Cause Of Bowel Obstruction Research Articles

Epidemiology of intussusception among infants in Togo, 2015-2018.

Introductionintussusception is the leading cause of bowel obstruction in infants and young children. We describe the epidemiology and diagnostic and treatment characteristics of intussusception among Togolese infants over a 4-year period.Methodswe implemented active surveillance among infants younger than 1 year of age admitted with intussusception from 2015 to 2018 at Sylvanus Olympio Teaching Hospital and in 2018 at Campus Teaching Hospital. Brighton Collaboration Level 1 case definition criteria were used to confirm the diagnosis of intussusception.Resultsduring four years, 41 cases of intussusception, with an annual range of 8 to 14 cases (median: 10) were reported; and the highest number of cases (89%) was enrolled at Sylvanus Olympio teaching hospital. Intussusception was uncommon in the first 2 months of life, peaked from 5 to 7 months old (63%), with male predominance (63%), and showed no significant seasonality. One third of cases (34%) were transferred to the sentinel surveillance site from another health facility; and the median delay in seeking care was 4 days (range: 0-11) with ≥ 48-hour delay in 59% of cases. Clinical symptoms, ultrasound and surgery were combined to diagnose intussusception in all the cases (100%). The treatment was exclusively surgical, and intestinal resection was common (28/41, 68%). A high case fatality rate (23%) was observed and the average length of hospital stay was 10 days (range: 1-23).Conclusionactive surveillance for intussusception in Togo has highlighted exclusive use of surgical therapy; often associated to an intestinal resection with a very high case fatality rate.

CLINICAL PROFILE OF INTUSSUSCEPTION IN CHILDREN ADMITTED TO A TERTIARY CARE CENTRE IN KERALA

Background and objectives: Intussusception is the commonest cause of bowel obstruction and is one of the common abdominal emergencies in children younger than 2 years of age.The objective of the study was to assess the clinical profile of intussusception in children and the management and the outcome and to assess whether the characteristics mentioned in clinical profile are predictive of subsequent management and outcome of the disease.
 Methods: A hospital based descriptive study conducted in a tertiary care centre in Kerala, using purposive sampling technique. 120 children admitted with diagnosis of intussusception fulfilling inclusion criteria and whose parents consented for study were included in the study population, during the study period from November 2018 to June 2020. Detailed history, clinical examination including per rectal examination and USG was done to make diagnosis of intussusception in suspected cases. Follow up is done at 72 hours,1 week after the admission and 1month later. To assess the clinical profile and outcome of patients, frequency and percentage is used. To obtain the association of clinical profile with outcome chi square test is applied.
 Results: Outcome of the problem was correlated with age, sex, symptoms, risk factors sonological findings treatment protocol and duration of hospital stay. Out of the 120 children in study population, majority were males(65.8%) with male to female ratio 1.9:1 and majority was in the age group 7- 12 months, which is similar to many other similar studies. Maximum number of cases were in the month of February(14.2%) and November(15%). Majority of the patients(57.5%) presented to healthcare facility within 24 hours of onset of first symptom.Irritability was the most common clinical symptom(62.5%) followed by vomiting(58.3%) and abdominal pain(49.2%). Ileocolic intussusception (96.7%) was the commonest type. Majority of the cases could be managed with hydrostatic saline reduction(73.3%) and significantly lesser number of patient went for surgical intervention(7.5%) and spontaneous resolution(19.2%).
 Conclusions: Incidence of intussusception is more common among males and more in the 7-12 month age group. Majority of the cases presented to health care facility within 24 hours of onset of symptom and could be managed with hydrostatic reduction technique and had a shorter duration of hospital stay compared to surgical reduction technique. Even recurrent cases could be managed with hydrostatic saline reduction.
 Keywords: Intussusception; Intestinal obstruction; Hydrostatic reduction; Spontaneous resolution

Laparoscopic repair of incarcerated transverse colon internal hernia in a patient with Crohn’s disease

Internal hernia is a rare cause of bowel obstruction in patients with no prior surgical history. Laparoscopic repair of a transverse bowel herniation through the foramen of Winslow is the rarest type of internal hernia, with only two case reports published in the literature. In a patient with a history with Crohn’s disease and no prior surgical history, presenting with signs of bowel obstruction, and no inflammatory symptoms, internal hernia should be suspected as one of the causes. Minimally invasive laparoscopic repair is a feasible safe option in those patients, allowing patients to go home the next day postoperatively.

Wilkie’s Weight Loss Wonder: A Case Series

INTRODUCTIONWilkie’s Syndrome, also known as Superior Mesenteric Artery Syndrome (SMAS), is a rare cause of bowel obstruction that can contribute to vague abdominal symptoms on clinical presentation. This syndrome occurs when the aortomesenteric angle decreases, compressing the third portion of the duodenum between the aorta and the superior mesenteric artery. An acute decrease in the mesenteric fat pad cushion between these two blood vessels is the primary etiology, although other causes (e.g., anatomical, postoperative, functional, and pubescent etiologies) have also been described.CASE PRESENTATIONIn the present cases, 2 females with a common history of recent weight loss presented to our institution with similar symptoms of abdominal pain, nausea and vomiting. Each patient was subsequently diagnosed with SMAS following imaging studies. Both patients experienced successful resolution of symptoms with conservative nutritional management.DISCUSSIONCommon presenting complaints of SMAS include nausea, vomiting, early satiety and postprandial pain. These symptoms overlap with other gastrointestinal disorders (i.e., mesenteric ischemia, intestinal volvulus, peptic ulcer disease) making diagnosis difficult. SMAS can be identified through imaging modalities including barium studies and computer tomography. First line therapies typically include conservative nutritional support and promotion of weight gain. If conservative therapies fail, various surgical procedures can be pursued. Delayed diagnosis can lead to further pathological sequelae, including duodenal compromise, ischemia and necrosis. As the syndrome progresses, success of conservative nutritional support is less likely, and surgical correction becomes increasingly necessary.CONCLUSIONTherefore, a clinical goal for SMAS should include as swift a recognition and diagnosis as possible.

Global Reports of Intussusception in Infants With SARS-CoV-2 Infection.

Idiopathic intussusception is a common cause of bowel obstruction in infants, presenting as refractory abdominal pain or mass, vomiting, lethargy, and currant jelly stool. Coronavirus disease 2019 is not well characterized in children, especially infants, but symptoms in children have included nausea, vomiting, diarrhea, and abdominal pain. From January to July 2020, intussusception was reported in 5 infants 4-10 months of age who had laboratory-confirmed SARS-CoV-2 infection. All 5 infants presented with currant jelly stool and at least 1 other abdominal symptom, and none presented with respiratory symptoms. Four infants recovered but the fifth infant progressed to a critical illness and death. While an association between SARS-CoV-2 infection and intussusception has not been established, infants with symptoms consistent with intussusception may warrant testing for viral pathogens, including SARS-CoV-2, especially if presenting to healthcare with a history of SARS-CoV-2 exposure or with signs and symptoms of COVID-19. More investigation is needed to determine whether intussusception is part of the clinical spectrum of COVID-19 in infants or a coincidental finding among infants with SARS-CoV-2 infection.

S3047 Intussusception: A Rare Presentation in the Proximal GI Tract

INTRODUCTION: Intussusception is a well-documented cause of bowel obstruction in pediatrics but is infrequently encountered in adults, accounting for less than 5% of all cases of intussusception. Typically observed in the small or large bowel, intussusception involving the stomach is rare. We present a unique case of gastro-gastric intussusception due to gastric adenocarcinoma arising in a pyloric gland adenoma with high grade dysplasia, with previous literature demonstrating only 5 other cases in the setting of an adenoma/adenocarcinoma. CASE DESCRIPTION/METHODS: A 57 year-old Caucasian female without significant past medical history presented with intermittent abdominal pain, nausea, vomiting, and weight loss for 3 months. Her labs on admission were notable for hypokalemia and hypomagnesemia, but were otherwise normal. A CT scan showed thickening of the gastric body with concern for gastro-gastric intussusception and underlying neoplasm (Figure 1). The surgical team requested an endoscopy by gastroenterology for biopsy and attempt at reduction, which confirmed the presence of gastric intussusception, beginning at 50 cm with a large, partially circumferential, frond-like mass noted in the gastric body, extending down into the intussusception. Multiple attempts were made to traverse the mass, but were unsuccessful and the pylorus was unable to be visualized nor was the intussusception able to be reduced. Multiple biopsies of the gastric mass were obtained during the procedure, demonstrating hyperplastic polyp tissue with low-grade dysplasia and negative for H. pylori (Figure 2). Two days later, the patient underwent a distal gastrectomy with Roux-en-Y gastrojejunostomy; intraoperative pathology revealed a hyperplastic polyp with high-grade dysplasia. Definitive pathology from the surgical specimen revealed a well-to-moderately differentiated adenocarcinoma arising from a 9 cm foveolar-type gastric adenoma with high-grade dysplasia and metastasis identified in 1 of 19 lymph nodes (Figure 3). DISCUSSION: Intussusception is rarely detected in the proximal GI tract, and when present, is most commonly seen in the setting of a surgical anastomosis, foreign body, or anatomic abnormality. This is the 1st documented case of gastro-gastric intussusception associated with a pyloric type adenoma with high grade dysplasia. Histology on endoscopic biopsies showed dysplasia without malignancy, highlighting that superficial biopsies may be misleading and a high index of suspicion for underlying malignancy should be maintained.Figure 1.: CT A/P with contrast shows thickening of the gastric body with concern for gastro-gastric intussusception and underlying neoplasm, no evidence of gastric obstruction or distant metastasis noted.Figure 2.: Superficial biopsy demonstrating adenomatous epithelium (pyloric gland type).Figure 3.: Invasive front of the tumor with overlying areas of high grade dysplasia.

Value of enhanced or non-enhanced computed tomography in the detection of rare causes of bowel obstruction

Purpose: This study aims to reveal the uncommon causes of intestinal obstructions and to compare the diagnostic accuracy of enhanced or non-enhanced computed tomography.Materials and Methods: This cohort was a retrospective study of different patients diagnosed with acute mechanical intestinal obstruction in the emergency room or hospital between 15 January 2009 and 15 June 2018. Exclusion criteria were common causes of mechanical bowel obstruction and inclusion criteria were uncommon causes of bowel obstruction. Non-enhanced or enhanced computed tomography were used to diagnose mechanical bowel obstruction.Results: The population included 46 females and 41 males and the age range from 20 to 81. Of the patients with uncommon mechanical obstruction, 58 (66.7 %) were caused by the small intestine, and 29 (33.3%) by the large intestine. When compared to uncommon causes of the small and large bowel with age, body mass index, and use of contrast or not, no significant difference was detected between them. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of enhanced computed tomography were %93.9, %93.3, %96.9, %87.5, %94 and non-enhanced computed tomography were %96.0, %85.7, %92.3, %92.3, %92.3 respectively.Conclusion: Non-enhanced computed tomography has similar diagnostic accuracy, sensitivity, and specificity compared to enhanced computed tomography for identifying the location, severity, and etiology of bowel obstruction.

Intussusception causing bowel obstruction in a nephrotic syndrome child

Abstract Intussusception is defined as an acquired telescoping of proximal bowel into the distal bowel. It is a common cause of bowel obstruction in infancy. Majority are reported between 3 and 9 months, 90% are affected within the first 3 years of life with idiopathic cause. A high index of suspicion must be maintained for bowel obstruction in typical infant age with no demonstrable hernias or previous surgery. Abdominal ultrasound is the gold standard for the diagnosis. We present a rare case in our practice of intussusception in a 4 years old male with nephrotic syndrome at our pediatric surgery department.

Adult Ileocecal Intussusception: A Case Report and Review

Intussusception is a rare cause of bowel obstruction in adult patients, it represents for five percent of all age intussusception. Several different aspects were found between adult and pediatric intussusception. We report a case of 39-year-old male with bowel obstruction due to ileocecal intussusception, which firstly diagnosed as acute appendicitis. Unlike pediatric intussusception which usually manifest as classical triad signs, unspecific symptoms of adult intussusception may become diagnostic challenge. Imaging modalities such as plain abdominal radiograph and ultrasonography may aid the preoperative diagnosis in the rural hospital setting. Prompt management which involved surgical approach is warranted to prevent further complications.

AKT answer relating to causes of bowel obstruction

AKT answer relating to causes of bowel obstruction

AKT question relating to causes of bowel obstruction

AKT question relating to causes of bowel obstruction

Colonic intussusception caused by giant lipoma: a rare cause of bowel obstruction.

Colonic intussusception caused by giant lipoma: a rare cause of bowel obstruction.

Bowel obstruction

Bowel obstruction is a surgical emergency and is the most common reason for undergoing emergency laparotomy within the United Kingdom. It has a diverse range of aetiologies with a significant mortality rate and high rates of morbidity amongst survivors. Prompt identification and management of the condition are essential for favourable outcomes. This article will focus on the causes of bowel obstruction in adults, assessment in primary care and subsequent management in secondary care.

Rolling in the Deep: Imaging Findings and Diagnostic Pearls in Gallstone Ileus.

Gallstone ileus is a dramatic complication of gallstone disease, uncommon but not exceptional in a busy emergency department. It represents a cause of mechanical intestinal obstruction, which predominantly occurs in elderly and frail patients; this contributes to the high morbidity and mortality rates associated with this condition. The modern radiologist is frequently asked to determine the cause of bowel obstruction and should be aware of the most pictorial features of this unusual disease. Broadly speaking, abdominal radiography and ultrasonography alone are limited in detecting the cause of bowel obstruction, but the sensitivity for the preoperative diagnosis of gallstone ileus may be improved by combining the findings obtained by both techniques. Computed tomography is the modality of choice for the diagnosis of this disease: it may accurately describe the number, size, and location of migrated gallstones and the exact site of bowel obstruction, providing a detailed preoperative planning. Magnetic resonance imaging may be used in selected cases for an exquisite anatomic definition of the fistulous communication.

An unusual cause of bowel obstruction in Crohn's disease

An unusual cause of bowel obstruction in Crohn's disease

Role of Multidetector Computed Tomography with Multiplanar and Curved Multiplanar Reformations in the Detection of Cause of Intestinal Obstruction: A Tertiary Care Experience.

ObjectiveTo determine the role of multidetector computed tomography (MDCT) with multiplanar (MPR) and curved multiplanar reformations (CMPR) in the detection of the cause of intestinal obstruction.Materials and methodsA retrospective analysis of 200 patients with a clinical suspicion of intestinal obstruction referred to the department of radiology, Dr. Ziauddin University Hospital, Clifton campus, from September 2016 to October 2019, was done. All patients who underwent an MDCT scan with oral and intravenous (I/V) contrast were included in the study. Patients with deranged serum creatinine and an allergic reaction to contrast were excluded from the study. MPR and CMPR images were acquired in each patient in addition to routine axial images. The causes of intestinal obstruction as determined by a computed tomography (CT) scan were confirmed on surgery and colonoscopy. The CT scans were analyzed by an independent radiologist with five years of experience blinded to the surgical and colonoscopy findings in detecting the cause of bowel obstruction using the axial, MPR, and CMPR images. Data analysis was done on IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp., Armonk, NY).ResultsOut of 200 patients with a clinical suspicion of intestinal obstruction, 120 patients with intestinal obstruction was confirmed on CT scan. Fifty-eight patients were males (48.33%) and 62 patients were females (51.66%) with a male-to-female ratio of 1:1.06. The mean age of the patients was 54.7 years (age range from 06 years to 85 years). Abdominal distension was the most common presentation seen in 37 patients (30.83%) followed by vomiting in 25 patients (20.83%). Small bowel obstruction was seen in 96 patients (80.00%) with the ileum being the most common site of obstruction seen in 76 patients (63.33%). Among the patients with the ileum being the site of obstruction, distal ileal obstruction was seen in the majority of patients (30 patients, with a frequency of 25.00%). Twenty-three patients (19.16%) had a large bowel obstruction, with sigmoid colon involvement seen as the most common site in 10 patients (8.33%). Adhesions were the leading extrinsic cause of bowel obstruction seen in 32 patients (26.6%). Intraluminal causes of obstruction were seen in 36 patients (30.0%) with carcinoma being the commonest cause (12 patients with a frequency of 10.0%). A foreign body is the primary cause of intraluminal obstruction (three patients, with a frequency of 2.5%). The sensitivity, specificity, positive predictive value, and negative predictive value of MDCT were 86.2%, 92.7%, 90.1%, and 96.4%, respectively.ConclusionMDCT has high sensitivity and specificity to diagnose and determine the cause of bowel obstruction. It not only determines the site of obstruction but also the cause of obstruction, including intrinsic, extrinsic, and intraluminal causes.

Meckel’s Diverticulum in Foramen of Winslow Hernia – A Rare Cause of Bowel Obstruction

Foramen of Winslow hernia is a rare cause of bowel obstruction, historically linked to high morbidity and mortality. With the progression of high-resolution imaging devices, the early diagnosis of this pathology can be safely made. This has caused significant improvement in outcomes, where prompt surgical reduction can be readily organized. There has, however, not been any reported case of Meckel’s diverticulum driving this internal hernia. This is a case report of a foramen of Winslow hernia (FOWH) containing a Meckel’s diverticulum, managed via laparoscopic reduction of hernia contents and diverticulectomy.

Peritoneal pocket hernia after laparoscopic femoral hernia repair: a rare cause of bowel obstruction.

Peritoneal pocket hernia after laparoscopic femoral hernia repair: a rare cause of bowel obstruction.

360 Degree Twisted Transverse Colon in a Neurological Impaired Girl with a History of Chronic Constipation - A Case Report

Introduction: Transverse colon volvulus is an uncommon cause of bowel obstruction. Predisposing factors are mental retardation, dysmotility disorders, chronic constipation, and congenital megacolon. Case report: We presented a transverse colon volvulus in a 14-year-old girl with mental retardation. Chronic constipation in neurologically impaired patients was a risk factor predisposing to volvulus. The girl was admitted to our Clinic because of problems that last 4-5 days and was followed by abdominal pain, vomiting and lack of stool. Vomiting was once a day. She was sub febrile up to 37.6°C. On examination, the abdomen was distended, tense, diffusely painful. During the surgery, a 360° clockwise volvulus of the transverse colon was found. After the reduction of volvulus, an enormous transverse colon was resected and protective ileostomy was formed. In the postoperative period, ileostoma functioned a good. The definitive surgical treatment was done on the 20th postoperative day when the occlusion of the ileostomy and transanal biopsy of the rectum was done, which showed the presence of ganglia cells. The patient was discharged from our institution after 1 month. Conclusion: Pediatric patients with neurological conditions and mental retardation present an increased risk of colon transversum volvulus due to chronic obstruction.

Waugh's syndrome: a rare cause of bowel obstruction in adults.

Waugh's syndrome is the association of intussusception and intestinal malrotation, almost always reported in the pediatric population. We present images of a middle-aged adult with a large ileocolic intussusception in association with intestinal malrotation, the latter was concluded to be the underlying cause.