Cause Of Large Bowel Obstruction Research Articles

Side-to-side anastomosis fashioned as stoma after sigmoid resection for sigmoid volvulus: a case report

Colonic volvulus is one of the causes of large bowel obstruction with sigmoid colon being the most usually affected part. Surgery is the gold standard when signs of peritonitis are present or endoscopic decompression fails. We report the case of 65-year-old man with acute large bowel obstruction due to sigmoid volvulus who underwent a laparoscopic-assisted sigmoid resection on an emergency basis. The condition of the bowel wall precluded a primary anastomosis. But instead, a side-to-side anastomosis that its common blind stump was brought out as an end stoma was performed. The postoperative period was eventless. The patient was discharged on the 6th postoperative day. Eight weeks after the initial operation, the patient was readmitted for the secondary closure of the anastomotic stoma. Local anesthesia and minor sedation were enough in order to perform the stoma take down. Laparoscopic-assisted sigmoid resection is a useful adjunct to the surgical armamentarium when facing the problem of sigmoid volvulus. When a safe restoration of the alimentary tract continuity cannot be achieved safely with a primary anastomosis, the proposed anastomotic stoma technique is a useful and practical alternative.

Contrast-enhanced CT as a preferred diagnostic tool in sigmoid volvulus in a 14-year-old girl

Summary Volvulus of the sigmoid colon is rare in children although it is a common cause of large bowel obstruction in elderly people. We report a case of sigmoid volvulus in a 14-year-old girl with intellectual disability. She had a 1-year history of chronic diarrhea despite supportive treatment. She was brought to the emergency department because of intermittent abdominal pain associated with vomiting of bile and passage of bloody stools. A plain X-ray showed dilated bowel loops. A contrast-enhanced computed tomography (CT) scan showed both limbs of the distended loop tapering in size and forming a round soft-tissue mass with whirled configuration in the left colonic compartment. Preoperatively, volvulus was suspected. Exploratory laparotomy disclosed a markedly distended sigmoid colon packed with fecal material and a counterclockwise rotation of 720 degrees with strangulating gangrene. The volvulus was untwisted, and a 65-cm segmental resection of the colon and primary anastomosis were performed. The patient was discharged on the 19th day following an uneventful postoperative course. We believe that a contrast-enhanced CT scan is a useful tool in the diagnosis of sigmoid volvulus.

Images of Cecal Volvulus From a Strangulating Fallopian Tube: A Case Report

An unusual case of cecal volvulus arising from a strangulating fallopian tube is presented. The etiology, diagnosis, and management guidelines of this infrequent cause of large bowel obstruction are reviewed. Computed tomography images are included, which demonstrate key features that are pathognomonic for this condition. To our knowledge, this is the first report of gynecologic adnexa giving rise to cecal volvulus.KeywordsCecal volvulus; Gynecologic and general surgery; Intestinal obstruction

Transverse Colon Volvulus with Chilaiditis Syndrome

Volvulus of transverse colon is a rare cause of large bowel obstruction. To our knowledge only 75 cases have been reported in the world literature and additionally only three cases of transverse colon volvulus with Chilaiditis syndrome have been reported to date. Because of its rarity here we report a case of transverse colon volvulus which was indeed associated with Chilaiditis syndrome. This is probably the fourth case of Chilaiditis syndrome caused by transverse colon volvulus. The online version of this article (doi:10.1007/s12262-010-0130-4) contains supplementary material, which is available to authorized users.

Gallstone Ileus of the Sigmoid Colon: An Unusual Cause of Large-Bowel Obstruction

Gallstone ileus of the colon is an exceedingly rare cause of large-bowel obstruction. It is usually the result of fistula formation between the gallbladder and large bowel facilitating entry of the stone into gastrointestinal tract. Contrast enhanced abdominal computed tomography is an important diagnostic aid. Surgical management is the treatment of choice to prevent the disastrous complications of large-bowel obstruction. We describe the case of a 92-year-old man who presented with symptoms and signs of large-bowel obstruction. Radiological investigation showed a large gallstone impacted in the sigmoid colon. Open enterolithotomy was undertaken relieving the obstruction and the patient made a full recovery.

Incarcerated lumbar hernia: a rare presentation

This case illustrates the diagnostic uncertainty seen in lumbar herniation as a rare cause of large bowel obstruction.

Percutaneous endoscopic colostomy: A new technique for the treatment of recurrent sigmoid volvulus

Sigmoid volvulus is a common cause of large bowel obstruction in western countries and Africa. It accounts for 25% of the patients admitted to the hospital for large bowel obstruction. The acute management of sigmoid volvulus is sigmoidoscopic decompression. However, the recurrence rate can be as high as 60% in some series. Recurrent sigmoid volvulus in elderly patients who are not fit for definitive surgery is difficult to manage. The percutaneous endoscopic placement of two percutaneous endoscopic colostomy tube placement is a simple and relatively safe procedure. The two tubes should be left open to act as vents for the colon from over-distending. In our opinion, this aspect is key to its success as it keeps the sigmoid colon deflated until adhesions form between the colon and the abdominal wall.

The coffee bean sign

An 89-year-old woman presented to our emergency department (ED) with a 4-day history of abdominal pain and vomiting. The physical exam revealed hypotension and a distended abdomen with generalized tenderness. Laboratory studies revealed hyperkalemia and elevated creatinine, lactate, and troponin. Given her hemodynamic instability, an emergent noncontrast abdominal computed tomography (CT) was obtained (Figs. 1 and ​and22). Fig. 1 Scout film of the CT abdomen, demonstrating the findings on a plain film Fig. 2 CT abdomen, revealing a twisted loop of sigmoid forming two large air-filled compartments with a central double wall ending at the point of the twist (white arrow) The patient was diagnosed with sigmoid volvulus. Sigmoid volvulus is the third leading cause of large bowel obstruction, behind cancer and diverticulitis [1]. Her CT scan revealed marked distention of the sigmoid colon and rectum with abundant stool in the rectum. The coronal image demonstrated a twisted loop of sigmoid with two air-filled compartments and a central double wall ending at the point of the twist, referred to as the “coffee bean” sign. This has also been observed in abdominal X-rays and is highly suggestive of sigmoid volvulus [2]. The diagnostic accuracy of plain X-rays ranges from 30 to 90%, depending on the experience of the interpreting physician [3]. When an X-ray is equivocal, contrast enema or a CT scan can be helpful [4]. Pseudo-obstruction and cecal volvulus can mimic sigmoid volvulus radiographically; however, this is rare [5]. Given the risk of gut ischemia, necrosis, and perforation, prompt management of sigmoid volvulus is warranted. Management with rectal tube placement can often be attempted. Surgery is recommended for patients with signs of bowel gangrene, peritonitis, or who fail nonoperative management [6]. Our patient and her family opted for comfort care only.

Large bowel obstruction by anomalous congenital band

The incidence of obstruction of large bowel is 3-4 times less frequent than the small bowel. The main causes of large bowel obstruction are malignancy, volvulus, diverticulae, inflammatory bowel disease and pseudo-obstruction [1]. Anomalous congenital bands (ACB) causing large bowel obstruction is a rare occurrence and to best of our knowledge, only three such cases has been reported in literature [2, 3, 4]. There is no report of congenital band causing both large bowel obstruction and jejunal ischemia. We report an unusual case of intestinal obstruction in a 76 year old lady who had an ACB obstructing the transverse colon causing a closed loop obstruction, caecal perforation and ischemia of proximal jejunum along with formation of pneumatosis cystoides intestinalis (PCI).

Unexpected cause of large bowel obstruction: Colonic bezoar

Colonic bezoars as a cause of obstruction have not been widely described in the literature, so no conclusions can be drawn based on available data. We present a case of large bowel obstruction in an adult blind patient caused by a colonic mass suspicious for tumor or bezoar by its radiological features. Colonic bezoar should be suspected when large bowel obstruction takes place in older patients with chronic constipation or a disability in controling food intake. There are no specific diagnostic findings related to colonic bezoars, but computerized tomography seems to be the most readily available to characterize bezoar in this case. CT diagnosis of bezoar was based on identifying a low-density intraluminal mass containing air bubbles and exhibiting a characteristic mottled appearance. The treatment may vary depending on the clinical situation. If diagnosis is correctly made, surgical operation can be averted. Early and effective management of constipation could help prevent this condition.

Distended urinary bladder and diverticulum—a rare cause of large-bowel obstruction

A 76-year-old man presented to the emergency department with diffuse abdominal pain and constipation. In the few months before this admission the patient had complained of strenuous micturition. The diagnostic work-up included a plain abdominal radiograph and an abdominal computed tomography scan that revealed large-bowel obstruction with a rare cause. The colonic obstruction was secondary to external compression of the rectosigmoid colon against the sacrum by a distended bladder and diverticulum. The immediate management was insertion of an indwelling urinary catheter that resulted in quick relief of the obstruction. Later the patient underwent surgery to remove an enlarged benign prostatic adenoma, which was the underlying cause of the bladder distention.

Volvulus: Small Bowel and Colon

Volvulus of the intestine is a surgical emergency. Volvulus of the small bowel is more common in children and is most often secondary to malrotation. Small bowel volvulus is an uncommon cause for small bowel obstruction in adults, and is more likely to be secondary to postoperative adhesive bands. Colonic volvulus is a rare cause of large bowel obstruction, but more common than small bowel volvulus. The sigmoid is most frequently involved, with redundant colon as the primary cause. Cecal volvulus most commonly is due to lack of fixation. Colonic volvulus has a specific radiographic appearance; however, small bowel volvulus is difficult to distinguish from other causes of small bowel obstruction by radiographic means. New surgical techniques with minimally invasive surgery are increasingly being applied to this old problem with good results in selected cases.

Large bowel obstruction in pregnancy: a rare entity, an unusual cause

Large bowel obstruction is a rare and difficult diagnosis in pregnancy. Common causes are caecal and sigmoid volvulus and less common pseudo-obstruction. An infrequent cause of large bowel obstruction from an adhesive band in pregnancy causing diagnostic difficulty is reported. Report of an unusual cause of large bowel obstruction in pregnancy. Diagnostic colonoscopy confirmed large bowel obstruction at the level of sigmoid. Laparotomy revealed this to be from a single band adhesion originating from the site of previous appendicectomy. Division of the band resolved the obstruction. A high index of suspicion is necessary for the diagnosis of large bowel obstruction in pregnancy especially in women with previous history of abdominal or pelvic surgery. Colonoscopy is helpful avoiding radiation to foetus and mother. Prompt surgical intervention reduces risks and maximises chances for a favourable outcome for both mother and child.

Large bowel obstruction and perforation secondary to endometriosis complicated by a ventriculoperitoneal shunt

A 36-year-old lady, with a past medical history of hydrocephalus requiring a ventriculoperitoneal (VP) shunt, was admitted with symptoms and signs of large bowel obstruction. Her condition worsened and she underwent laparotomy, where she had faecal peritonitis secondary to a perforated sigmoid colon. The shunt was contaminated with faeces leading to postoperative shunt infection and meningitis. Histology of the resected sigmoid colon revealed endometriosis at the site of perforation. Endometriosis is a rare cause of large bowel obstruction and literature review has found only two other cases of perforation because of endometriosis not associated with pregnancy. No case has been reported involving the concurrent surgical management of a contaminated VP shunt. We discuss the rarity of large bowel perforation and obstruction because of endometriosis, and the complications and management of VP shunts.

Malrotation with volvulus of the transverse colon and duodenal obstruction secondary to Ladd's bands

Colonic volvulus is a relatively uncommon cause of large bowel obstruction, accounting for 10% of colonic obstructions. Volvulus of the transverse colon is quite rare, accounting for only 4-11% of all reported cases of colonic volvulus (Kerry RL, Ransom HK. Volvulus of the colon: etiology, diagnosis, and treatment. Arch Surg 1969;99:215-221). We report an unusual case of documented volvulus of the transverse colon in a young man with intestinal malrotation and concomitant duodenal obstruction by Ladd's bands.

Calcified fecolith—a rare cause of large bowel obstruction

The authors present a rare case of colonic obstruction caused by a fecolith in a 59-year-old female who presented with symptoms suggestive of intestinal obstruction. The computed tomography (CT) confirmed the diagnosis. The patient was managed by laparotomy and colotomy to remove the fecolith.

Cholecystocolonic fistula: an unusual cause of large bowel obstruction

A 70-year-old woman was admitted to the emergency department with a 2-week history of pain in the upper abdomen, vomiting, fever and jaundice. She was also complaining of pale stool and dark urine. Subsequently she developed abdominal distension with colicky pain and absolute constipation. There was no history of previous biliary symptoms. On examination she was pale and tachycardic with a fever of 37.9°C. Abdominal examination revealed generalized abdominal distension with a tender mass at right upper quadrant and hyperactive bowel sounds on auscultation. Laboratory examination showed a white blood cell count of 15 600/mm3 (neutrophil 85%), bilirubin of 47mmol/litre, alkaline phosphatase of 220 U/litre with normal liver enzymes and amylase. Plain abdominal X-ray demonstrated pneumobilia and dilated small and large bowel loops suggestive of intestinal obstruction (Figure 1). An unprepared barium enema showed a large smooth filling defect in sigmoid colon with large bowel obstruction (Figure 2). A diagnosis of large bowel obstruction presumably caused by a gall-stone was made. Surgical treatment followed a period of physiological optimization. At laparotomy the abnormalities were large bowel obstruction caused by an impacted gall-stone in a section of sigmoid diverticular disease plus right upper quadrant mass. A sigmoid colectomy with removal of diverticular disease and the stone, then a primary anastomosis was performed. Exploration of right upper quadrant mass revealed an inflamed friable gall bladder with a fistula between its fundus and the transverse colon. A partial cholecystectomy was performed, the cystic duct closed in-situ and the defect in transverse colon was brought out as a loop colostomy. Her postoperative course was uneventful. Closure of colostomy was performed 3 months later and she made a full recovery.

Cecal volvulus: Case report and overview of the literature

Cecal volvulus is an uncommon cause of large bowel obstruction in developed countries. Clinical presentation is not specific and, therefore, diagnosis is usually made by radiological investigation. Plain abdominal radiograph and CT-scan are the examinations of choice. Therapy consists of urgent surgery, usually with resection of the twisted cecum. A case is presented here and an overview of the literature is given.

Sigmoid volvulus in Department of Veterans Affairs Medical Centers.

Sigmoid volvulus is the third leading cause of large-bowel obstruction. The optimal management strategy remains controversial. This study was undertaken to evaluate the care of patients with sigmoid volvulus recently treated at Department of Veterans Affairs hospitals. All patients with the International Classification of Diseases, Ninth Revision, Clinical Modification, Third Edition code for colonic volvulus during the period 1991 to 1995 were identified in the computerized national Department of Veterans Affairs database. Data on patient demographics, clinical course, and outcomes were analyzed. Two hundred twenty-eight patients had volvulus of the sigmoid colon and sufficient clinical data for evaluation. The mean age was 70; all were males. Endoscopic decompression was attempted in 189 of 228 (83 percent) patients and was successful in 154 of 189 (81 percent). Management included celiotomy in 178 of 228 (78 percent) patients. There were no intraoperative deaths. Twenty-five of 178 (14 percent) patients died within 30 days of surgery. The mortality rate was 24 percent for emergency operations (19/79), and 6 percent for elective procedures (6/99). Mortality was correlated with emergent surgery (P < 0.01) and necrotic colon (P < 0.05). Among those 50 patients managed by decompression alone, six (12 percent) died during the index admission. Ten of the remaining 44 (23 percent) patients eventually developed recurrent volvulus requiring further treatment, and 2 of 10 (20 percent) patients died. In this cohort sigmoid volvulus often presents as a surgical emergency. Initial endoscopic decompression resolves the acute obstruction in the majority of cases. Surgical intervention carries a substantial risk of mortality, particularly in the setting of emergent surgery or in the presence of necrotic colon.

Ogilvie's syndrome in the surgical patient: A new therapeutic modality

Acute colonic pseudo-obstruction, Ogilvie's syndrome, most often appears as a complication of other clinical conditions. It is characterized by massive colonic dilation in the absence of a mechanical cause. Therapy for this condition has traditionally been colonoscopic decompression via a flexible colonoscope. We performed a retrospective study to assess the efficacy of Cystografin enema for colonic decompression in Ogilvie's syndrome. We present a series of 18 patients who developed Ogilvie's syndrome while hospitalized for trauma (n = 10), burn (n = 1), gastrointestinal surgery (n = 4), and hip replacement (n = 3). The mean pre-enema cecal size was 13 cm (range 10 to 15 cm). The mean postenema cecal size was 8.5 cm (range 6 to 15 cm). Fifteen of the 18 patients underwent Cystografin enema as the primary mode of decompression. Three had undergone prior colonoscopy, which had failed. One of the 18 patients required repeat enema for inadequate decompression after the first enema and one underwent colonoscopy for recurrence. Two patients underwent operative intervention after the enema. There were no complications related to the enema. In all patients we were able to rule out a mechanical cause of large bowel obstruction. We believe the safety, efficacy, and ease of this procedure make Cystografin enema optimal firstline treatment for acute colonic pseudo-obstruction.