Cause Of Intestinal Obstruction Research Articles

Hypothyroidism as a cause of ileus after laparoscopic appendectomy

Nausea, vomiting, anorexia, and constipation are frequent symptoms of hypothyroidism with ileus and megacolon being rare and dangerous manifestations. Ileus and pseudo-obstruction have been described in newborns and infants with congenital hypothyroidism. In adults only limited data on hypothyroid-associated postoperative ileus are available. A 53-year-old Caucasian woman presented with acute right lower quadrant pain. Computed tomography (CT) scan revealed appendicitis and the patient underwent laparoscopic appendectomy. She was discharged on postoperative day one with antibiotics for an incidentally noted Urinary tract infection (UTI) and antifungals for candida vaginosis. On postoperative day three, she developed abdominal distention and pain and nausea. She returned to the emergency department, where imaging demonstrated dilated bowel loops suggestive of small bowel obstruction or ileus. She was placed on bowel rest and a nasogastric tube (NGT) drained ample gastric contents. After initial improvement, she refused to keep the NGT. Within 24 hours she again developed abdominal distention and pain and chest discomfort, and cardiac workup was initiated. Troponins were negative and electrocardiogram (ECG) was negative for myocardial ischemia; however, low voltage QRS complexes were noted. Upon further questioning, the patient revealed that she had a diagnosis of mild hypothyroidism but had been weaned off her thyroxine three months ago. Her thyroxine stimulating hormone (TSH) was found elevated. Intravenous thyroid hormone replacement therapy was started and the patient improved overnight, passed ample gas and had multiple bowel movements. She was discharged with restored bowel function and much improved clinical condition with follow-up with endocrinology. Hypothyroidism should be considered in patients with protracted postoperative ileus after abdominal surgery.

ILEOSIGMOID NODE DURING PREGNANCY: RARE SURGICAL ENTITY

The ileo-sigmoid knot is a rare surgical entity, corresponding to the wrapping of the ileum around the base of the sigmoid colon forming a knot.An associated condition with a rapid progression to intestinal gangrene and high mortality. It is a rare cause of intestinal obstruction and especially during pregnancy. We report here the case of a patient at 13 weeks of amenorrhea with an ileo-sigmoid knot diagnosed at a late stage with fetal loss.

Intestinal Intussusception as Crohn’s Disease Debut

Intussusception is a rare cause of intestinal obstruction in adults, occurring only in 5% of cases. Clinical case: a 22-year-old male patient with intestinal obstruction secondary to ileocolic intussusception as the onset of inflammatory bowel disease, who underwent en bloc resection of the affected segment. Keywords: Intussusception; Crohn’s disease

A rare case of intestinal obstruction caused by internal hernia through post hysterectomy peritoneal defect

Internal hernia is a rare cause of intestinal obstruction. Nowadays acquired internal hernias are in increasing trends due to increased surgical procedures thus iatrogenic causes surpassing congenital internal hernias. Internal hernias after hysterectomy due to peritoneal defect is extremely rare. Here we present a case of 67 years old female status post hysterectomy ten years back, also a known type 2 diabetic presented to the emergency department with features suggestive of intestinal obstruction. Patient was taken up for emergency laparotomy and intra operative findings revealed small bowel loops herniating in a cavity that is formed by bladder anteriorly, caecum and sigmoid colon laterally and rectum posteriorly. Bowel loops were released. The bowel was found to be viable and the defect was closed. Bowel movements resumed on the third post-operative day. This case is presented here as it is an extremely rare case of internal hernia causing small bowel obstruction.

Surgical Management of Intestinal Obstruction

Background : Intestinal obstruction is one of the common abdominal emergencies and if not treated anddelayed it may lead to bowel ischemia. Hence diagnosis and management of the patient with intestinalobstruction is one of the most important and challenging step to decrease its morbidity and mortality. Thismortality due to acute intestinal obstruction can be decreased with better understanding of pathophysiology,improvement in diagnostic techniques, fluid and electrolyte correction, much potent antimicrobial hence ourstudy focuses on early diagnosis of obstruction, skill full operative management, proper technique duringsurgery and intensive postoperative treatment and carries grateful results.Aim and Objectives :1. To study the various causes of intestinalobstruction.2. To study the symptomatology of intestinalobstruction.3. To study the various Modalities of treatment(surgical) and also the role of imaging studies in determiningthe etiology and intervention in intestinal obstruction.Conclusion : Through our study we came to the conclusion that men are more commonly involved thanfemales . Plain X-ray abdomen and ultrasonography were important for diagnosing out of which Plain X-rayerect abdomen was almost conclusive in all cases. Where diagnosis was inconclusive an ultrasonographywas carried out. Amongst the causes, Postoperative adhesions are the common cause to produce intestinalobstruction. Intestinal obstruction with tuberculosis intestine are more likely to develop postoperativecomplications, proper anti-tubercular management is necessary to prevent mortality and morbidity. Earlyoperations depending upon the etiology of obstruction are mandatory to avoid perforation, the developmentof peritonitis and systemic sepsis associated with multisystem organ failure. Through our study, Adhesiolysisfollowed by resection and anastomosis were the two procedures which were commonly performed. InPostoperative period, few patients had wound infection followed by would dehiscence, chest infection,septicemia and fecal fistula. Morbidity increased in old age patients and those whose presentation was late

The first report on CFTR mutations of meconium ileus in cystic fibrosis population in Saudi Arabia: A single center review.

IntroductionMeconium ileus (MI) is one of the most common causes of intestinal obstruction in newborns. It is the earliest clinical manifestation of cystic fibrosis (CF). MI is suspected if a baby fails to pass meconium shortly after birth and develops symptoms of bowel obstruction, such as distention of the abdomen or vomiting. MI can lead to bowel perforation, a twisting of the bowel, or inflammation and infection of the abdominal cavity.ObjectivesTo find the incidence and prevalence of meconium ileus in cystic fibrosis patients and to report on the most common gene mutation of MI in CF patients.MethodologyRetrospective review of the medical documentations of all MI patients during the period of 1989–2018.ResultsA total of 40 CF confirmed patients were presented with MI. Twenty-nine patients (71%) are alive and 11 patients (29%) died or lost to follow-up. The following CFTR mutations were found: Eight patients (20%) with c.2988+1G>A; Intron 18. Seven patients (17.5%) with c.1418delG; Exon 11. Five patients (12.5%) with c.579+1G>T; Intron 5. Four patients (10%) with c.1911delG; Exon 14. Four patients (10%) with c.1521_1523delCTT; Exon 11. Four patients (10%) with c.416A>T; Exon 13. Three patients (7.5%) with c.2421A>G; Exon 14. Two patients (5%) with c.3908A>C; Exon 21. One patient (2.5%) with c.3889dupT; Exon 24. One patient (2.5%) with c.1657C>T; Exon 12. One patient (2.5%) with c.2547C>A; Exon 14a. Eighteen patients (45%) were presented with vomiting, 38 patients (95%) had postnatal radiological findings, 7 patients (17.5%) had electrolytes imbalance. Five patients (12.5%) had cholestasis and 4 patients (10%) developed chronic liver disease. Thirty-five patients (79.5%) underwent surgical repair and 9 patients (20.5%) were treated medically. Mean age of operation was 2.25 (2) days. Of 9 patients, 6 (66.6%) were treated with gastrograffin enema, 2 patients (22.2%) with oral N-acetylcysteine and 1 patient (11.1%) with saline rectal wash. Thirteen patients (31.5%) required TPN. Five patients had recurrent operation.ConclusionCF and meconium ileus are commonly present in CF patients in Saudi Arabia. Prognosis is similar to other CFs without MI, if treated early. Thirty percent of our CF/MI patients have intronic mutations.

Patterns and Surgical Outcome of Pediatric Intestinal Obstruction in Pakistan

Background: Intestinal obstruction in children is a very common cause of admission in hospitals with usually a high mortality andmorbidity rate. There is a geographical variability in patterns of intestinal obstruction in pediatric population around the globe.Objectives: To evaluate patterns of presentation and surgical outcome of pediatric intestinal obstruction in Pakistan.Material and Methods: A prospective observational study with non-probability sampling technique was done in the departmentPediatric Surgery (East Surgical Unit), The Children's Hospital, Pakistan Institute of Medical Sciences (PIMS), Islamabad,Pakistan, from January to December 2017. Operated cases of intestinal obstruction from 1 day to 12 years were included. Age,patterns of presentation, sign and symptoms, surgical intervention, complications, outcome and correlation between variableswere studied.Results: Total cases were 316 (231 males, 85 females). Congenital Causes of intestinal obstruction in descending order wereAnorectal Malformations(75),Jejuno-Ileal Atresia(28), Hirschsprung Disease(27), Meckel's Diverticulum(17), DuodenalAtresia(16), Malrotation(12), Meconium Ileus(11), Midgut Volvulus(8), Mesenteric cyst(1) and Rectal Atresia(1).Acquired causeswere Intussusception(40), Perforated Appendix(20), Infantile Hypertrophic Pyloric Stenosis(14), Band Obstruction(12), BluntAbdominal Trauma(10), Obstructed Inguinal hernia (9), Worm infestation(9), Enteric Perforation(3), Necrotizing Enterocolitis(3).The overall mortality rate was 3.5% and postoperative complications rate was 40.8%. Statistically significant relationship wasfound between Age and post operative complications (P=0.048), Age and outcome (P=0.002) and between post operativecomplications and outcome (p<0.001).Conclusions: Causes of intestinal obstruction vary according to the age and geographical area. Accurate and timely diagnosis ofthe cause of intestinal obstruction along with prevention and treatment of sepsis can reduce morbidity and mortality.Key words: Intestinal obstruction; Children; Congenital; Acquired Causes; Neonate; Pakistan

Patterns and Surgical Outcome of Pediatric Intestinal Obstruction in Pakistan

Background: Intestinal obstruction in children is a very common cause of admission in hospitals with usually a high mortality andmorbidity rate. There is a geographical variability in patterns of intestinal obstruction in pediatric population around the globe.Objectives: To evaluate patterns of presentation and surgical outcome of pediatric intestinal obstruction in Pakistan.Material and Methods: A prospective observational study with non-probability sampling technique was done in the departmentPediatric Surgery (East Surgical Unit), The Children's Hospital, Pakistan Institute of Medical Sciences (PIMS), Islamabad,Pakistan, from January to December 2017. Operated cases of intestinal obstruction from 1 day to 12 years were included. Age,patterns of presentation, sign and symptoms, surgical intervention, complications, outcome and correlation between variableswere studied.Results: Total cases were 316 (231 males, 85 females). Congenital Causes of intestinal obstruction in descending order wereAnorectal Malformations(75),Jejuno-Ileal Atresia(28), Hirschsprung Disease(27), Meckel's Diverticulum(17), DuodenalAtresia(16), Malrotation(12), Meconium Ileus(11), Midgut Volvulus(8), Mesenteric cyst(1) and Rectal Atresia(1).Acquired causeswere Intussusception(40), Perforated Appendix(20), Infantile Hypertrophic Pyloric Stenosis(14), Band Obstruction(12), BluntAbdominal Trauma(10), Obstructed Inguinal hernia (9), Worm infestation(9), Enteric Perforation(3), Necrotizing Enterocolitis(3).The overall mortality rate was 3.5% and postoperative complications rate was 40.8%. Statistically significant relationship wasfound between Age and post operative complications (P=0.048), Age and outcome (P=0.002) and between post operativecomplications and outcome (p<0.001).Conclusions: Causes of intestinal obstruction vary according to the age and geographical area. Accurate and timely diagnosis ofthe cause of intestinal obstruction along with prevention and treatment of sepsis can reduce morbidity and mortality.Key words: Intestinal obstruction; Children; Congenital; Acquired Causes; Neonate; Pakistan

A comparative study of surgical procedures in neonatal intestinal atresia - resection and anastomosis, Bishop Koop, Santulli and Mikulicz procedure

Background: The aim of this work was to assess the outcome for patients with jejunoileal atresia who underwent primary anastomosis, Bishop–Koop, Santulli procedure and Mikulicz procedure. Intestinal atresia is one of the most common causes of intestinal obstruction in neonates. But ideal surgical management of this condition remains controversial.Methods: During the period from January 2017 to January 2019, 112 neonates (62 males and 50 females) suspected to have intestinal atresia were operated in NRSMCH, Kolkata. 30 patients were treated with primary resection/ anastomosis, 30 patients underwent Bishop-koop (BK) technique, 27 patients who were treated with Santulli technique and 25 patients who were treated with Mikulicz procedure. Demographics, treatment and outcomes including mortality, morbidity and nutrition status were reviewed and were compared among the four groups.Results: 20 patients (17.86%) died during the perioperative period. Among them, 10 died due to uncontrolled sepsis and 10 due to malnutrition. Mortality was highest in Primary anastomosis group (33.33%) followed by BK group (13.3%), Santulli group (11.1%) and lowest in Mikulicz group (4%). The Mikulicz group experienced the lowest re-operation rate (4%) and Primary anastomosis group experienced highest re-operation (26.7%). This difference was statistically significant (P<0.003).Conclusions: Using Mikulicz procedure in the current study has improved the survival of these patients and minimized the post-operative complications.

Factors Associated with Failure of Pneumatic Reduction in Children with Ileocolic Intussusception.

Intussusception is one of the most common causes of intestinal obstruction in children. Pneumatic reduction is the treatment of choice and has a high success rate. The most common cause of pneumatic reduction failure is the presence of a pathological leading point. We aimed to identify other factors that can lead to pneumatic reduction failure in children with ileocolic intussusception. This was a retrospective study conducted in two centers. Data were collected from January 2013 to December 2014. A total of 156 patients were diagnosed with intussusception and underwent pneumatic reduction, with the exception of one patient with peritonitis. We included patients with ileocolic-type intussusception without apparent pathological leading points. Logistic regression analysis of clinical parameters was performed to identify factors associated with pneumatic reduction failure. Of 156 patients diagnosed with intussusception in both hospitals, 145 were enrolled in the study. The overall efficacy of pneumatic reduction was 85.7%, and surgical reduction was performed in 21 patients. Univariate analysis showed that a high segmented neutrophil count, low hemoglobin level, high body temperature, and higher weight percentile were associated with pneumatic reduction failure. Multivariate analysis showed that a high segmented neutrophil count, low hemoglobin level, and higher weight percentile were significantly associated with pneumatic reduction failure. Pneumatic reduction is safe and effective as a first-line treatment for pediatric intussusception. However, a high segmented neutrophil count, low hemoglobin level, and higher weight percentile are associated with the failure of this treatment.

Pericecal fossa strangulated internal hernia.

Pericecal fossa internal hernias are a rare cause of intestinal obstruction, and high clinical suspicion is required to diagnose them.

Brown bowel syndrome: a rare cause of intestinal obstruction.

Brown bowel syndrome: a rare cause of intestinal obstruction.

Anisakidosis intestinal como causa infrecuente de obstrucción intestinal

Resumen La infección por Anisakidosis ha ido aumentando de forma insidiosa en España llegando a ser el segundo país con la incidencia más alta. Este tipo de infecciones no solo aparece por viajes a países extranjeros sino que también puede darse por ingesta de pescado crudo. Suele ser una infección insidiosa, sin síntomas específicos y es por ello que hay que tener una alta sospecha para su diagnóstico, sobretodo en los casos en los que se presenta en forma de urgencia intestinal como es nuestro caso. El órgano más comúnmente afectado es el estómago pero también puede afectar al intestino delgado, causando cuadros que simulan obstrucción intestinal e incluso perforación. Al no existir una prueba Gold estándar de urgencia, muchas veces será necesaria una laparotomía exploradora urgente, obteniendo el diagnóstico definitivo tras los hallazgos anatomopatológicos. Existen pocos casos en la literatura de anisakidosis intestinal, no obstante, creemos que hay que considerarla en los diagnósticos diferenciales ante cuadros de obstrucción intestinal dada su incidencia creciente. Presentamos el caso de un paciente de 37 años con cuadro de Obstrucción intestinal causada por una infección por Anisakis.

Shortening and Plication of Entero-enterostomy for Intussusception in Roux-en-Y Gastric Bypass: Video Report.

Laparoscopic Roux-en-Y gastric bypass (LRYGB) is considered by a large percentage of bariatric surgeons' the operation of choice for obesity surgery as reported by Melvin (J Gastrointest Surg. 4:398-400, 2004). It is considered a generally safe procedure with a low percentage of complications. One of these complications is small bowel obstruction which has different etiologies. A rare cause of intestinal obstruction is intussusception at the entero-enterostomy as reported by Arapis et al. (Surg Obes Relat Dis. 1:23-33, 2019) and Sneineh et al. (OBES SURG 30:846-850, 2020). The accurate incidence of intussusception after LRYGB is unknown but Simper et al. (Surg Obes Relat Dis. 4:77-83, 2008) found a 0.15% incidence in their study. Diagnosis of intussusception requires a high index of suspicion because neither physical examination nor imaging is sensitive. CT scan might identify the problem, but a negative CT scan image does not rule out intussusception. Treatment of intussusception varies according to the clinical picture of the patient at the presentation. These variations may include conservative treatment up to resection of the entero-enterostomy and do a re-anastomosis as discussed by Daellenbach et al. (OBES SURG 21:253-263, 2011). The video aims to present an alternative option for surgical management of intussusception of the entero-enterostomy following LRYGB which to our knowledge was not published before.

L’invaginazione ileocolica

Ileo-colic intussusception is a major cause of intestinal obstruction in early childhood. Diagnosis of this condition might be hampered by variability in clinical presentation. Indeed, the so-called “classic” symptoms, namely abdominal pain, red currant jelly stool, vomiting and palpable mass, may not be present. Nevertheless, prompt diagnosis and treatment are critical to prevent bowel perforation or necrosis and peritonitis. Pneumatic reduction of intussusception with an air enema is the usual treatment. The aim of this study is to highlight the main clinical features of ileo-colic intussusception and its management.

Colonic obstruction secondary to incarcerated transiliac bone hernia.

Transiliac bone hernias are a rare cause of intestinal obstruction, and high clinical suspicion is required for their diagnosis.

Small bowel obstruction secondary to primary enterolith: A rare and delayed complication of radiation enteritis.

Primary enteroliths as a result of pelvic radiotherapy are a rare cause of intestinal obstruction.

Inverted Meckel's diverticulum associated with heterotopic pancreatic tissue causing intestinal obstruction: a case report

BackgroundMeckel’s diverticulum is the most frequent congenital anomaly of the gastrointestinal tract. It can invert or invaginate into the small intestine lumen. It is usually associated with heterotopic tissue elements.Case presentationWe present a case of inverted Meckel's diverticulum, clinically and radiologically diagnosed as intestinal obstruction due to intussusceptions. The diagnosis was suspected due to target sign shown on radiological examination. Pathologically, it was inverted Meckel's diverticulum obstructing the lumen in parallel plan mimicking the telescoping appearance, with heterotopic pancreatic tissue formed of exocrine and ductal components only.ConclusionsInverted Meckel’s diverticulum may present by vague symptoms and may simulate other causes of intestinal obstruction.

Cecal Volvulus: Rare Presentation of Intestinal Obstruction-Case Report

Introduction: Cecal volvulus is a rare cause of intestinal obstruction that occurs 1% - 1.5% of all intestinal obstructions. Causes of volvulus are usually unknown but it can be due to a defective peritoneal fixation of the ascending colon and cecum in 10% and secondary causes (surgical adhesions, colonic carcinoma or diverticulitis). Case Presentation: A 56-year-old woman presented with colicky abdominal pain, bilious vomiting and abdominal distention for two days, who has no history of previous surgery and no other gastrointestinal symptoms or chronic illness. On examinations, she looks ill, dehydrated, abdomen massively distended with exaggerated bowel sound but no signs of peritonitis. CT abdomen with contrast finding: type 11 cecal volvulus seen in midline to the left above the umbilicus reaching 8 cm with ileocecal junction as well as the elongated appendix is reaching the right iliac fossa. Emergency exploratory laparotomy was done and the finding was, obstructing rectosigmoid tumor with cecal volvulus. Discussion: Cecal volvulus is one of the rare causes of mechanical intestinal obstruction which required urgent surgical intervention, and it occurs due to an axial twist of the caecum, ascending colon and terminal ileum around the mesenteric pedicle. Conclusion: Radiological imaging helps in the diagnosis of cecal volvulus especially CT scan with contrast as gold standard for both diagnosis and assessment for complications. However, this should not delay the time of intervention especially if patient presented at late stage with evidence of peritonitis or bowel ischemia and surgical right hemicolectomy is the most effective treatment option. The colonic pathology always should be assessed, as it could be the primary cause of cecal volvulus.

Changing pattern of adult intestinal obstruction in Nigeria: A narrative review

Intestinal obstruction is a failure of craniocaudal propagation of intestinal contents and may be due to a mechanical or functional pathology. Acute mechanical intestinal obstruction is one of the leading causes of surgical admissions in most emergency departments worldwide and is a significant cause of morbidity and mortality, especially when associated with bowel gangrene or perforation. It accounts for 15% of all emergency visits from acute abdominal pain. In Nigeria and most of Africa, external hernias were the main causes of intestinal obstruction throughout the 20th century; however, at the onset of the 21st century, some reports have shown a rising frequency of adhesive obstruction in our environment. We conduct this narrative review to determine if there is a changing pattern of adult intestinal obstruction in Nigeria. Literature search was conducted by two independent reviewers. The keywords used were “adult,” “intestinal obstruction,” “cause,” and “Nigeria.” The keywords were combined using the Boolean logic. The keywords were searched in PubMed and Google Scholar. The overall mean age of the study population is 44.3 years, with a male-to-female ratio of 3.6:1. Of the 1435 cases of intestinal obstruction reported in the studies selected, post-operative adhesive intestinal obstruction was responsible for 590 of them, which is equivalent to 41.1% of all the obstruction. Obstructed external hernias were responsible for 357 cases of obstruction, which is equivalent to 25.9%. The most common cause of intestinal obstruction in Nigeria is post-operative adhesion.