Closed-loop Bowel Obstruction Research Articles

Recurrent Closed Loop Bowel Obstruction in Third Trimester of Pregnancy: Case Report and Review of Literature

Recurrent Closed Loop Bowel Obstruction in Third Trimester of Pregnancy: Case Report and Review of Literature

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.

Case report: Closed-loop bowel obstruction secondary to a double gallstone ileus.

Introduction and importanceIn this paper, we report an unusual case of a closed-loop bowel obstruction secondary to a double gallstone ileus. This type of pathology constitutes an emergency, and requires prompt surgical intervention to prevent further complications.Presentation of caseThe patient was a 90-year-old female who came to our emergency room with a clinical picture compatible with an acute abdomen. Imaging tests performed included a plain radiograph and abdominal CT-scan, which confirmed the diagnosis. The patient was then transferred to the operating room, and an open double enterolithotomy was performed, extracting two cylindrical gallstones with a diameter of over 2.5 cm. No treatment was given for either the gallbladder nor the biliary-enteric fistula due to the patient's physical status.Clinical discussionGallstone ileus is a rare entity, but must be taken into consideration when a patient with an abdominal obstruction arrives to the emergency department, especially when signs such as pneumobilia or visualization of the stones are detected by imaging tests. Early surgical intervention is required to avoid complications. However, addressing the biliary-enteric fistula at the same time is a sensitive procedure that may not be advisable, depending on the status of the patient. This report includes a bibliographic review of existing cases of gallstone ileus and the specifics of its diagnosis and management.ConclusionThis pathology can lead to serious complications if not managed properly. Prompt diagnosis and surgical intervention are essential to avoid complications such as intestinal gangrene and perforation. Inspecting the entire intestine during surgery is crucial for removing any additional gallstones that may be present to prevent the reappearance of symptoms.

Closed Loop Bowel Obstruction From a Loose Staple After Laparoscopic Appendectomy.

Closed Loop Bowel Obstruction From a Loose Staple After Laparoscopic Appendectomy.

CT diagnosis of closed loop bowel obstruction mechanism is not sufficient to indicate emergent surgery.

To identify computed tomography (CT) findings associated with successful conservative treatment of closed loop small bowel obstruction (CL-SBO) due to adhesions or internal herniation. The local institutional review board approved this study while waiving informed consent. Clinical and CT data were collected retrospectively for 96 consecutive patients with a CT diagnosis of CL-SBO due to adhesions or internal herniation established by experienced radiologists who had no role in patient management. Mechanical obstruction with at least two transition zones on the bowel at a single site defined CL-SBO. Two radiologists blinded to patient data independently performed a retrospective review of the CT scans. The patient groups with successful versus failed initial conservative therapy were compared. Univariate and multivariate analyses were performed to look for CT findings associated with successful conservative therapy. Interobserver agreement was assessed for each CT finding. Of the 96 patients, 34 (35%) underwent immediate surgery and 62 (65%) received first-line conservative treatment, which succeeded in 19 (31%) and failed in 43 (69%). The distance between the transition zones was the only independent predictor of successful conservative therapy (odds ratio, 4.6 when ≥ 8mm; 95% confidence interval [95% CI], 1.2-18.3). A distance ≥ 8mm had 84% (95% CI, 60-97) sensitivity and 46% (95% CI, 31-62) specificity for successful conservative treatment. The correlation coefficient for the distance between transition zones between readers 1 and 2 was fair (r = 0.46). CL-SBO can be resolved without surgery. When there is no CT sign of ischemia, the distance between the transition zones should be assessed. • Twenty percent (19/96) of all cases of closed loop small bowel obstruction (CL-SBO) representing 31% of the patients given first-line conservative therapy, were resolved without surgery. • The distance between the transition zones may help to choose between conservative and surgical management in patients with a CL-SBO but no CT evidence of ischemia. • A distance < 8mm between the transition zones suggests a need for emergent surgery.

Closed-Loop Bowel Obstruction Secondary to Acute Appendicitis

Closed-Loop Bowel Obstruction Secondary to Acute Appendicitis

Internal hernia caused by a free intraperitoneal staple after laparoscopic appendectomy

Background: Laparoscopic appendectomy is the gold standard for treatment of appendicitis. Stapled closure of the appendiceal stump is commonly performed and has several advantages. Few prior cases have demonstrated complications from free staples left within the abdomen after the stapler has been fired.Case report: A 29-year-old female underwent laparoscopic appendectomy for acute uncomplicated appendicitis during which the appendix and mesoappendix were divided using laparoscopic gastrointestinal anastomosis (GIA) staplers. Her initial recovery was uncomplicated. She returned on postoperative day 17 with sharp mid-abdominal pain, obstipation, and emesis. Her abdomen was distended, and she had a mild leukocytosis. Computed tomography (CT) demonstrated twisted loops of dilated small bowel in the right lower quadrant with two transition points, suggestive of internal hernia with closed loop bowel obstruction. Diagnostic laparoscopy was performed through the three prior appendectomy incisions. An adhesion between the Veil of Treves and the mesentery of the ileum caused by a solitary free closed staple, remote from the staple lines, had caused an internal hernia. The hernia was reduced, and the small bowel was noted to have early ischemic discoloration. The adhesion was lysed by removing the staple from both structures. The compromised loops of bowel began to show peristaltic movement and color returned to normal, and the procedure was concluded without resection. She was discharged home the following day.Conclusions: Gastrointestinal staplers are commonly used due to ease of use and low complication rate. It is not uncommon to leave free staples in the abdomen as retrieval can be difficult and time consuming. Our case is only the second in the literature reporting an internal hernia with closed loop bowel obstruction as a complication of retained staples. Choosing the most appropriate size staple load to reduce the number of extra staples, removing free staples, or the use of an endoloop can prevent potentially devastating complications.

Delayed Small Bowel Obstruction Due to Intra-Abdominal Drain: Case Report and Literature Review

This is a unique case of a closed-loop bowel obstruction secondary to intra-abdominal drain insertion to illustrate a new complication of drain usage. A 47-year-old patient presents with bowel distention and obstruction. Laparotomy revealed obstructed small bowel looped around a fibrotic tract tracing back to a drain insertion point. This is a case report where a patient suffers rare long-term complications from routine drain insertion. Although beneficial in treating infection and abscess formation after anastomotic leaks, drain insertion as a prophylactic measure has not been proven to be beneficial. Surgeons who routinely use intra-abdominal drains should be aware of the complications of drain insertion and use with caution. Although not extensively documented, serious complications from drain insertion do occur. There is no role for prophylactic drain insertion in colonic anastomoses procedures.

Umbilicus and its extensive clinical repertoire.

The umbilicus is involved in a wide range of abnormalities in infants and children. The most severe are evident at birth and include exomphalos (omphalocele) and gastroschisis, both of which can be life-threatening but are easy to diagnose. Exomphalos is often associated with other congenital abnormalities, whereas the associated problems in gastroschisis are largely confined to the gut. Infection of the umbilicus in the neonate presents as omphalitis. The causes of a moist umbilicus following separation of the umbilical stump are multiple, from the relatively minor umbilical granuloma or ectopic bowel mucosa to the more significant patent urachus that leaks urine. Patency of the entire vitello-intestinal (omphalomesenteric) tract allows air and faecal fluid to drain through the umbilicus. The clinical manifestations of persistence of the vitello-intestinal tract vary markedly according to which part remains: clinical presentations include melaena and anaemia, closed-loop bowel obstruction and Meckel diverticulitis. An umbilical hernia occurs when the umbilical cicatrix fails to close. On the other hand, the umbilicus has its uses, which range from being a route for intravenous access in the neonate to being a convenient point of access in laparoscopic surgery.

PMM.50 A case of small bowel obstruction and ischaemia in second pregnancy after a laparoscopic Roux-en-Y gastric bypass surgery

Obstetricians need to be aware of known complications related to bariatric surgeries and the diagnostic difficulties in pregnancy.We report a rare case of G2P1 28 year old with previous laparoscopic...

CTによるclosed-loop型腸閉塞診断と緊急手術適応判断の有用性に関する検討

目的:緊急手術適応であるclosed-loop型腸閉塞症のCT検査における鑑別の妥当性と，CTによる鑑別診断の臨床的意義を示すこと．対象および方法:2012年1月から2013年3月までに当科で小腸閉塞症の入院治療を行い，CTで閉塞機転を指摘できた62例のCT所見と臨床経過を後方視的に検討した．結果:Closed-loop型CT所見群:open-loop型CT所見群は15例:47例だった．Closed-loop型CT所見群の14例が手術を施行され，open-loop型CT所見群より手術施行頻度が有意に高率だった．絞扼性腸閉塞症とclosed-loop型腸閉塞症を緊急手術適応とすると，closed-loop型CT所見群の緊急手術適応に対する感度は80％，特異度は93.6％だった．結論:Closed-loop型CT所見の鑑別は緊急手術適応の決定に有用である．

Internal hernia due to adjustable gastric band tubing: review of the literature and illustrative case video

Laparoscopic adjustable gastric banding (LAGB) is a commonly performed bariatric procedure. Device-related morbidity is typically associated with the subcutaneous port or the band itself. Complications related to band tubing are unusual. Small bowel obstruction (SBO) after LAGB is a unique and serious complication; there is the potential of delayed diagnosis and the risk of closed-loop bowel obstruction. SBO secondary to internal hernia caused by band tubing is very rare, with only five cases reported in the literature. In this article, we describe our experience and provide an illustrative video of a case of SBO related to band tubing. We also provide a detailed review of the few previously published case reports. Based on the common features of our case and other published case reports, we hypothesize some risk factors that might lead to this unique morbidity of adjustable gastric band tubing and provide potential solutions to prevent this problem. Tubing-related SBO is a serious complication with the risk of closed-loop bowel obstruction. Urgent operative exploration is required to avoid bowel strangulation. To prevent recurrence we advise functionally shortening the tubing by tucking it to the right upper quadrant above the liver and also provide some omental coverage between the bowel and band tubing if possible.

Classic signs of closed loop bowel obstruction

A 75-year-old man presented to this hospital with abdominal pain. The patient described the sudden onset of: left lower quadrant pain nine-out-of-ten in severity, associated with multiple episodes of bilious vomiting. The patient had not had a bowel movement in 4 days. Physical examination was notable for tenderness to palpation and guarding in the left lower quadrant. Computed tomography of the abdomen and pelvis without contrast material was completed, and demonstrated a closed-loop bowel obstruction involving an ileal loop (Figs. 1, 2). The patient underwent an exploratory laparotomy, which confirmed an ischemic closed-loop obstruction. A small bowel resection was performed (Fig. 3), and the patient recovered uneventfully.

Duodenal necrosis secondary to a closed-loop bowel obstruction with novel reconstruction

Duodenal necrosis is rare in children and presents a significant surgical challenge. We describe a 12-year-old girl who presented with duodenal necrosis secondary to a closed-loop bowel obstruction. We describe the diagnostic images, operative findings, and a novel reconstruction technique. This case highlights an alternative strategy for reestablishing gastrointestinal and biliopancreatic continuity while avoiding more complex procedures.

Closed-Loop Small-Bowel Obstruction

Multidetector computed tomography is a highly accurate method in evaluating high-grade intestinal obstruction. Closed-loop obstruction is a relatively uncommon subcategory of small-bowel obstruction; however, it is associated with a high risk of vascular impairment and is, therefore, important to diagnose accurately. Closed-loop obstruction is often caused by conditions such as internal hernias, congenital bands, postoperative adhesions, and malrotation. The purpose of this article is to review the imaging features of closed-loop bowel obstruction and various underlying conditions. Special emphasis will be placed on the technique of multidetector computed tomography and its role in diagnosing this entity.

Primary Mesenteric Lipoma Causing Closed Loop Bowel Obstruction: A Case Report

Primary mesenteric lipoma is rare, with fewer than 50 cases described in English-language literature, and those causing bowel obstructions are even more uncommon. The long stalk of the lipoma that caused secondary volvulus and rapid ischemic change in our patient is worth reporting because of its rarity and distinctive picture in emergency abdominal computed tomography.

Laparoscopy for adhesions.

Intestinal and abdominal adhesions may be responsible for a variety of clinical conditions, including chronic recurrent small-bowel obstruction, acute small-bowel obstruction, closed-loop bowel obstruction and, debatably, abdominal or pelvic pain. Experience in laparoscopic surgery has increased at a rapid pace, thus adhesions are no longer considered a contraindication to treatment of these conditions. In recent years, numerous publications have reported the feasibility, safety, and favorable outcome of laparoscopic intervention in various adhesion-related conditions. As adhesions are the most common cause of recurrent or acute bowel obstruction, this review will focus on the laparoscopic management of these conditions and outline the technical considerations, indications, contraindications, and results.