Cause Of Intestinal Obstruction Research Articles

Circular Mini-Incision in the Left Iliac Fossa Followed by Purse-String Closure as a Minimally Invasive Approach for the Sigmoid Volvulus: A Technical Note.

Introduction: Volvulus of the sigmoid is a common cause of intestinal obstruction in Morocco. It is a serious condition with substantial mortality. Initial endoscopic decompression followed by resection of the redundant colon via laparotomy or laparoscopy is the procedure of choice. Exteriorization of the sigmoid colon through a linear skin incision in the left iliac fossa has been described as an alternative approach for the classic midline incision, with or without laparoscopic assistance, with acceptable results.Methods: We describe herein a novel, minimally invasive approach for fit patients with non-complicated volvulus sigmoid. This approach consists of a skin-disk incision in the left iliac fossa, exteriorization of the redundant colon, and resection with or without primary anastomosis, followed by a purse-string closure.Results: A 65-year-old patient with no prior notable medical history, presented to the emergency department with his first episode of sigmoid volvulus. A skin-disk incision was made in the left iliac fossa, exteriorization of the sigmoid was done easily through the incision, and resection and manual anastomosis were done. The closure was made in a purse-string fashion. Recovery was uneventful and the patient was discharged home on the fourth postoperative day. No wound infection was noted and the cosmetic result was satisfactory.Conclusion: Left iliac skin-disk incision followed by a purse-string closure is an option for approaching the abdomen in the case of sigmoid volvulus. It has been demonstrated that this technique helps reduce wound-related complications in patients undergoing stoma reversal. Authors suggest that cosmetic results are better and the incidence of surgical site infection can be lower with this technique as compared to the classic linear skin incision. Results, however, should be confirmed by larger studies.

Idiopathic Encapsulating Peritonitis as Unusual Cause of Bowel Obstruction Discovered Intraoperative: A Case Report

Idiopathic sclerosing encapsulating peritonitis (SEP) is a rare cause of intestinal obstruction that is characterized by total or patial encasement of the intestines by a fibrocollagenous coccon-like a membrane. Early clinical features of this condition are generally non-specific and are frequently not recognized until the patient develops signs of small bowel obstruction. We report the observation of an adult patient operated for an acute bowel obstruction, in which the diagnosis of sclerosing encapsulating peritonitis (SEP) was made intraoperative. A good understanding of SEP and a better awareness of its clinical, paraclinical and therapeutic findings may aid to establish better management of this rare condition.

Jejunal adenomyoma in a neonate, an extremely rare cause of neonatal bowel obstruction

We report a case of jejunal adenomyoma in a neonate, found during exploratory surgery for bilious vomiting and feeding intolerance. This is the first reported case of neonatal jejunal adenomyoma as an isolated cause of intestinal obstruction.

An unusual cluster of Waugh syndrome as a cause of intestinal obstruction in children - A case series.

Introduction and importanceThe association of intussusception with intestinal malrotation is a rare phenomenon named Waugh syndrome by Brereton et. It is a rare disease entity with less than 100 cases described so far. A cluster presentation is something unusual for rare diseases.Case presentationAll four patients have presented with features suggestive of bowel obstruction as all of them have had colicky abdominal pain. Three patients have vomiting as an additional complaint, so as the diarrhea. Fever has also been reported in one patient. Patients have presented in 6 months period, non-consecutively. Abdominal pain, diarrhea and vomiting are alarming in the pediatric population. When each case presented, an immediate resuscitation was performed including IV lines, nasogastric suctioning, electrolytes correction, and blood and FFP transfusion as necessary. Abdominal ultrasonography was performed revealing target sign. After optimization for surgery, manual reduction of the intussusception was done followed by a Ladd's procedure for the malrotation was performed for all 4 patients with excellent outcomes.Clinical discussionWith the surgery, after case optimization, remains the standard of care; the presence of cluster presentation for Waugh syndrome could suggest that some environmental factors might be implicated and further observations can be carried out to look more into such phenomenon.ConclusionWaugh syndrome, a combined presentation of intestinal malrotation and intussusception, is a rare syndrome that can present in children. Optimization for surgery followed by a 2-step surgical approach is the usual treatment with excellent outcomes described.

A Case Report on the Spontaneous Intraperitoneal Rupture of Urinary Bladder Presenting as Acute Intestinal Obstruction – Lessons Learnt

Acute intestinal obstruction is a common surgical emergency. Most of the time, the cause lies in the gastrointestinal track. A 19 year old boy presented with clinical features of acute intestinal obstruction and radiological features suggestive of large bowel obstruction was taken up for surgery. During evaluation we found extravasation of urine inside pelvic cavity. Exploratory laparotomy showed intraperitoneal rent in dome of urinary bladder with dense adhesion of omentum kinking the transverse colon causing acute intestinal obstruction. We were surprised to see the resolution of obstruction with excision of omental band. The bladder was repaired and he was relieved of the problem. This article is a rare example of nongastrointestinal cause for intestinal obstruction. Most of these cases are seen by a general surgeon in an emergency setting. Hence this report is to enlighten the medical caregivers about the existence of this rare entity.

Caecal volvulus: a rare entity of intestinal obstruction: 2 cases report

Caecal volvulus is a very rare cause of intestinal obstruction. Patients with this condition may present with variable clinical presentation ranging from intermittent, self-limiting abdominal pain to acute abdominal pain associated with progressive intestinal ischemia, sepsis, and death. In this report, we presented two cases of caecal twist which was diagnosed with series of radiological imaging and labs. The first patient, 83 years old male underwent caecopexy, appendicectomy, and the second female who was 36 years old underwent right hemicolectomy with ileocolic anastomosis. We reported our experience in the management of 2 cases of caecal volvulus in our department.

Sigmoid Volvulus in Pregnant Women, a Pregnancy Complication or a Coincidence?

Intestinal obstruction complicating pregnancy is an extremely rare complication during pregnancy. Volvulus of the sigmoid colon is the most common cause of intestinal obstruction complicating pregnancy. Which can be associated with extremely high rates of mortality and morbidity for both mother and fetus. We report a case of sigmoid volvulus complicating pregnancy in a woman with 39 weeks amenorrhoea, which was diagnosed early and successfully managed with deterioration and fixation.

Colocolic intussusception secondary to colonic adenocarcinoma with impending caecal perforation in an elderly patient: A rare case report.

IntroductionIntussusception is a surgical emergency in which a part of the intestine slides into the distal adjacent part. Adult colocolic intussusception secondary to a tumoral process is a rare but serious clinical condition requiring immediate surgical intervention.Case presentationWe report a case of a 65-year-old male patient presenting with abdominal pain and distention, subsequently diagnosed with colocolic intussusception in the descending colon with closed-loop bowel obstruction with impending caecal perforation. An exophytic mass on the descending colon was discovered intra-operatively, prompting a subtotal colectomy with ileosigmoidal anastomosis and loop ileostomy with the suspicion of malignancy. The histopathological examination of the surgical specimen concluded a moderately-differentiated colonic adenocarcinoma with 40% mucinous component.Clinical discussionAdult intestinal intussusception is a rare but serious condition differing greatly in etiology from its pediatric counterpart. Its preoperative diagnosis is challenging in adults, which appears to be due to its imprecise presenting signs and symptoms; thus, the condition can be mistaken for other causes of intestinal obstruction. Adenocarcinomas remain the most common cause of malignant tumors in the colon, which also makes them one of the causes for colocolic intussusception.ConclusionIntussusception can appear as a surgical emergency even in the elderly, necessitating prompt surgical intervention to avoid intestinal ischemia and gangrene. Its diagnosis can be aided to a great degree by CT imaging.

Retrospective Analysis of Congenital Neonatal Intestinal Obstruction in a Tertiary Care Hospital in Bangladesh

Introduction: Patients with congenital neonatal intestinal obstruction are the main bulk of neonatal surgical departments. The incidence is approximately 1 in 1500-2000 live birth. Commonly caused by anorectal malformation (ARM), intestinal atresia, hirschsprungs disease (HD), meconium ileus, malrotation of gut, volvulus neonatorum, necrotizing enterocolitis (NEC) and rarely bands adhesion. These patients presented with vomiting, gradual abdominal distension and delayed or no passes of meconium. Usually, an abdominal radiograph is all that is necessary to make the diagnosis, since the gas pattern is distinctive and often will be a clue to the site of obstruction. The aim of the study is to detect the type of congenital neonatal intestinal obstruction, initial surgical approaches, and their outcome in our hospital. Materials and methods: This is a retrospective study conducted at the division of pediatric surgery in Bangladesh Shishu hospital & institute, Dhaka, Bangladesh. The study period was 2 years from January 18 to December 19. All the neonates who underwent surgery for congenital neonatal intestinal obstruction were included. In this study only initial diagnosis, surgical procedure and outcome were included. Results: Our surgical department operated on a total of 246 neonates with congenital neonatal intestinal obstruction during this study period. Out of them, 139(56.50%) patients were male and 107 (43.50%) were female. The male-female ratio is 1.3:1. Gestational age was varied from 31 weeks to 40 weeks (Mean 36.2 weeks). Birth weight was from 1300 gm to 3800 gm (mean 2100gm). The most common cause of intestinal obstruction was ARM 72(29.27%), followed by hirschsprungs disease 53(21.54%), atresia 41(16.67%), meconium ileus 37(15.04%), malrotation of gut 28(11.38%) and other like bands adhesion, etc 15(6.09%). In case of atresia ileal atresia was common 16(39.02%) then jejunal 13(31.70%) and duodenal 9(21.95%). Only 3(7.31%) colonic atresia was found. ........

Wandering liver as a cause of intestinal obstruction

Wandering liver as a cause of intestinal obstruction

Contrast Enema: Solving Diagnostic Dilemmas in Neonates With Lower Intestinal Obstruction.

BackgroundAnatomical abnormalities leading to bowel movement failure are the major cause of intestinal obstruction. This study was done to assess the diagnostic efficacy of contrast enema in neonates with lower intestinal obstruction.MethodologyThis prospective study was conducted in The Children’s Hospital and University of Child Health Sciences, Lahore from February 2021 to July 2021. Patients presenting with constipation, abdominal distension, vomiting, and unable to pass meconium, evaluated clinically and by X-rays, were included in the study. Patients with lower intestinal obstruction (i.e., meconium ileus, Hirschsprung’s disease, ileal atresia, meconium plug syndrome, and small left colon) were given contrast enema (gastrografin) after hydration. The radiologist was blinded by the clinical diagnosis or reference standard diagnosis, which was labeled prior to image interpretation. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for major contrast enema diagnosis.ResultsDuring this period, a total of 34 patients were included in the study. The mean age of presentation was 72.0 ± 24 hours. There were 21 (61.8%) boys and 13 (38.2%) girls, representing a male to female ratio of 1.7:1. In four cases, our diagnosis on the basis of contrast enema was proven wrong. Sensitivity, specificity, PPV, and NPV of Hirschsprung’s disease were found to be 93.3%, 50%, 87.5%, and 66.7%, while these were 84.6%, 66.7%, 91.7%, and 50.0%, respectively, for meconium ileus.ConclusionThe diagnostic efficacy of contrast enema was found to be good in neonates with lower intestinal obstruction. The spectrum of intestinal obstruction among neonates shows diversity while contrast enema seems to play a major role in the identification and remodeling of the diagnostic plan in a major proportion of cases.

Inflammatory fibroid polyp (Vanek's tumor) causing double compound ileo-ileal intussusception in an adult patient, a case report

Introduction and importanceThe majority of the of small bowel intussusception causes are benign, and different types of benign tumors have been reported as the lead points of an intussusception. Among these, some studies have reported inflammatory fibroid polyp as a cause of small bowel intussusception. However, according to our knowledge this is the first case to be reported in Africa of an adult double compound intussusception due to an inflammatory fibroid polyp.Case reportA 32-year-old female presented with epigastric abdominal pain, nausea, vomiting and diarrhea for 2 weeks. Investigations revealed a small bowel obstruction due to intussusception, and exploratory laparotomy was planned.Clinical discussionInflammatory fibroid polyp causing this unique feature of double compound ileo-ileal intussusception should be observed in adult patients who presents with intestinal obstruction. A CT scan is the diagnostic modality of choice, and we think that the disease is the first of its kind to be reported in Africa.ConclusionsDouble ileo-ileal intussusception is a rare cause of intestinal obstruction in adult patients.Interventions and outcomeLaparotomy reviled an ileo-ileal intussusception. After manual reduction of this intussusception, another intussusception was observed and containing a polyp. A clear margin resection and end-to-end primary anastomosis were performed. The histopathological report established the diagnosis of Inflammatory Fibroid Polyp. After the procedure, the patient's condition improved well with no complications.MethodsThis case report has been reported in line with the SCARE Criteria (Agha et al., 2020 [1]).

Clinical Study of Right Iliac Fossa Mass: A Prospective Study

A right iliac fossa mass is a ‘temple of surprises’ and a common presentation at emergency department, requiring skill and keeness to diagnose. Patients with right iliac fossa mass will be dealt by a general practitioner, a surgeon or a gynecologist and knowledge of anatomy, with detailed history, clinical examination directing towards the pathological process followed by lab analysis and imaging leads to a diagnosis. The most common differential diagnosis encountered are: appendicular mass, appendicular abscess, ileocecal tuberculosis, right ovarian mass, right ectopic kidney, rectus sheath hematoma, carcinoma caecum and ameboma, actinomycosis and crohn’s disease. An important differential diagnosis is often between an appendicular mass, carcinoma of the caecum and ileocecal tuberculosis.3 In Subcontinent, tuberculosis has been the main cause of intestinal obstruction and perforation. Cecal carcinoma is more common in the elderly and higher socio-economic group consuming less brous diet.1,5,6 Appendicular masses are seen in relatively younger people with both conservative and operative strategies. Other less common causes are diagnosed and managed accordingly.7

Abdominal Cocoon Syndrome: A Rare Cause of Intestinal Obstruction

Abdominal cocoon syndrome, also known as Sclerosing Encapsulating Peritonitis, is characterized by a fibro-collagenous membrane that involves abdominal viscera and it’s a rare cause of intestinal obstruction.We present here two cases. Two male patients, 29 and 75 years old, were admitted to our emergency department with abdominal pain, vomiting, tender and painful abdomen but without changes in intestinal transit or peritoneal reaction. They were treated surgically and diagnosed with abdominal cocoon syndrome.Patients with abdominal cocoon syndrome usually present with recurrent episodes of intestinal obstruction, which result from the compression of the bowel within the constricting cocoon. Most of the time, this clinical picture resolves with conservative measures, delaying the diagnosis. The definitive treatment consists of excision of the membrane with lysis of adhesions, which is usually reserved for more severe cases of obstruction.This is a rare disease, where a high suspicion index is of paramount importance, especially considering that most of the diagnoses are made at the surgery.

Small-bowel atresias: a case series with review of the disease and imaging findings

Small-bowel atresias are among the most common causes of intestinal obstruction in newborns, and they often require urgent surgical treatment. Imaging techniques play a very important role in their diagnosis, which is often suspected on prenatal obstetric ultrasound and confirmed on postnatal plain-film X-rays. Abdominal ultrasound's lack of ionizing radiation, wide availability, low cost, and high resolution is making this technique increasingly important in confirming atresias and in detecting possible complications in newborns. This review analyzes a series of cases seen at our center. It summarizes the different types of small-bowel atresias, focusing on the clinical presentation, imaging findings on different modalities, presence of associated disease, management, clinical course, and outcomes.

Hirschsprung’s disease and associated syndrome and malformation -A report of four cases.

Background: Hirschsprung’s disease is a genetic disorder characterized by the absence of ganglion cells in different lengths of the intestine. It is one of the common causes of intestinal obstruction in neonates.
 Materials and Methods: The study was carried out from January 2017 to January 2020 in the Department of Pathology in a Tertiary care hospital. The biopsy specimens from spastic segment and colostomy or ileostomy sites were sent for evaluation of ganglion cells. 
 Results: During carrying out the study we came across two cases of biopsy that proved Hirschsprung’s disease who manifested the various signs and symptoms associated with two different syndromes and one malformation and one associated neoplasm
 Conclusion: Two different syndromes and one associated malformation and neoplasm were detected in patients of Hirschsprung’s disease during a 3-year study.
 Keywords: Hirschsprung's disease, ganglion cell, hypertrophic nerve fiber, malformation, neoplasm, syndrome.

EARLY OUTCOMES AFTER POSTERIOR SAGITTALANORECTOPLASTY FOR ANORECTAL MALFORMATION

Anorectal malformations (ARM) are one of the commonest causes of intestinal obstruction in the new-born. It comprises a wide spectrum of anomalies which affect the distal part of gastrointestinal tract with or without urogenital system and sacral involvement. Childrens born with this condition, therefore, have no anal opening in the expected site of anal orice. The aim of this prospective observational study of 75 patients is to study early outcome of ARM after posterior sagittal anorectoplasty (PSARP), to study Incidence, Classication, Clinical Presentation & Management of ARM, to study associated abnormalities with ARM. The study shows mean age of study subjects at the time of surgery is 10.74 ± 2.33 months. Majority of cases are male 73% and female 27%. Among these 75 cases, cases with Imperforate anus 55, Rectovaginal stula 9, Recto-vestibular stula 11, high level anomaly found in 39%, intermediate 35% and low level 26% cases. Primary management Sigmoid loop Colostomy is done in 72 cases and denitive management PSARP is done in 75 cases. Outcome of anorectal malformation after PSARP presented as, Constipation 15, Wound infection 7, Wound dehiscence 4, Fecal impaction 4 and Anal stenosis found in 1 case

English

BACKGROUND The commonest surgical emergency worldwide in adults is Acute intestinal obstruction. The commonest aetiology was found to be different in India and the western world and middle east. In the former it was obstructed inguinal hernia and in the later it was adhesions. Among the different diagnostic modalities radiology was accurate in 60 % of the patients. Demography reeled different aetiological factors and diagnostic methods adopted. Aims and Objectives of the Study- To elaborate the demography, clinical features, diagnosis and final outcome in the Adult intestinal obstruction. METHODS 57 patients who underwent exploratory laparotomy for Adult acute intestinal obstruction (AAIO) were studied for their demography, clinical presentation, diagnostic methods adopted and operative findings were noted. The final outcome in the management of AAIO were elaborated. RESULTS The mean age of the patients was 47.30 ± 6.74 years with the youngest patient aged 36 years and the eldest was aged 54 years. Adhesions was the commonest cause for intestinal obstruction in 25 / 57 (43.85 %) obstructed inguinal hernia in 19 / 57 (33.33 %) patients and tumours in 09 / 57 (15.78 %) patients. The mortality rate was 19.29 % (11 / 57) and the complication rate was 35.08 % (20 / 57). Radiological diagnosis was accurate in 26.31 % (15 / 57) of the patients. CONCLUSIONS The major aetiological agent was adhesions in the Adult Acute Intestinal obstruction followed by obstructed inguinal hernias and tumours. The change in the causative factor similar to the western literature was observed. CT abdomen must always be chosen as first choice for diagnosing AAIO before undertaking the surgery. Presence of strangulated bowel during surgery had grave mortality (p value - 0.001). Presence of shock was another factor contributing to the mortality (p – value - 0.021). KEY WORDS Intestine, Obstruction, CT Scan Abdomen, and Abdominal Emergencies

Radiological manifestations of benign mesenteric lipoma that presented with acute intestinal obstruction: A case report

BackgroundIntestinal obstruction is a common surgical emergency that is presented to the hospital with various aetiologies. Among all, mesenteric lipoma is one of the uncommon extraluminal causes of intestinal obstruction. In such conditions, bowel volvulus, compression or even adhesion are the underlying pathologies.Case presentationWe report a 69-year-old gentleman who presented with a triad of intestinal obstruction which required exploratory laparotomy. Preoperative computed tomography revealed multiple coalescing lobulated hypoattenuating lesions encircling part of a small bowel forming transitional zone. These lesions are comparatively more hypoattenuating in comparison with the surrounding mesenteric fat. Intraoperatively, a giant ileal mesenteric lipoma was identified causing compression and folding to the adjacent small bowel, leading to proximal bowel dilatation. Excision of the lipoma with a few mesenteric lymphadenectomy was done, revealing a benign mesenteric lipoma and reactive lymph nodes. Despite ileus, he made a good postoperative recovery and was discharged well.ConclusionsPatients with recurrent abdominal pain must have a thorough endoscopic and imaging assessment. Besides common or malignant aetiology, rarities should be considered and actively sought. Mesenteric lipoma is a relatively indolent tumour for which early detection can alter clinical presentation.

Epidemiology and causes of intestinal obstruction in Ethiopia: A systematic review.

Objective:This systematic review was aimed to address the prevalence and causes of intestinal obstruction in Ethiopia.Methods:Systematic searches were conducted on PubMed, EMBASE, CINAHL, Scopus, African Journals Online, HINARI, and other supplementary sources, including Google Scholar. We conducted methodological quality assessments for the articles by employing a critical appraisal checklist of Joanna Briggs Institute.Results:The reported prevalence of intestinal obstruction in Ethiopia ranges from 18.6% to 50.7% among patients with acute abdomen. However, the prevalence varies from 4.3% to 34.6% among total surgical admissions. The leading causes of small intestinal obstruction were small bowel volvulus, intussusception, and adhesion. Sigmoid volvulus was the most commonly reported cause of large intestine obstruction, followed by colonic cancer.Conclusion:The highest reported prevalence of intestinal obstruction in Ethiopia was 50.7% among patients with acute abdomen and 34.6% among surgical admissions. Small intestine volvulus and sigmoid volvulus were the common causes of small and large bowel obstructions, respectively. Therefore, clinicians have to consider the common causes during the diagnosis and management of intestinal obstruction.