Case Of Intestinal Obstruction Research Articles

Appendiceal endometriosis as a cause of ileus in pregnancy

Endometriosis is the presence of ectopic endometrial tissue outside the uterine cavity. It is a well-known cause of chronic pelvic pain and infertility in women. Endometriosis of the appendix is rare and may present with acute or chronic abdominal pain. Preoperative diagnosis is difficult. The definitive diagnosis is usually established following histopathological examination of the appendix. The authors report a case of ileus at the ground of adhesions formed due to appendiceal endometriosis clinically presented with recurrent attacks of abdominal pain in the eight month of pregnancy after laparoscopic removal of the ovarian endometriosis.

Gallstone Ileus in Cipto Mangunkusumo General Hospital, Jakarta: A Case Series

Introduction . Gallstone ileus is an uncommon mechanical bowel obstruction caused by gallstone in gastrointestinal tract which enter due to bileo-enteric fistulae. We report two gallstone ileus cases at Cipto Mangunkusumo General Hospital, Jakarta which admitted in the last 20 years. This study aims to describe gallstone ileus and its management. Method . Data were retrospectively collected from medical records in the last 20 years. Result . The first case was a woman 33 years in 2002 and the second was man 45 years in 2017. Ileus was main clinical symptoms. Clinical manifestations, laboratory data, supporting radiographic examinations, treatment, postoperative care, and outcomes were collected. Gallstone ileus was diagnosed pre operatively based on clinical and radiology findings. Laparotomy was performed and ileostomy for stones evacuation and cholecystectomy were performed without bileo-enteric fistula repair . Large black stones were found at terminal ileum which made the obstruction. Conclusion . Gallstone ileus was uncommon disease which can be treated and has good prognosis.

Paraduodenal hernias: a systematic review of the literature.

Paraduodenal hernias (PDH), also called mesocolic hernias, account for up to 53% of all internal hernias, but they cause only 0.2-0.9% of all cases of intestinal obstruction. This is the first systematic review of all reported cases so far, investigating their clinical presentation, radiological imaging, and treatment outcomes. After a detailed search in PubMed and Medline, using the keywords "paraduodenal hernia", 115 studies matched our criteria. A review of these reports was conducted and the full texts were examined. A total of 159 patients were included in our analysis, with 69.8% and 30.2% of them suffering from either a left or a right PDH, respectively. Mean age at diagnosis was 44.1years, with a 2/1 male/female ratio. PDH were associated with non-specific symptoms and signs; abdominal pain being the most common. Computed tomography (CT) scan of the abdomen was the most frequently used diagnostic modality. Regardless of PDH localization, all patients were operated on, with approximately one-third of them undergoing a laparoscopic operation, which was associated with a significantly decreased morbidity rate as well as length of hospital stay, compared with the open repair. PDH are not usually associated with specific symptoms and signs; thus, they constitute a diagnostic challenge, requiring a high level of knowledge and clinical suspicion. Undoubtedly, CT scan of the abdomen is the gold standard diagnostic tool. Their operative repair is mandatory, with the laparoscopic approach demonstrating significant advantages over the open repair, seeming to be the optimum treatment strategy.

Surgical treatment of monogenic inflammatory bowel disease: A single clinical center experience

PurposeWith the wide application of immunologic reconstitution treatment, such as hematopoietic stem-cell transplantation (HSCT), most patients of inflammatory bowel disease (IBD) with immunodeficiency owing to monogenic abnormalities need surgical intervention during the course of treatment, which is quite different from traditional IBD surgery. The aim of this study was to generalize the surgical strategies as a part of comprehensive therapy for these rare diseases. MethodsA retrospective study was conducted based on the clinical data of children with immunodeficiency-derived IBD who underwent surgical treatment in Children's Hospital of Fudan University between January 2015 and December 2017. ResultsA total of 18 patients with monogenic abnormalities were enrolled. The major surgical indications included 11 cases of acute or chronic intestinal obstructions, 4 refractory intestinal infections, and 3 pneumoperitoneum, while 12 cases had perforations noted during intraoperative exploration. All of the patients underwent varieties of enterostomies to divert the affected or obstructed intestine during the primary surgery. Wound infections or dehiscence occurred in 7 patients, and 2 patients underwent reoperations for adhesive intestinal obstruction and prolapse. Postoperatively, 15 patients survived, 13 of which achieved immune reconstitution through subsequent HSCT or immunoglobulin supplementation. In the second-stage surgery, a posterior sagittal approach rectal resection was performed in 5 patients with complex anorectal complications. Twelve patients had undergone stoma closure procedures. ConclusionSurgical intervention should be performed earlier because the perforations are usually insidious in monogenic IBD. Preventative enterostomies are suggested in preparation for HSCT among patients with severe anorectal complications. Wound infections are the most common complication after the primary operation. Posterior sagittal rectal resection is a good option for patients with complex anorectal complications. Type of studyClinical research paper. Level of evidenceLevel IV.

Obstrucción intestinal por hernia obturatriz: Serie de casos

Objective : 3 cases of intestinal obstruction that resulted in diagnosis of obturator hernia, their management and a brief international literature review are presented. Material and methods : Discussion of the presentation, images, and management. In all cases surgery was performed the same day from the diagnosis of intestinal obstruction and confirmation of obturator hernia. The management of the hernia and it’s content was adjusted to each patient’s situation. Case 1: 80 year old woman presents with intestinal obstruction and palpable mass in right inguinal region. Images are informed as a femoral hernia and surgery is performed. An obturator hernia is found, unviable intestine is resected and defect repair is made with polipropileno mesh plug. Case 2: 91 year old woman arrives because of abdominal pain and vomits in the last 3 days. Images suggest intestinal obstruction but can not identify a cause. Laparotomy is performed and an obturator hernia is found. Resection of necrotic intestine is made and the defect is repaired with simple suture. Case 3: 78 year old woman with pain in the thigh that radiates to the abdomen. Imagenology informs a femoral hernia. Surgery is performed through preperitoneal approach. An obturator hernia is found and reduced. Repair of the defect is made with polipropileno mesh plug. Results: Our 3 patients, when reviewed retrospectively, had the classic presentations and images of obturator hernia. All of them had a favourable evolution with an early discharge and no complications on follow up. Discussion : Our 3 cases had clinical presentations and imaging studies that correlated well with international literature. Conclusion : Obturator hernia is an infrequent pathology, but appears in a particular type of patient and with classic presentation. Axial computed tomography is an important tool and usually makes the diagnosis previously to surgical exploration. It is important to consider this diagnosis when being faced with patients with intestinal obstruction.

Obstrução intestinal associada a tricobezoares de grande volume – um relato de caso

Objetivo: Relatar um caso de obstrução intestinal causada por massa formada a partir da ingesta de pelos Relato do caso: Trata- se de paciente do sexo feminino, 15 anos, procura o serviço de Pronto Socorro com relato de constipação intestinal há 15 dias, sem comorbidades conhecidas até o momento. Após lavagem intestinal com clister glicerinado, foi avaliada com melhora e alta no mesmo dia. Após 24 horas, evoluiu com vômitos fecalóides, distensão abdominal e febre não aferida. Após estabilização hemodinâmica, foi realizada tomografia computadorizada de abdômen, evidenciando sinais de obstrução intestinal sem fator obstrutivo evidente. Foi indicada laparotomia exploradora para melhor avaliação e tratamento do caso. Discussão: Tricobezoares são causas raras na população em geral, mas em populações específicas, como adolescentes do sexo feminino por exemplo, tendem a ser mais comuns. Não obstante, apenas o tratamento cirúrgico não é suficiente no tratamento, devendo a mesma ser encaminhada aos serviços de assistência social, psicologia e psiquiatria, para evitar novos casos e complicações.

Is Meconium Obstruction Distinguishable from Intestinal Obstruction through Ultrasound

Background: Since the treatment of meconium ileus is very different from other types of intestinal obstruction, it is very important to distinguish these two entities. The aim of this study was to assess sonographic findings to differentiate meconium ileus from other types of obstruction. Methods: This study was performed in Dr. Sheikh and Akbar hospitals, Mashhad Medical University of Science, Iran, during 2017- 2018. The imaging signs of 25 newborns (aged 2-8 days) with delayed passage of meconium were documented. These neonates were suspicious of low type intestinal obstruction. In cases with the simple form of meconium ileus and the small left colon syndrome, ultrasonic guided Gastrografin enema was performed for the treatment. In the patients with the failure of medical treatment and in other surgical cases, the appropriate surgical procedure was performed. Results: The subjects in this study were diagnosed with small bowel atresia (n=9), a simple form of meconium ileus (n=6), a complicated form of meconium ileus (n=3), small left colon syndrome (n=3), bowel atresia and duplication (n=1), and Hirschsprung’s disease (n=3). The ultrasound findings were as follows: a totally or partially micro-colon in almost all patients, collapsed small bowel in right lower quadrant in all of the patients with bowel atresia, hypoechoic meconium in rectosigmoid in small left colon syndrome and Hirschsprung’s disease, hypoechoic tubular or beaded intraluminal inspissated meconium within terminal ileum, and the floating air bubbles (sonographic soap bubble sign) within fluids on proximal dilated loops in meconium ileus cases. Conclusion: Although plain abdominal radiography confirmed bowel obstructions in all patients with delayed passage of meconium, it had a low level of specificity in the diagnosis and cause of obstruction. Abdominal ultrasound had a high level of accuracy in the correct diagnosis of meconium obstructions and its differentiation from other intestinal obstructions. Accordingly, it eliminates the need to do a diagnostic contrast enema in order to differentiate these entities.

A clinical study of aetiology of acute intestinal obstruction

Background: Acute intestinal obstruction is one of common abdominal emergency and is associated with significant morbidity and mortality especially if it progresses to bowel ischemia. The diagnosis and management of the patient with intestinal obstruction is one of the more challenging emergencies that a general surgeon can come across. Although the mortality due to acute intestinal obstruction is decreasing with better understanding of pathophysiology and improvement in diagnostic techniques, fluid and electrolyte correction, much potent anti-microbials but still mortality ranges from 10-15% and more so in developing countries.Methods: The study will be conducted in the department of general surgery with symptoms and signs of acute intestinal obstruction admitted in the surgical ward. Fifty cases of intestinal obstruction have been studied. Patients belonged to all the age groups except infants are included in present study. The criteria for selection of cases was based on clinical history, physical findings, radiological and haematological investigations. The study was divided into clinical study, investigations and treatment. The results are tabulated stressing on following points age, sex, symptoms examination findings, investigations, abnormalities, probable causative factors, operative findings and operative procedure adopted and complications if any.Results: The commonest cause of intestinal obstruction in the adults in this study series was postoperative adhesions (36%) followed by obstructed/strangulated hernia (26%). Malignancy of the large bowel was seen in 9 cases constituting 18% of cases where as incidence of Volvulus of bowel was 4% in this series. Although pulmonary tuberculosis is more prevalent in India due to advent in use of antitubercular drugs incidence of abdominal tuberculosis is becoming less. In present study incidence of ileocaecal tuberculosis was 10%. One case of mesenteric ischaemia was present in our study.Conclusions: Acute intestinal obstruction remains an important surgical emergency in the surgical field. Success in the treatment of acute intestinal obstruction depends largely upon its early diagnosis, skilful management and treating the pathological effects of the obstruction just as much as the cause itself.

A rare case of ventriculoperitoneal shunt knot causing intestinal obstruction in an adult

Despite high incidence of complications, Ventriculoperitoneal shunting for hydrocephalus is the cornerstone and the most common neurosurgical procedure. Ventriculoperitoneal shunt knot causing intestinal obstruction is an extremely rare complication needing surgical intervention. A 19 years old male with history of VP shunting in infancy for hydrocephalus with no history of any revision surgery presented in emergency with pain abdomen and multiple episodes of vomiting for 2 days. X ray showed dilated bowel loops with a coiled up VP shunt in the abdomen. Exploratory laparotomy showed multiple dilated bowel loops with a loop of VP shunt around ileal segment with dense fibrotic adhesions causing obstruction. Extensive adhesiolysis was done. Procedure underwent uneventful. Patient recovered swiftly in postoperative period and is currently asymptomatic after 6 months of surgery. Improved surgery skills and shunt design have prevented much of the morbidity of VP shunting. Most of the cases reported earlier were paediatric patients with history of repetitive handling of catheter. We believe this to be the first case of intestinal obstruction by a VPS knot in an adult with no history of manipulation after primary surgery. Due to low incidence it is difficult to clinically suspect such an extremely rare complication. Therefore, an awareness of VP shunt related complications in adult is essential.

Comparison of perioperative conditions between total and partial colpocleisis for elderly patients suffered from severe pelvic organ prolapse

Objective: To study perioperative period conditions of total and partial colpocleisis with severe pelvic organ prolapse (POP) in elderly patients. Methods: From Jan. 2014 to Oct. 2017 286 severe POP elderly patients underwent total or partial colpocleisis. The mean age was (76.0±5.1) years (60-90 years) . Of which, 220 patients (76.9%, 220/286) presented more than one kind of medical disease. The operative time, intraoperative blood loss, hospital stay after surgery, postoperative complications, preoperative urinary dysuria symptoms of total and partial colpocleisis in treatment of 286 patients were analyzed. Results: In 286 patients, 172 patients (60.1%) underwent total colpocleisis and 114 patients (39.9%) underwent partial colpocleisis. Totally 48 patients (16.8%) in 286 patients underwent anti-urinary incontinence procedure. The mean operating time of 286 patients was (67±22) minutes,the mean blood loss was (52± 57) ml, the mean hospital stay after surgery was (5.9±1.9) days (2-16 days) . The rate of postoperative complications was 8.7% (25/286) . Those complications including 1 case of bladder injury during operation, 3 cases of postoperative pelvic hematoma, 1 case of intestinal obstruction, 5 cases of atrial fibrillation, 10 cases of postoperative morbidity, 3 cases of pulmonary embolism, 1 case of lower limb thrombosis, 1 case of urinary retention underwent electrical stimulation treatment because of ineffective application of urinary retention catheter. The mean operating time was (67±22) minutes in total colpocleisis and (68±20) minutes in partial colpocleisis (P>0.05) , the mean blood loss was (58±62) ml in total colpocleisis and (41±45) ml in partial colpocleisis (P>0.05) , the mean hospital stay after surgery was (5.9±1.9) days in total colpocleisis and (6.0±1.8) days in partial colpocleisis (P>0.05) , the rate of post operative complications was 8.1%(14/172) in total colpocleisis and 9.6% (11/114) in partial colpocleisis (P>0.05) , respectively; those four of comparisons showed no significant difference. There were 129 patients (45.1%, 129/286) with voiding difficulty before surgery; the mean postvoid residual volumes of the above two operation types of people after operation were (35±43) and (34±41) ml, which showed no significant difference (P>0.05) . Conclusions: Colpocleisis is a safe and effective management in selected elderly patients with severe POP, who no longer desire to maintain vaginal coital function. There is no significant difference in the perioperative period conditions between total and partial colpocleisis. The choice of surgical procedure is based on factors such as the presence or absence of malignancy in the uterus, age and willingness of the patient, and general condition.

A Case of Intestinal Obstruction After Esophageal Cancer Surgery Caused by Incarceration in to the Gap between the Jejunostomy Site and the Abdominal Wall

A Case of Intestinal Obstruction After Esophageal Cancer Surgery Caused by Incarceration in to the Gap between the Jejunostomy Site and the Abdominal Wall

A case of intestinal obstruction caused by trichobezoar

A case of intestinal obstruction caused by trichobezoar

A Case of Intestinal Obstruction Caused by Abdominal Cocoon in an Adult Male: A Case Report

A Case of Intestinal Obstruction Caused by Abdominal Cocoon in an Adult Male: A Case Report

Rare case of acute strangulated intestinal obstruction - ileo-ileal knotting

Intestinal knot is a rare cause of closed loop obstruction. It originates with the wrapping of the mobile ileal loop compromising the mesentery in the center of knot and is an unusual cause of intestinal strangulation. Here we report a case of acute intestinal obstruction due to ileo-ileal knotting that was surgically managed by emergency laparotomy and resection of gangrenous segment and double barrel ileostomy. The main reported problem, it is very difficult to diagnose preoperatively. High index of suspicion and early surgical intervention greatly reduces morbidity and mortality.

A Case of Intestinal Obstruction due to Rectal Endometriosis

A Case of Intestinal Obstruction due to Rectal Endometriosis

A Case of Intestinal Obstruction due to a Malignant Lymphoma of the Rectum in a Patient with Ulcerative Colitis

A Case of Intestinal Obstruction due to a Malignant Lymphoma of the Rectum in a Patient with Ulcerative Colitis

A Case of Intestinal Obstruction due to Synchronous Caecal and Sigmoid Volvulus

A Case of Intestinal Obstruction due to Synchronous Caecal and Sigmoid Volvulus

An appraisal of the presentation and management of adult intussusception at a Nigerian Tertiary Hospital

Intussusception in adults is considered rare in surgical practice. It is the causative lesion in a small proportion of cases of intestinal obstruction and lower gastrointestinal bleeding. In the last decade, the incidence of adult intussusception appears to be increasing at our centre. This study aims to document the pattern of presentation and management outcome of adult intussusception at our institution during the last decade. We also observed the occurring trends of this lesion. This was a 10-year retrospective study of consecutive adult patients with intussusception seen at our institution from July 2008 to June 2018. Information on biodata, clinicopathological features and management outcome retrieved from case notes and pathology records were analysed on a personal computer using SPSS version 23. Twenty adult patients who had intussusception were seen during this period. There were 9 (45%) males and 11 (55%) females giving a male-to-female ratio of 1:1.2. The mean age of presentation was 45 (range 18-66) years. Clinical features were abdominal pain (85%), abdominal distension (80%), vomiting (70%), rectal bleeding (70%) and palpable abdominal mass (35%). Majority of patients (70%) presented with features of intestinal obstruction. Idiopathic intussusception (55%) accounted for more than half of the cases with the jejunoileal variety (30%) as the most common pathological type. One patient who had intussusception in the postoperative period was treated with manual reduction at laparotomy. Bowel resections were performed in the remaining 19 (95%) patients. Adult intussusception is still uncommon in our general surgical practice. Bowel resection is the mainstay of treatment.

Peritoneal defect herniation after laparoscopic inguinal hernia repair (transabdominal preperitoneal) - A case report with review of literature

The development of newer techniques in the field of surgery is associated with its own set of possible complications. Laparoscopic mesh repair is now widely accepted as the standard of care for inguinal hernias. Both transabdominal preperitoneal approach and totally extraperitoneal approach are almost equally popular worldwide. We report a case of intestinal obstruction following herniation of small bowel through the peritoneal defect and resultant adhesions to the mesh. We also present a literature review of instances of small bowel herniation through the peritoneal defect and resultant intestinal obstruction after inguinal hernia repair.

A case of intestinal obstruction by pseudoenterolith formed after anastomosis of transverse and sigmoidal colon

A case of intestinal obstruction by pseudoenterolith formed after anastomosis of transverse and sigmoidal colon