Case Of Bowel Obstruction Research Articles

A Case of Acute Mechanical Bowel Obstruction by Intestinal Ascariasis in a Child in the Era of Routine Deworming Prevention: Can this Infestation be Eradicated?

A Case of Acute Mechanical Bowel Obstruction by Intestinal Ascariasis in a Child in the Era of Routine Deworming Prevention: Can this Infestation be Eradicated?

Cryptorchidism as an obscure cause of adhesive small bowel obstruction in an adult, a case report.

Introduction and importanceCryptorchidism is seen in 3% of fullterm neonates. Rarely, it may cause small bowel obstruction. Knowledge of this presentation of cryptorchidism is essential to treat bowel obstruction arising due to cryptorchidism before the patient suffers complications.Case presentationWe present a case of a patient who underwent exploratory laparotomy for small bowel obstruction that did not resolve with conservative management. At laparotomy, on initial exploration, this patient had adhesive bands causing the small bowel obstruction. On further exploration, the bands were found to arise from a cryptorchid testis.Clinical discussionCryptorchidism is a common finding among newborns and needs to be corrected by 1 year of age. Failure to correct cryptorchidism in a timely manner can result in complications such as bowel obstruction.ConclusionThorough intraoperative exploration is key at operation for all cases of small bowel obstruction, so as to find and treat anatomic causes of obstruction. Congenital causes of bowel obstruction should be suspected in all unexplained cases of bowel obstruction and may be revealed by careful physical examination and thorough intraoperative exploration.

Gallstone Ileus in an Adult Male Patient: Computed Tomographic Findings and Case Report

Gallstone ileus is a mechanical intestinal obstruction due to gallstone impaction within the gastrointestinal tract, and responsible for less than 1% of cases of intestinal obstruction. This is a case of a 50-year-old male who was referred for computed tomography of the abdomen on account of abdominal pain, abdominal swelling and discomfort, restlessness, vomiting, constipation, easy fatigability, excess sweating and restlessness. The scout image of the computed tomography (CT) demonstrated linear streaks and foci of radiolucency beneath and around the 10th and 11th anterior ribs on the right most likely pneumobilia. Air distended bowel loops were also demonstrated. Serial axial slides demonstrated an impacted calculus measuring about 30mm in widest transverse diameter in the right iliac region most probably the ileocecal valve region extending in to the cecum with associated dilated bowel loops showing multiple air-fluid levels raising a suspicion of mechanical bowel obstruction. The gall bladder measures about 50mm x 30mm in cranio-caudal and mediolateral diameter, with turbid contents and thickened walls of about 4mm most likely from cholecystitis. A diagnosis of mechanical bowel obstruction following an impacted calculus at the ileocecal valve was entertained; Gallstone ileus in a 50-year-old man. The patient had surgical treatment, this comprised of exploratory laparotomy with entero-lithotomy, fistula repair and cholecystectomy. The patient did well post-operatively and was discharged home subsequently and advised on follow-up visits. We present a case of mechanical bowel obstruction following an impacted gall stone at the ileocecal valve in a 50-year-old male patient.

Sigmoid volvulus: definitive surgery is safe and should be considered in all instances

BackgroundAcute sigmoid volvulus (ASV) represents a small but significant portion of cases of large bowel obstruction, especially in the elderly and co-morbid. Given the characteristics of the patient cohort most commonly affected, a non-operative/conservative approach is often undertaken but is associated with a high rate of recurrence.ObjectiveWe sought to evaluate outcomes for those patients who underwent non-operative management, emergency surgery or staged, semi-elective surgery following decompression for ASV at our institution.MethodsHospital in-patient enquiry (HIPE) data were used to identify all patients who presented with sigmoid volvulus between January 2005 and June 2020 inclusive. Patient notes were interrogated, including surgical and endoscopic procedures performed. Patient demographics and co-morbidities were recorded.ResultsThirty-nine patients were treated over a 15-year period with a mean age of 73 years at first presentation (range 36–93). Twenty-two patients (56%) had just a single admission for ASV with three deaths in this group.Seventeen patients (44%) had more than one admission with volvulus due to recurrence after a decompression-only strategy on the index admission. Of these, three succumbed to complications of their subsequent episodes of volvulus.Twenty-five patients underwent surgical intervention (fifteen on, or shortly following, their first admission and ten following at least two admissions for ASV). The overall mortality in the operative group was 2/25 (8%) with both deaths in those undergoing emergency surgeries. Five patients were treated successfully with endoscopic measures alone and had required no further interventions at the time of compiling data.ConclusionThere is a high recurrence rate following non-operative management of acute sigmoid volvulus and consequently, a cumulative increase in the attendant significant morbidity and mortality with subsequent episodes. Given the relatively low complication rate of definitive surgery, even in those patients perceived to be high risk, we contend that all patients should be considered for early surgery to prevent the likely recurrence of sigmoid volvulus.

CAN ULTRASOUND ALONE SUFFICE IN THE EVALUATION OF ACUTE ABDOMEN IN ADULTS – A COMPARATIVE COMPUTED TOMOGRAPHY VERSUS ULTRASOUND (HOSPITAL BASED) STUDY

OBJECTIVE The objective of this study was to study the role of ultrasound and computed tomography in evaluation of acute abdomen and to assess whether ultrasound alone will sufce in majority situations, so that radiation exposure may be minimized. MATERIALS AND METHODS This institutional review board approved prospective observational study comprised of 50 adult patients attending the emergency department for non-traumatic acute abdominal pain less than 3 days of duration. The radiological evaluation with US and CT scan (Non contrast and contrast enhanced) of abdomen was done at radiology department of Sharda hospital. The exclusion criteria were trauma and pregnancy. The equipments used were Ultrasound with color Doppler PHILIPS EPIQ 7G and CT Scan - GE Optima 660 - 128 slice CT Scanner with slice thickness of 0.6 mm. RESULTS The overall sensitivity of US was 74% and that of CT was 96.15% with insignicant difference (p value – 0.018). Also, the sensitivity of US compared to CT in diagnosing common etiologies of acute abdomen namely acute cholecystitis, acute appendicitis, intestinal obstruction, pancreatitis and ureteric calculi sensitivity did not differ signicantly. CT was necessary only in patients with retro-caecal appendicitis, bowel obstruction cases for dening the transition point and in patients with pancreatitis to obtain the CT Severity index. CONCLUSION We propose that US should remain the primary imaging modality in all patients of acute abdomen in order to prevent radiation exposure, especially as it was found to have a sensitivity comparable to CT, in majority of the clinical situations. Moreover, it is a more cost-effective investigation. Therefore, CT should be reserved only for the minority of clinical situations where US is signicantly inconclusive.

Intussusception Secondary to Adenocarcinoma of the Colon

Intussusception in adults is a rare occurrence, accounting for approximately 1%–3% of bowel obstruction cases. Here, we present a case of colocolic intussusception of the sigmoid colon caused by adenocarcinoma. A 67-year-old male presented to the emergency department with abdominal pain and rectal bleeding. A computed tomography (CT) scan revealed intussusception involving the sigmoid colon and a potential mass. In the operating room, the patient underwent flexible sigmoidoscopy, followed by sigmoidectomy and end colostomy. Pathological examination of the resected specimen confirmed moderately differentiated adenocarcinoma of the sigmoid colon with negative margins, and two of the 54 lymph nodes were positive for metastasis. A repeat CT scan of the abdomen showed multiple sub-centimeter low-density hepatic lesions, and biopsy confirmed a metastatic lesion. The patient ultimately elected hospice care. In this report, we describe a rare case of sigmoid intussusception in an adult patient, review the relevant literature, and summarize the diagnostic and management approaches suitable for adult intussusception cases.

Automatic segmentation of large bowl obstruction area with hough transform from erect abdominal radiograph images

Large bowel obstruction is less frewuent but often appears acute and needs emergent treatment. Erect abdominal radiograph is usually the first imaging study performed in patients suspected of having large bowel obstruction. However, that mordality suffers from operator subjectivity thus a fully automatic computer aied tool is necessary. In this paper, we peopose an automatic large bowel feature (air-fluid region) segmentation method based on Canny edge detection and Hough transform. In experiment, the proposed method was successful in finding target region from large bowel obstruction patients’ radiographic images in all 30 cases provided. Whilie limited only applicable to the large bowel obstruction cases, the proposed method is practically feasible in application.

Automated tracking of emergency department abdominal CT findings during the COVID-19 pandemic using natural language processing.

PurposeDuring the COVID-19 pandemic, emergency department (ED) volumes have fluctuated. We hypothesized that natural language processing (NLP) models could quantify changes in detection of acute abdominal pathology (acute appendicitis (AA), acute diverticulitis (AD), or bowel obstruction (BO)) on CT reports.MethodsThis retrospective study included 22,182 radiology reports from CT abdomen/pelvis studies performed at an urban ED between January 1, 2018 to August 14, 2020. Using a subset of 2448 manually annotated reports, we trained random forest NLP models to classify the presence of AA, AD, and BO in report impressions. Performance was assessed using 5-fold cross validation. The NLP classifiers were then applied to all reports.ResultsThe NLP classifiers for AA, AD, and BO demonstrated cross-validation classification accuracies between 0.97 and 0.99 and F1-scores between 0.86 and 0.91. When applied to all CT reports, the estimated numbers of AA, AD, and BO cases decreased 43–57% in April 2020 (first regional peak of COVID-19 cases) compared to 2018–2019. However, the number of abdominal pathologies detected rebounded in May–July 2020, with increases above historical averages for AD. The proportions of CT studies with these pathologies did not significantly increase during the pandemic period.ConclusionDramatic decreases in numbers of acute abdominal pathologies detected by ED CT studies were observed early on during the COVID-19 pandemic, though these numbers rapidly rebounded. The proportions of CT cases with these pathologies did not increase, which suggests patients deferred care during the first pandemic peak. NLP can help automatically track findings in ED radiology reporting.

327 Rare Synchronous Volvulus of Sigmoid Colon and Caecum, Management of Two Cases

Abstract Colonic volvulus accounts for approximately 5% of cases of large bowel obstruction. Sigmoid volvulus is commonest (75%), followed caecal volvulus (15%). Synchronous volvulus of the caecum and sigmoid is rare, with five reported cases in the literature. We report two cases in a London teaching hospital managed within 6 months. Both male patients (aged 72 and 79 years) had presented to the emergency department on multiple occasions (2-5 times in the preceding 1-8 months), with obstructive symptoms including tender abdominal distension and constipation. On all occasions, sigmoid volvulus was diagnosed based on plain abdominal films and flatus tubes were inserted, with initial clinical resolution. On their final presentation, both patients were admitted for definitive surgery. CT scans of the abdomen and pelvis were consistently reported as showing only sigmoid volvulus. Only intra-operatively was the diagnosis of synchronous caecal and sigmoid volvulus appreciated. Complete symptom resolution was achieved with subtotal colectomy and ileostomy formation. The key learning points from these cases are: 1) synchronous large bowel volvulus is a rare and easily missed diagnosis, 2) conservative management is unlikely to be successful, 3) radiological appearances may only suggest one type of large bowel volvulus and 4) definitive diagnosis is made intra-operatively.

Ischiorectal fossa metastasis from colon cancer: Case report of a rare entity and review of literature.

Introduction and importanceColorectal cancer is one of the most common cancers both nationally and internationally. It commonly metastases to local lymph nodes, liver and lungs, with few reported cases of rare sites of metastasis such as adrenal glands, breast and skin.Case presentationWe report a 55-year-old-female admitted as case of large bowel obstruction and unintentional weight loss. Computed tomography scan of chest, abdomen and pelvis (CT CAP) showed sigmoid colon circumferential thickening with three lesions in the right hemi-liver. A laparoscopic diverting ileostomy followed by a colonoscopy showed a sigmoidal mass consistent with adenocarcinoma on histopathology. Hence, she received neoadjuvant chemotherapy followed by hepatectomy for the liver metastasis. Post-operatively CT CAP showed a newly developed right ischiorectal fossa (IRF) nodule along with newly developed porta hepatis lymph node. PET scan showed uptake in these two new lesions. Therefore, the patient underwent resection of the primary tumor, porta hepatis lymph node and right ischiorectal fossa nodule excision. The histopathology of the primary tumor came as moderately differentiated adenocarcinoma with both ischiorectal lesion and the porta hepatis nodule being positive for metastatic disease.Clinical discussion & conclusionIschiorectal fossa tumors are extremely rare with the majority being benign in origin. Nevertheless, the possibility of metastasis is there with no clear explanation regarding the pathway of how the metastatic cells can reach the IRF. Pre-operative diagnosis is important to determine the appropriate approach particularly if the mass is thought to be malignant. Further larger studies are needed to understand the pathway of metastasis to IRF.

Applying Quality Improvement Methods to Decrease Bowel Obstruction Complications After Total Joint Arthroplasty

BACKGROUND: Though infrequent, bowel obstruction complications after total joint arthroplasty (TJA) can cause significant patient morbidity and mortality. There are few reports of prevention protocols for these complications in current literature. The purposes of this study were to (1) create a protocol to prevent bowel obstruction complications in TJA patients using the Plan-Do-Study-Act (PDSA) quality improvement model as well as (2) assess the effect of the protocol on the incidence of such complications. METHODS: The protocol was created by a multidisciplinary task force at a single specialty orthopedic hospital. Gastrointestinal complications were monitored after implementation of the protocol. The protocol was continually evaluated for problems and modifications were made as necessary. RESULTS: The protocol was implemented in May 2018. From that time until the end of the year, there was a 31.9% decrease in cases of ileus and no cases of bowel obstruction or perforation were observed. CONCLUSION: Bowel obstruction complications after TJA adversely affect patient outcomes. This study describes a standardized protocol created via the PDSA method of quality improvement that aims to prevent these complications in this patient population through early identification and intervention. Given the growing demand of TJA, future research should focus on further standardization of postoperative care in efforts to improve patient outcomes and reduce healthcare costs.

Bowel obstruction due to Chlamydia trachomatis: a case report and review of literature

BackgroundChlamydial infection is a difficult-to-diagnose type of sexually transmitted disease that occurs mainly in young people. We report a case of bowel obstruction caused by intrapelvic adhesions formed by chlamydial infection.Case presentationThis patient was a 23-year-old woman who had been suffering from acute abdominal pain. She had been previously treated several times for intrapelvic abscesses and had a history of chlamydial infection. Endometriosis was thought to be the cause of her pelvic abscess based on endoscopic findings. Computed tomography demonstrated a small bowel obstruction caused by a pelvic abscess. However, the diagnosis could not be confirmed. She underwent laparoscopic surgery and was diagnosed with bowel obstruction due to adhesion of chlamydial infection based on the intraoperative findings and Chlamydia trachomatis antibody test. She was discharged 5 days after surgery.ConclusionsIt is necessary to consider the possibility of chlamydial infection as a cause for lower abdominal pain and unexplained bowel obstruction in female patients.

Adhesive Small Bowel Obstruction and the six w’s: Who, How, Why, When, What, and Where to diagnose and operate?

Background and Aims: Approximately 75% of patients admitted with small bowel obstruction have intra-abdominal adhesions as their cause (adhesive small bowel obstruction). Up to 70% of adhesive small bowel obstruction cases, in the absence of strangulation and bowel ischemia, can be successfully treated with conservative management. However, emerging evidence shows that surgery performed early during the first episode of adhesive small bowel obstruction is highly effective. The objective of this narrative review is to summarize the current evidence on adhesive small bowel obstruction management strategies. Materials and Methods: A review of the literature published over the last 20 years was performed to assess Who, hoW, Why, When, What, and Where diagnose and operate on patients with adhesive small bowel obstruction. Results: Adequate patient selection through physical examination and computed tomography is the key factor of the entire management strategy, as failure to detect patients with strangulated adhesive small bowel obstruction and bowel ischemia is associated with significant morbidity and mortality. The indication for surgical exploration is usually defined as a failure to pass contrast into the ascending colon within 8–24 h. However, operative management with early adhesiolysis, defined as operative intervention on either the calendar day of admission or the calendar day after admission, has recently shown to be associated with an overall long-term survival benefit compared to conservative management. Regarding the surgical technique, laparoscopy should be used only in selected patients with an anticipated single obstructing band, and there should be a low threshold for conversion to an open procedure in cases of high risk of bowel injuries. Conclusion: Although most adhesive small bowel obstruction patients without suspicion of bowel strangulation or gangrene are currently managed nonoperatively, the long-term outcomes following this approach need to be analyzed in a more exhaustive way, as surgery performed early during the first episode of adhesive small bowel obstruction has shown to be highly effective, with a lower rate of recurrence.

Gastrogastric Intussusception Secondary to Gastrointestinal Stromal Tumour: a Case Report

Intussusception is rare in adults and accounts for only 1–5% of cases of bowel obstruction; in the majority of cases, it is secondary to a lead point and most commonly occurs as ileocolic intussusception; gastrogastric intussusception is extremely rare. The case of a 60-year-old lady with gastrogastric intussusception secondary to a gastric gastrointestinal tumour is reported and the relevant literature briefly reviewed.

Exstensive gastric heterotopia of the distal ileum: A case of bowel obstruction

Exstensive gastric heterotopia of the distal ileum: A case of bowel obstruction

A Case of Recurrent Bowel Obstruction Caused by Radiation Ileitis Performed Massive Small Bowel Resection

A Case of Recurrent Bowel Obstruction Caused by Radiation Ileitis Performed Massive Small Bowel Resection

A Case of Large Bowel Obstruction- An Unusual Cause in a Middle Aged Female

Endometriosis is a disease seen among women in reproductive age group. It is characterised by deposition of endometrial tissue outside the uterus. It commonly involves the pelvic organs like ovary, fallopian tube and pelvic ligaments. Involvement of gastrointestinal tract by endometriosis is uncommon and the incidence varies widely among different studies. Colonic endometriosis can be confused as malignancy both clinically and radiologically. In these instances, histopathology is essential for a correct diagnosis. Here, the authors report a case of colonic endometriosis presenting with features of large bowel obstruction in a 49-year-old female with previous history of laparoscopic hysterectomy. Radiological scanning of abdomen and colonoscopic examination were suspicious of sigmoid malignancy. Although colonic biopsy was inconclusive and tumour markers were normal, she underwent sigmoidectomy with lymphnode clearance as per oncological principles with primary anastomosis. Her final histopathological examination revealed features of colonic endometriosis without any evidence of malignancy. Detailed evaluation of the patient didn’t reveal endometriosis at any other site. Patient was discharged after full surgical recovery and was doing well till the last follow-up.

Leiomyosarcoma: A Rare Cause of Colocolic Intussusception

Intussusception is an infrequent presentation in adult patients and accounts for less than 1% of all cases of adult bowel obstruction. Colon is most commonly involved site and in 56% cases, the underlying cause is a malignant neoplasm. Leiomyosarcoma of colon is an extremely rare tumour. A 30-year-old male patient presented to the Surgery Department with chief complaints of dull, diffuse and colicky abdominal pain associated with abdominal distension and vomiting for 15 days. On abdominal examination, abdomen was distended with generalised tenderness and rigidity. X-ray abdomen showed features suggestive of bowel obstruction. Contrast Enhanced Computed Tomography (CECT) revealed bowel within bowel appearance of a segment of descending colon suggestive of colocolic intussusception. Exploratory laparotomy revealed colocolic intussusception with a large obstructing growth in the descending colon acting as a lead point. Left hemicolectomy with colocolic anastomosis was done. Final histopathological report confirmed epithelioid leiomyosarcoma. Adjuvant chemotherapy was administered and the patient is disease free at one year of follow-up. Present case report was a rare case of colonic leiomyosarcoma presenting with intussusception. The rarity of this disease and the rare presentation makes this an interesting case. Surgical management remains the mainstay of treatment of these cases.

A Case of a Bezoar Causing Small Bowel Obstruction That Passed via the Anus with Conservative Therapy

A Case of a Bezoar Causing Small Bowel Obstruction That Passed via the Anus with Conservative Therapy

Gallstone ileus after hepaticojejunostomy in liver transplant recipient: case report

Presenter: Patricio Vanerio MD | Hospital Central de las Fuerzas Armadas Background: Gallstone ileus is an infrequent cause of mechanical bowel obstruction. It is caused by transition of a gallstone in the gastrointestinal tract usually through a biliary-enteric fistula, occurring in 1 to 3% of all cases of mechanical bowel obstruction. In patients with a hepaticojejunostomy gallstones can be formed at the proximal side of it and then pass through the lumen. In this cases hepatolithiasis is associated with recurrent anastomotic stricture and cholangitis. Even though abdomen computed tomography (CT) is very informative for diagnosis of gallstone ileus, it is oftenly found during laparotomy performed for unexplained small bowel obstruction. We present the case of a patient who was admitted with a gallstone ileus, in whom the gallstone stone was formed at the hepaticojejunostomy (liver transplant recipient) and entrapped at afferent loop of the Roux-en-Y jejunojejunostomy. Methods: We present the case of a 22yo female. Heretopic reduced liver recipient 20 years ago because of biliary atresia. Admitted 2 years ago with a mild cholangitis, MRCP demonstrated stenosis of hepaticojejunostomy associated with hepatolithiasis. Treatment consisted in percutaneous dilation of bilioenteric anastomosis and progression of litiasis to jejunum. No complications or symptoms were registered during follow up in the next 2 years. Begun with sudden intermittent colicky abdominal pain, nausea, and vomiting. Computed tomography (CT) evidenced small intestine dilation associated with 2 hyperdense structures of about 30 and 40mm as cause of obstruction (figure). Mild intraabdominal fluid, no large intestine dilation, no other pathological findings. Exploratory laparotomy was performed, extensive adhesiolysis, dilation of roux en Y afferent loop, a gallstone of 40mm was the cause of obstruction. A second gallstone was found distally. Enterotomy with gallstone removal was performed. Postoperative occurred without incidents. Patient was discharged at day 3. Results: Intestinal obstruction has many causes, gallstone ileus is infrequent and usually secondary to cholecystoduodenal fistula which is corresponds to an abnormal communication between the gallbladder and the duodenum that occurs as a rare complication of an untreated gallstones. Other cause of gallstone ileus is hepatolihtiasis formed over a pathologic hepaticojejunostomy with anastomotic stricture and recurrent cholangitis. In this cases, the usual complication is a cholangitis secondary to the obstruction and infection of the bile duct. Percutaneous approach consists in stricture dilation and extraction and/or progression of lithiasis, surgery is a more aggressive and morbid approach which consists in hepaticojejunostomy re do. In our patient gallstone ileus was caused by gallstones advanced during percutaneous treatment 2 years before. Clinical and radiological manifestations of small bowel obstruction do not differ. Neither does surgical treatment, in which laparotomy is the most common approach and enterotomy with gallstone extraction is indicated. Conclusion: We present an extremely rare case of gallstone ileus due to hepatolithiasis caused by stricture of hepaticojejunostomy in a liver transplant recipient. Percutaneous treatment was performed to treat bilioenteric stricture, however this procedure progressed lithiasis distally into jejunal loop causing a small bowel obstruction 2 years later.