Cause Of Acute Intestinal Obstruction Research Articles

Study of clinical spectrum and management of acute intestinal obstruction

Background: Acute intestinal obstruction is one of the major surgical emergencies. Intestinal obstruction is defined as partial or complete interference with forward flow of small or large intestinal contents. Intestinal obstruction of either small or large bowel continues to be a major cause of morbidity and mortality. Study aims to find the aetiology, diagnosis and management of acute intestinal obstruction.Methods: A total of 135 patients of acute intestinal obstruction was studied from November 2013 to October 2015 in government medical college, Nagpur. Study was done in patients in OPD of this tertiary centre. Inclusion criteria being patients coming to the hospital with features suggestive and further confirmed of acute intestinal obstruction. Patients included were in, age group of 18 years to 80 years giving written informed consent. Patient of pseudo obstruction were excluded from the study.Results: A total of 135 patients, presented with acute intestinal obstruction during the period of the study. Mean patient age was 45.87 years with peak incidence in those aged 21-30years. The foremost signs and symptoms were constipation (85.93%) and abdominal pain (91.11%). Adhesions and bands (61.9%) was the leading causes of intestinal obstruction.Conclusions: Present study concluded that small bowel obstruction is more common than large bowel obstruction. Abdominal pain, constipation and distension are the most common symptoms, while increased bowel sounds, tachycardia and tenderness is most common sign. Post-operative adhesion in small bowel and malignancy in large bowel is major cause of acute intestinal obstruction.

Internal hernia: Isolated small intestinal peritoneal encapsulation, a rare cause of acute intestinal obstruction in adolescent: A case report

Intestinal peritoneal encapsulation as the sole cause of acute intestinal obstruction in adolescent is rare. It poses a diagnostic dilemma where there is lack of high technological equipment to aid diagnosis, usually confirmed at surgery. A good knowledge of this condition will raise the index of suspicion and guide prompt surgical intervention, thus this report.Keywords: acute intestinal obstruction, adolescent, peritoneal encapsulation

РОЛЬ УЗИ И ВИДЕОЛАПАРОСКОПИИ В ДИАГНОСТИКЕ И ЛЕЧЕНИИ ОСТРЫХ ХИРУРГИЧЕСКИХ ЗАБОЛЕВАНИЙ ОРГАНОВ БРЮШНОЙ ПОЛОСТИ У ДЕТЕЙ

Objective: To improve the results of diagnostic and treatment of acute surgical diseases of organs of the abdominal cavity (ASDOAC) in children. Methods: The work is based on the study of 327 seek children with different ASDOAC at the age of 2 to 15 years. The boys were 125 (38.2%), girls – 202 (61.8%). The ASDOAC included: acute appendicitis and its complications – 163 (49.9%), pathology of pelvic organs – 139 (42.5%), intussusception – 14 (4.2%) and pathology of Meckel's diverticulum – 11 (3.3%) of cases, of which in 5 – Meckel's diverticulum was the cause of acute intestinal obstruction. Results: Suggested therapeutic and diagnostic tactics for ASDOAC in children with the extensive use of ultrasound and video laparoscopy is rational and very effective. Sensitivity and specificity of ultrasound in the diagnosis of ASDOAC was more than 92%. Video laparoscopy is also a highly informative, relatively safe and objective method for diagnosing ASDOAC in children and in 100% of cases, it allows to clarify the diagnosis and choose the optimal tactics for surgical treatment. Conclusion: Comparative analysis of diagnosis and treatment of ASDOAC convincingly proves that traditional methods are much inferior to video-laparoscopic operations on the severity of the operating period, the number of postoperative complications, the normalization of clinical and laboratory parameters, the reduction in hospitalization of patients, and cosmetic results, especially in girls. Keywords: Ultrasound, video laparoscopy, acute surgical diseases of the abdominal cavity organs.

Diagnosis and treatment of gallstone intestinal obstruction

To analyze informative value of radiological examination in diagnosis of acute gallstone intestinal obstruction. Diagnosis and treatment of 7 patients with acute gallstone intestinal obstruction have been analyzed. Diagnostic protocol included radiography of abdominal cavity, sonography and computed tomography. Computed tomography within the first hours after hospitalization is highly informative to diagnose gallstone intestinal obstruction if other methods are ineffective. Inclusion of computed tomography into survey algorithm optimizes diagnostic process, clarifies the cause of acute intestinal obstruction and promptly determines the indications for video-assisted surgery.

Clinical study of bowel obstruction in relation to etiological factors

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 aims of this study was to analyse various modes of presentation of acute intestinal obstruction in both children and adult age group, etiopathogenesis, various therapeutic modalities of treatment and to accomplish operative management and anticipate the post operative complications.Methods: 50 consecutive patients of all age groups presenting with acute intestinal obstruction were admitted were taken randomly and managed between October 2013 to September 2015.Out of these 50 cases, 36 were male, 14 were female, patients with subacute intestinal obstruction and patients with paralytic ileus were excluded in this study. Plain X-ray erect abdomen was done in all cases. Ultrasonography was done only in those patients whose X-ray finding was inconclusive. CT as a modality also included for work up.Results: Mean age distribution was 35.4years and the standard deviation measured 24.57. Incidence in male (36) was more as compared to female population (14). Pain abdomen was found in 45(90%) patients, vomiting in 35(70%) patients, distension abdomen in 34 (68%) patients and constipation in 30 (60%) patients were noted as many patients had coincidence of symptoms. Commonest cause of acute intestinal obstruction noted was postoperative adhesions.Conclusions: Postoperative adhesions were the commonest cause of obstruction. Earlier the presentation, the better the outcome was found.

Migrating Lump in Abdomen—Ileo-Colo-Colic Intussusception Up to the Rectum with Hypermobile Caecum and Ascending Colon

In pediatric age group, Intussusception is the most common cause of acute intestinal obstruction. They present with the classic clinical triad of colicky abdominal pain, vomiting and bloody stools. But clinically very few patients (20%) present with this classical symptoms. This article highlights an importance of suspecting intussusception by physician and rare presentations of intussusception lump in abdomen in a child with abdominal pain, gastrointestinal symptoms. Here a case reported of 16-year-old male child who presented with migrating lump in abdomen on and off with varied clinical presentation every time in single admission. Patient underwent laparotomy and manual reduction of intussusception was done. It is advisable to have high suspicion of intussusception while dealing with such cases.

Dealing with intramesosigmoid hernia: A rare variety of internal hernia

Internal hernia, as the cause of acute intestinal obstruction, is rare and sigmoid hernia is not one of the most common internal hernias. Moreover, intramesosigmod hernias are of the rarest variety. Establishing precise preoperative clinical diagnosis is a challenge for a surgeon. Strangulated sigmoid hernia has high morbidity and mortality. Prompt exploration has to be undertaken based on clinical signs and symptoms rather than searching for the exact cause of obstruction. Here, an extremely rare case of intramesosigmoid hernia is presented with a defect in the medial leaf of the mesentery leading to small bowel obstruction.

A rare association of intussusception and celiac disease in a child.

Intussusception is a common cause of acute intestinal obstruction in the pediatric population and it is normally idiopathic. Rare cases of chronic intussusception require investigation with greater attention. We present a clinical case of a three-year-old boy with aqueous diarrhea, abdominal distension, vomiting and weight loss over a two-month period. During the investigation, abdominal ultrasound showed imaging of intussusception. The intraoperative findings showed the intussusception had resolved spontaneously. In further investigation, it was found that the diarrhea was malabsorptive and, after the patient underwent upper gastrointestinal endoscopy, a diagnosis of celiac disease was made. After a gluten-free diet was introduced, the patient showed complete remission of symptoms and regained weight, and normal growth was reestablished. If the clinical presentation of intussusception is unusual, etiological investigation should be undertaken. In this case report, celiac disease was the underlying cause.

Acute Intestinal Obstruction Complicating Abdominal Pregnancy: Conservative Management and Successful Outcome.

Background. Acute intestinal obstruction during pregnancy is a very challenging and unusual nonobstetric surgical entity often linked with considerable fetomaternal morbidity and mortality. When it is synchronous with abdominal pregnancy, it is even rarer. Case Presentation. A 28-year-old lady in her second pregnancy was referred to Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria, at 27 weeks of gestation due to vomiting, constipation, and abdominal pain. Examination and ultrasound scan revealed a single live intra-abdominal extrauterine fetus. Plain abdominal X-ray was diagnostic of intestinal obstruction. Conservative treatment was successful till the 34-week gestational age when she had exploratory laparotomy. At surgery, the amniotic sac was intact and the placenta was found to be adherent to the gut. There was also a live female baby with birth weight of 2.3 kg and Apgar scores of 9 and 10 in the 1st and 5th minutes, respectively, with the baby having right clubbed foot. Adhesiolysis and right adnexectomy were done. The mother and her baby were well and were discharged home nine days postoperatively. Conclusion. To the best of our knowledge, this is the first report of abdominal pregnancy as the cause of acute intestinal obstruction in the published literature. Management approach is multidisciplinary.

Pattern of Intussusception on Infants and Children in Dr. Hasan Sadikin Hospital Bandung

Background : Intussusception is the most frequent cause of acute intestinal obstruction in infants and toddlers. Incidence was reported at 1.5 to 4 cases for every 1000 live birth. In Dr. Hasan Sadikin General Hospital, Bandung, 55 cases were reported between 2005–2008. This study aimed to identify the characteristics of intussusception patients at Department of Pediatric Surgery Dr. Hasan Sadikin General Hospital, Bandung periode 2009–2011. Methods : This was a retrospective descriptive study by using medical records of intussusceptions patient’s from January 2009 to December 2011. The information collected were age, gender, chief complaint, signs and symptoms, onset of symptoms, nutritional status, history of previous infection, type of intussusceptions, pathologic lead point, and complications; including bowel necrosis and sepsis. The collected data was analyzed and presented as percentages shown in tables Results: There were 32 cases found, of which 84.4% affected well-nourished infants <1 year. Male was predominant (2:1). Bloody mucous stool was the major chief complaint (84.4%). Accompanying symptoms were pain due to colic, vomiting, bloating, and abdominal mass. Eleven patients were found with the onset of symptoms at ≤24 hours. Thirty-one percent (31%) cases were reported with the history of respiratory tract infection and 44% cases with the history of diarrhea. Most common type found was ileocolic. Pathologic lead point was only found in a single case. Conclusions : Intussusception cases in Dr. Hasan Sadikin General Hospital are decreasing, with the characteristics mainly affect well-nourished children, under 1 year old, predominantly male. The prominent chief complaint is bloody mucous stool, whereas ileocolic is the most common type with history of infection. [ AMJ .2015;2(3):458–62] DOI : 10.15850/amj.v2n3.502

Cecal volvulus: Case report and review of literature

Cecal volvulus as an uncommon cause of acute intestinal obstruction is due to axial twist of the cecum and terminal ileum around their mesentery. Cecal volvulus is a surgical emergency requiring urgent laparotomy. Resection and anastomosis is the proposed choice of the operation depending on the general condition of the patient. In addition, to its rarity, lack of familiarity causes diagnostic doubt and consequently delays in treatment. In this paper, we report a case of cecal volvulus seen in a 31-year-old Saudi male presented with vomiting, abdominal pain, and distension.

Острая спаечная толстокишечная непроходимость

Among the causes of acute intestinal obstruction the colon obstruction takes 29-40%. Non-neoplastic colonic obstruction develops in the presence of predisposing factors, due to variations of the anatomical structure of the colon. They are - increased mobility, due to the extended mesentery, which creates conditions, predisposing to the development of bloat and strangulated intestinal obstruction. We analyzed clinical cases - patients with acute colon adhesive obstruction, operated in an emergency or delayed order. These clinical examples show that involvement of colon in adhesive process occurs over a long period of time and flows through the obstructive type, which greatly complicates the diagnosis. To prevent the development of adhesions in the abdominal cavity, the authors recommend to perform preventive measures. These methods are strongle recommended to apply in patients with peritonitis, and after surgery, accompanied by extensive damage to the leaves of the peritoneum. Selecting a method of prevention is determined by the urgent character of surgery, the duration and degree of traumatization of the peritoneum. Preventative measures can improve the outcomes of surgical treatment and reduce the incidence of early postoperative complications, reduce the cost of treating patients with adhesive disease and prevent its development.

Клиническое наблюдение синдрома Bouveret (билиарный илеус)

Background Biliary ileus is a rare cause of acute intestinal obstruction and is 1-4% of all cases of small bowel obstruction. Objective: to Analyze the current data of the world medical literature on the problem of biliary ileus, basic medical diagnostic techniques aimed at improving the provision of health care to patients with this pathology. Materials and methods the authors review the literature and 1 the author nablyudeniya Bouveret syndrome. Discussion Bouveret's Syndrome is a rare form of obstructive ileus due to obstruction of the biliary calculus in the presence of biliodigestive fistula output Department stomachs or 12-p K-CI. The main clinical sign is the presence of signs of intestinal obstruction. The final diagnosis is established during surgical intervention. Mortality after enterotomy with extraction of ureteral stones is about 12%, after an extended intervention - up to 30% Completed surgical treatment, enterotomy, anterolateral. Conclusions despite the fact that the variation of the biliary ileus, Bouveret syndrome, a rare pathology, it is necessary to remember about this cause intestinal obstruction. Special attention should be given to elderly patients with clinic intestinal obstruction.

Abdominal cocoon: A rare cause of acute intestinal obstruction

Sclerosing encapsulating peritonitis (SEP) is a relatively rare cause of intestinal obstruction resulting from encasement of variable lengths of bowel by dense fibro-collagenous membrane. The idiopathic cases of SEP, which lack any identifiable cause from clinical, radiological and histopathological findings, are also reported under the descriptive term “abdominal cocoon syndrome”. Patient with SEP present with intestinal obstruction. Persistent untreated SEP may advance to bowel gangrene or intestinal perforation, which are life threatening conditions. We report the rare occurrence of SEP in a 45-year-old male presenting with signs of intestinal obstruction. Imaging findings revealed abdominal cocoon with bowel gangrene leading to perforation and the same was confirmed at surgery. Surgical excision of the fibrotic sac encasing the bowel, resection of gangrenous bowel segment and end ileostomy were performed. Histopathology of the excised membrane confirmed the diagnosis of SEP. Radiologists should be aware of this relatively rare cause of intestinal obstruction, its imaging findings and complications, as an accurate preoperative diagnosis will prevent diagnostic delay and aid the surgeon in planning treatment.

English

Intussusception is the most common cause of acute intestinal obstruction in infants. Intussusception affects predominantly children in the 1 st and 2 nd years of life. We present here our experience with four patients of intussusception presenting in early infancy in early summer months.

Intussusceptions in adults: clinical features and operative procedures.

To determine the clinical presentation and treatment outcomes of adult patients with intussusceptions. Case series. The Aga Khan University Hospital, Karachi, from January 1988 to December 2008. Medical records of patients with diagnosis of intussusceptions in adults (above 15 years of age) from January 1988 to December 2008 were retrieved through ICD 9 coding system. Patients with complete records were included in the study and those with incomplete medical record or under 30 days follow-up were excluded. Data was analyzed on SPSS version 16. The treatment outcomes were hospital stay, 30 days-morbidity, mortality and recurrence of intussusceptions during follow-up period. The mean age of the 19 patients was 37 years with male predominance. Most patients presented with acute bowel obstruction. In 14 patients, small bowel were involved. CT scan diagnosed intussusception in 10 out of 12 patients. Benign lead point were found in 80% cases. Eighteen patients were treated surgically. Fourteen (70%) patients underwent resection with primary anastomosis while in 4 patients only reduction was done. In resection group, 11 patients had resection after reduction and in 3 patients only resection was done. There was no recurrence in resection group. One recurrence was noticed in the reduction group and one patient died of advanced gastrointestinal malignancy in the nonoperative group. Intussusception is a rare cause of acute intestinal obstruction in adult population. CT scan is a promising diagnostic tool to establish pre-operative diagnosis. Early surgical resection could achieve optimal outcome. Small bowel intussusception could be reduced before resection if there is no doubt about bowel viability. In most of the patients the lead point could be benign disease.

Cecal Volvulus

A twisted loop of the bowel and its mesentery on a fixed point is known as volvulus and it may arise more frequently in the sigmoid colon and cecum. Cecal volvulus as an uncommon cause of acute intestinal obstruction is axial twist of the cecum, ascending colon and terminal ileum around their mesenteric pedicles. Although there are many different etiologic and predisposing factors for cecal volvulus, exact etiology is most likely multifactorial in presence of mobile cecum. Its clinical presentation is highly variable, ranging from intermittent episodes of abdominal pain to abdominal catastrophe depending on pattern, severity and duration of cecal volvulus causing intestinal obstruction. Due to its rarity and nonspecific presentation, preoperative diagnosis is rarely achieved in most cases. Abdominal radiographs as an initial diagnostic test are usually abnormal and can detect cecal volvulus in half of cases. Nowadays, computerized tomography is used for more accurate diagnosis and differentiation from other acute emergent conditions. Resection with right hemicolectomy and primary ileocolic anastomosis has been recommended for surgical treatment of cecal volvulus.

Congenital band of the vitelline artery remnant as a cause of chronic lower abdominal pain in an adult: Case report

INTRODUCTIONIntraabdominal bands of the vitelline vessel remnant are the rarest form of congenital mesodiverticluar bands which may or may not be associated with Meckel's diverticulum. In the majority of cases they cause an acute abdominal disease such as intestinal obstruction, especially in children. PRESENTATION OF CASEWe report a case of a 64 year old gentleman who experienced recurrent episodes of abdominal distension and bloating over two years. Computed tomography of his abdomen, colonoscopy, and barium follow through were all normal. Diagnostic laparoscopy revealed a single band adhesion stretching between the distal ileal mesentery and the anterior abdominal wall near the umbilicus. DISCUSSIONCongenital vascular bands are established causes of acute intestinal obstruction especially in children but are relatively uncommon. Their role in chronic abdominal pain is rare and diagnosis is difficult preoperatively. Pain in the patient was most likely due to recurrent partial twisting and untwisting of the bowel around the band. CONCLUSIONThis case not only highlights an unusual cause of chronic abdominal pain, but also the effectiveness of laparoscopy as a diagnostic tool in such patients.

Prospective surveillance study of the management of intussusception in UK and Irish infants

Intussusception is the most common cause of acute intestinal obstruction in infants. This study examined the clinical presentation, management and outcomes of intussusception in this age group. Prospective surveillance of intussusception in infants was carried out between March 2008 and March 2009 in the UK and Ireland. Monthly cards were sent to paediatric clinicians who were requested to notify cases of intussusception. The study identified 261 confirmed cases. The commonest presenting symptom/sign was non-bilious vomiting, in 210 (80·5 per cent) of the infants. Abdominal ultrasonography was done in 247 infants (94·6 per cent) and was diagnostic in 242 (98·0 per cent), compared with plain abdominal X-ray, which was diagnostic in 33 (23·6 per cent) of 140 infants. Enema reduction was carried out in 240 (92·0 per cent) of the 261 infants; the majority (237, 98·8 per cent) had pneumatic reduction with a success rate of 61·2 per cent (145 of 237). Surgery was required in 111 infants (42·5 per cent); 92 operations were as a result of unsuccessful enema reduction, and the remaining 19 infants (17·1 per cent) had primary surgery. Forty-four infants (39·6 per cent of operations) needed a bowel resection. The majority of children (238, 91·2 per cent) recovered uneventfully; 21 (8·0 per cent) had sequelae, one child died (0·4 per cent), and the outcome was unknown for one infant. This study described current treatment patterns for intussusception in infancy; these represent a benchmark for improved standards of care for this condition.

Ileosigmoid Knot

Ileosigmoid knotting, also known as compound volvulus or double Volvulus, is a rare cause of acute intestinal obstruction. In this condition the ileum wraps around the base of the sigmoid colon and forms a knot. The condition is serious, generally progressing rapidly to gangrene of both ileum and sigmoid colon. Ileosigmoid knotting is an unusual entity in the West, but is comparatively common in certain African, Asian and Middle Eastern nations. Awareness of the condition is essential for prompt diagnosis and optimal management. This article will focus on the etiopathogenesis, presentation, diagnostic modalities, surgical interventions and outcome with review of articles and case reports published till date.