Cause Of Bowel Obstruction Research Articles

Risk Factors Associated With Increased Mortality From Intussusception in African Infants.

Morbidity and mortality from intussusception, the leading cause of bowel obstruction in infants, is higher in Africa than in other regions of the world, but the reasons have not been well examined. We sought to identify risk and protective factors associated with death or intestinal resection following intussusception. Infants with intussusception from 7 sub-Saharan African countries (Ethiopia, Ghana, Kenya, Malawi, Tanzania, Zambia, and Zimbabwe) were enrolled through active, hospital-based surveillance from February 2012 to December 2016. We examined demographic, clinical, and socioeconomic factors associated with death or intestinal resection following intussusception, using multivariable logistic regression. A total of 1017 infants <1 year of age with intussusception were enrolled. Overall, 13% of children (133/1017) died during the hospitalization, and 48% (467/966) required intestinal resection. In multivariable analyses, female sex [odds ratio (OR) 1.8, 95% confidence interval (CI) 1.2-3.3], longer duration of symptoms before presentation (OR 1.1; 95% CI 1.0-1.2), and undergoing intestinal resection (OR 3.4; 95% CI 1.9-6.1) were associated with death after intussusception. Diagnosis by ultrasound or enema (OR 0.4; 95% CI 0.3-0.7), and employment of a household member (OR 0.7; 95% CI 0.4-1.0) were protective against intestinal resection. Delays in hospital presentation and female sex were significantly associated with death, whereas higher socioeconomic status and availability of radiologic diagnosis reduced likelihood of undergoing resection. Efforts should be intensified to improve the awareness, diagnosis, and management of intussusception in sub-Saharan African countries to reduce morbidity and mortality from intussusception in these resource-limited settings.

Infectious Etiologies of Intussusception Among Children

The etiology of intussusception, the leading cause of bowel obstruction in infants, is unknown in most cases. Adenovirus has been associated with intussusception and slightly increased risk of intussusception with rotavirus vaccination has been found. We conducted a case-control study among children <2 years old in Bangladesh, Nepal, Pakistan, and Vietnam to evaluate infectious etiologies of intussusception before rotavirus vaccine introduction. From 2015 to 2017, we enrolled 1-to-1 matched intussusception cases and hospital controls; 249 pairs were included. Stool specimens were tested for 37 infectious agents using TaqMan Array technology. We used conditional logistic regression to estimate odds ratio (OR) and 95% confidence interval (CI) of each pathogen associated with intussusception in a pooled analysis and quantitative subanalyses. Adenovirus (OR, 2.67; 95% CI, 1.75-4.36) and human herpes virus 6 (OR, 3.50; 95% CI, 1.15-10.63) were detected more frequently in cases than controls. Adenovirus C detection <20 quantification cycles was associated with intussusception (OR, 18.59; 95% CI, 2.45-140.89). Wild-type rotavirus was not associated with intussusception (OR, 1.07; 95% CI, 0.52-2.22). In this comprehensive evaluation, adenovirus and HHV-6 were associated with intussusception. Future research is needed to better understand mechanisms leading to intussusception, particularly after rotavirus vaccination.

Clinical Impact of the Introduction of Pediatric Intussusception Air Enema Reduction Technology in a Low- to Middle-Income Country Using Low-Cost Simulation-Based Medical Education.

Pediatric intussusception is a common cause of bowel obstruction in infants. Air enema (AE) reduction is routine first-line management in many countries; however, there is a high rate of operative intervention in low- and middle-income countries. The aims of the study were to use simulation-based medical education with an intussusception simulator to introduce AE reduction to Myanmar and to assess its effect on provider behaviors and the resulting clinical care. Clinical evaluation was conducted by comparing clinical outcomes data for children with intussusception 12 months before implementation with that from 12 months subsequent to implementation. These included the following: AE success rates, recurrence rates, length of stay, intestinal resection, and operative intervention rates. An educational workshop was developed that used a low-cost mannequin to facilitate practice at the reduction of intussusception using AE. Curriculum evaluation was performed through 5-point rating scale self-assessment in several domains. Data analysis was performed with Mann-Whitney U test, Student t test, or Wilcoxon signed-ranks test as appropriate; a P value of less than 0.05 was considered to be significant. After implementation, there was a significant reduction in the overall operative intervention rates [82.5% (85/103) vs. 58.7% (44/75), P = 0.006]. Intestinal resection rates increased [15.3% (13/85) vs. 35.9% (14/39), P = 0.02]. The success rate with attempted AE reduction was 94.4% (34/36), with a recurrence rate of 5.6% (2/36). The simulation-based medical education workshop was completed by 25 local participants. There was a significant difference in the confidence of performing (1.9 vs. 3.6, P ≤ 0.0001) or assisting (2.8 vs. 3.7, P = 0.018) an AE reduction before and after the workshop. Simulation-based educational techniques can be successfully applied in a low- and middle-income country to facilitate the safe introduction of new equipment and techniques with significant beneficial impact on provider behaviors and the resulting clinical care.

Diagnosis and Management of Pediatric Patients with Intussusception

AbstractIntussusception is one of the most common cause of bowel obstruction in infancy. While surgical intervention is sometimes needed, the primary modality for the reduction of intussusception is pneumatic or air enema. This is highly successful in the reduction of ileocolic intussusception with 90% success rate. Here we review the presentation, pathophysiology, appropriate radiographic studies and findings, and fluoroscopic reduction technique.

Promising results of a new treatment in patients with bowel obstruction in colorectal surgery

IntroductionBowel obstruction increases risk of emergency surgery and leads to suboptimal physical and nutritional condition. Preventing emergency surgery and prehabilitation might improve outcomes. This pilot study aimed to examine the effect of a multimodal obstruction protocol for bowel obstruction patients on the risk of emergency surgery and postoperative morbidity and mortality. Materials and methodsAll bowel obstruction patients treated according to the obstruction protocol in the period 2013–2017 were included in this uncontrolled observational cohort study. Benign and malignant causes of bowel obstruction were included. The protocol consisted of: 1. specific dietary adjustments to reduce prestenotic dilatation, 2. oral laxatives and 3. prehabilitation. Emergency surgery and postoperative morbidity and mortality rates were compared to known rates from the literature. ResultsSixty-one patients were included: 44 (72%) were treated for colorectal cancer and 17 (28%) for Crohn's disease or diverticulitis. Four patients (7%) underwent emergency surgery. Primary anastomosis was constructed in 49 out of 57 elective patients (86%). Severe complications (Clavien-Dindo ≥ III) occurred in four patients (7%). No bowel perforation, anastomotic leakages or 30-day mortality was observed. These rates were much lower than rates reported in the literature after surgery for colorectal cancer (3% bowel perforation, 8% anastomotic leakage, 4% 30-day mortality, 15% severe complications) and benign disease (30-day mortality 17%, severe complications 7%). ConclusionUsing the obstruction protocol in patients with bowel obstruction reduced emergency surgery and postoperative morbidity and mortality in this pilot study. This protocol seems to be a viable and efficient alternative to emergency surgery.

3208 Small Bowel Obstruction Due to Tuberculous Lymphadenopathy

INTRODUCTION: Mycobacterium tuberculosis is estimated to infect 1.7 billion people worldwide. When untreated, disseminated tuberculosis can occur through hematogenous seeding from primary infection or reactivation of latent disease. Abdominal tuberculosis can be seen in 5% cases of tuberculosis worldwide, with complications such as bowel obstruction resulting from localized infection or tuberculous lymphadenopathy. We present a patient with a history of latent tuberculosis who presented with bowel obstruction secondary to calcified mesenteric lymphadenopathy. CASE DESCRIPTION/METHODS: An 82-year old woman was initially seen in Pulmonology clinic regarding latent tuberculosis. Testing was notable for a positive interferon gamma release assay and a chest CT showed calcified lymphadenopathy in the neck and chest. She was started on isoniazid but was unable to tolerate the medication due to dizziness, headaches, and gastrointestinal upset. Over the next year, she developed intermittent abdominal discomfort and was eventually hospitalized for severe abdominal pain, nausea and vomiting. Physical examination revealed stable vital signs and a mildly distended abdomen. Laboratories were notable for a sodium of 129 mmol/L and hemoglobin 11.3 g/dL. An abdominal CT revealed a dilated stomach and duodenum with a transition point in the distal duodenum. There were multiple new calcified mesenteric and retroperitoneal lymph nodes compressing the distal duodenum, causing partial small bowel obstruction (Figure A). Subsequent esophagogastroduodenoscopy demonstrated white plaques in the distal esophagus, consistent with candida esophagitis (Figure B). The stomach and duodenal mucosa appeared endoscopically normal, with exception of narrowing at the second portion of the duodenum. This was suggestive of extrinsic compression and correlated with the area seen on the CT scan (Figure C). Duodenal biopsies were unremarkable. Her presentation was attributed to progressive calcific tuberculous lymphadenopathy and she improved with conservative management. Due to her other comorbidities and intolerance of prior therapy, anti-tubercular treatment was not pursued. DISCUSSION: Bowel obstruction is a common complication of abdominal tuberculous. Calcified tuberculous lymphadenopathy should be considered in the differential as a cause for bowel obstruction in patients with a history of untreated latent tuberculosis. Most cases clinically improve with medical therapy; however, in some cases, surgical management is needed.

An uncommon presentation of cryptorchidism

Cryptorchidism as a cause of bowel obstruction is very unsuspecting. Bowel obstructions in cases of cryptorchidism, though reported were mostly as a complication of malignant transformation. Only two case reports of cryptorchidism document a non-malignant aetiology for bowel obstruction. This case is of a 16 year old boy referred for pain abdomen and obstipation for last 3 days. He had signs of peritonitis on examination and so, urgent exploratory laparotomy was planned. A loop of jejunum of approx. 30 cm length at a distance of 35 cm from duodeno-jejunal junction was found gangrenous with gubernacular bands around the loop emerging from a left cryptorchid testis. Resection– anastomosis was done along with left orchidectomy. Histopathology revealed an atrophied testis with no malignant changes. This is the first case report of a non-malignant cryptorchid testis as a cause of strangulated intestinal obstruction in literature.

Distal intestinal obstruction syndrome: an important differential diagnosis for abdominal pain in patients with cystic fibrosis.

As life expectancy for those with cystic fibrosis (CF) now exceeds 40 years of age, adult hospitals away from specialized CF services are being exposed more frequently to people with acute complications of CF. Well-known manifestations of CF include pulmonary disease and pancreatic insufficiency with malabsorption. However, a less well-known entity is distal intestinal obstruction syndrome (DIOS), which is an important cause of obstructive symptoms in people with CF that must be differentiated from other causes of bowel obstruction. However, one confounding factor is that adults with CF may have elements of both DIOS and mechanical bowel obstruction due to adhesions from previous operations. A recent tragic outcome in a young adult with CF highlights the need for all doctors, both junior and senior, especially those who are not directly involved in day-to-day CF care, to understand the features of DIOS and the appropriate management, which differs from that of a mechanical bowel obstruction. This review aims to highlight the clinical and pathophysiological features of DIOS, differentiate it from other causes of bowel obstruction and contrast management strategies. Improved knowledge of DIOS will help to facilitate appropriate recognition and permit optimal, multidisciplinary management of this CF complication.

Postoperative adhesions after abdominal surgery in children: a pilot study in the Philippines

BackgroundPostoperative adhesions (POAs) causing mechanical bowel obstruction is a challenging problem for children who underwent prior abdominal surgeries. Unlike in adults, the role of conservative management remains controversial and children...

Transverse colon volvulus presenting as bowel obstruction: a case report

BackgroundTransverse colon volvulus is an uncommon cause of bowel obstruction. The total number of cases reported in the literature is 100. It constitutes a surgical emergency since it can lead to bowel infarction, peritonitis, and death if not diagnosed at once. It seemed appropriate to report this case that was treated at the Department of Visceral Surgery A, University Hospital Center Hassan II of Fez in Morocco.Case presentationWe report a rare case of transverse colon volvulus in a 42-year-old Arabic man, with no particular history, who presented to our emergency department with a 5-day history of constipation, progressive abdominal pain, nausea, and vomiting. His last bowel movement had been 3 days ago. Abdominal radiography showed a large bowel obstruction with a “U-shaped” loop in the left upper abdomen. Abdominal computed tomography was not performed because of impaired renal function.He was operated on urgently after conditioning and the diagnosis of a transverse colon volvulus was done intraoperatively. Rotated in a 360° clockwise direction on its mesentery, the bowel was intact without signs of ischemia. An extended right hemicolectomy was carried out with end-to-side ileocolic anastomosis.Through this case, we will try to discuss its physiopathology, etiologies, diagnosis, and management in emergencies.ConclusionThis case is unusual because no etiological factor has been found. Its diagnosis can be difficult and management effectiveness remains controversial.It is important to highlight this case and those of the literature, as many surgeons may have never seen a case of transverse colon volvulus. Volvulus of the transverse colon may therefore not be considered in the differential diagnosis of recurrent intermittent abdominal pain or acute intestinal obstruction.Prompt recognition with emergency intervention constitutes the key to a successful outcome.

Pericaecal hernia: an unusual cause of bowel obstruction

Pericaecal hernia: an unusual cause of bowel obstruction

Prevention of meconium obstruction in very low birth weight preterm infants

IntroductionDelayed meconium expulsion is a cause of bowel obstruction in the extremely premature newborn (<28 WGE) weighing less than 1500g at birth. ObjectiveTo evaluate the efficacy of conservative treatment in the prevention of meconium obstruction in very-low-birth-weight preterm infants. MethodDescriptive and retrospective study performed at the Neonatal Intensive Care Unit of a tertiary level hospital. All very-low-birth-weight preterm infants who were born during the study period, from August 2016 to January 2017, and who had meconium obstruction were included. ResultsA sample of 42 newborn infants was obtained. Regarding the expulsion of meconium, 57.1% of the sample spontaneously ejected meconium, while 42.9% received different treatments. Of these, 72.2% were treated with saline enemas, 16% with acetylcysteine enemas, 16% with Gastrografin® and none required surgical treatment. ConclusionConservative treatment seems to be an effective therapeutic measure for the prevention of meconium obstruction in very-low-birth-weight preterm infants since it achieved the expulsion of meconium without having to apply surgical treatment.

Outcomes in cecal volvulus: Does age affect outcomes in patients who undergo surgery?

Background: Colonic volvulus is a rare cause of bowel obstruction with an incidence of 2%–10%. Cecal volvulus accounts for 10%–40% of cases, with a mean age of 53 years. There is a paucity of literature reporting how older patients with cecal volvulus fair relative to their younger counterparts. Objective: The goal of our study is to evaluate the outcomes after surgical resection in patients ≥50 years old with cecal volvulus. Design: The design of the study was to collect the National Surgical Quality Improvement Program (NSQIP) data and analyze primary outcomes. Settings: These data were collected from NSQIP database focusing on patients with cecal volvulus. Materials and Methods: We utilized the NSQIP database. We identified volvulus by ICD-9 code 560.2. We selected patients with cecal volvulus who underwent surgical resection by specifying the CPT codes for open and laparoscopic right hemicolectomy. Main Outcome Measures: The primary outcomes were mortality and major and minor postoperative complications. Student's t-test was used to compare continuous variables. Chi-square and Fisher's exact tests were used to compare categorical variables. Sample Size: Analyzing the NSQIP database from 2010 to 2015, 1220 patients were identified. Results: 21.8% of patients were

Transmesenteric hernia: A rare cause of bowel obstruction in pregnancy

Transmesenteric hernia: A rare cause of bowel obstruction in pregnancy

Gallstone ileus: unusual cause of bowel obstruction. Experience of an African center and literature review

Gallstone ileus: unusual cause of bowel obstruction. Experience of an African center and literature review

Jejunojejunal Intussusception Secondary to Feeding Gastrojejunostomy: A Rare Complication

Intussusception refers to a condition whereby one segment of the gastrointestinal tract telescopes into an adjacent one. It is a rare cause of bowel obstruction in adults, with two to three cases occurring in a population of 1,000,000 per annum. In adults, implicated primary causes involve a lead point within the bowel such as malignancy. Iatrogenic mechanical factors, although more rare, have played roles. We present a case of small bowel intussusception related to a jejunal feeding tube as the lead point. A 30-year-old male with history of traumatic brain injury and resultant spastic quadriparesis with gastrojejunostomy (GJ) tube, presented with projectile black emesis. Clinical examination revealed abdominal distention. The GJ tube insertion site appeared normal. Primary concern was of hematemesis therefore the GJ tube was irrigated and aspirated, however with return of clear yellow fluid. Upper endoscopy showed moderate esophagitis. He was initially managed with antacids but he continued to have projectile emesis. Abdominal X-Ray showed dilated small bowel loops in the mid-abdomen. Computed tomography (CT) abdomen with contrast given through gastrostomy tube showed wall thickening of a segment of bowel starting from the top of the GJ tube representing intussuscepted bowel. Patient was clinically stable therefore a nonoperative approach was used with injection of contrast medium through the GJ tube followed by multiple vigorous flushings which reduced the intussuscepted bowel and his symptoms resolved. Intussusception is the leading cause of intestinal obstruction in children, however it is infrequently encountered in adults accounting for less than 1% of all cases of small bowel obstruction. Majority of cases of adult jejunal intussusceptions are difficult to diagnose especially cases related to feeding tubes as the tube may still be functioning normally and symptoms are nonspecific. CT is the diagnostic modality of choice. Generally, intussusception in adults is managed surgically by resection of the leading point as opposed to reduction to evade risks of perforation. However, in our patient, resection was avoided for a more conservative approach given the etiology was benign and the bowel was still viable. Signs of bowel obstruction in patients with GJ tubes should raise concern for intussusception and early diagnosis is crucial to avoid complications including bowel ischemia.

A clinical study of surgical management of acute intestinal obstruction

Background: Mechanical bowel obstruction remains one of the most common intra-abdominal problems faced by general surgeons in their practice and continues to be a major cause of morbidity and mortality.Methods: This retrospective study was carried out on data obtained from 50 patients who underwent emergency laparotomy for acute intestinal obstruction in Victoria and Bowring and Lady Curzon Hospital from January 2016 to December 2016.Results: Adhesions (26%) were found to be the most common cause followed by obstructed hernia (22%). The common age group was 51-60 years. The commonest symptom was abdominal pain followed by vomiting and constipation. The average duration of presentation was 2 days. Strangulation was found in 20% of cases. Mortality rate in the study was 16%.Conclusions: In conclusion, we have found that adhesions are becoming an ever-increasing underlying cause of bowel obstruction. A trend of elective hernia surgery has reduced the number of patients of hernias presenting with obstruction of bowel.

Prevención de la obstrucción meconial en recién nacidos prematuros de muy bajo peso

IntroductionDelayed meconium expulsion is a cause of bowel obstruction in the extremely premature newborn (<28 WGE) weighing less than 1500g at birth. ObjectiveTo evaluate the efficacy of conservative treatment in the prevention of meconium obstruction in very-low-birt- weight preterm infants. MethodDescriptive and retrospective study performed at the Neonatal Intensive Care Unit of a tertiary level hospital. All very-low-birth-weight preterm infants who were born during the study period, from August 2016 to January 2017, and who had meconium obstruction were included. ResultsA sample of 42 newborn infants was obtained. Regarding the expulsion of meconium, 57.1% of the sample spontaneously ejected meconium, while 42.9% received different treatments. Of these, 72.2% were treated with saline enemas, 16% with acetylcysteine enemas, 16% with Gastrografin® and none required surgical treatment. ConclusionConservative treatment seems to be an effective therapeutic measure for the prevention of meconium obstruction in very-low-birth-weight preterm infants since it achieved the expulsion of meconium without having to apply surgical treatment.

Sigmoid volvulus at the University Hospital of Iceland 2000-2013

Backround Sigmoid volvulus is an uncommon cause of bowel obstruction in most western societies. Treatment options include colonoscopy in uncomplicated disease with elective surgery later on. The aim of this study was to assess what treatment sigmoid volvulus patients receive along with long-term outcomes at Landspitali University Hospital. Methods The study was retrospective. Patients diagnosed with sigmoid volvulus at Landspitali University Hospital from 2000-2013 were included. Information regarding age, sex, and duration of hospital stay, treatment, short and long-term outcomes were gathered. Results Forty-nine patients were included in the study, of which 29 men and 20 women. Mean age was 74 (25-93). One patient underwent acute surgery on first arrival due to signs of peritonitis. Others (n=48) were treated conservatively in the first attempt with colonoscopy (n=45), barium enema (n=2) and rectal tube (n=1). Three other patients underwent acute surgery due to failed colonoscopy, 8 patients had planned surgery during the index admission. Thirty-six patients were discharged after conservative treatment with colonoscopy (n=35), barium enema (n=1) or rectal tube (n=1). Two patients came in for elec-tive surgery later on. Twenty-two patients (61%) had recurrence. Median time to recurrence was 101 days (1-803). Disease-free probability in 3, 6 and 24 months was 66%, 55% and 22% respec-tively. Total disease related mortality was 10.2%. Mortality (30 days) after acute surgery was 25% (1/4) and 16,6% (3/18) after planned surgery. Conclusions Sigmoid volvulus has high recurrence rate if not treated operatively. Total mortality due to sigmoid volvulus at Landspitali is low but surgery related mortality high.

Study on Some Effective Factors for Successful Non-Surgical Reduction in Intussusception among Children

Background Intussusception is the main cause of bowel obstruction and one of the most common surgical emergencies that can occur during childhood. That is why this study investigates the effective factors for non-surgical reduction in patients who have experienced successful reduction in intussusception to determine the effective factors. Materials and Methods This retrospective study was performed between 2011 and 2017. The following subjects, including age, gender, degree of reduction, leukocyte level, symptom onset interval, Appearance of Signs and the Visit of Children, presence of blood in stool, free abdominal fluid in ultrasound, and length of the intestinal tract involved in ultrasonography, were extracted. Results A total of 217 patients with intussusception had visited the emergency department. The average of the leukocyte level of children with successful intussusception non-surgical reduction was lesser the children with unsuccessful intussusception non-surgical reduction and there was a significant difference (P<0.0001). The average distance between the appearance of signs and the visit of children was 1.66±0.4 days for successful intussusception non-surgical reduction and 4.31±0.6 days for unsuccessful intussusception non-surgical reduction. There were 30 instances (21.6%) of blood in stool positive and 109 (78.4%) instances of blood in stool negative. Conclusion The success rate of non-surgical reduction is relatively high and has a significant relationship with age, leukocyte level, and the distance between the beginning of signs and visit, the existence of blood in stool, and the length of the involved intestine.