Cause Of Large Bowel Obstruction Research Articles

Twist of a Lifetime: A Transverse Colon Volvulus

Transverse colon volvulus is a rare but serious cause of large bowel obstruction, often necessitating urgent surgical intervention to prevent complications such as strangulation and perforation. We present a case of a 55-year-old man who presented with a one-day history of abdominal symptoms. Emergency abdominal computed tomography (CT) revealed transverse colon volvulus, leading to immediate laparotomy and successful detorsion with resection of the affected segment. Postoperative recovery was uneventful, and the patient was discharged in stable condition. This case underscores the importance of prompt diagnosis through imaging, particularly CT, in guiding appropriate therapeutic measures. Additionally, the discussion highlights the rarity of transverse colon involvement, predisposing factors, clinical presentations, and the necessity of surgical intervention, emphasizing the higher mortality rate associated with delayed diagnosis.

The Outcome Of Sigmoid Volvulus Cases: A Single Centre Experiences Over 8 Years

Introduction
 Sigmoid volvulus is one of the causes of large bowel obstruction. Its management can be challenging because of its prevalence in high-risk individuals. This study was designed to review the management and outcome of all patients admitted with sigmoid volvulus.
 Methods
 A retrospective review of all patients admitted at Hospital Sultanah Nur Zahirah, Terengganu, for Sigmoid Volvulus from January 2015 to December 2022 was performed. The data was extracted from Hospital Information System (HIS) and analysed using SPSS 27.
 Results
 Twenty-four patients were admitted, a total of 41 admissions for sigmoid volvulus during the study periods. The majority of the patients (n=16, 66.7%) were male and (n=8,33.3%) were female. Seven (29.2%) patients underwent emergency surgery on the presentation, and three (12.5%) patients died on admission due to septic shock. The remaining 14 (58.3%) were managed by endoscopic decompression. 13 (92.9%) patients had successful decompression procedures, and one patient (7.1%) failed, which required emergency surgery. About seven patients (53.8%) were readmitted for recurrence of sigmoid volvulus after successful decompression on initial admission, in which subsequently all of them required emergency surgery. The remaining six (46.2%) did not experience any recurrence episodes, and three (50%) of them underwent subsequent elective surgery. In our series, three patients died on initial presentation due to perforation and septic shock without any intervention, two patients died after emergency surgery due to septic shock and multi-organ failure, and one patient died due to covid 19 pneumonia. There was no mortality after elective surgery.
 Conclusion
 Sigmoid volvulus is a surgical emergency in which the majority (58.3%) can be successfully decompressed non-operatively. Emergency surgery in these patients is associated with 13.3% mortality in our series. Elective definitive surgery is suggested in view of the high recurrence rate (>50%) and considerable risk of emergency surgery.

Cecal Volvulus Presenting after Onset of Acute Pancreatitis: A Case Report

Cecal volvulus is a rare, potentially life-threatening cause of large bowel obstruction (LBO). Discerning LBO in the background of chronic episodes of epigastric or abdominal pain ensures timely treatment and reduces the risk of complications. Atypical demographic presentation may pose a clinical danger that can be best avoided with standardized diagnostic imaging. We report a case of cecal volvulus in a male patient with a history of alcohol use disorder and pancreatitis. The patient underwent a right hemicolectomy with small bowel resection and primary anastomosis.

Role of Multi-Detector CT (MDCT) in Diagnosis of Intestinal Obstruction

Background CT is appropriate imaging modality for evaluation of patients with suspected intestinal obstruction in whom clinical examination and radiography do not yield a definitive diagnosis. CT is sensitive for detection of high-grade obstruction and has the additional benefit of defining the cause and level of obstruction. Aim of the Work The aim of this study is to evaluate the role of MDCT in the diagnosing of intestinal obstruction, detection of its causes and possible complications, and to correlate the association between imaging features and operative finding. Patients and Methods A cross sectional study was conducted including 31 patients between 7 months and 75 years with clinically suspected intestinal obstruction. Patients underwent multi-detector CT. Image interpretations performed by Independent radiologists were compared with the final diagnosis that was based on clinical and lab information as well as surgical findings in operated cases. Results Adhesive intestinal obstruction was the main cause of small bowel obstruction while adenocarcinoma was the main cause of large bowel obstruction in our study. The most common site diagnosed on CT was jejunum (87.1%). Highly significant correlation was found between CT and operative findings in the diagnosis of the site and cause of obstruction with P value of < 0.001. Conclusion MDCT is highly accurate and specific in the diagnosis of intestinal obstruction. It can demonstrate the exact site of obstruction, as a result it is useful for developing an appropriate treatment plan and managing the patient.

[It does not always have to be cancer: a rare cause of large bowel obstruction].

Die häufigste Ursache eines mechanischen Dickdarmileus ist das Kolonkarzinom, gefolgt von Dickdarm-Volvulus und fäkaler Impaktion [Verheyden C et al. Eur J Radiol 2020; 130: 109155]. Betroffen sind vor allem ältere Patientinnen und Patienten. Die typische Klinik umfasst abdominelle Schmerzen sowie Stuhl- und Windverhalt. Wir präsentieren den Fall einer tief infiltrierenden Endometriose des Colon sigmoideum als seltene Ursache eines mechanischen Dickdarmileus bei einer jungen Patientin.

Sigmoid Volvulus Necessitating Total Colectomy

Sigmoid volvulus is a well-known cause of large bowel obstruction. Its management includes urgent endoscopic decompression or emergency laparotomy. The gangrenous sigmoid colon is resected with either end to end anastomosis or Hartmann’s procedure. Here we present a rare presentation of sigmoid volvulus causing gangrene of the whole colon. It was probably due to double closed loop obstruction caused distally by the volvulus itself and proximally by the competent ileo-caecal valve. It was managed by total colectomy with terminal ileostomy and Hartmann’s procedure. To our knowledge only one such case report has been published in the literature so for.

S2217 A Rare Case of Synchronous Double Volvulus of the Sigmoid Colon and Cecum

Introduction: Colonic volvulus is one of the leading causes of large bowel obstruction. Synchronous cecal and sigmoid volvulus is a rare presentation. Cecal volvulus and sigmoid volvulus have traditionally been thought of as separate clinical presentations with distinct clinical features, radiological findings, and treatment modalities. We focus on the classical radiological findings, uncharacteristic presentations, and definitive treatment to prevent recurrence, morbidity, and mortality. Case Description/Methods: A 67-year-old female with a past medical history of severe chronic constipation secondary to stercoral colitis presents to the emergency department complaining of abdominal pain for 5 days. Pain is diffuse, and associated with nausea and vomiting. The last colonoscopy performed 4 years ago, was normal. The patient was in immense pain and was not able to provide further information. On presentation, the patient was afebrile, BP 127/52, HR 73, RR 16 breaths/min. The abdomen was distended, and peritoneal sounds were auscultated in all quadrants but were worse in lower quadrants bilaterally. X-ray of the abdomen showed pneumoperitoneum and dilated bowel related to stercoral colitis. Subsequent CT abdomen showed small volume ascites, hollow perforated viscus, markedly distended cecum with peri-cecal inflammatory changes, and significant wall thickening with inflammation in the sigmoid colon secondary to concurrent cecal and sigmoid volvulus. The patient immediately underwent exploratory laparotomy, ileocecectomy with primary anastomosis, sigmoidectomy with primary anastomosis, and abdominal washout (Figure). Discussion: When evaluating acute abdomen, we propose consideration of synchronous large bowel volvulus is a rare and easily missed etiology of large bowel obstruction due to challenging radiological presentation. Even with detailed cross-sectional imaging like CT scan, it is possible to miss coexisting cecal volvulus due to massively enlarged sigmoid volvulus causing mass effect. The preferred treatment is total or subtotal colectomy with or without anastomosis on a case-to-case basis. This approach provides the advantage of avoiding the risk of recurrence and histopathological analysis to rule out underlying malignancy. Commonly, only one type of large bowel volvulus is found radiologically, it is advisable to pay attention to the possibility of coexisting cecal volvulus and a definitive diagnosis being made intraoperatively.Figure 1.: A. Chest X-ray showing gas under diaphragm; B. Volvulous with dilated caecum and Sigmoid colon on Abdominal X-ray; C. Scout film of the CT scan abdomen; D. Twisted Caecum with dilated sigmoid colon on axial film.

A Young Man With Epigastric Abdominal Pain

Question: A 29-year-old generally healthy man visited the emergency department with a sudden onset of severe epigastric cramping pain for hours. Nausea sensation and bilious vomiting occurred a few minutes after intake, including clear liquid intake. His vital signs were relatively stable despite tachycardia (heart rate, 110 beats/min). The physical examination showed epigastric dull tenderness without a sign of peritoneal irritation. His blood test revealed leukocytosis (white blood cell, 11,600/μL) and mild elevated serum lactate level (1.5 mmol/L). The kidneys, ureters, bladder (KUB) X-ray revealed dilated colon and cecum on the left side of the abdomen (Figure A). Subsequent abdominal computed tomography (CT) revealed a whirl sign at the transverse colon (Figure B). What is the possible diagnosis? See the Gastroenterology website (www.gastrojournal.org) for more information on submitting to Gastro Curbside Consult. According to the dilated colon in the KUB X-ray, a large bowel obstruction was highly suspected. The abdominal CT demonstrated small bowel occupying the right side of the peritoneal cavity and the colon on the left, and a transition point at the transverse colon (Figure B, red arrow), with the colon rotation and proximal colon dilatation (Videos 1 and 2). Surgical laparotomy with segmental resection of the bowel is indicated, however, the patient rejected it. Because of no intestinal pneumatosis in CT and the stable vital sign of the patient, we attempted colonoscopic decompression using carbon dioxide (CO2) during the procedure instead. The colonoscope type Olympus CF-H290L/I was chosen because the distal end outer diameter (12.2 mm) was smaller than other CF-HQ290 (13.2 mm). We kept the patient in clear consciousness without anesthesia in the procedure to detect subtle signs of peritoneal irritation or progression of abdominal pain. We initiated the procedure with the patient in the left lateral position, however, we required the patient to change the position to either supine or right lateral position repeatedly during the procedure when a sharp angle of the tunnel was met to avoid iatrogenic injury. The colonoscopy revealed a colon stricture point at 60 cm above the anal verge. We advanced the endoscope near the stricture site, and the strangulated transition point was exposed (Figure C). After carefully passing through with minimal air inflation and endoscopy rotation, the dilated ascending colon was reached. After endoscopic decompression with air suction, the patient’s abdomen flattened and the abdominal tenderness became less. Subsequently, we performed endoscopic colon reduction with clockwise endoscopic rotation with the guidance of the endoscopic view. The patient’s abdominal pain was relieved and the serum lactate level decreased (0.6 mmol/L). The following KUB X-ray after colonoscopy showed improving bowel dilation (Figure D). Further laparoscopy will be scheduled. We suggested the patient intake food without high fiber before the surgery to prevent recurrent volvulus. Colon volvulus is the third most common cause of large bowel obstruction, followed by malignant obstruction and diverticulitis. Although sigmoid colon and cecum volvulus accounted for 95% of colon volvulus, transverse colon volvulus is rare.1Pickett M.L. Mottershaw A.M. Gupta P. Huerta S. Volvulus of the transverse colon in an octogenarian veteran.J Surg Case Rep. 2021 May 10; 2021 (rjab166)Crossref Scopus (0) Google Scholar,2Huerta S. Pickett M.L. Mottershaw A.M. Gupta P. Pham T. Volvulus of the Transverse Colon.Am Surg. 2021 Aug 30; 31348211041564Crossref Scopus (2) Google Scholar The risk factors for transverse colon volvulus are categorized into congenital (malrotation and abnormal fixation), anatomic (nonfixation and bowel redundancy), mechanical (adhesions and distal bowel obstruction from malignancy or strictures), and physiological (constipation, bowel dysmotility, and high-fiber diet)3Sana L. Ali G. Kallel H. et al.Spontaneous transverse colon volvulus.Pan Afr Med J. 2013; 14: 160Crossref PubMed Scopus (9) Google Scholar. Transverse colon volvulus is considered to be a surgical emergency based on an exploratory laparotomy, followed by either colopexy or colectomy.1Pickett M.L. Mottershaw A.M. Gupta P. Huerta S. Volvulus of the transverse colon in an octogenarian veteran.J Surg Case Rep. 2021 May 10; 2021 (rjab166)Crossref Scopus (0) Google Scholar However, detorsion with colopexy had a higher recurrence rate of volvulus than resection with primary anastomosis or resection with colostomy.3Sana L. Ali G. Kallel H. et al.Spontaneous transverse colon volvulus.Pan Afr Med J. 2013; 14: 160Crossref PubMed Scopus (9) Google Scholar Delayed diagnosis and treatment of transverse colon volvulus may result in bowel infarction, peritonitis, and death.3Sana L. Ali G. Kallel H. et al.Spontaneous transverse colon volvulus.Pan Afr Med J. 2013; 14: 160Crossref PubMed Scopus (9) Google Scholar In our case, the young man with congenital intestinal malrotation encountered his first episode of transverse colon volvulus after constipation for 2 days. The physical examination and the abdominal CT had ruled out intestinal pneumatosis and peritonitis, suggesting the very early stage of the transverse colon volvulus. In this situation, our trying colonoscopic decompression relieves the discomfort temporarily. The assistance of fluoroscopy may increase the success rate and safety if available. However, further surgical laparotomy with colon resection should be arranged if the volvulus recurs. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiJiYTAwNjkxOTgwYTBkZjcyYmFhMjNhNDM0MTlmNjY1MiIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjgwMTM1MzAzfQ.MK5lRlQ0CZphYjpFOKF4nqVQo1ipOteR_3KSl-OaVG1ItiUMvPezjMeESQ9MEAO-tH4Gz9hRtK5YGd8OUzGmWPUavhiKCY4gfBIH-gwawg434-Gk792-d0Wwde38hG5EiA_cZ7P9Mnv3z-mCPSSmTz0Z13LOnlsqduaoZoBn1CANJG8hjl8kL4wbLHJi_5jQKUGMm-vqKM4r_X4QVgOE2k0k5exg2LYZzNtgMawq7RLRTGz6BKlieoxoQrA5O3wpZ54fc5net78Uofnpzs81tDntpJy2McgDPS1ogKNB5Hu1Qxh_8iAjdhqwjE2w_J7vN_PxQXSu8qFcBgjIiH7mxg Download .mp4 (3.67 MB) Help with .mp4 files Video 1eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI5ZTQzOTY1YzNmMTg1ZWNmMWUyODg0YzVlNjg3OGQ4OCIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjgwMTM1MzAzfQ.UjIK4Q45DWzyGslZ4Olg--bgdxT6dTTO6M6h0me7ns-HVkAG6jIg6LRHCRDplly-3NlQFKEIuMSCcl-d98ycM2G7s65j2QN5OBZt6G6LFKsGapl55uVLXPNkC8x5u8L0EDRMPE5xdX0rh0TatzjSatmCwRm79rH-m6aS8OzU8mEYddOQsJzLHBNMz2uw94vTUlxRXmQuKcPEeLdg3F2y1GaOtBudPr3dqFMeFwzZYbNQ4Oj92euQ7oBZ3_8zMeUFPn43BxgU8truHJ4Ku9NlO26-10dnCtdvzBRLcXIblCHIFvPSqpVFJViiPKXD61_sb3OlGaNMtSQpqFskIXgrUg Download .mp4 (2.66 MB) Help with .mp4 files Video 2

“An observational study of intestinal obstruction in adults”

Background: Mechanical intestinal obstruction is a common surgical emergency. The causes of intestinal obstruction include hernias, postoperative adhesions, malignancy, strictures etc. The etiology of this condition varies in different parts of the world and within same country. Methods: This prospective descriptive study was conducted in department of surgery at a tertiary care teaching hospital.  All the adult patients, irrespective of sex with diagnosis of dynamic intestinal obstruction undergoing exploratory laparotomy were included in the study. Laparotomy findings were recorded and in the postoperative period patients were followed up for detection of complications and treatment. Results:45 patients were treated for mechanical intestinal obstruction. Mean age was 49.5 years and male to female ratio was 1.81:1. Most common cause of small bowel obstruction is Small bowel adhesions i.e. 13 patients (39.39%) ; while the most common cause of large bowel obstruction is malignancy arising from different parts of large bowel i.e. 66.67% of patients (8 patients) Wound infection was the commonest postoperative complication. There were 12 deaths in this study giving mortality rate of 26.6%. Conclusions: Bowel Adhesion  is the leading causes of mechanical intestinal obstruction in our region.

EP-593 Blind loop mucocele of a side-to-end colorectal anastomosis as a rare cause of large bowel obstruction

Abstract Background Large bowel obstruction (LBO) after colorectal surgery draws wide differentials. Very few reports of LBO secondary to closed loop mucocele have been published. To our knowledge, LBO due to mucocele of the blind colonic limb of a side-to-end colorectal anastomosis has not been described. Case Details A 57-year-old man presented with pain, gradual abdominal distension and one week history of constipation. He had extensive surgical history – colo-vesical fistula takedown, sigmoid resection and Hartmann type end colostomy followed by reversal, and mesh repair of incisional ventral hernia among others. Notably, a side-to-end configuration was fashioned as a descending colo-rectal anastomosis. CT, followed by MRI scans, of the abdomen and pelvis respectively suggested a mucus-filled short blind colonic bowel segment compressing the anastomotic site as the cause of large bowel obstruction proximal to the site. On flexible sigmoidoscopy under general anaesthesia, external compression of the rectum with narrowing of the lumen was noted. Transrectal needle aspiration of the blind colonic segment yielded 145 mL of mucoid fluid and allowed proximal examination. Anastomotic site was of normal calibre. The patient's symptoms improved and he was discharged with scheduled outpatient follow-up. Gastrografin enema post-discharge demonstrated an end-to-side rectosigmoid anastomosis with local rectal stenosis and showed the blind loop had emptied. Conclusion This case highlights that blind colonic loop mucoceles in colorectal anastomosis can rarely cause obstruction and endoscopic management is feasible when accurate diagnosis is confirmed on imaging.

TU4.3 Caecal volvulus: A District General Hospital Experience and Review of the Literature

Abstract Aim Caecal volvulus (CV) is an uncommon cause of large bowel obstruction with potential for complications such as ischaemia, and perforation. Prompt diagnosis and treatment only will ensure better outcomes. We aim to describe our experience in the largest series of CV reported in the United Kingdom. Methodology This was a retrospective study of 16 consecutive patients diagnosed with CV between March 2017 and March 2020. Results Out of 16 patients, 11 were female, with a median age of 64 (range 33–80) years. All patients presented with abdominal pain and vomiting. An initial diagnosis of bowel obstruction was made only in 8 patients (50%). Computed tomography (CT) scan of the abdomen and pelvis correctly diagnosed CV in fourteen (87.5%). Fifteen patients (94%) underwent surgical intervention. All but one (n=14,93.4%) underwent laparotomy, and one patient (6.6%) underwent successful laparoscopic intervention. Right hemicolectomy was performed in all operated patients, and fourteen patients (93.4%) had primary anastomosis. Twelve patients (80%) had one or other form of morbidity. Seven patients (47%) and three patients (20%) had grade II and III (Clavien-Dindo Classification) complications respectively with a median hospital stay of 10 (range 1–49) days. One patient (6.7%) managed conservatively was deemed to be futile. There was no postoperative mortality. Conclusion CV can present with non-specific symptoms, and a definite preoperative diagnosis is only possible with the aid of CT. Open resectional procedures with primary anastomosis is the most favoured approach in management, though laparoscopic access is also feasible in fit patients.

Gallstone ileus of the colon: case report about an unusual cause of large bowel obstruction

Gallstone ileus of the colon: case report about an unusual cause of large bowel obstruction

Sigmoid Colectomy for Sigmoid Volvulus Through a Limited Left Lower Quadrant Transverse Laparotomy Incision Without Laparoscopy.

Sigmoid volvulus (SV) is a relatively rare cause of large bowel obstruction encountered by general surgeons in the United States. It predominantly affects the elderly, infirm, and institutionalized. Surgery after endoscopic reduction is the mainstay of treatment. Given the frail nature of the population requiring partial colectomy for SV, formal laparotomy and laparoscopic sigmoid colectomies come with significant risks. Much of the risk related to a minimally invasive, laparoscopic approach is due to the physiologic impacts of pneumoperitoneum. This series demonstrates a technique whereby a complete sigmoid resection with or without anastomosis can be achieved via a single, small incision equivalent to a laparoscopic extraction port. This technique took advantage of the redundancy in the sigmoid colon characteristic of SV. All patients tolerated their procedures well and had rapid return to their baseline function.

Caecal Volvulus: A District General Hospital Experience and Review of the Literature

Background: Caecal volvulus (CV) is an uncommon cause of large bowel obstruction with potential for complications such as ischaemia and perforation. Prompt diagnosis and treatment only will ensure better outcomes. We aim to describe our experience in the largest series of CV reported in the United Kingdom. Methods: This was a retrospective study of 16 consecutive patients diagnosed with CV between March 2017 and March 2020. Results: Out of 16 patients, 11 were female, with a median age of 64 (range 33–80) years. All patients presented with abdominal pain and vomiting. An initial diagnosis of bowel obstruction was made only in 8 patients (50%). Computed tomography (CT) scan of the abdomen and pelvis correctly diagnosed CV in fourteen (87.5%). Fifteen patients (94%) underwent surgical intervention. All but one (n = 14, 93.4%) underwent laparotomy, and one patient (6.6%) underwent successful laparoscopic intervention. Right hemicolectomy was performed in all operated patients, and fourteen patients (93.4%) had primary anastomosis. Twelve patients (80%) had one or another form of morbidity. Seven patients (47%) and three patients (20%) had grade II and III (Clavien–Dindo Classification) complications, respectively, with a median hospital stay of 10 (range 1–49) days. One patient (6.7%) managed conservatively was deemed to be futile. There was no postoperative mortality. Conclusions: CV can present with non-specific symptoms, and a definite preoperative diagnosis is only possible with the aid of CT. Open resectional procedures with primary anastomosis are the most favoured approach in management, though laparoscopic access is also feasible in fit patients.

The Outcome of Resection and Primary Anastomosis (With On-table Lavage) Management of Acute Sigmoid Volvulus, A Developing Country Experience

Background: Acute sigmoid volvulus is the third most common cause of large bowel obstruction. It occurs when the sigmoid part of the colon twists around its blood supply. Methodology: This is a retrospective cross-sectional study detailing the outcome of 15 patients with acute sigmoid volvulus who underwent resection of the affected part of the colon and primary resection with on-table lavage in Khartoum, Sudan in the period from January 2019 to January 2021. All 15 patients were recruited on the basis of their fitting status for surgery and their consent to the procedure. All patients have been followed-up for a period of 2 months post-operatively with no loss to follow-up. Results: The outcome for all 15 patients was excellent with no complications. All patients have been followed up for a period of 2 months following their surgeries. There was no loss to follow-up among them and all of them have attended their post-operative follow up clinics. There were no reported wound problems of dehiscence and infection, anastomotic leakages or the need for revision surgery. Patients have a mean age of 46 years. One of the participants was a Jehovah’s witness; therefore, a cautious approach was implemented during surgery. Another one of the participants were suffering from left hip fracture when he underwent surgery, requiring a high level of care during his pre, peri as well as post-operative care. Conclusion and Recommendation: The outcome for resection and primary anastomosis with on-table lavage can be excellent with no complications. One limitation of this study, as this is not a comparative study, is that no comparison between the outcome of such procedure with the Hartmann’s procedure approach to managing such a condition. We recommend large-scale comparison between the outcome for both approaches to managing acute sigmoid volvulus.

Subacute splenic flexure volvulus following low anterior resection

Splenic flexure volvulus is a rare cause of large bowel obstruction. Patients often present in a delayed fashion after the onset of peritonitis and require emergent surgical exploration. Here, we present a case of a subacute splenic flexure volvulus following previous low anterior resection and subsequent management.

1354 A Rare Case of Gallstone Ileus Due to Cholecystocolonic Fistula

Abstract Introduction Gallstone Ileus (GI) is an uncommon but potentially lethal complication of cholelithiasis. 50 to 70% of gallstones obstruct in the ileum, the narrowest point of the intestine. More uncommonly the gallstone can travel into the large bowel via an incompetent ileo-caecal valve and impact in the colon at a recto sigmoid junction. GI involving the sigmoid colon is extremely rare cause of large bowel obstruction. The gallstone often enters the large bowel through a fistula formation between the gallbladder and colon, and impacts at a point of narrowing, causing large bowel obstruction. Case Report We describe the case of a 72-year-old man who presented with features of bowel obstruction. CT of abdomen pelvis (CTAP) showed a large 5x5cm intraluminal gallstone obstructing at the rectosigmoid area. It showed presence of pneumobilia and incidental finding of abdominal aortic aneurysm (AAA). An emergency laparotomy revealed a cholecystocolonic fistula. The stone was extracted after milking the stone proximally and loop colostomy formed at colotomy site. The patient made an uneventful recovery. Reversal of stoma was postponed pending endovascular repair of enlarging AAA. Discussion Presenting symptoms of GI are often non-specific, frequently leading to a delay in diagnosis and treatment. Although no fistula was identified in this patient by imaging, the most common cause of GI in most patients is formation of a cholecystoduodenal fistula. Conclusions Compared with biliary enteric fistulae, the occurrence of cholecystocolonic fistulae is remarkably rare. Temporary colostomies can be considered for treating these cases alongside one-stage operations

Sigmoid colon strangulation caused by bilateral fallopian tubes: A case report.

IntroductionThere are no reports regarding sigmoid colon strangulation caused by bilateral fallopian tubes, which is a rare type of large bowel obstruction. Herein, we report a case of successful laparoscopic treatment of sigmoid colon strangulation.Presentation of caseA 54-year-old woman presented to our hospital with intermittent abdominal pain. Her medical history was significant for endometriosis; however, there was no surgical history. The physical examination revealed tenderness over the lower abdomen. CT scan shows closed loop obstruction of sigmoid colon. Exploratory laparoscopy was performed, and a sigmoid colon strangulated by bilateral fallopian tubes was detected. The adhesions consisting of bilateral fallopian tubes were dissected laparoscopically. The patient's postoperative course was uneventful, with no complications.DiscussionThe most common cause of large bowel obstruction (LBO) is colorectal cancer, including volvulus and diverticulitis. In this case, the adhesion of both the right and left fallopian tubes caused LBO, and it is conceivable that the etiology involved is endometriosis.Few cases have reported bowel obstruction associated with a fallopian tube, and the laparoscopic approach is very rare. In our case, we immediately performed laparoscopic exploration before colon strangulation led to necrosis or perforation. Therefore, we succeeded in releasing the strangulation laparoscopically.ConclusionWe report a case of sigmoid colon strangulation that was treated laparoscopically. This approach can be the treatment of choice for sigmoid colon strangulation.

The colon membrane as a cause of large bowel obstruction in a child of 11-month old: a case report

Introduction. Colon atresia is a rare form of congenital bowel obstruction. In scientific literature, there are isolated publications devoted to colon atresia, and only some authors discuss the membranous form of atresia.Material and methods. The article describes a rare clinical case of an incomplete colon membrane in an infant. At the age of 11 months, the child developed symptoms of acute intestinal obstruction. Irrigography was performed; Hirschsprung’s disease was suspected. At the first stage, the child was taken a floor-by-floor biopsy of the colon, and an ileostomy was put. Visually, Hirschsprung’s disease seemed to be present; however, histological examination turned aside this diagnosis. Given this, the colon membrane was suspected. Partial resection of the altered part of the sigmoid colon was performed with good clinical effect. Histological examination revealed an incomplete serous-muscular membrane of the colon.Conclusion. Colon atresia is a rare disease that presents a serious problem for diagnosis and treatment. Preoperative morphological verification of the diagnosis is important, even in case when Hirschsprung’s disease seems obvious. Preoperative diagnostics is important because surgical tactics may be considerably different in colon local lesions. 

Adult sigmoid volvulus in West Africa: Management and outcome at principal hospital of Dakar

Background: Sigmoid volvulus (SV) is the commonest cause of large bowel obstruction in sub Saharan Africa. However few studies have been done in our country. Our goal was to describe the presentation, management outcome of adult SV and to evaluate our therapeutic methods in a context of non availability of endoscopic decompression.Methods: It was a retrospective, descriptive review of all adult patients, admitted in the visceral surgery department of Hospital Principal of Dakar for SV, from January 2014 to August 2018. We studied demographics variables, clinical and paraclinical features, treatment and outcome. The data were entered and analyzed using Excel 2017 software and Epi-info version 7.2.2.6.Results: We collected 103 cases of SV for 86 patients, representing 45.9% of intestinal obstruction. The mean age was 54.9 years. There were 82 males and 4 females. The mean duration of symptoms was 3.8 days. The triad acute abdominal pain, inability to pass gaz and feces, abdominal meteorism was noted in 52.4%. Plain abdominal X-ray (n=55; 53.3%) showed the classical ‘coffee bean’ sign in 69%. CT scan (n=77; 74.7%) confirmed the diagnosis in 100%. It revealed signs of intestinal gangrene in 8 cases confirmed at laparotomy in 6 cases. In 4 cases imaging was not performed.Detorsion was spontaneous in 2 cases. Faucher rectal tube decompression was performed in 81 cases with a success rate of 86.4% representing 53 patients. Elective sigmoidectomy was realized in 33 patients (31 after successful rectal tube decompression, 2 after spontaneous decompression). After elective sigmoidectomy mortality and morbidity were nil.In those with successful rectal tube decompression, 7 did not have elective sigmoidectomy for comorbidities, 12 refused the elective sigmoidectomy.Emergency surgery was performed in 34 patients: 20 patients for suspicious of complicated SV, 14 patients after failure of rectal tube decompression. It was 9 (26.4%) one stage sigmoidectomy, 24 (70.5%) 2 stage sigmoidectomy, 1 surgical detorsion without pexy. Mortality and mortality after emergency surgery were respectively 8.3% and 14.7%. After 2 stage sigmoidectomy, 86.3% benefited from a restoration of digestive continuity.During the follow-up, no recurrence occurred in patients who were operated. Conclusion: SV is a middle-age man pathology in sub Saharan Africa. In uncomplicated SV rectal tube decompression followed by elective sigmoidectomy is a good option.