Cause Of Intestinal Obstruction Research Articles

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

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

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

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

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

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

Predictive Factors for Bowel Resection in Childhood Intussusception.

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

ОСЛОЖНЕННОЕ ТЕЧЕНИЕ БОЛЕЗНИ КРОНА ПРИ БЕРЕМЕННОСТИ

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

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

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

Intestinal Intussusception in Adults: A Diagnostic Challenge

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

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

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

Persistent unmet need for surgical care in Western Uganda.

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

Silent Danger: Uncovering Greater Omental Internal Herniation

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

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

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

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

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

Acute Intestinal Intussusception in Children at Somine Dolo Hospital in Mopti

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

A case report on cocoon abdomen

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

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

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

Appendico-Ileal Knotting: A Rare Cause of Strangulated Small Bowel Obstruction

BACKGROUND: Bowel obstruction is a common surgical emergency worldwide. It may result into high morbidity or mortality whenever intervention is delayed. It affects all age groups. The most commonly seen etiologies of bowel obstruction are post-operative adhesions, neoplasm and hernia in that order. Intestinal knot syndrome is an extremely rare cause of intestinal obstruction, and when it occurs, it poses diagnostic challenges. We report a case of appendico-ileal knotting causing strangulated small bowel obstruction due to its rarity and diagnostic difficulty. Our objective is to discuss the clinical presentation and management of this rare cause of surgical emergency. CASE: A-72- year old man was seen at the emergency unit of our center with 4 days history of gradual onset of colicky abdominal pain with nausea and vomiting. He had a two-day history of constipation and a one-day history of fever. He was acutely ill-looking and his vital signs were abnormal. Urgent abdominopelvic ultrasound and plain abdominal x-ray was performed and were suggestive of intestinal obstruction. He had emergency laparotomy, and intra-operatively appendico-ileal knotting was seen with gangrenous appendix and terminal ileum. This necessitated limited right hemicolectomy and ileo-colonic anastomosis. The patient was managed post-operatively and discharged on post-operative day 10. CONCLUSION: Appendico-ileal knotting is a cause of small bowel obstruction although it is very rare. The diagnosis is commonly confirmed intra-operatively. There are reports of simple small bowel obstruction secondary to appendico-ileal knotting, but this case confirmed that it could also lead to strangulated intestinal obstruction.

Obturator hernia as a cause of intestinal obstruction in an elderly female patient – A clinical image

Obturator hernia as a cause of intestinal obstruction in an elderly female patient – A clinical image

A CASE OF SIGMOID VOLVULUS ASSOCIATED WITH CONSTIPATION

Sigmoid volvulus (SV) is a rare cause of intestinal obstruction in adolescents. Delay in diagnosis may lead to complications such as necrosis and perforation of the volvulated colon. Clinical presentations are non-specific and the diagnosis is based on high clinical suspicion. We report a 14-year-old male patient who presented to the emergency department with abdominal pain and no stool output. It was learned that the patient had these complaints for the last four years and had been receiving constipation treatment. In the standing abdominal X ray, the classic coffee bean finding seen in the sigmoid volvulus was found. A diagnostic laparotomy was performed, which revealed a 180-degree rotation of the mesentery and a significant diameter difference in the colon due to significant dilatation proximal to the volvulus. This case with SV without complications reminds us that SV should be considered as a differential in patients presenting with acute or recurrent abdominal pain and intestinal obstruction.

A STUDY ON INTESTINAL OBSTRUCTION REGARDING ITS EPIDEMIOLOGY, ETIOLOGY AND MANAGEMENT IN A PERIPHERAL MEDICAL COLLEGE

Objectives: The intestinal obstruction is a widespread emergency problem in our surgical practice day by day. It is a significant cause of morbidity and mortality in our health system. It is caused by adhesions, hernias, malignancies, endometriosis, inflammatory bowel disease stenosis, intussusception, and others. Our research aims to identify the etiology, epidemiology, and clinical presentations of the pathology so that we can manage the disease as early as possible for better outcomes in our peripheral institution. Methods: The study was performed on 100 cases of the age group 12–76 years admitted in the surgical ward of Midnapore Medical College and Hospital, Paschim Medinipur (W.B.) from December 2016 to June 2018. Cases of acute intestinal obstruction who underwent operation were included in our research to establish the pathology of intestinal obstruction. Results: In our study, the incidence of acute intestinal obstruction is 1.6% of total surgical cases. Maximum patients (25%) were in the age group 51– 60 years. The most common cause of intestinal obstruction was obstructed/strangulated hernia (40%). The most common symptoms were pain abdomen (88%), abdominal distension (84%), and vomiting (78%). An X-ray revealed presence of air-fluid levels in 75% of patients. The overall mortality rate was 10%. Conclusion: The morbidity and mortality of intestinal obstruction are dependent on early diagnosis, prompt resuscitation, and proper management. The critical determinants of the morbidity are age of the patient, duration of the disease, existing comorbidity, and delay in treatment. X-ray in erect view is an essential mode of diagnostic method and obstructed hernia is the most common etiology of obstruction in our research study.

Sigmoid volvulus as a rare cause of intestinal obstruction in the pediatric population: case series and literature review

Introduction: Sigmoid volvulus is an uncommon cause of intestinal obstruction in the pediatric population. This pathology is associated with intestinal malrotation and sometimes with the presence of internal hernias. The clinical presentation includes pain, abdominal distension, and emesis; however, sometimes patients report nonspecific chronic symptoms. Among the diagnostic tools commonly used in children are radiography and abdominal tomography. There are multiple treatment strategies ranging from endoscopic to surgical procedures including resection with stoma creation. Timely diagnosis is crucial given the increased morbidity and mortality resulting from intestinal ischemia and perforation. Methods: A review of the medical records of the patients with a diagnosis of sigmoid volvulus treated by pediatric surgeons of the institution and led to devolvulation and subsequent sigmoidectomy presented below was carried out. Likewise, a literature search was carried out in electronic databases, using two equations using terms selected from ‘Medical Subject Heading’ (MeSH) and ‘Descriptors in Health Sciences’ (DeCS). The quality of the studies was evaluated with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) tool for the construction of the manuscript. Results: Upon continuation, the experience of six patients between the ages of 5 and 17 with a diagnosis of sigmoid volvulus between the years 2021 and 2023 is presented. These patients were taken to initial decompression by different approaches and in a second surgical stage to sigmoidectomy, most of them with anastomosis. All patients had an adequate postoperative evolution without complications. Conclusion: Sigmoid volvulus is a rare condition in pediatrics with a variable and sometimes nonspecific clinical presentation; however, given the increased morbidity and mortality resulting from a delay in diagnosis, it is important to consider the clinical, paraclinical, and radiological findings that allow early identification as a cause of intestinal obstruction.