Cause Of Small Bowel Obstruction Research Articles

Foodborne botulism presenting as small bowel obstruction: a case report

BackgroundSmall bowel obstruction is one of the leading reasons for accessing to the Emergency Department. Food poisoning from Clostridium botulinum has emerged as a very rare potential cause of small bowel obstruction. The relevance of this case report regards the subtle onset of pathognomonic neurological symptoms, which can delay diagnosis and subsequent life-saving treatment.Case presentationA 24-year-old man came to our Emergency Department complaining of abdominal pain, fever and sporadic self-limiting episodes of diplopia, starting 4 days earlier. Clinical presentation and radiological imaging suggested a case of small bowel obstruction. Non-operative management was adopted, which was followed by worsening of neurological signs. On specifically questioning the patient, we discovered that his parents had experienced similar, but milder symptoms. The patient also recalled eating home-made preserves some days earlier. A clinical diagnosis of foodborne botulism was established and antitoxin was promptly administered with rapid clinical resolution.ConclusionsThough very rare, botulism can mimic small bowel obstruction, and could be associated with a rapid clinical deterioration if misdiagnosed. An accurate family history, frequent clinical reassessments and involvement of different specialists can guide to identify this unexpected diagnosis.

Uterine leiomyoma as a cause of small bowel obstruction!

Introduction: Small bowel obstruction (SBO) is a condition with many well-recognized common causes and a distinct set of symptoms, including constipation, vomiting, and abdominal distension. Recent developments in both imaging modalities and minimally invasive techniques have meant that patients can be more appropriately selected for surgical intervention and that common causes of SBO can be readily identified. Despite these advances, it must be acknowledged that rare causes of SBO are still causing a diagnostic dilemma. Case Report: We are presenting a rare cause of a 45-year-old lady with mechanical bowel obstruction leading to intestinal gangrene caused by a huge uterine fibroid. Conclusion: It is essential that rare causes of bowel obstruction are identified and presented to facilitate their recognition in future to reach better patient’s outcome.

Incidence of adhesive small bowel obstruction and outcome of management

Background: Small bowel obstruction (SBO) is a common surgical condition that leads to emergency admission. Adhesions are the single most common cause for SBO, accounting for 60% of cases. The occurrence of adhesive SBO (ASBO) is higher following specific surgeries including colorectal, high gynaecological and paediatric surgeries. Initially, all patients are treated conservatively, but in case they fail to improve, surgical management is considered. Aim & Objectives: The objective of the study is to assess the number of patients admitted at Rashid Hospital with ASBO and the outcomes of their management. Materials and Methods: A retrospective study was conducted on patients who were admitted with ASBO from April 2017 until December 2019. A total of number of 85 patients who met the inclusion criteria were enrolled in the study. Those with underlying inflammatory bowel disease, abdominal tuberculosis and small bowel tumours were excluded. The outcomes of non-operative management (NOM) in terms of success rate, length of hospital stay and surgical intervention were assessed. Result: A total of 303 records were reviewed, of which 85 met the inclusion criteria (50 males and 35 females). The most common type of previous abdominal surgeries includes lower gastrointestinal (38.8%) and gynaecological surgeries (12.9%). Seventy-eight patients who underwent NOM had a success rate of 77.6% (n = 59) with a mean length of stay (LOS) of 3.5 days. Seventeen patients (22.4%) needed surgical intervention after a mean of 3.5 days. These patients were found to have intra-abdominal bands in 52.9% of the cases (P = 0.191). During the time period set for the study, the recurrence rate of patients who had successful NOM versus those who needed surgical intervention was 12% and 35.3%, respectively (P = 0.061). Sixty per cent of these recurrent cases were treated non-operatively on the second admission to the hospital whereas 40% required surgical intervention. Conclusion: NOM for ASBO has a shorter LOS and a lower recurrence rate as compared to those who required surgical management.

Seaweed food bolus: A rare cause for small bowel obstruction

Introduction: Small bowel obstruction is a common acute general surgical presentation. A bezoar is a concretion found within the lumen of the gastrointestinal tract, composed of partially digested or indigestible material. We present a rare case of a small bowel obstruction caused by seaweed phytobezoar. Presentation of Case: A young woman with a virgin abdomen presented to our facility with a 3-day history of abdominal pain and vomiting. Computed tomography of the abdomen and pelvis was consistent with small bowel obstruction. At laparoscopy, a soft intraluminal obstructing mass was seen. After conversion to mini-laparotomy, an obstructing food bolus consisting of seaweed was found and removed via enterotomy. Conclusion: Bezoars are an uncommon cause of small bowel obstruction because objects able to traverse the pylorus will usually migrate through to the rectum without impaction. Diagnosis is dependent on a thorough history as findings on computed tomography are nonspecific. Treatment options range from chemical dissolution to endoscopic or surgical intervention depending on the size, location, and substance of the bezoar. It is important to consider food bolus and bezoar in the differential diagnosis for intestinal obstruction, and seaweed is among the food substances that should be asked about.

Clinicopathological spectrum of small bowel obstruction and management outcomes in adults - experience at a regional academic hospital complex

ABSTRACT BACKGROUND: Delay in operative management of small bowel obstruction (SBO) results in increased morbidity and mortality. The objective was to evaluate clinical presentation and treatment outcome of SBO METHOD: Prospective cohort study between 2013-2014. Adult patients presenting with SBO were included. Demographics, clinical details, investigations, operative findings, in-hospital progress and outcomes were documented RESULTS: There were 156 patients (median age 37 [IQR 27-54 years]) with early (44) and delayed (112) presentation. :F ratio was 1.4:1. Common causes of obstruction were adhesions (94; 60.3%) and hernias (31; 19.9%). Non-operative management was feasible in 59 patients (37.3%) with a success rate of 71.2%. Nonviable bowel was present in 45.1% (early 31%, delayed 50%; p = 0.078). Sixty-one patients (54%) underwent bowel resection; nine patients (20.5%) in the early presentation group and 52 (46.4%) in the delayed group (p = 0.003). Thirty-one patients needed ICU admission (early 5, delayed 26; p = 0.091). The delayed group had longer ICU stay (p = 0.018) and longer hospital stay (p < 0.001). There were more complications (p = 0.084) and re-laparotomies (p = 0.156) in the delayed group. Eight patients died (5.1% CONCLUSION: The main causes of SBO were adhesions and hernias. Late presentation was associated with higher resection rate, higher critical care admission and longer hospital stay Keywords: small bowel obstruction, adhesive bowel obstruction, acute abdomen

Small Bowel Obstruction Induced by Phytobezoar: A Case Report in Innocent Abdomen and Literature Review

Introduction: Small bowel obstruction (SBO) is defined as a complete and persistent cessation of the transit of materials and gases. It occurs in a segment of the digestive tract located between the pylorus and the colorectal junction. Herein, we report a case of small bowel obstruction (SBO) following excessive consumption of wild grapes with no previous abdomen medical or surgical history. Presentation of case: A 65-year-old male farmer presented with cessation of materials and gas associated with vomiting of food and then bilious. The abdomen was bloated and painful on palpation with a moving, painful mass in the left iliac fossa. The hypothesis of acute occlusion of the colon was retained and confirmed on the X-Ray which showed a dilation of small bowel with air-fluid levels. The diagnostic of acute SBO was retained. We performed urgently a median laparotomy. We found the dilation of the loops from the jejunum to the sigmoid colon with a compact mass at the sigmoid colon of 15 cm in length and 6 cm in diameter. We proceeded to crush the mass that was made up with wild grape seed fecal, and push it back to the rectum. The phytobezoar made up with wild grape seeds was extracted through the anus with the fingers after anal dilation. After extraction of the bezoar, the patient’s complaints completely subsided. Discussion: SBO is a frequent emergency surgical pathology. SBO induced by phytobezoar often occurs in patients with abdomen surgery history. However, it is particularly rare in virgin abdomen. Conclusion: This case report aims to raise awareness of phytobezoar as a cause of SBO in elderly even though without abdomen surgery history.

A fruity bowel obstruction: ingested dehydrated apple as a cause for small bowel obstruction

Small bowel obstructions are common acute surgical presentations often as a result of intraabdominal adhesions or herniations; rarer causes include malignancies, strictures, foreign bodies and bezoars. Phytobezoars (bezoars composed of undigested plant material) account for<4% of small bowel obstructions. Here we report an unusual case of a 56-year-old male with a virgin abdomen presenting with a small bowel obstruction, a CT scan of his abdomen and pelvis was suggestive of a closed loop small bowel obstruction. The patient progressed to have an emergency laparotomy and was found to have multiple intraluminal obstructing foreign bodies within the distal ileum. On making an enterotomy to remove and examine these, they were found to be rehydrated apple segments that the patient had ingested in the dehydrated form several hours earlier. This is an example of a phytobezoar causing bowel obstruction, contributing factors to the occurrence of these include poor gastrointestinal motility and problems of mastication; in this instance the patient had poor dentition that likely pre-disposed him to this problem.

Heterozygote Triplets. A Rare Case of Wilkie’s Syndrome

Wilkie’s Syndrome is a rare cause of small bowel obstruction that rarely occurs in a familiar setting. We report a rare variant, related to heterozygote triplets in a case that underwent laparoscopic duodenojejunostomy to bypass the obstructed segment. During the patient’s clinical evolution, we collected and discussed preoperative and post-operative studies. In addition, we performed a review of literature.

Seasonal unusual cause of small bowel obstruction in South East Asia.

Seasonal unusual cause of small bowel obstruction in South East Asia.

Non-operative management for small bowel obstruction in a virgin abdomen: a systematic review.

Small bowel obstruction (SBO) is a common general surgical presentation and there has been a shift towards non-operative management (NOM) for patients with previous abdominal surgery. Historically, exploratory surgery has been mandated for SBO in patients with a virgin abdomen. However, there is increasing evidence for NOM in this group of patients. A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A search was undertaken between 1995 and 2020 on Ovid MEDLINE, EMBASE and PubMed. Primary outcome measures were success and failure rates, whereas secondary outcome measures were morbidity, mortality rates and identifying underlying aetiologies. Six observational studies were included, with 205 patients in the NOM and 211 patients in the operative group. There was a high success rate of 95.6% and low morbidity rate of 3.1% in the NOM group compared to 88.6% and 26% in the operative group, respectively. Both groups reported no mortalities. The most common aetiologies for SBO in a virgin abdomen were adhesions (63%), malignancy (11%), foreign body/bezoar (5%), internal hernia (4%) and volvulus (4%). NOM for SBO is a safe and feasible option for a select group of clinically stable patients with a virgin abdomen without features of closed-loop obstruction. Adhesions are the most common cause of SBO in this group of patients. Further large-scale prospective clinical studies with standardized NOM modality, homogenous clinical resolution indicators and long-term follow-up data are warranted to allow for quantitative analysis to reinforce this evidence.

Small bowel obstruction and intestinal ischemia: emphasizing the role of MDCT in the management decision process.

The objective of this article is to assess the computed tomography (CT) findings of small bowel obstruction (SBO) complicated by ischemia. SBO is a frequent clinical entity characterized by high morbidity and mortality. The radiologic aim is not just to diagnose the obstruction itself but to rule out the presence of complications related to SBO. This is crucial for differentiating which patients can be safely treated non-operatively from the ones who may need an urgent surgical approach. The main complication of SBO is intestinal ischemia. In the emergency setting, CT imaging is the modality of choice for SBO because of its ability to assess the bowel wall, the supporting mesentery and peritoneal cavity all in one. On the other hand, the radiologist who documents an intestinal ischemia should think about SBO as possible cause. In this case, the main finding which helps the radiologist in the identification of SBO is the presence of multiple and packed valvulae conniventes in the dilated bowel wall and the "transition zone" that indicates the passage between compressed and decompressed small bowel, otherwise the localization of the obstruction cause. Once the site of obstruction has been recognized, the other issue is to assess the cause of obstruction, considering that the most common cause of SBO remains "unidentified" and related to intra-abdominal adhesions. After that, the following most important point is to rule out the presence of an ischemic bowel and mesenteric changes associated to SBO. CT signs of bowel ischemia include reduced or increased bowel wall enhancement, mesenteric edema or engorgement, fluid or free air in the peritoneal cavity. This condition usually leads to an urgent laparotomy and, in some cases, to a surgical resection.

Small bowel volvulus (SBV) in Northcentral Ethiopia

BackgroundSmall bowel volvulus (SBV) is a benign gastrointestinal surgical condition in which there is a torsion of all or parts of a segment of small bowel on its mesenteric axis. It has been contributed significant burden of surgical emergency as cause of small bowel obstruction in developing countries. The main objective this study was to explore clinical and epidemiological profile of Small bowel volvulus in Northcentral Ethiopia.MethodThe study was conducted at Debre Tabor General Hospital, South Gondar in Northcentral Ethiopia. The medical records of patients with a discharge diagnosis of small bowel volvulus were reviewed. The patients were seen for a 4-year period from Jan1, 2016-Dec31, 2019. The study was hospital-based retrospective cross-sectional and data were collected with a standardized structure questioner tool. The collected data checked for any inconsistency, code, and enter SPSS version 23 for data processing and analysis. Descriptive analyses were represented as frequency, percent, mean ± standard deviation for normal distribution, and Median ± Interquartile range for skewed data. Cross tabulation analysis was done for risk factors contributed for mortality and morbidity of SBV.ResultThere were 148 patients with Small bowel volvulus as a cause of small bowel obstruction was admitted within 4 years. The annual occurrence rate was 35cases per year. It represented 59% of small bowel obstruction and 36.3% of bowel obstruction. The majority were males (N = 125, 84.5%) and females were (N = 23, 15.5%). The age ranged from 15 to 78 years. The mean age was 41.14 ± (SD = 15.4). The most common clinical presentation was abdominal pain 98% and vomiting 91.2%. The median time of hospital stay was 5 days (± IQR = 2). The mean duration of illness before hospital admission was 2 days (± SD = 1.4) and median was 1 day (± IQR = 2). The morbidity rate was 5.4% (N = 8) and the mortality rate was 3.4%(N = 5).ConclusionAnnual occurrence of SBV was 37 cases per year. The prevalence of SBV was 59% of small bowel obstruction and 36.3% of bowel obstruction respectively.

Managing Meckel diverticulum

The most common causes of small bowel obstruction are hernias and adhesive disease. Other causes include malignancy, inflammation, infection, and Meckel diverticulum with an omphalomesenteric ligament. This article describes a patient who presented to the ED with abdominal pain, nausea, and vomiting. A CT scan revealed dilated loops of bowel with an adjacent air-filled structure, possibly related to an internal hernia. Meckel diverticulum was discovered on diagnostic laparoscopy and a mesodiverticular band was lysed; the diverticulum was left in situ. The patient did well without further invention needed.

A rare case of superior ileocecal recess hernia

Internal hernias are a rare cause of small bowel obstruction, and one such internal hernia is superior ileocecal recess hernia, the subtype of pericycle hernia. The present study reports a case of small bowel obstruction due to superior ileocecal hernia for which laparotomy was performed. The surgery achieved a good outcome.

Incarceration of a Meckel's diverticulum by jejunal diverticulosis: an atypical cause of small bowel obstruction

Incarceration of a Meckel's diverticulum by jejunal diverticulosis: an atypical cause of small bowel obstruction

Emergency laparoscopic surgery during COVID-19: What can we do and how to do it safely.

Emergency laparoscopic surgery during COVID-19: What can we do and how to do it safely.

Intragastric balloon inside a Meckel's diverticulum: a rare cause of small bowel obstruction

Intragastric balloon inside a Meckel's diverticulum: a rare cause of small bowel obstruction

MON-681 Dulaglutide Commonly Known as Trulicity; An Anti-Diabetic Medication Causing Small Bowel Obstruction

Introduction Small bowel obstruction is a common and life threatening surgical emergency. The general causes are intra and extra-intestinal mechanical obstruction, such as from post-operative adhesions, malignancy, hernias, Crohn’s disease, and volvulus. Less frequently neurologic, metabolic, and medications interfere with intestinal motility and lead to obstructive features. Here, we present a rare case of small intestinal obstruction caused by the anti-diabetic glucagon-like peptide 1 (GLP-1) agonist, Dulaglutide (Trulicity). Case A 52-year-old male with Diabetes Mellitus, presented with two weeks of severe nausea and vomiting, accompanied by four days of diffused abdominal pain. CT scan of the abdomen showed multiple mildly distended dilated loops of the proximal jejunum. The results lead to suspect the presence of fecal stasis with an apparent transition zone of a normal caliber bowel. This is strongly indicative of partial or evolving small bowel obstruction. The patient was treated with conservative management of bowel rest and NG tube per the surgery on board. However, patient deteriorated too quickly and the partial bowel obstruction lead to full obstruction and eventually taken for an emergent surgery. With careful investigation to identify underlying causes of small bowel obstruction revealed no mechanical, structural, or metabolic explanation. However, a review of patient’s medication list disclosed a daily consumption of Dulaglutide (Trulicity). The medication was started 3 weeks prior to admission. He started developing partial bowel obstruction symptoms within one week of starting the medications. Unfortunately, surgeon ended up performing a partial resection a small bowel due to severe ischemia. Patient improved clinically in four to five days and was discharged home with an alternative anti-diabatic medications. He follows up with us in the clinic and has no signs of bowel obstructions with the other anti-diabatic medications. Discussion: Dulaglutide (Trulicity) is associated with small bowel obstruction. The side effect is more common in males and in patients who are using the medication for less than one month. A total of 8 cases were reported in 2017 with majority of them requiring surgical intervention for the small bowel obstruction. In our patient, it also required a surgical intervention and was life threatening. Unfortunately, the actual mechanism Trulicity causing the small bowel obstruction is unknown; however the moderate side effect of Trulicity is constipation. In this case, our patient was not constipated. He had normal bowel movements on a regular basis. Also, he never had any history of abdominal surgeries which can cause adhesion and lead to small bowel obstruction. All the other caused of small bowel obstructions had been ruled out and finally concluded Trulicity was the culprit of this unfortunate case.

Endometriosis as a rare cause of small bowel obstruction.

Endometriosis as a rare cause of small bowel obstruction.

Factors Predicting the Need for Early Surgical Intervention for Small Bowel Obstruction.

Purpose Small bowel obstruction (SBO) is a common disease that requires hospitalization. The most common cause of SBO is postoperative adhesion. Delayed timing of operations in patients who need surgical intervention results in mortality or morbidity. A number of studies on SBO have established criteria for emergency surgery. However, few objective clinical parameters are available for screening patients who need a delayed operation. Therefore, we analyzed factors that affect the clinical course of SBO to select appropriate therapeutic plans for reducing the risk of complications in these patients.Methods We investigated the clinical characteristics of patients admitted to the surgery department of our hospital between January 1, 2015, and December 31, 2016, who were diagnosed with SBO. Patients were divided into an operative treatment group (n = 12) and a conservative treatment group (n = 96). We compared clinical characteristics between the 2 groups.Results The operative treatment group underwent more operations before SBO than the conservative treatment group (P = 0.007). Initial leukocyte counts (P = 0.004) and C-reactive protein (CRP) levels (P = 0.028) were elevated in the operative group. Body mass index (BMI) was lower in the operative group (P = 0.013).Conclusion The number of operations before SBO, leukocyte counts, CRP levels, and BMI were useful parameters for selecting patients who needed an urgent operation for SBO.