Cause Of Acute Bowel Obstruction Research Articles

Exploring the infectious contribution to intussusception causality using the effects of COVID-19 lockdowns in Australia: An ecological study.

Intussusception is the primary cause of acute bowel obstruction in infants. The majority of cases under 2 years of age are classed as idiopathic with viral infection implicated as one of the causes. COVID-19 public health measures led to significant decreases in communicable disease prevalence. During these times, reductions in intussusception frequency were reported - reductions greater than would be expected with our previous understanding of its infectious aetiology. We conducted a retrospective, multi-state, ecological study over a twelve-year period. Monthly case numbers of ICD-10-AM K56.1 'Intussusception' coded admissions were acquired from state-wide admissions datasets from New South Wales (NSW), Victoria and Queensland, representing 77.62% of the eligible Australian population. These counts within differing jurisdictional lockdowns were compared to non-lockdown periods in order to investigate a correlation between intussusception frequency and lockdown periods. We found a negative association between intussusception frequency and lockdown periods in both eligible states. The largest reductions were seen in the under 2 year age groups with Victoria experiencing a 62.7% reduction (Rate ratio (RR) = 0.37, p < 0.0001) and NSW a 40.1% reduction (RR = 0.599, p = 0.006) during lockdown times. Controls for variations in lockdown restrictions between both regional and metropolitan areas also showed expected decreases. Our ecological study demonstrates significant decreases in the frequency of paediatric intussusception admissions during the COVID-19 lockdown periods. The unexpected magnitude of the reductions suggests that the true proportion of infectious disease-caused idiopathic intussusception is greatly underestimated.

Richter port site hernia as cause of acute bowel obstruction after laparoscopic gastric bypass: A case report

Introduction: Early post-operative small bowel obstruction is challenging. After laparoscopic surgery, port site herniation and herniation through a peritoneal defect into the preperitoneal space should be considered as causes of early post-operative small bowel obstruction. Case Report: A 36-year-old female developed early post-operative small bowel obstruction due to port-site Richter hernia after laparoscopic gastric bypass managed by diagnostic laparoscopy. Conclusion: Early post-operative small bowel obstruction should always be suspected and diagnosed early in certain high risk procedures.

Clinical Features and Outcome of Saline Hydrostatic Reduction in Patients with Intussusception in a Tertiary Care Centre

Background: Intussusception is one of the most frequent causes of acute bowel obstruction in infants and toddlers. Abdominal sonogram is highly specific, accurate and is the first line diagnostic modality. The primary treatment options are non-operative hydrostatic or pneumatic reduction. In our institution, we use normal saline for reduction of intussusception under ultrasound guidance (USGR). The aim of the study is to analyse the clinical pattern and treatment outcome of intussusception. Methodology: Retrospective analysis of all cases admitted with intussusception in our department during 2014-2018 was done. Results: 785 cases (527 males: 258 females) with a mean age of 25 months and median of 16 months had abdominal pain (92.5%), vomiting (59%) and blood in stools (32%) as the predominant symptoms. 710/785 cases (90.4%) underwent successful USGR and 75/785 of the failed cases underwent surgery. Age group &lt; 12 months, presence of blood in stools irrespective of its duration and prolonged vomiting &gt;48 hours were found to be significant factors for failed USGR. Vomiting and blood in stools were found to be significantly higher in children &lt;12 months of age (p&lt;0.005), whereas pathological lead points were more frequent in children &gt;3 years of age. Conclusion: With a high success rate and no significant complication rate, USGR is an effective non-operative treatment modality for intussusception. Age group &lt;12 months, prolonged vomiting and presence of blood in stool were found to affect the success rate of hydrostatic reduction. Keywords: Intussusception, saline, ultrasound, hydrostatic reduction.

Operative Management and Outcomes of Patients with Sigmoid Volvulus at a Tertiary Public Hospital in Malawi

Background: Sigmoid Volvulus (SV) is a common cause of acute bowel obstruction in Malawi. We aimed to  describe the surgical  management of SV and its outcomes at Kamuzu Central Hospital, Lilongwe, Malawi.&#x0D; Methods: We retrospectively reviewed records from January 2019 to December 2019 of all SV patients, aged 18 years and above. Data  extracted included age, sex, admission date, surgery date, bowel viability at time of surgery, procedure done, suspected anastomotic leakage, length of hospital stay and mortality. The data was analyzed using STATA 14.0.&#x0D; Results: There were more males (n= 59, 81.9 %) than females. The median (IQR) age was 50.5 (38-60) years. A viable sigmoid colon was present in 61 (84.7%) patients. The commonest procedures done were sigmoid  resection and primary anastomosis (RPA) (59.7%, n=43) and Hartmann’s procedure (HP) (36.1%, n=26). The median length of hospital stay was 5 days in HP, 7 days in RPA and longest in  mesosigmoidopexy (10 days). Suspected anastomotic leakage occurred in 2(4.7%) patients. The overall mortality was 6.9% with all deaths occurring in RPA patients.&#x0D; Conclusion: Mortality is high in SV patients who undergo RPA. We recommend Hartmann’s procedure in cases where the bowel has  significant oedema or is gangrenous.

Trans-anal protrusion of intussusception (TAPI) revisited: managed successfully in a resource limited hospital setting

Intussusception is the most common cause of Acute bowel obstruction in infants and toddlers. However, a Trans-anal protrusion of an intussusception (TAPI) is relatively rare and is not well reported in literature. A high index of suspicion is essential as the diagnosis is purely clinical, and often confused with rectal prolapse. Most patients present late due to neglect on the part of the parents or the primary treating physician. A late presentation usually results in a poor outcome and increased morbidity and mortality. Uncommonly these children may present early, where a prompt surgical management is desirable. The author reports a single case of a Trans anal protrusion of intussusception (TAPI) in a 1-½ -year old female child who was successfully managed in the author's resource-limited teaching institution without a dedicated pediatric surgery unit.

Study of Clinical Features, Etiology and Operative Management of Acute Intestinal Obstruction in Adults

Introduction: Acute bowel obstruction is an emergency. It should be diagnosed early and treated promptly, if not the patient’s life may be endangered. Hence it is essential for every surgeon to have complete knowledge of this condition. Aims &amp; objectives: To study clinical presentation, various etiologies and management of acute intestinal obstruction in adults. Material and Methods: Present study was a hospital based prospective study conducted over period of 2 years. Hundred patients admitted with acute bowel obstruction were evaluated on basis of detailed clinical history and physical examination. Results: Presenting symptoms were pain (100%), constipation (99%), vomiting (94%), fever in 54% of the cases. Obstipation was least common symptom (40%), distension was next commonly seen sign (89%) followed by abdominal tenderness (100%). Patients with absent bowel sounds were 68%, 18% patients showed evidence of hypotension. Causes of obstruction were: adhesions (27%), obstructed external hernias (19%) followed by volvulus (15%), pseudo obstruction (3%). For postoperative adhesions appendectomy was most common cause (44.44%) followed by gynecological operations and perforation peritonitis. Conclusion: Abdominal pain was most common presenting symptom of acute intestinal obstruction. Most common sign of acute obstruction was tenderness followed by abdominal distention and absent bowel sounds. Small bowel obstruction was more common than large bowel. Most common cause of acute bowel obstruction in adults was adhesions followed by obstructed external hernias and Volvulus. In large bowel obstruction, malignancy was most common cause. Most common procedure performed for acute bowel obstruction in adults was resection and anastomosis followed by adhesiolysis.

High frequency of internal hernias after Roux-en-Y gastric bypass.

Internal hernias (IH) after Roux-en-Y gastric bypass (RYGB) are a serious concern among surgeons and are often under-diagnosed due to heterogeneity of clinical manifestations. Our aim is to assess the frequency of IH after a RYGB in symptomatic and asymptomatic patients. Retrospective analysis of our bariatric surgery unit's database between 2001 and 2013 is obtained. Patients are surgically explored after RYGB due to acute bowel obstruction (ABO), intermittent abdominal pain (IAP), or being asymptomatic (during an elective cholecystectomy) in whom anatomical presence of IH was established. Also, we compared patients with retrocolic and antecolic technique. Statistical analysis with non-parametric tests and chi-square are used. Of the patients, 3,656 submitted to RYGB during this period, 81.9% (2,993) by laparoscopy and 26.3% (963) with retrocolic technique. Of the patients, 130 (3.5%) were surgically explored due to ABO, 27 patients (0.7%) due to IAP, and 93 patients (2.5%) submitted to an elective cholecystectomy with exploration for IH. IH was present in 75% of the obstructed patients, and in 69%, it was the cause of obstruction. Patients with IAP showed 59% of IH, but only 15% have herniated bowel. In asymptomatic patients, 25% showed IH and none of them have herniated bowel. Retrocolic technique showed a higher risk of whole causes of ABO and IH than the antecolic technique, with a relative risk of 1.53 (1.07-2.17) and 1.62 (1.06-2.47), respectively. A high frequency of IH exists in all operated patients of this series. All members of the bariatric team should be aware of the symptoms related to IH and actively pursue it during follow-up.

Role of multidetector computed tomography (MDCT) in diagnosis of secondary intussusception in children

IntroductionIntussusception occurs when a segment of bowel, the intussusceptum, prolapses and invaginates into another segment, the intussuscipiens. It is the most common cause of acute bowel obstruction in infants. Over 90% of childhood intussusceptions are idiopathic, perhaps related to relative hyperplasia of lymphoid follicles in the distal ileum. Underlying pathologic lead points are uncommon. Lymphoma, polyps, Meckel’s diverticulum and hematoma are most common identified lead points in children. Aim of the workTo assess the role of multidetector computed tomographic imaging in the diagnosis of secondary intussusception with pathological leading points in children. Materials and methodsThis study is a retrospective study including 12 children referred to the radiodiagnosis department at Alexandria University Hospitals presenting with signs of acute abdomen, in the period between June 2012 and January 2013, all of which were radiologically diagnosed by computed tomographic imaging as secondary intussusception with pathological leading points which were confirmed by surgery. All the studied patients were subjected to full history taking, thorough clinical examination, laboratory investigations and CT of the abdomen and pelvis: using multidetector row CT. ResultsAll the patients were radiologically diagnosed by computed tomographic imaging as secondary intussusception with pathological leading points which were confirmed by surgery. The associated leading points detected in our cases were reactive mesenteric lymph nodes in three patients, lymphoma in four cases, one post appendectomy case, mesenteric lymphangioma in one case, malrotation in one case and Meckel’s diverticulum in another one case. Intramural hematoma was detected in one case diagnosed as Henoch–Schönlein purpura (8.33%). ConclusionsFinally we conclude that multidetector CT could efficiently diagnose children presenting with secondary intussusceptions.

Simultaneous Intussusception in Monozygotic Twins

Intussusception is a well-known disease, and one of the most frequent causes of acute bowel obstruction in children aged 3-18 months, with an incidence of 0.1-0.4% of live births. Although idiopathic intussusception has not been considered a genetic disease, it has also been reported in families and relatives (1-4). Herein, we present the first case report in the English literature of simultaneous occurring intussusception in monozygotic twins.

A rare cause of acute bowel obstruction in adult

A rare cause of acute bowel obstruction in adult

Volvo de ceco complicado por icterícia séptica

Cecal volvulus is an uncommon cause of acute bowel obstruction in adults. The mechanism is torsion of the enlarged, poorly-fixed or hypermobile cecum. Patients with this condition may display highly variable clinical presentations, ranging from intermittent, self-limiting abdominal discomfort to acute abdominal pain associated with intestinal strangulation and sepsis. The treatment needs to be individualized for each case, but surgical management is required in almost every case. In the presence of gangrene or perforation of the cecum, resection and primary ileocolic anastomosis is recommended. However, in non-complicated cases detorsion and cecopexy are adequate. The authors report one case of cecal volvulus in a 55-year-old women treated with cecopexy that complicated with septic jaundice.

Pattern of acute intestinal obstruction: Is There a change in the underlying etiology?

Background/Aim:To study the changing pattern of acute intestinal obstruction at a teaching institute.Patients and Methods:It is a prospective descriptive study conducted at a teaching hospital during the period from June 2004 to June 2009. All patients with clinical or radiological evidence of acute intestinal obstruction were included in this study regardless of the gender of the patient. Patients below the age of 10 years were excluded from the study. The treatment strategy was planned ranging from conservative treatment to emergency laparotomy after resuscitation and rehydration of the patient. Details of individual patients were recorded on a pro forma sheet and data analyzed statistically on SPSS version 14.Results:A total of 229 patients with acute intestinal obstruction were admitted and treated. The mean age of the study population was 43.08 ± 13.07 years. Postoperative adhesions accounted for 41% (n= 95) of the total cases, followed by abdominal tuberculosis (25%, n= 58), obstructed/ strangulated hernias of different types (18%, n= 42). There was an obvious change in the pattern of etiology of acute intestinal obstruction as the common causes were postoperative adhesions and abdominal tuberculosis instead of obstructed inguinal hernias.Conclusion:An increase in the adhesive obstruction and a concomitant decrease in the incidence of obstructed hernias indicate a changing trend towards early operation before it gets complicated. Abdominal tuberculosis is emerging as another common cause of acute bowel obstruction.

A report of 15 cases of small-bowel obstruction secondary to phytobezoars: Predisposing factors and diagnostic difficulties

Phytobezoars are a rare cause of acute bowel obstruction. The purpose of this work was to identify the predisposing factors and diagnostic difficulties of this rare entity. This was a retrospective study including all cases of small-bowel obstruction secondary to phytobezoars observed between April 2001 and August 2007. The diagnosis of bezoars was established by surgical exploration or by computed tomography (CT). During the study period, 375 patients were hospitalized at our institution with a diagnosis of bowel obstruction that, in 15 (4%) cases, was secondary to phytobezoars. The average patient age was 55 years, with a gender ratio of 1.7, favoring men. The predisposing factors were gastroduodenal surgery for peptic ulcer in nine patients, and excessive consumption of prickly pears (cactus figs) in 12. The diagnosis was established by CT scans in three patients, who were successfully treated with gastric aspiration, thereby avoiding surgery. Laparotomy was performed in 12 patients to allow digital fragmentation of the bezoar, which was then washed into the colon. There were no postoperative deaths and morbidity was about 13%. An abdominal CT scan should be obtained for patients with small-bowel obstruction. This examination offers a precise diagnosis of bezoars, reducing the number of unnecessary surgical procedures, and helping to guide the approach if surgery is needed.

Accuracy of ultrasonography for the diagnosis of intussusception in infants in Vietnam

Intussusception (IS) is the most common cause of acute bowel obstruction in infants and young children. Ultrasonography is being increasingly used as the primary investigation for the diagnosis of IS and to guide air or hydrostatic enema reduction. However the accuracy of ultrasonography outside tertiary care settings in developed countries has not been assessed, particularly in Asia where the incidence of IS based on sonographic diagnosis has been reported as the highest in the world. The aim of this study was to evaluate the accuracy of ultrasonography in the diagnosis of acute IS in infants less than 2 years of age in a paediatric hospital in Vietnam. A prospective study was conducted at the National Hospital for Paediatrics, Hanoi, Vietnam, over a 14-month period recruiting patients <2 years of age with IS. Abdominal ultrasonography was performed on each patient and the accuracy of the diagnosis was evaluated against the final diagnosis provided by air enema and/or surgery. A total of 640 infants <2 years of age presented with clinical symptoms and signs of IS. The diagnosis was confirmed in 533 patients via air enema or surgery. Abdominal ultrasonography was 97.5% (466/478) sensitive and 99% (106/107) specific in the detection of IS. Ultrasonography is an accurate, safe and valuable clinical tool in the diagnosis of IS. The use of ultrasonography as a primary investigation for patients with suspected IS prevents unnecessary radiological or surgical procedures being performed, and reduces radiation exposure while maintaining a high level of diagnostic accuracy. These results validate the use of ultrasonography for the diagnosis of IS in a developing country setting.

Malrotation with volvulus: a rare cause of acute bowel obstruction in an adult

Malrotation with volvulus: a rare cause of acute bowel obstruction in an adult

A Report of Three Cases of Small-Bowel Obstruction Arising from Mesenteric Defects, with a Review of the Literature.

Herniation of small bowel through defects in the gastro-intestinal mesentery is a rare cause of acute bowel obstruction. Its possible presence must be borne in mind if the clinical condition of the patient suggests bowel obstruction, despite the absence of external herniae and in the absence of any history of previous abdominal surgery. Early operation is essential, and three cases of the condition are now reported. The relevant literature is reviewed.