Cause Of Intestinal Obstruction Research Articles

Sigmoid volvulus and descending colon adenocarcinoma, a double cause of intestinal obstruction: a case report

Sigmoid volvulus and descending colon adenocarcinoma, a double cause of intestinal obstruction: a case report

Venous intestinal ischemia of fungal origin as a cause of intestinal obstruction in immunocompromised patients: case report and literature review

BackgroundMucormycosis is a highly lethal opportunistic fungal disease caused by ubiquitous molds of the order Mucorales, with Rhizopus, Lichtheimia and Mucor being the most common genera. This rare disease primarily affects immunocompromised patients, with presentations ranging from rhino-orbito-cerebral infections to disseminated mucormycosis with angioinvasion, leading to thrombosis and tissue infarction. Gastrointestinal mucormycosis is the least common clinical presentation and is believed to be secondary to spore ingestion. It can involve multiple components of the gastrointestinal tract, such as the stomach, liver, ileum, and colon, with nonspecific manifestations, including pain, nausea, vomiting, and abdominal distension. The initial clinical presentation may even manifest as gastrointestinal bleeding due to gastric ulceration or intestinal perforation.Case presentationHere we present the case of a 48-year-old male patient with a 9-year history of human immunodeficiency virus (HIV) infection who was hospitalized in the context of febrile neutropenia and whose acute respiratory infection was documented; therefore, antibiotic treatment was initiated. However, due to persistent febrile peaks and peripheral blood showing documentation of multilineage cytopenias, a bone marrow biopsy was performed, compatible with presenting features of marrow myelodysplasia. During hospitalization, the patient presented left flank abdominal pain, and an abdominal computed tomography (CT) scan revealed signs of intussusception of a small bowel loop at the distal jejunum level, leading to intestinal obstruction with ischemic progression, requiring ileectomy (60 cm). Histopathological analysis of the resected intestine revealed severe transmural ischemic changes associated with venous thrombosis due to fungal structures, with histochemical studies demonstrating the presence of zygomycete (Mucor) fungal structures, leading to the initiation of treatment with amphotericin B. However, despite treatment, the patient experienced progressive clinical deterioration with persistent fever and ventilatory failure, with follow-up tests showing absolute neutropenia and blood cultures positive for yeast, leading to death 52 days after admission.ConclusionsThe diagnosis of intestinal mucormycosis may be delayed due to the lack of specificity of the signs and symptoms. Pathologists as well as histopathological studies are essential for timely treatment.

Case report: strangulated spigelian hernia as an uncommon cause of intestinal obstruction

Spigelian hernias (SH) are very rare, representing approximately 0.5% to 2% of ventral wall hernia defects. Due to their low incidence, they pose a diagnostic and surgical challenge in General Surgery. This case report describes a rare strangulated Spigelian hernia causing intestinal obstruction in a 72-year-old female with a history of laparoscopic cholecystectomy. The patient presented with periumbilical pain, nausea, vomiting, and no bowel movements for 48 hours. Initial imaging suggested partial obstruction, but a CT scan confirmed herniation of ileal loops through the Spigelian aponeurosis. Surgical intervention included ileum resection, hernioplasty with mesh, and VAC drain placement. The complexity of diagnosing Spigelian hernias arises from their location, resembling umbilical or incisional hernias, and risk factors like obesity. This case emphasizes the need for accurate imaging and prompt surgery to prevent complications.

004. Confirming The Diagnosis of Hirschsprung Associated Enterocolitis Based on The Hirschsprung Associated Enterocolitis Guidelines: A Literature Review

Background: Hirschsprung's disease (HD) is one of the most common causes of intestinal obstruction in neonates. One of the most frequently encountered complications, and the leading cause of morbidity and mortality in HD patients, is Hirschsprung-associated enterocolitis (HAEC). In 2017, Gosain et al. developed a guideline to aid in the diagnosis of HAEC, but there are limited studies discussing this guideline and diagnosing HAEC remains unclear. The aim of this study is to establish the diagnosis of HAEC in patients using the HAEC guideline. Methods: The studies were selected from online databases such as Scopus, EBSCOhost, PubMed, ScienceDirect, and Medline. Searches were conducted using Boolean OR and AND. Literature selection was based on abstracts, titles, and keywords. The literature selected were based on predetermined inclusion and exclusion criteria. Results: A total of 1,610 studies were identified from the literature search conducted on five databases using appropriate keywords. The articles were then screened using the PRISMA flow diagram, resulting in the selection of three articles that met the inclusion and exclusion criteria. These three selected studies included two retrospective cohort studies and one literature review and expert consensus study for the diagnosis of HAEC. Conclusion: The HAEC guideline by Gosain et al. can be used to clinically establish HAEC; however, it has not been tested in the population and remains an expert consensus, so its validity as a diagnostic guideline cannot yet be compared to previous scoring methods that have been analyzed in the HAEC patient population.

Intestinal obstruction following antituberculosis therapy in a patient with pancreatic carcinoma and pulmonary tuberculosis: a case report

IntroductionIntestinal obstruction is a common complication in patients with advanced malignancies, often attributed to the disease itself or as a side effect of opioid analgesics used for pain management. However, the occurrence of intestinal obstruction following antituberculosis therapy is rare.Case presentationWe report a unique case of a 58-year-old Asian male diagnosed with stage IV pancreatic carcinoma and pulmonary tuberculosis. The patient was initiated on a regimen of ethambutol hydrochloride, pyrazinamide, rifampicin, and isoniazid tablets (II) for tuberculosis, alongside morphine for the management of severe cancer-related pain. Subsequently, he developed symptoms indicative of intestinal obstruction. Despite discontinuation of morphine, the patient’s symptoms persisted until he autonomously ceased all medications, leading to a rapid improvement in his condition. This unexpected resolution highlighted the antituberculosis drugs as the probable cause of his intestinal obstruction.ConclusionsThis case underscores the importance of considering antituberculosis drugs as a potential cause of intestinal obstruction, especially in patients who do not respond to conventional management strategies for drug-induced gastrointestinal side effects. It also emphasizes the need for heightened vigilance and monitoring when prescribing these medications to patients with advanced malignancies, to promptly identify and address rare but significant side effects.

Factors Associated with Postoperative Complications After Congenital Duodenal Obstruction Surgery: A Retrospective Study.

Background and Objectives: Duodenal atresia and stenosis are common causes of intestinal obstruction. Associated anomalies significantly influence early postoperative mortality, while postoperative complications impact long-term survival. Materials and Methods: Over a 13-year period from January 2010 to August 2023, a total of 74 infants and children with congenital duodenal obstruction were treated at "Grigore Alexandrescu" Children's Emergency Hospital and met the inclusion criteria. All patients diagnosed with duodenal obstruction (both instrinsic and extrinsic causes) were included. Analysed data included congenital anomalies, Apgar scores, birth weights, surgical techniques, and complications. Results: The associated anomalies included cardiac (n = 33), Down syndrome (n = 13), neurological (n = 11), pulmonary (n = 7), renal (n = 4), skeletal (n = 1), and gastrointestinal and hepatobiliopancreatic anomalies (n = 25). In total, 12 patients experienced perioperative ventilation problems. Early postoperative complications (within 30 days) occurred in 21 patients, while 6 had late postoperative complications (after 30 days). Among non-surgical complications, we noted ventilation problems, sepsis (n = 7), and pneumothorax (n = 1). Surgical complications included adhesive bowel obstruction (n = 7), incisional hernia (n = 3), peritonitis (n = 3), dysfunctional duodenoduodenostomy or duodenojejunostomy (n = 3), pneumoperitoneum (n = 5), enteric fistula (n = 3), and volvulus (n = 4). Conclusions: Surprisingly, this retrospective study revealed that an Apgar score below 8, along with neurological and pulmonary abnormalities, is associated with postoperative complications. Conversely, other congenital anomalies, low birth weight, and age at admission do not serve as prognostic factors.

Chilaiditi Syndrome: An Incidental Finding on a Chest Radiograph in a Long-Term Ventilated Patient

Background: Chilaiditi syndrome is a situation with a structural impingement of the colon on the liver, leading to an elevated hemidiaphragm in the X-ray along with a gas-like ap-pearance in the right hemithorax. It is generally a benign disease that is managed conservatively upon diagnosis. Rarely, it can be a cause of intestinal obstruction. Chilaiditi syndrome was origi-nally named after Demetrius Chilaiditi, the Greek radiologist who first described the case in 1910 while working in Vienna. Case Presentation: Here, we have described the case of a 76-year-old male who was admitted to our long-term care facility for chronic respiratory failure, and he was connected to mechanical ventilation via tracheostomy. He was having occasional bouts of constipation, and was on regular laxatives. In a CT chest film done because of very thick respiratory secretions and desaturation, an incidental finding of Chilaiditi syndrome was noted. : The patient has been managed conservatively with laxatives and per-need enemas. : Chilaiditi syndrome is a rare condition in which the colon interposes between the liver, right hemidiaphragm, and the abdominal wall, causing occasional clinical symptoms. Conversely, radiographic findings without clinical symptoms are known to exhibit the Chilaiditi sign. The disease's prevalence is estimated to be somewhere between 0.025 and 0.28%. Conclusion: Chilaiditi syndrome is a syndrome that refers to the interposition of the colon upon the hepatic flexure. It is a very rare but a serious cause of constipation, resulting in severe symptoms to the extent that they may warrant surgical intervention.

Predictive Factors for Bowel Resection in Childhood Intussusception.

Intestinal intussusception is the most common cause of intestinal obstruction in infants and children under 3 years of age. Any delay in diagnosis or management can lead to intestinal ischaemia and perforation. The aim of this study is to determine the sociodemographic and clinical risk factors associated with bowel resection in infants and children with intussusception. This is a retrospective analytical study of 118 patients operated at the Hassan II Hospital and University of Fez between 1 January 2008 and 1 January 2018. A comparison of risk factors between patients with and without bowel resection was performed using multivariate logistic regression. One hundred and eighteen patients met the inclusion criteria. Of these, 44% had undergone bowel resection. Age >2 years (P = 0.006), duration of symptoms progression of more than 2 days (P = 0.002), bilious vomiting (P = 0.04) and palpation of an abdominal mass (P = 0.01) were significantly associated with bowel resection. Multivariate logistic regression showed that age <2 years (odds ratio [OR] =4.47 95% confidence interval [CI]: 1.12-17.78) and duration of symptom progression of more than 2 days (OR = 2.62 95% CI: 1.12-6.11) were independent risk factors for bowel resection. Intussusception that occurs in child old than 2 years of age, or which has progressed for more than 2 days, is associated with an increased risk of intestinal resection.

ОСЛОЖНЕННОЕ ТЕЧЕНИЕ БОЛЕЗНИ КРОНА ПРИ БЕРЕМЕННОСТИ

Crohn's disease is an inflammatory bowel disease of unknown etiology. This pathology more often affects young people, so it can occur during pregnancy and complicate its course. A case of intestinal obstruction caused by Crohn's disease during pregnancy was presented. Clinical manifestations are described; data from additional research methods and the results of morphological studies are presented. Particular emphasis is made on management of patients with acute surgical pathology during pregnancy. A brief review of the literature on this issue is presented. In the described case, the cause of intestinal obstruction was Crohn's disease, first diagnosed only during pregnancy. Complications of Crohn's disease are an indication for surgical intervention and not a reason for changing obstetric tactics: in most cases, pregnancy should be prolonged using specific therapy.

Ileo-sigmoid knotting presented as a rare cause of intestinal obstruction and bowel ischemia: A case report

Ileosigmoid knotting causing intestinal obstruction is also known as double volvulus or compound volvulus. It is a rare cause of intestinal obstruction. It involves the sigmoid and ileum causing closed-loop intestinal obstruction. The endoscopic decompression in ileosigmoid knotting may lead to perforation of intestine. We present a case of 80-year-old male patient who presented with ileosigmoid knotting at our surgical emergency setting.

Intestinal intussusception, colorectal cancer and intestinal endometriosis as a combined cause of intestinal obstruction: a case study

The paper describes a unique clinical case involving a patient with two tumours of mesenchymal and epithelial origin, along with ectopic endometriosis located within the cecum. This combination of pathologies resulted in colonic intussusception and subsequent colon-small intestine obstruction due to a cecal lipoma, compounded by colorectal cancer in the same area with local endometriosis foci. The surgical intervention involved laparoscopic resection of the terminal ileum, cecum, ascending, transverse, and descending colon, along with D2 lymphadenectomy and laparoscopically assisted ileosigmoid anastomosis. The patient was discharged in satisfactory condition on the 7th day post-surgery. This clinical observation garnered significant attention due to its atypical presentation of a rare complication, initially leading to a misdiagnosis and necessitating extensive intestinal resection for cancer under urgent circumstances with adequate lymph node dissection. Furthermore, the favourable treatment outcome despite the long-term presence of intussusception for at least one month underscores the noteworthy aspect of this case.

Intestinal Intussusception in Adults: A Diagnostic Challenge

Intussusception, a rare cause of intestinal obstruction in adults, accounts for only 1% of obstruction cases and 5% of all intussusceptions. Its global incidence is 1-3 cases per million per year. Early identification is challenging, which can lead to significant morbidity and mortality. In adults, intussusception is often associated with benign or malignant lesions, with primary adenocarcinoma being the principal cause. Preoperative diagnosis can be complex, and computed tomography (CT) is considered the preferred imaging modality. Most cases require surgical intervention, and the decision on whether to reduce before resection depends on the type and location of the lesion. Both laparoscopic and open surgeries are valid options, depending on clinical conditions and the surgical team's experience. We present the case of a patient in their fourth decade of life with a 15-day history, who presented to the emergency room with symptoms of intestinal obstruction secondary to intussusception. An emergency laparotomy was performed, revealing intussusception from the ascending colon to the transverse colon with a neoplastic-looking lesion in the cecum. A right radical hemicolectomy with intestinal diversion was performed. Histopathological examination revealed a moderately differentiated grade 2 adenocarcinoma.

Surgical Treatment of Gastric Trichobezoar in a Patient with Trichophagia: A Case Report

There are multiple causes of intestinal obstruction of mechanical origin, being a rare entity in young patients without underlying organic pathology or previous surgical interventions. The presence of a large bezoar in the gastric cavity as the origin of the obstructive condition is unusual, particularly that of trichobezoars, which is why we describe the following case We present a 19-year-old woman with a history of anxiety-depressive syndrome who has had a trichophagia disorder for the last year. Given the diagnosis of gastric sub-occlusive syndrome with diffi culty in ingestion secondary to large gastric bezoar, surgical intervention was decided to resolve the condition surgically

Persistent unmet need for surgical care in Western Uganda.

Treatable surgical diseases account for a significant proportion of the global burden of disease, particularly in low- and middle-income communities. The number of deaths owing to poor surgical care or its non-availability has been reported to exceed those from HIV/AIDS, tuberculosis and malaria combined. The Ugandan government and its development partners aim to put in place measures to achieve universal health coverage for all communities. These include construction and equipping health facilities, training of health workers, opening up road networks, and poverty alleviation programmes. However, these efforts have, as yet, fallen short as evidenced by external hernias remaining the leading cause of intestinal obstruction for more than 40 years. We recommend establishment of global surgery collaborations with rural-based medical training schools and other health facilities, essential surgical skills training for medical students, task shifting in surgical care and integration of regular surgical camps in the Uganda's healthcare delivery model.

Silent Danger: Uncovering Greater Omental Internal Herniation

Background: Internal hernias, though infrequent, are significant causes of intestinal obstruction, contributing to 0.2 to 4% of cases. Greater omental hernias, even rarer at 8%, predominantly affect older individuals, where senile atrophy often leads to omental defects. Objective: This study aims to highlight the importance of considering internal hernias in the differential diagnosis for intestinal obstruction, particularly in patients without prior abdominal interventions or trauma. Methods: We review a case of a 75-year-old female presenting with symptoms indicative of internal herniation, including the absence of significant historical abdominal insults. Diagnostic strategies involved physical examinations, imaging via X-ray and CT scans, and eventual surgical intervention. Results: The patient's initial presentation involved subacute obstruction symptoms, progressing to complete obstruction on the second day of admission. Imaging failed to reveal a definitive transition point, but suggested small bowel obstruction. Surgical findings confirmed an intact herniated bowel loop, successfully treated without complications. Conclusion: Internal hernias should be suspected in patients with intestinal obstruction symptoms, even in the absence of typical predisposing factors. Prompt recognition and treatment are crucial to prevent severe outcomes such as strangulation and necrosis.

A case of intermittent bilious emesis in a term neonate: a case report and brief review of literature

BackgroundNeonatal intestinal obstruction is a complex condition that poses challenge in management. Prompt recognition and appropriate management are crucial to prevent complications. We present a case of a term neonate with intermittent bilious vomiting.Case presentationThe baby underwent routinely performed investigations, including abdominal radiography and ultrasound, which provided inconclusive results. However, contrast-enhanced computed tomography revealed a web at duodenojejunal flexure. Exploratory laparotomy confirmed the diagnosis, and surgical intervention was performed. The baby’s postoperative course was prolonged with a gradual transition from parenteral nutrition to enteral feeds.ConclusionThis case highlights a rare cause of intestinal obstruction, the unusual location of duodenal web, the importance of maintaining a high index of suspicion for intestinal obstruction, even in the absence of classical signs, and the value of utilizing contrast-enhanced computed tomography when initial investigations are inconclusive.

Cecal volvulus, a rare cause of intestinal obstruction with incidental jejunal diverticula: an unusual case report

Cecal volvulus, a rare cause of intestinal obstruction with incidental jejunal diverticula: an unusual case report

Acute Intestinal Intussusception in Children at Somine Dolo Hospital in Mopti

Introduction: It is defined as the penetration of an intestinal segment and its meso into the lumen of the distal segment by a glove-like turning mechanism (invagination sausage) whose perpetuation results in obstruction of the intestinal lumen and the intestinal necrosis. Acute intestinal intussusception (IIA) or intussusception is the most common cause of intestinal obstruction in infants. IIA is primary or idiopathic in 90% and mainly affects infants between 2 months and 2 years with a peak frequency between 6 and 9 months. Objectives: To study acute intestinal intussusception in children aged 0 to 15 years in the general surgery department of the “SOMINE DOLO” hospital in Mopti. Method: This was a retrospective, descriptive study which took place from January 2017 to September 2020 in the general surgery department of the Sominé Dolo Hospital in Mopti. Result: During the study period, 1244 children were operated on including 32 cases of IIA, representing a frequency of 2.57% of surgical interventions. The male gender was in the majority (62.5%) with a sex ratio of 1.7. The average consultation time was 6.2 ± 4.3 days. Infants were the majority in 68.8% of cases and the main reason for consultation was abdominal pain (78.1%). The average treatment time was 2.9 hours. The ileocecocolic form was more frequent in 50% cases. Manual disinvagination was most often performed in 75% and the postoperative course was simple in 56.3%. Conclusion: AII is a common condition in our structure. It mainly affects infants and boys. Patients consult late but early treatment reduces mortality.

A case report on cocoon abdomen

Abdominal Cocoon is one of the rare causes of intestinal obstruction. A complete or partial small bowel encapsulation caused by thick fibro collagenous membrane. Cocoon Abdomen is otherwise called Sclerosing Encapsulating Peritonitis (SEP). This SEP is divided into two: abdominal cocoon (AC) also known as idiopathic or primary sclerosing encapsulating peritonitis, which is extremely a rare and secondary sclerosing encapsulating peritonitis, which is a common one. Symptoms are nonspecific and preoperative diagnosis was extremely difficult. Surgery is very essential to take membrane samples that confirm diagnosis and for treatment.

One-step approach by enterolithotomy as surgical treatment of biliary ileus associated with bridle: case report and literature review

Gallstone ileus is a rare cause of intestinal obstruction, more common in adults and in the context of late complications due to gallbladder stones. The pathophysiology describes long-term inflammatory processes of the gallbladder, with biliodigestive fistula development and passage of the gallstone into the intestine, impacting the terminal ileum in most cases. It manifests with data of intestinal obstruction in patients with a chronic history of gallbladder lithiasis. The ideal imaging study is a computed tomography (CT) scan of the abdomen to identify pneumobilia, intestinal obstruction and the lithiasis impacting on the bowel. The surgical approach depends on the context of each patient through laparoscopy or laparotomy in order to perform enterotomy and extraction of the stone or by performing also the management of the fistula and cholecystectomy at the same surgical time. Management must be individualized for each patient. We present the case of a patient in her tenth decade of life with a history of recurrent biliary colic without management, who was admitted to the general surgery department with data of probable intestinal occlusion. Imaging studies were performed, with radiographic evidence of distension of the small bowel loops and tomography with findings suggestive of biliary ileus. Due to the clinical context and comorbidities of the patient, laparotomy with enterotomy and extraction of the stone was performed.