis. Conclusion: Total bowel obstruction, renal impairment, bajakah, foreign body, foreign body extraction.

Machine Learning Approaches for the Prediction of Postoperative Major Complications in Patients Undergoing Surgery for Bowel Obstruction.

Performing emergency surgery for bowel obstruction continues to place a significant strain on the healthcare system. Conventional assessment methods for outcomes in bowel obstruction cases often concentrate on isolated factors, and the evaluation of results for individuals with bowel obstruction remains poorly studied. This study aimed to examine the risk factors associated with major postoperative complications. We retrospectively analyzed 99 patients undergoing surgery from 2015 to 2022. We divided the patients into two groups: (1) benign-related obstruction (n = 68) and (2) cancer-related obstruction (n = 31). We used logistic regression, KNN, and XGBOOST. We calculated the receiver operating characteristic curve and accuracy of the model. Colon obstructions were more frequent in the cancer group (p = 0.005). Operative time, intestinal resection, and stoma were significantly more frequent in the cancer group. Major complications were at 41% for the cancer group vs. 20% in the benign group (p = 0.03). Uni- and multivariate analysis showed that the significant risk factors for major complications were cancer-related obstruction and CRP. The best model was KNN, with an accuracy of 0.82. Colonic obstruction is associated with tumor-related blockage. Malignant cancer and an increase in C-reactive protein (CRP) are significant risk factors for patients who have undergone emergency surgery due to major complications. KNN could improve the process of counseling and the perioperative management of patients with intestinal obstruction in emergency settings.

S2352 Between a Stone and a Hard Place: A Case of Cholecystocolonic Fistula and Large Bowel Obstruction

S2352 Between a Stone and a Hard Place: A Case of Cholecystocolonic Fistula and Large Bowel Obstruction

Early outcomes of robotic modified retromuscular Sugarbaker technique for end colostomy parastomal hernia repair.

The modified retromuscular Sugarbaker or Pauli technique is a technique for parastomal hernia repair, which requires the dissection of the retromuscular space and a transversus abdominis release for stoma lateralization and placement of a retromuscular mesh. Given the limited evidence regarding the robotic approach to this technique, this study aims to evaluate the outcomes of this newly introduced procedure, focusing on the rate of 30-day complications and recurrence rates. Retrospective case series report. Patients included underwent an elective robotic modified retromuscular Sugarbaker technique for the repair of a parastomal hernia associated with an end colostomy. All surgeries were performed at a tertiary referral center from September 2020 to December 2023. A total of 21 patients underwent a robotic modified retromuscular Sugarbaker in our study. The parastomal hernias operated on were classified according to the European Hernia Society as 9.5% (2/21) type I, 52.4% (11/21) type II, 23.8% (5/21) type III, 14.3% (3/21) type IV. Early complications observed included 14.3% (3/21) seroma, 9.5% (2/21) surgical site infection, 19% (4/21) postoperative ileus, and one case of large bowel obstruction due to colitis (4.8%), which was managed conservatively. No Clavien-Dindo grade III complications were reported. The overall recurrence rate was 9.5% (2/21) with a median follow-up of 12.5 months (IQR: 3.9-21.3). Both recurrences occurred during the early phases of the learning curve and were possibly attributed to insufficient lateralization of the stoma. Robotic modified retromuscular Sugarbaker for parastomal hernia repair is a challenging procedure with promising early outcomes.

Adult Ileal Duplication Cyst Acting as Lead Point of Ileo-Caecal Intussusception: A Rare case of Complete Bowel obstruction in Adults

Adult Ileal Duplication Cyst Acting as Lead Point of Ileo-Caecal Intussusception: A Rare case of Complete Bowel obstruction in Adults

Rare Case of Bowel Obstruction due to Abdominal Metastases from Malignant Melanoma

Rare Case of Bowel Obstruction due to Abdominal Metastases from Malignant Melanoma

Intestinal Obstruction Following Barium Swallow

Intestinal obstruction following a barium examination is a rare complication. We report a case of distal large bowel obstruction caused by large barium plugs – Baroliths, occurring a few weeks after a barium swallow.

Adult ileal duplication cyst acting as lead point of ileo-caecal intussusception a rare case of complete bowel obstruction in adults

Enteric duplication cyst presenting as intussusception in adult and causing complete small bowel obstruction is a rare phenomenon. A 19 year old female presented with complaints of abdominal pain, bilious vomiting, abdomen distension and constipation for 2 days. Patient had similar episodes in the past. Computed tomography of abdomen showed dilated small bowels with “Target Sign” suggestive of Ileo caecal intussusception. Patients was taken for surgery and intraoperatively it was noted to have thick walled cystic swelling in the terminall ileum. Segmental resection done along with cyst and primary anastamosis was done. Histopathological confirmation was done as Duplication cyst.

Cytomegalovirus colitis as intestinal obstruction in an immunocompetent adolescent: a case report and literature review

BackgroundCytomegalovirus infection manifests varying clinical characteristics and severity in diverse populations with different immune statuses. The signs and symptoms of gastrointestinal involvement are nonspecific. Here, we present a case of cytomegalovirus colitis in an immunocompetent adolescent, which manifested as intestinal pseud-obstruction.Case presentationA 15-year-old man who had contracted novel coronavirus infection one month earlier was admitted to our hospital with fever, abdominal pain, and hematochezia. His abdomen was distended, and laboratory evaluation revealed a decrease in the blood count, an increase in inflammatory indicators and hepatic impairment. Imaging shows bowel wall thickening and dilatation of the colon. A diagnosis of intestinal infection combined with acute intestinal pseud-obstruction was made. Diarrhea persisted despite conservative treatment with empirical antibiotics. A colonoscopy was performed. Pathology confirmed cytomegalovirus infection. Ganciclovir therapy was initiated, and subsequent review showed a good recovery.ConclusionsThe case was diagnosed as cytomegalovirus colitis. We reviewed the reports of 9 cases of bowel obstruction, including our own, and found that the majority of the adult patients were elderly with underlying disease. Clinical and endoscopic manifestations are typically nonspecific, and imaging shows typical signs of intestinal obstruction. The final diagnosis was confirmed by pathology. Most of them have a good prognosis. We suggest that cytomegalovirus colitis can also lead to intestinal obstruction and that viral reactivation in immunocompetent individuals may be associated with inflammatory conditions and viral coinfection, particularly with the novel coronavirus.

Diagnostic accuracy of computed tomography scan against surgical findings in small bowel obstruction cases

Diagnostic accuracy of computed tomography scan against surgical findings in small bowel obstruction cases

An unusual case of bowel obstruction secondary to endometriosis

Introduction: Endometriosis is a common disease of women of childbearing age. It can affect the intestines in a portion of patients, although it is generally asymptomatic. Case Report: Here we present an unusual case of a large bowel obstruction due to intestinal endometriosis. Conclusion: In the absence of signs or risk factors for colorectal malignancy, endometriosis should be considered in the differential diagnosis for large bowel obstructions occurring in women of fertile age.

"Bezoar Egg"-A Rare Cause of Small Bowel Obstruction.

Small bowel obstruction is a frequent medical condition with various causes, the most common being postoperative adhesions, volvulus, intussusception, hernias, and tumors. A bezoar-induced blockage of the small intestine is a rare condition that accounts for approximately 4% of all small bowel obstruction cases. Herein, we present the case report of a 71-year-old patient with diffuse abdominal pain caused by a small bowel obstruction due to a calcified bezoar (bezoar egg) resulting from a post-radiation intestinal stricture. The patient underwent a small bowel excision with the extraction of the bezoar, after which a full recovery was made.

Rare case of large bowel obstruction caused by giant rectal laterally spreading tumor

Rare case of large bowel obstruction caused by giant rectal laterally spreading tumor

INVAGINATION INTESTINALE AIGUË DE L’ADULTE : ASPECTS DIAGNOSTIQUES, THERAPEUTIQUES A PROPOS DE SEPT CAS DIAGNOSTIQUES AU CHU DE L’AMITIE SINO-CENTRAFRICAINE DE BANGUI, RCA

ABSTRACT Objective: To report the diagnostic and therapeutic difficulties of acute intussusception in adults in Bangui, Central African Republic. Patients and method: It was a retrospective descriptive study carried out in the general surgery department of Friendship Sino Centrafricaine University Hospital in Bangui. The reported data run from January 2019 to June 2023. It focuses on the records of adult patients of both sexes who underwent exploratory laparotomy for a bowel obstruction in which intussusception was diagnosed. Results: Intussusception accounted for 1.03% (N:7) of the 674 cases of acute bowel obstruction operated during the period. The mean age of patients was 32.8 years ± 9.7. Male subjects accounted for 57.14% (sex ratio = 1.33). At admission, five patients had occlusive syndrome and the other two had prolapse of a mass through the anus. Laparotomy was used to diagnose intussusception in all cases. These were ileoileal intussusception (57.1%), ileocecal (14.3%), colo-colic profunated by the anus (14.3%) and ileo-caeco-colic profunted by the anus (14.3%). Surgical procedures consisted of hail resection followed by termino-terminal anastomosis (42.8%), hail resection followed by ileocolic anastomosis (28.6%) and colonic resection, colostomy and restoration of delayed digestive continuity (28.6%).The histopathological study of the operating rooms had found chronic inflammation of the colonic mucosa (28.6%), colonic adenocarcinoma (14.3%), and adenomatous polyp (14.3%). In 3 patients aged 18, 22, and 29 years respectively no cause was found (42.8%). The postoperative follow-up was simple in all operated patients. Conclusion: Intussusception is a rare condition in adults. The diagnosis is often difficult and made on laparotomy. Practitioners' attention should be drawn to prolapsed masses in the anus in adults Keywords: Acute bowel obstruction, intussusception, surgery, Laparotomy, Central African Republic

Results of robot-assisted minimally invasive esophagectomy in 111 consecutive patients: an Asia cohort study

BackgroundRobot-assisted minimally invasive esophagectomy (RAMIE) is becoming increasingly popular as a treatment for esophageal cancer. The purpose of this study was to use the da Vinci robotic system (Intuitive Surgical, Sunnyvale, CA, USA) to perform 111 consecutive cases of radical esophageal cancer and report the perioperative data of surgery and postoperative complications and short-term oncological outcomes.MethodsWe retrospectively analyzed 111 patients who underwent RAMIE conducted at Fujian Medical University Union Hospital from August 2016 to January 2021. Each patient’s characteristics, clinicopathological stage, postoperative pathological stage, surgery outcome, postoperative recovery, and short-term oncological outcomes were analyzed.ResultsOf the 111 patients who underwent RAMIE, 77 were male and 34 were female, and the mean age was 62.1 ± 8.8 years. Twenty-seven patients (24.3%) received preoperative neoadjuvant therapies, the most popular of which was preoperative induction chemotherapy in 16 cases (14.4%), followed by preoperative induction radiotherapy in 8 cases (7.2%) and preoperative induction chemotherapy plus immunization in 3 cases (2.7%). The vast majority of patients (110/111, 99.1%) underwent radical resection, with a mean intraoperative bleeding amount of 99.9 ± 68.4 mL and a mean operative time of 271.9 ± 70.0 min. The mean total number of lymph nodes removed was 40.9 ± 16.7, including 21.8 ± 9.0 thoracic lymph nodes. Fifty-five (49.6%) patients had lymph node metastases, including 17 (15.3%) with lymph node metastases in the left recurrent laryngeal nerve, 24 (21.6%) with lymph node metastases in the right recurrent laryngeal nerve, and 7 (6.3%) with lymph node metastases in the bilateral recurrent laryngeal nerve. The positive rate of left recurrent nerve lymph nodes was 4.77%, and he positive rate of right recurrent nerve lymph nodes was 8.38%. The main postoperative complications included pulmonary infection in 24 cases (21.6%), celiac disease in 3 cases (2.7%), tracheoesophageal fistula in 1 case (0.9%), anastomotic fistula in 3 cases (2.7%), postoperative cardiac arrhythmias in 11 cases (9.9%), VTE in 3 cases (2.7%), and pleural effusion (requiring postoperative tube drainage) in 13 cases (11.7%). Additionally, 2 cases of postoperative pneumothorax (1.8%), 1 case of poor incision healing (0.9%), 1 case of incomplete bowel obstruction (0.9%), 1 case of neck hematoma (0.9%), and 1 case of postoperative admission to the intensive care unit (0.9%) occurred. The median length of stay was 10.9 ± 6.1 days, and there were no cases of perioperative death.ConclusionsRobotic esophageal cancer radical surgery is safe and feasible. The surgeon can be proficient in thoracic robotic surgery and mediastinal lymph node dissection and achieve high levels of perioperative safety and short-term efficacy.

Gastro gastric intussusception in the setting of unclear lead point Radiological imaging

Intussusception is defined as telescoping or invagination of the proximal part of the gastrointestinal tract (intussusceptum) into an adjacent section (intussuscipiens) which results in obliteration of the lumen [1-2]. It is considered as a form of bowel obstruction as it accounts for only 1-5% of cases of bowel obstruction [3]. Intussusception in children can occur at any site in the GI tract, and it often presents similar clinical and radiographic features at all sites. These characteristic features are the key to diagnose intussusception even at unusual sites [4]. While Intussusception is a common diagnosis among children, it is in fact a rare condition in adults with the incidence of approximately 2-3 per 1,000,000 per year [5-6]. Adult intussusception is usually presented with vaguely unusual symptoms where the use of EUS and CT is extremely useful to aid in diagnosis [1-7]. Our case presents an even rarer type of Intussusception called Gastro-gastric Intussusception. According to multiple sources it consists of only 10% of the adult Intussusceptions [7-8].

Intussusception-induced acute abdomin caused by a giant lipoma in the transverse colon: a rare case report.

The authors present a case of a 48-year-old male who presented to the emergency department suffering from severe abdominal pain. Following examination and investigations, a giant lipoma (GL) in the transverse colon was identified via ultrasound which showed the classical "target sign" Intussusception among adults is unusual as it accounts for only 1% of bowel obstruction cases. Being colo-colonic makes it even more unlikely since it occurs only in 17% of intestinal obstruction cases. GLs exceeding 5cm in size can present with a variety of symptoms. Intussusception is an uncommon presentation of a GL. Preoperative diagnosis of GL-induced intussusception is highly improbable and surgical resection is the treatment of choice. Despite the dominance of the asymptomatic presentation of lipomas, considering its diagnosis in the case of an intussusception-induced acute abdomen should cross physicians' minds.

Gallstone ileus at 17 years after living donor liver transplantation: A case report

Gallstone ileus (GI) occurs in <0.1% of all cases of mechanical bowel obstruction. There have been a few reports of GI occurring after Kasai procedures or Roux-en-Y anastomosis for bariatric surgery. We herein report a case of GI that occurred over 17 years after liver transplantation (LT). A 33-year-old woman who had undergone living donor LT for biliary atresia at 16 years old and had been regularly followed on an outpatient basis in our hospital presented with the sudden onset of increased abdominal distension, pain, and nausea. Enhanced abdominal computed tomography showed dilatation of the intrahepatic bile duct and the whole intestinal tract of the Roux limb as well as ischemic changes near the jejuno-jejunal anastomosis. On laparotomy, a movable and hard foreign body was palpated in the intestinal tract close to the jejuno-jejunal anastomosis site. Enterotomy was performed, and a 4-cm gallstone was removed. The patient had a good postoperative course and was discharged on postoperative day 12. Although GI after LT is a rare complication, it may need to be differentiated as a cause of ileus. An accurate differential diagnosis and early reliable intervention for stone removal will help prevent serious bowel complication, which may lead to graft dysfunction.