Cause Of Acute Intestinal Obstruction Research Articles

Congenital trans-mesentric internal hernia: a rare cause of acute intestinal obstruction in adult

Introduction and Importance: Internal hernia is responsible for 0.6–5.8% of all small intestinal obstructions. Only 8% of internal hernias are of the congenital trans mesenteric variant. Urgent surgical intervention should be considered in individuals who exhibit intestinal obstruction before the development of irreversible bowel ischemia and necrosis. Case Presentation: The authors report a 38-year-old male patient who presented to the emergency department with abdominal pain, distension, and vomiting for the last three days. After an explorative laparotomy, it was confirmed that there was a trans mesenteric hernia defect with strangulated distal ileal loops. End-to-end ileo-ileal anastomosis was done. Clinical Discussion: Early recognition and subsequent surgical treatment permit proper management and prevent complications. There should be a differential diagnosis. In this case, there is no prior history of abdominal surgery, and the patient presents with recurrent abdominal pain and intestinal obstruction. Conclusion: Early diagnosis and emergency laparotomy can save the intestine before gangrene, lowering morbidity and mortality, correcting the mesenteric defect to prevent recurrences, and enhancing clinical outcomes because many studies have shown that some cases are missed before radiological investigation. Laparotomy is still the method of choice for acute cases of incarceration with bowel obstruction, strangulation, and ischemia. The entire mesentery needs to be evaluated, and all mesenteric defects need to be sutured to prevent recurrence.

Ileosigmoid knotting: A rare cause of acute intestinal obstruction and peritonitis

Introduction: Ileosigmoid knotting (ISK) is one of the rarer causes of bowel obstruction compared to others. This is also called compound volvulus or double loop obstruction. The presentation symptoms are similar to those of other large bowel or distal intestinal obstructions. But the pathogeny’s or disease’s progression is rapid. So the patient develops ischemia or strangulation of the involved segment of the bowel earlier than the sigmoid or ceal volvulus. One of the challenges of the disease is that, especially in low-income countries like ours, there is no access to contrast computed tomography (CT), which is more sensitive diagnostic imaging. Case Report: A 58-year-old male patient presented to our hospital with abdominal pain for two days. He was referred from the primary hospital. The pain was initially central and later diffused to other parts of the abdomen. Associated with this, he was vomiting of ingested matter for more than two episodes. On physical examinations, he was in acute pain, and his vital signs showed a pulse rate of tachycardia at 127 BPM. On abdominal examination, he had distention and diffused tenderness with gardening. So we diagnosed him with peritonitis secondary to gangrenous sigmoid volvulus obstruction (SVO). So I chose the imaging that is available in our hospital, a plain abdominal X-ray. So the patient was resuscitated with normal saline, an antibiotic was initiated, and he was taken to the operation after giving consent. The ilium and sigmoid colon were gangrened and en bloc resection was done, and the jejunum and remaining 7 cm of ilium from the ileocecal valve were anastomosed. The patient was taken to or for a relook, and the anastomosis was disrupted, then refreshed, and both the proximal and distal segments were taken out as stomas. The output was significant and later developed a controlled entrocutaneous fistula, which was closed after three weeks. Conclusion: The prognosis is poor for ISK compared to other common types of volvulus and worse prognosis challenging management in conditions with both active and passive bowel ischemia which happened to our patients. Diagnosis is also challenging before the surgery. The abdominal X-ray and ultrasound are available and commonly the surgeon commonly will not send for this unless the patient is stable. Blind rectal tube deflation the common intervention in our setup with no access for sigmoidoscopy is not indicated for this non-surgical initial management rather with a highly suspicious diagnosis early resuscitation with early surgical treatment.

Postpartum Ogilvie syndrome, cause of acute intestinal obstruction

Postpartum Ogilvie syndrome, cause of acute intestinal obstruction

Occlusion By Transmeso - Internal Hernia Congenital Sigmoid: About A Case

Internal hernia through a meso-sigmoid defect or hernia Transmesosigmoid is a rare cause of acute intestinal obstruction. Its diagnosis is most often made intraoperatively. Knowledge of its clinical particularities makes it possible to consider the preoperative diagnosis. We present 1 case of acute intestinal obstruction caused by a hernia Transmesosigmoid congenital in 1 adults. We discuss the clinical particularities of this rare form of internal hernia.

Chylolymphatic cyst as a rare cause of acute intestinal obstruction in infants

BackgroundChylolymphatic cysts are benign pathology in lymphatic vessels due to obstruction in the lymphatic system. Their incidence is still unknown. However, they account for approximately 3 to 9% of all pediatric lymphangiomas. Most of these lesions are asymptomatic and are discovered accidentally. They can be presented with nonspecific abdominal pain, vomiting, and changes in bowel habits. Rarely, chylolymphatic cysts can as intestinal obstruction, volvulus or even torsion.Case presentationA 3-month-old male presented to our unit with manifestations of acute intestinal obstruction. Abdominal examination revealed signs of generalized peritonitis and intestinal obstruction. Abdominal ultrasound revealed minimal turbid intraperitoneal collections and no motility of bowel loops. Plain erect abdominal radiograph revealed multiple small bowel air fluid levels. Abdominal exploration revealed a large chylolymphatic cyst causing acute intestinal obstruction. Excision of the cysts was done with preservation of adjacent bowel loop. The patient was discharged in good health on the 6th day postoperative. A chylolymphatic cyst with a diameter of 5 cm was identified by histological investigation.ConclusionsMost chylolymphatic cysts in infants are asymptomatic, but they can cause fatal complications such as intestinal obstruction, volvulus, or even torsion.

INCIDENCE OF ABDOMINAL TUBERCULOSIS IN CASES OF THE INTESTINAL OBSTRUCTION WITH ITS CLINICAL COURSE AND MANAGEMENT

Objective: Intestinal obstruction occurs due to the failure of passage of contents through intestine. It can be because of a mechanical or functional pathology. Main causes of intestinal obstruction may vary from country to country or among zones within a specific country. The aim of this study was to evaluate the etiology, presentation, management strategies, and patients with acute mechanical intestinal obstruction and to find incidence of abdominal tuberculosis at a tertiary care hospital in Punjab, North India. Methods: This prospective study was conducted in the Department of Surgery, Rajindra Medical College Hospital, Patiala, Punjab, India, between November 2020 and September 2022. A total of 100 patients were enrolled in our study who were diagnosed to have intestinal obstruction. Observation and Results: The most common age group affected was 21–50 years (63%). Intestinal obstruction was diagnosed with males preponderance (66%). Abdominal pain, constipation, and vomiting were the most common presenting symptoms and abdominal distension was the most common physical finding on the clinical examination. The most common radiological finding was multiple air fluid levels seen on X rays. The main cause of obstruction was Adhesions and Bands followed by Ileocecal tuberculosis. About 13% patients diagnosed with abdominal tuberculosis. Patients showed good response to anti-tubercular therapy. About 6% mortality rate was reported. Conclusion: Adhesions and bands were the main causes of acute intestinal obstruction in our region. An algorithmic diagnostic approach based on different radio investigations, biopsy, and appropriate management with a rational combination of anti-tubercular therapy can reduce the morbidity of this easily curable yet potentially lethal disease.

Spectrum of Clinical Presentations and Surgical Management of Tuberculous Small Intestinal Obstruction

Background: The causes of acute Intestinal Obstruction vary demographically. In the developing world, tuberculosis account for more than half of all cases of small bowel obstruction. Tuberculosis is a major health burden in developing countries. It can result some medical as well as surgical emergencies. Among the surgical emergencies, small gut obstruction is the burning issue. It can show wide spectrum of presentations. Objective: To find out spectrum of clinical presentations and surgical management of tuberculous small intestinal obstruction. Methods: It was a cross- sectional study conducted in the Department of Surgery, Sher-E-Bangla Medical College Hospital from July 2015 to December 2015. A total of 100 patients were selected by purposive sampling methods. The detail history and clinical examination findings were recorded including patient’s demographic profile and clinical as well as investigation findings. Preoperative findings and post-operative complications were also observed and recorded. Results: According to the result analysis, maximum patients were young adult and the highest patients (54%) came from 21-30 year’s age group followed by 31-40 year’s age group (18%). Among the respondents, 62% were male and 38% were female patients. The male to female ratio was 1.63:1. The results of clinical presentations revealed that all (100%) patients presented with abdominal pain followed by abdominal distension (78%) as small gut obstruction was mostly prevalent. Besides, constitutional features like weight loss and low grade and evening rise of temperature were present in almost all tuberculous patients. Operative findings revealed that single/multiple small bowel stricture in 80% patients followed by bands and adhesion in 14% patients. Strictures as well as perforation were present in case of 11% patients. Maximum operative procedures performed right hemicolectomy with ileo- transverse anastomosis (58%) followed by segmental bowel resection with end ........

Sigmoid Volvulus: A Narrative Review and Current Management

Sigmoid volvulus is a common cause of acute intestinal obstruction in older patients and the diagnosis is made by clinical examination and imaging. Sigmoid volvulus can be divided into complicated or uncomplicated clinical presentation. Once the diagnosis of sigmoid volvulus is made, the treatment is initially endoscopic decompression followed by flatus tube insertion. This is followed by surgical intervention which is sigmoid colectomy followed by anastomosis. For complicated sigmoid volvulus, the Hartmann’s procedure is the most common operation. We have conducted this review article to review the current management of sigmoid volvulus.

A CASE SERIES ON THE MANAGEMENT OF INTUSSUSCEPTION IN INFANTS: CHALLENGING ENTITY WHILE DEPLOYED IN REMOTE SETTINGS DURING OVERSEAS DEPLOYMENT

Intussusception is a major cause of acute intestinal obstruction in children. Idiopathic intussusception occurs predominantly under the age of 3 and is rare after the age of 6 years. This paper reports three cases of infant intussusception, including one Ileo-ceaco-colic intussusception in an 8-month-old baby boy (an uncommon condition in small infants) treated at the peripheral hospital during deployment in remote settings. This case series highlights diverse signs and symptoms of intussusception, and very few cases present with a typical triad of intussusception (abdominal pain, vomiting, and red currant jelly stool). Strong clinical suspicion is required for the diagnosis of intussusception, especially in a remote peripheral setting where diagnostic facilities are scarce. Furthermore, the surgeon should be ready for a surprise challenge after opening Pandora’s box. Delay in diagnosis may result in complications such as perforation, necrosis, and death. An important lesson learned from these three different cases is that the postoperative behavior of surgically reduced intussusception differs from case by case, and we have to be careful and alert during the postoperative period.

Idiopathic Small Bowel Volvulus: A Case Report

Idiopathic small bowel volvulus is a rare cause of acute intestinal obstruction by strangulation in adults and is defined by the twisting of a segment of the small bowel around its mesenteric axis with no obvious underlying congenital or acquired cause.
 This article reports the case of a 56-year-old patient, chronic smoker and cannabis user, who was admitted with febrile occlusive syndrome and generalized abdominal contracture.
 The abdominal CT scan showed a distension of the small intestines upstream of a probable small bowel volvulus, associated with signs of digestive distress.
 Surgical exploration revealed a large peritoneal effusion of distressed fluid, with a volvulus of the distal small bowel causing 1.80 m of small bowel and coecum necrosis from 2.20 ADJ without rotational abnormality or docking defect.

Ileo-ileal knotting masquerading as internal hernia: a rare cause of acute intestinal obstruction

Intestinal knotting is a rare cause of acute intestinal obstruction and in most cases is diagnosed intraoperatively due to its rarity and uncommon presentation. Out of different types of intestinal knots, ileo-ileal knotting is rarest and very few such cases have been reported in the literature. Due to very high mortality, early diagnosis and immediate surgical intervention are needed. Here we present a case of a 52-year-old male patient who presented with a history of non-passage of stool and flatus, after resuscitation patient was planned for exploratory laparotomy. Findings revealed gangrenous ileal loops and an ileo-ileal knot masquerading as an internal hernia. End-to-end anastomosis of the gangrenous ileum was done along with a decompressive proximal loop ileostomy. The patient was transferred to the intensive care unit after surgery. He died on postoperative day 1 due to metabolic acidosis with endotoxic shock. By reporting this case we want to emphasize on the need of keeping intestinal knots as a differential diagnosis while operating a case of acute intestinal obstruction.

The Ileo-Sigmoid Knotting a Rare cause of Acute Intestinal Obstruction: About a Case

The ileosigmoid knotting is an exceptional clinical entity, it is a surgical emergency characterized by a strangulation of the small bowel by forming a knot around the base of the sigmoid colon with risk of rapid necrosis of the small bowel and colon. We report the case of a young women admitted for intestinal obstruction; and in which the diagnosis of ileo-sigmoid knotting was made on CT. Through this case and a review of the literature we will define the diagnostic, therapeutic and prognostic aspects of this rare clinical entity.

Ileosigmoid knotting: a rare cause of acute intestinal obstruction in an elderly patient

Ileosigmoid knotting (ISK) is difficult to diagnose preoperatively due to its rarity and uncommon presentation. It has a high mortality rate; hence early diagnosis and immediate surgical intervention are required. This report describes a case in an 80-year-old male patient with gangrenous ileal loops and sigmoid colon and was managed with resection of gangrenous bowel loops and double stoma, Patient was discharged with a functional stoma and good well-being and was further followed up.

Клинический случай Диоспиробезоара, осложненного острой кишечной непроходимостью

INTRODUCTION: Bezoars are foreign bodies formed in the digestive tract as a result of ingestion of some indigestible substances: plant fibers, hair and animal dander, chemical compounds. They are mainly found in animals. But although this is an extremely rare pathology of humans, it can be complicated with such threatening conditions as acute intestinal obstruction, decubitus ulcers of the digestive tract, gastrointestinal bleeding and perforation with the development of peritonitis. Bezoars are the cause of acute intestinal obstruction in only 2–4% of cases, but mortality, according to the literature, can reach 30%. Difficulties in the clinical diagnosis of bezoar disease lie in the absence of specific symptoms: it manifests itself as an abdominal syndrome, like a rather wide range of various diseases. Therefore, the importance of informing physicians of various profiles both about the factors provoking the formation of bezoars and about the methods of their diagnosis and treatment is undeniable. The article presents a case report of an 86-year-old female patient with acute intestinal obstruction caused by diospyrobezoar. CONCLUSION: The clinical interest of the presented case lies in its highly illustrative character. We could observe a combination of all predisposing factors for the formation of diospyrobezoar, compare the effectiveness of various methods of instrumental diagnostics and apply the optimal tactics of surgical intervention.

Strangulated transomental hernia: case report and literature review

Internal hernias are a rare cause of acute intestinal obstruction and are defined as an incarceration of the small bowel through a natural or abnormal intra-abdominal orifice. Transomental internal hernias represent 1 to 4% of all reported internal hernias and are generally observed after the age of 50years old. Imaging is still of interest in the diagnosis of obstruction, but only 8% of transomental hernias would be diagnosed pre-operatively. Their surgical management is done urgently, either by laparotomy or by laparoscopy. We report a case of a patient with an occlusive syndrome and whose diagnosis of a strangulated transomental hernia was per operative.

Rupture of a peritoneal hydatid cyst: Rare cause of acute intestinal obstruction

Intraperitoneal rupture of the primary peritoneal hydatid cyst with an intact proligerous membrane is rare. We report the case of a 5-year-old girl who had consulted for febrile occlusive syndrome. Abdominal scan without injection found mechanical obstruction without finding the cause. Surgical exploration found a univesicular hydatid cyst of the peritoneum in the right iliac fossa ruptured with an intact proligerous membrane and blocked by the intestinal loops. The aim of this work is to report a new case of intraperitoneal rupture of a hydatid cyst with intact proligerous membrane and to specify the diagnostic and therapeutic difficulties met during this complication.

PATTERN, MANAGEMENT AND OUTCOME OF ACUTE INTESTINAL OBSTRUCTION AT CHITWAN MEDICAL COLLEGE TEACHING HOSPITAL

Background: Acute intestinal obstruction is one of the commonly encountered emergencies in surgical practice. Gynecological surgery, especially adnexal surgery and hysterectomy has a higher incidence of bowel obstruction as compared to bowel surgery. Conservative management can be done in patients with post-operative adhesive bowel obstruction if there is no evidence of ischemia, bowel necrosis, or perforation. Therefore, a correct diagnosis is essential for appropriate management. We conducted a study to evaluate the etiology, clinical presentation as well as management and outcome of patients presenting with Acute intestinal obstruction at our center. Methods: This was a retrospective study of all the patients with a diagnosis of Acute intestinal obstruction from January 2015 to December 2019. The diagnosis of Acute intestinal obstruction was made by a combination of clinical and radiological parameters. The data were analyzed using Statistical Package for Social Sciences (SPSS) for Windows version 16. The data were expressed in number and percentage. Results: During the study period, 178 patients were admitted with the diagnosis of Acute intestinal obstruction. Abdominal pain and vomiting were the main complaints seen in 98.3% (n=175) and 84.8% (n=151) respectively. Hernia (n=49, 27.5%) was the most common cause of acute intestinal obstruction in adults, and Intussusception (n=15, 8.4%) was the leading cause of Acute intestinal obstruction in a pediatric age group. Majority of the patients’ needs (n=148,83.1%) operative intervention to relieve the obstruction. The overall mortality rate was 6.7% (n=12). Conclusions: Hernia was the most common cause of Acute intestinal obstruction in adults while intussusception was the commonest in the pediatric age group.

ASSESSMENT AND MANAGEMENT OF INTESTINAL OBSTRUCTION IN PATIENTS ATTENDING TERTIARY CARE INSTITUTE

Background and Aim: Bowel obstruction is the most common intra-abdominal problem faced by general surgeons in their practice. Therefore better understanding of pathophysiology, improvement in diagnostic techniques, fluid and electrolyte correction, much potent antibiotics and knowledge of intensive care is required. present study was undertaken to study the management and post-operative complications of intestinal obstruction.
 Material and Methods: This is a prospective study of 97 cases presenting with symptoms and signs suggestive of acute intestinal obstruction. All patients are subjected to required preoperative biochemical investigations. Patients who showed reduction in abdominal distention and improvement in general condition especially in individuals with postoperative adhesions, a chance of conservative management was taken (by extending the supportive treatment) for further 12 to 24 hours; those who showed improvement by moving bowels, reduction in pain and tenderness was decided for conservative treatment, such individuals were excluded in this study.
 Results: The occurrence of acute intestinal obstruction was common in male in comparison with female. The commonest presenting symptom was abdominal pain (100%) followed by vomiting (92.7%), distention of abdomen (87.6%) and absolute constipation (53.6%). In this study, Adhesive obstruction (56.7%) was the commonest cause of acute intestinal obstruction. Release of adhesions and bands was done in 43 cases. Resection and end-to-end anastomosis was done in 25 cases, which included cases of intussusceptions, adhesions, stricture, ileocaecal growth, colonic growth.
 Conclusion: Most common etiological factor for intestinal obstruction is postoperative adhesions. Obstructed Inguinal Hernia is second most common cause of intestinal obstruction. Clinic radiological and operative findings put together can bring about the best and accurate diagnosis of intestinal obstruction.
 Key Words: Abdominal pain, Adhesions, Bands, Bowel obstruction, Inguinal Hernia,

Management of Symptomatic Meckel's Diverticulum in Infants and Children

Objectives The primary objective of the present study was to review the demographics of infants and children operated upon for Meckel's diverticulum. The secondary objectives were to review the clinical characteristics, surgical procedures performed, postoperative complications, and the outcome. Materials and Methods This study is a single-institutional, retrospective study and descriptive in nature. It consisted of infants and children below 12 years who were operated upon for Meckel's diverticulum at the author's institute and included data from January 1, 2000 to December 31, 2020. Results Eighty-four children below 12 years were operated upon for Meckel's diverticulum during the study period. The ratio for males to females was 3:1. This study consisted of infants, (n = 22, 26.19%), children of 1 to 5 years of age (n =19, 22.61%), and children of 6 to 12 years of age (n = 43, 51.19%). Clinically, children with Meckel's diverticulum presented in the following order of frequency: (1) intestinal obstruction (n = 59, 70.23%), (2) perforation peritonitis (n = 17, 20.23%), (3) lower gastrointestinal bleeding (n = 4, 4.76%), and (4) incidental finding (n = 4, 4.76%). In 35 (41.66%) children, bowel gangrene was detected. One-fifth (n = 17) of Meckel's diverticulum was responsible for the secondary intussusception. The surgical procedures were performed in the following order of frequency: (1) resection of Meckel's diverticulum, an adjacent segment of ileum and ileoileal anastomosis (n = 36, 42.85%); (2) Meckel's diverticulectomy (n = 32, 38.09%); (3) resection of Meckel's diverticulum, an adjacent segment of ileum with or without cecum and an ileostomy (n = 12, 14.28%); and (4) resection of Meckel's diverticulum, an adjacent segment of ileum, cecum, part of the colon, and ileocolic anastomosis (n = 4, 4.76%). In 8 (9.52%) children, complications were documented during the postoperative period. The present study observed three (3.57%) deaths during the postoperative period. Conclusion Meckel's diverticulum was one of the common causes of acute intestinal obstruction in infants and older children. Ninety percent of children with Meckel's diverticulum presented with features of an acute abdomen. Forty percent of children evidenced bowel gangrene during the surgical procedures. In these children, early diagnosis, timely referral, and institution of surgical therapy for acute abdomen/intestinal obstruction may prevent the development of bowel gangrene and the requirement of bowel resections to some extent.

Outcome of ultrasound guided reduction of intussusception in children by saline enema

Background: Intussuception is a common cause of acute intestinal obstruction in children and contributor of morbidity and mortality in children. The purpose of this study was to evaluate efficacy of hydrostatic reduction of intussusception over operative reduction using normal saline enema in children and to identify procedure related complications.Methods: All patients presenting to us with features of intussusception clinically and confirmed by ultrasonography between June 2015 to November 2017 were included in study. Depending on haemodynamic stability of patient and surgeon’s preference, patients were subjected to trial of hydrostatic reduction by normal saline enema or operative procedure. Patients with failure or partial reduction were taken for surgery.Results: The mean age was 21.07 months with a male preponderance. Of 53 patients attending the institute, 32 were given a trial of hydrostatic reduction which was successful in 28. Thus success rate was 87.5%. 1 patient succumbed resulting in 1.4% mortality rate after the procedure. It was observed that longer duration of symptoms reduced chances of reduction. 88%patients with successful hydrostatic reduction were discharged within 4 days of admission.Conclusions: We conclude that ultrasound guided saline enema is simple ,safe and effective method of treating intussusception in children with low rate of complications and can be strongly recommended as first line of treatment of intussusception in select group of paediatric patient, especially those reporting early to the hospital.