Diagnosis Of Acute Intestinal Obstruction Research Articles

Case Report] Occlusive Syndrome by Internal Transmesosigmoid Hernia: A Case Report and Review of the Literature

Internal transmesosigmoid is a rare condition, that can cause unusual small bowel obstruction we report of an 80-year-old male patient presenting an acute intestinal obstruction due to transmesosigmoid hernia, the patient was operated for bladder lithiasis 6 years ago. Auscultation revealed intestinal borborygmus, and CT scan showed sigmoid volvulus in a dolichocolon. The diagnosis of acute intestinal obstruction was made, and an emergency laparotomy was indicated. Because of the high risk of strangulation with transmesosigmoid hernia, it is mandatory to timely and periodically reassess. Early surgical intervention is crucial to reduce mortality.

Acute Intestinal Obstruction Due to a Foreign Body Migrated into the Abdomen after a Clandestine Abortion Almost 20 Years Ago

Acute intestinal obstruction caused by a foreign body is no longer a rare phenomenon, especially if the latter is found in the digestive tract. However, the migration of an extradigestive foreign body as a cause of obstruction is extremely rare. We report the case of a 60-year-old female patient seen urgently on September 5, 2023 at 3:00 p.m. at the District Hospital of Commune IV of Bamako with the diagnosis of acute intestinal obstruction. Intraoperatively we noted grélo-uterine, grélo-sigmoid adhesions and bands tying the terminal ileum with significant intestinal dilatation upstream without signs of necrosis. Also a foreign body (tubing of a serum infuser) rigid curved of approximately 40 cm was located between the loop. The procedures performed were: adhesiolysis, sectioning of the flanges, extraction of the foreign body, toileting and installation of a Redon drain in the Douglas cul de sac. The in-depth postoperative questioning revealed a notion clandestine abortion in 2003 by a nurse in a country in the sub-region, leaving an infusion tube in place for a few hours. And she was supposed to go in the next day for a check-up, but she didn't show up. Our medical team reviewed the ASP image where we noted in addition to the central hydroaeric levels, an inverted U-shaped image of a foreign body (infuser tubing) going from the left hypochondrium to the left iliac fossa. confirming the diagnosis intraoperatively. The postoperative course was simple. The patient returned home on postoperative day 5.

Sigmoid colonic metastasis from a squamous cell carcinoma of the cervix: A rare case report with literature review.

As the third most common cancer in women, cervical cancer usually spreads to adjacent organs. Distant metastasis from the cervix to the gastrointestinal tract is an extremely rare occurrence. Herein, we present a rare case of a 57-year-old woman who was treated by hysterectomy and bilateral salpingo-oophorectomy with pelvic lymphadenectomy for squamous cell carcinoma (SCC) of the uterine cervix. A metastatic location in the sigmoid colon was revealed after 8 years causing an acute intestinal obstruction in this patient. Final surgical pathology showed an invasive lesion with squamous differentiation in full thickness of the colon wall from mucosa to serosa. Meanwhile, the results of immunohistochemistry (IHC) showed the cancer cells were positive for CK5/6, P63, P40, and P16 confirming the diagnosis of metastatic sigmoid colonic carcinoma originating from SCC of the uterine cervix. Sigmoid colon resection with lymph node dissection followed by adjuvant chemotherapy (paclitaxel, carboplatin, and paprillizumab) was performed on the patient. The patient was disease-free 16 months after surgery. SCC is one of the rare malignant tumors of the gastrointestinal tract occurring as either a primary or secondary lesion. However, the secondary SCC of the colon has a poorer prognosis compared with the primary SCC. Therefore, colonic metastasis must be considered in the differential diagnosis of acute intestinal obstruction, especially in patients with the medical history of SCC in other organs.

A Prospective Study of Clinicoradiological Scores in Predicting risk of Strangulation in Bowel Obstruction

Introduction: Acute intestinal obstruction is one of the common surgical emergencies leading to variable amount of morbidity and mortality. Strangulation is the most important factor in influencing the outcome and it is critical to accurately and promptly identify the existence of intestinal strangulation. The objective of the study was to assess the clinicoradiological scores in predicting risk of strangulation in bowel obstruction.
 Methods: A prospective study of 50 patients with clinical diagnosis of acute intestinal obstruction attending General Surgery department of Government Mohan Kumaramangalam Medical College and Hospital, Salem during January 2021 and September 2022.
 Results: Most of the study population is between 51 – 60 years with mean age of 55 years with male predominance. Mean time between admission and surgery is 6 hours. All patients had previous history of surgery, with appendicectomy being most common followed by hollow viscous perforation. Of the 50 patients in the study 19 patients underwent resection. Pain > 4 days, Guarding, Total leucocyte count > 10000/mm3, CRP > 75mg/dl, reduced contrast enhancement in CECT is frequently found in strangulated obstruction. On comparing with Schwenter score, of 36 patients who scored 0 -3, 5 patients underwent resection whereas all 14 patients who scored > 4 underwent resection.
 Conclusions: A combination of clinical, laboratory and radiological parameters helps in earlier prediction of risk of ischaemia in acute intestinal obstruction and timely intervention.

A CLINICAL STUDY AND MANAGEMENT OF ACUTE INTESTINAL OBSTRUCTION

Aims And Objectives: The current study aims to review the various causes, clinical features and the outcome of surgical procedures in relation to etiological factors in 50 intestinal obstruction patients admitted at Government general hospital ,Kurnool july2020 –july2022. This study was done on 50 cases of acute intestinal obstruction Materials And Methods: that presented to emergency department of government general hospital,Kurnool(july 2020-july2022).All patients with provisional diagnosis of acute intestinal obstruction were assessed clinically in detail after admission. Investigations done included Hb, Blood counts including TC, DC, ESR, serum electrolytes ,X-ray Chest PA view, Plain X-ray abdomen erect lm & Ultrasonography abdomen, CECT abdomen. . The commonest Results: age group affected was 31-40 years. M:F ratio is 2.6:1. In our patients, the main cause of obstruction was obstructed hernia (36%). Adhesions and bands (26%) were the second most common cause of intestinal obstruction followed by sigmoid volvulus (12%), TB abdomen (8%) and malignant obstruction (6%). Surgery was the mainstay of treatment, with herniorraphy, adhesiolysis and resection - anastomosis being the most commonly performed procedures. Post-operative complications noted were wound infection (12%), respiratory infection (6%) and prolonged ileus (6%). In the present study of 50 cases, 5 patients (10%) died due to septicemia,leak and MODS. The incidence of intestinal Conclusion: obstruction is more common in males, Mode of presentation also differs in different levels of intestinal obstruction, Adhesions accounted for majority of small bowel obstruction (26%),Malignancies are common causes of large bowel obstruction.Early recognition and timely intervention is important to prevent the bowel going for gangrenous changes.Morbidity was due to anastomotic leak, would infection, chest infection. Prognosis was poor in elderly patients and , in patients with co-morbid conditions, presence of strangulated bowel that required resection & anastomosis and those whose presentation to hospital was late

PATTERN, MANAGEMENT AND OUTCOME OF ACUTE INTESTINAL OBSTRUCTION AT CHITWAN MEDICAL COLLEGE TEACHING HOSPITAL

Background: Acute intestinal obstruction is one of the commonly encountered emergencies in surgical practice. Gynecological surgery, especially adnexal surgery and hysterectomy has a higher incidence of bowel obstruction as compared to bowel surgery. Conservative management can be done in patients with post-operative adhesive bowel obstruction if there is no evidence of ischemia, bowel necrosis, or perforation. Therefore, a correct diagnosis is essential for appropriate management. We conducted a study to evaluate the etiology, clinical presentation as well as management and outcome of patients presenting with Acute intestinal obstruction at our center. Methods: This was a retrospective study of all the patients with a diagnosis of Acute intestinal obstruction from January 2015 to December 2019. The diagnosis of Acute intestinal obstruction was made by a combination of clinical and radiological parameters. The data were analyzed using Statistical Package for Social Sciences (SPSS) for Windows version 16. The data were expressed in number and percentage. Results: During the study period, 178 patients were admitted with the diagnosis of Acute intestinal obstruction. Abdominal pain and vomiting were the main complaints seen in 98.3% (n=175) and 84.8% (n=151) respectively. Hernia (n=49, 27.5%) was the most common cause of acute intestinal obstruction in adults, and Intussusception (n=15, 8.4%) was the leading cause of Acute intestinal obstruction in a pediatric age group. Majority of the patients’ needs (n=148,83.1%) operative intervention to relieve the obstruction. The overall mortality rate was 6.7% (n=12). Conclusions: Hernia was the most common cause of Acute intestinal obstruction in adults while intussusception was the commonest in the pediatric age group.

Reliability of Medical Imaging in the Pre-Therapeutic Assessment of Acute Intestinal Obstruction at the Centre Hospitalier Universitaire Du Point “G”

Introduction: Acute intestinal obstruction is a serious pathology, a surgical emergency for which medical imaging plays an important role in the management. We initiated this work in order to study the contribution of imaging in the diagnosis of acute intestinal obstruction at the Point-G University Hospital. Patients and Methods: This was a prospective, descriptive and analytical study of 96 patients collected at the radiology and medical imaging department of CHU Point-G from January 2018 to January 2019. Results: The age of our patients varied from 11 to 86 years, with an average of 36 years old. There was a male predominance of 64.6% against 35.4% for women, i.e., a sex ratio of 1.82. Previous surgery was found in 61.5% of our patients. The pain was present in all patients. An unprepared abdominal X-ray was performed in 89.6% of patients. Hydroaerobic levels were found in 96.5% of patients. Abdominopelvic CT scans were performed on 12 patients, all of whom were diagnosed with occlusion. These positive diagnostic findings were consistent with intraoperative findings in 92% of cases. The causes were dominated by bridges in 46 patients and tumors in 9 patients. Signs of severity on CT were dominated by signs of distress of the upstream bile ducts in 8.3%. Exactly 8% of our patients spontaneously resumed transit, 91% received surgical treatment and 1% died before surgery. The outcome was favorable in 80 patients (83.3%) and poor with death in 16 patients (16.7%). Conclusion: Acute intestinal obstruction remains a serious pathology for which the X-ray of the PSA is often the only radiological examination performed in an emergency. However, abdominopelvic CT seems to us to be widely indicated thanks to its contribution both to the positive diagnosis and to the diagnosis of severity and etiology. However, this imaging technique is widely underused in our practice because of its high cost and lack of availability.

CLINICAL STUDY AND MANAGEMENT OF ACUTE INTESTINAL OBSTRUCTION

Background: The etiology of acute intestinal obstruction, which is one of the commonest surgical emergencies, varies between countries, and has also changed over the decades'.The current study aims to review the various causes, clinical features and the outcome of surgical procedures in relation to etiological factors in 50 intestinal obstruction patients admitted at Government General Hospital, Kurnool (Oct 2019 to Oct 2021). Methods: This was a prospective study of 50 patients admitted with a diagnosis of acute intestinal obstruction at GGH, Kurnool between Oct 2019- Oct 2021. Data related to the objectives of the study were collected and analysed by comparing with various standard studies. Results: Acute intestinal obstruction was the diagnosis in 3% of all patients admitted, with a M: F ratio of 1.38:1. The commonest age group affected was 31-40 years. In our patients, the main cause of obstruction was obstructed hernia (36%), due to lack of awareness among the rural population. Adhesions and bands (26%) were the second most common cause of intestinal obstruction followed by sigmoid volvulus (12%), TB abdomen (8%) and malignant obstruction (6%). Surgery was the mainstay of treatment, with herniorraphy, adhesiolysis and resection - anastomosis being the most commonly performed procedures. Post-operative complications noted were wound infection (12%), respiratory infection (6%) and prolonged ileus (6%). In the present study of 50 cases, 5 patients (10%) died due to septicemia and MODS. Conclusion: This study demonstrates that the pattern of intestinal obstruction differs from the Western world with obstructed hernias rather than adhesions being the most common cause. Majority of the patients need timely surgical relief of obstruction to avoid the development of peritonitis, sepsis and multi-organ failure.

НЕЙРОЭНДОКРИННАЯ ОПУХОЛЬ СЛЕПОЙ КИШКИ, ОСЛОЖНЕННАЯ НЕКРОЗОМ СТЕНКИ НА ФОНЕ COVID-19

Aims/Objectives. The purpose of this work is to analyze the diagnosis and treatment of a neuroendocrine tumor of the caecum complicated by wall necrosis, peritonitis in the presence of COVID-19 infection. Materials and methods. The results of the examination and treatment of a 63-year-old patient L., who was hospitalized in the surgical department with a diagnosis of acute intestinal obstruction, were analyzed. History of appendectomy. Biological material was tested for Covid-19 infection (September 5, 2021): SARS-CoV-2 coronovirus RNA was not detected. When controlling the passage of barium suspension through the intestines, it was established: a contrast mass along the colon. There are abnormal fluid levels in the mesogastrium. Areas of narrowing of the right and left flanks of the large intestine are determined. On the third day, symptoms of peritoneal irritation appeared. Operated. There is a cloudy effusion in the abdominal cavity. In the right iliac region, an infiltrate is determined, formed by the caecum, ascending colon, terminal ileum, sigmoid, strand of the greater omentum. There are also fibrin plaques here. The dome of the caecum is black. In the intestine, palpation is determined by volume formation dense, spreading to the proximal section of the ascending colon and the terminal section of the ileum. Performed right-sided hemicolectomy with anastomosis "end to side", lymph node dissection D 2. Performed sanitation and drainage of the abdominal cavity. Results and discussion. The next day after surgery, the patient is in the ICU. Severe condition. Not adequate. Excited. Body temperature - 36.4C. Breathing is independent, auscultatory is somewhat weakened in the lower sections, single dry rales. Respiratory rate - 16/minute, SpO2 - 97-98% against the background of humidified oxygen insufflation at a rate of 1.5 liters/minute. Hemodynamics stable: blood pressure - 137/105 mm Hg. Art. Heart rate - 80 beats / min. Cardio monitoring - sinus rhythm. Abdomen: responds to palpation in the area of the postoperative wound. Peristalsis is sluggish. Rapid test for SARS-CoV-2 antigen No. 784 is positive. Ag SARS-CoV-2 - detected (09/08/2021). Histological conclusion: highly differentiated neuroendocrine tumor of the caecum with germination of the intestinal wall, ingrowth into the periintestinal fatty tissue. Resection margins: no tumor growth. Phlegmonous-ulcerative typhlitis. Focal phlegmonous-purulent peritonitis. Omentit. On the 6th day the patient is conscious and takes food. Removed drainage from the abdominal cavity. On the 7-th day, he was transferred to the infectious diseases department of another hospital for aftercare. Сonclusions 1. PCR test does not always detect Covid-19 if present. 2. Despite the presence of Covid-19 in patients suffering from a complicated malignant tumor of the intestine, a radical operation should be performed followed by treatment of the underlying pathology.

Paradoxical Reaction of Acute Intestinal Occlusion in an Immunocompetent Patient: A Case Report in Benin

Tuberculosis is a real public health problem. It is due to Mycobacterium tuberculosis, a bacterium with a strong pulmonary tropism. Extra-pulmonary forms represent 14% of all tuberculosis cases worldwide. Digestive damage represents 3% to 5%. The treatment of tuberculosis is well codified these days. A paradoxical reaction (PR) to anti-tuberculosis drugs is defined as worsening of pre-existing clinical or radiological lesions or the appearance of new lesions during anti-tuberculosis treatment. They are rarely described in the digestive system with an acute intestinal obstruction type. We report here a clinical case of a paradoxical reaction to the type of acute intestinal obstruction in an immunocompetent patient on anti-tuberculosis treatment. It was a 56-year-old male patient with no specific history, HIV-negative followed by pulmonology for bacteriologically confirmed pulmonary tuberculosis. He was put on Poly Chemotherapy (2ERHZ / 4RH). Progress under this treatment was marked by onset on day 35 of generalized abdominal pain associated with mechanical bowel obstruction with no fever. On admission to the surgical emergency room, besides abdominal pain, the patient presented bloating and bilious vomiting, abdominal meteorism and abdominal tympanism. The diagnosis of acute intestinal obstruction of the small intestine by obstruction of probable tuberculous etiology had been suggested and the patient operated on. During the operation, we had discovered dilated small intestine, multiple ileal and parieto-ileal adhesions with ileal strangulation 60 cm from the ileo-cecal junction, multiple granular micronodular lesions and mesenteric lymphadenopathy. Procudure included adhesions resection, biopsy of omentum and mesenteric lymphadenopathy The evolution was favorable and Histopathology analysis found images in favor of mycobacteriosis.

Clinicoepidemiology and treatment outcome of acute intestinal obstruction in adult in KIMS Amalapuram: a retrospective observational study

Background: The intestinal obstruction is a common potentially risky surgical emergency in all age group globally. This is responsible for 12% to 15% of surgical admission due to acute abdomen. Obstruction to gastrointestinal tract can occur at all labels but it is small intestine which more commonly involved. To improve the outcome early diagnosis and management is essential. Present study has been designed to study the epidemiology, demography and clinical presentation of acute intestinal obstruction and to study the complications and outcome of surgical management of acute intestinal obstruction.Methods: In present study patients admitted with diagnosis of acute intestinal obstruction during study period were enrolled for this study as per inclusion and exclusion criteria. As per that 126 patients were enrolled for this study. Case record of all patients were closely reviewed and analysed thoroughly.Results: The mean age of the patients was 54.64±12.93 years. The acute intestinal obstruction was more common in 41 to 60 years of age group that is (44.45%). Regarding etiology of acute intestinal obstruction 44.45% patient adhesion was the etiology of obstruction. Resection of adhesion was most common procedure done for removal of obstruction (42.85%).Conclusions: Adhesion was most common etiology and pain abdomen and tachycardia was common presentation. Regarding management of obstruction resection of adhesion was most common procedure done for removal of obstruction. Infection of wound was common complication.

Bowel obstruction due to the tightening of a loose bowel adhesion with uterus enlargement during pregnancy

Introduction. Acute intestinal obstruction during pregnancy is a rare digestive surgical emergency. Generally, it is associated with significant maternal and fetal mortality. The diagnosis is difficult, often delaying the therapeutic management. It is reported an exceptional association of acute intestinal obstruction due to a band adhesion that is put into tension as the uterus enlarges. Case Report. A 35 years old Caucasian pregnant woman with a past medical history of appendectomy was examined and found with abdominal pain, severe vomiting, and bowel obstruction. The patient underwent surgery. Per operatively, the obstruction was caused by an adhesion put into tension by the enlargement of the uterus. The postoperative course was uneventful and the patient was discharged on day 2. Conclusions. The etiological diagnosis of acute intestinal obstruction during pregnancy is difficult. Surgery is the cornerstone of the treatment and the management varies depending on the intraoperative findings and the condition of the patient.

Long Term Effect of Acute Intestinal Obstruction Management following Laparotomy in a Tertiary Care Hospital

Background: Post-surgical outcomes are very crucial for acute intestinal obstruction following laparotomy.
 Objective: The purpose of the present study was to identify the causes and risk factors that influence the outcome of post laparotomy acute intestinal obstruction and also to assess their management and outcome.
 Methodology: This cross sectional study comprising fifty patients irrespective of age and sex with diagnosis of Acute intestinal obstruction following laparotomy who attended at the Department of Surgery in different tertiary Hospital of Dhaka city, within the time period of July 2017 to June 2019. All these data were analyzed and tried to find out the outcome of management of acute intestinal obstruction following laparotomy.
 Results: All the 50 patients had undergone some conventional surgeries in previous instance. Acute intestinal obstruction was found in 80.0% of cases who had undergone emergency surgery and 20.0% cases were after routine surgery. The reasons behind Laparotomy for burst appendix (16.0%) followed by laparotomy for blunt trauma abdomen (12.0%) and classical appendicectomy (12.0%). After conservative management complication rate was low (21.0%) and the most prominent complication was UTI (28.57%) whereas mortality was 14.29%. After surgical management complication rate was higher which was in 56.25% of cases.
 Conclusion: Post laparotomy of acute intestinal obstruction can improve the outcome and reduce the chance of relaparotomy, surgical morbidity.
 Journal of Current and Advance Medical Research 2020;7(2): 73-79

Diagnosis and surgical treatment of acute intestinal obstruction caused by extragenital form of endometriosis

Damage to the gastrointestinal tract with extragenital endometriosis is a very rare pathology. According to the literature, the frequency of damage to the gastrointestinal tract in endometriosis, after previously performed gynecological operations, is less than 1%. At the same time, involvement in the pathological process of the intestine is noted in 337% of women of childbearing age with diagnosed genital endometriosis. In most clinical cases extragenital endometriosis occurs intraoperatively due to the complexity of early diagnosis.
 This article presents a clinical case of successful surgical treatment of a 43-year-old patient admitted to a surgical department with signs of intestinal obstruction. According to the anamnesis the patient had been suffering from recurrent pains in the lower abdomen in the right mesogastrium and constipation. The day before hospitalization, the above mentioned symptoms become worse with additional nausea, vomiting, lack of gases and feces. Based on the clinical laboratory and instrumental data the diagnosis of acute intestinal obstruction was established; and the urgent surgical treatment was carried out. Two formations were revealed intraoperatively (in the terminal ileum and in the elongated loop of the sigmoid colon). Both formations circularly narrowed the intestinal lumen, however the ileum was the cause of obstruction. Due to the lack of histological verification and the inability to exclude the malignant nature of the formation, the surgical treatment was carried out taking into account oncological standard in the amount of ileum resection and obstructive resection of the sigmoid colon with lymphadenectomy and small intestine intubation. Pathohistological examination confirmed intestinal endometriosis. The course of the postoperative period revealed no complications. The patient was discharged on the 12th day for outpatient treatment under the supervision of a surgeon and a gynecologist at the place of residence with recommendations and subsequent planned hospitalization in order to conduct reconstructive surgery to restore intestinal patency.

Comparison of two examination methods in the diagnosis of acute intestinal obstruction in children

Objective To compare the value of 64-slice spiral CT and digital radiography(DR)in the diagnosis of acute intestinal obstruction in children. Methods Eighty-one children with suspected acute intestinal obstruction were selected. All patients were given DR and CT examinations. The diagnostic accuracy rates of the two examination methods were analyzed by taking surgery or follow-up results as golden standards. Results Among the 81 children patients, there were 58 cases with intestinal obstruction, with a sensitivity of 91.38% in CT and 87.93% in DR, a specificity of 86.96% and 82.61%, respectively, the accuracy rate of 90.12% and 86.42%, respectively, and the consistency Kappa value of 0.763 and 0.679, respectively. McNemar test results showed no significant difference between the two groups(P>0.05). Among 58 children patients with intestinal obstruction, there were 19 cases with adhesive obstruction, 16 cases with intussusception, 11 cases with congenital intestinal obstruction, 5 cases with incarcerated hernia, 3 cases with necrotic enteritis and 4 cases with volvulus, and the accuracy rates of CT and DR for etiology of intestinal obstruction were 91.38% and 75.86%, respectively(P<0.05). Among 58 children patients with intestinal obstruction, there were 48 cases(82.76%)with low intestinal obstruction, 6 cases(10.34%)with high intestinal obstruction and 4 cases(6.90%)with colon obstruction, with the accuracy rates of CT and DR for the obstruction site examination were 94.83% and 82.76%, respectively(P<0.05). Conclusion The accuracy rate of CT in diagnosis of intestinal obstruction is comparable to that of DR, but CT has obvious advantages over DR in the etiology and sites of obstruction.

Diagnostic accuracy of ultrasound in common acute abdominal conditions

Background: Ultrasound evaluation is cheap, easily available, even at rural level, and can predict need for surgical intervention in majority of conditions. It involves no exposure to radiation, can diagnose easily, can be repeated any number of times for follow up. Disadvantages are that it is user dependent and distended bowel containing air prevents satisfactory evaluation of abdomen. The objective was to study diagnostic accuracy of ultrasound in common acute abdominal conditions.Methods: All patients presenting to the emergency Department of General Surgery, Narayana general hospital, Nellore with abdominal pain of acute onset and who were diagnosed to be suffering from acute appendicitis, acute perforation peritonitis, acute intestinal obstruction, acute pancreatitis, acute calculous cholecystitis were included in the present study.Results: Diagnostic accuracy of USG for acute appendicitis was little bit low with sensitivity of 71.8% and specificity of 59.1% for operative findings and similar for CT findings. For acute perforation peritonitis it was still very low with sensitivity of 42.9% and specificity of 66.7% for operative findings and similar for CT findings. It was very good for acute intestinal obstruction with sensitivity of 90.9% and specificity of 83.3%, but here it was low compared to CT findings. It was also pretty good for diagnosing acute calculus cholecystitis in comparison with operative as well as CT findings.Conclusions: USG can be used as a diagnostic tool for diagnosis of acute intestinal obstruction and acute calculus cholecystitis but doubtful role in the diagnosis of acute appendicitis and acute perforation peritonitis and acute pancreatitis.

Endoscopic Management of Benign Colonic Obstruction and Pseudo-Obstruction.

There are a variety of causes of intestinal obstruction, with the most common cause being malignant diseases; however, volvulus, inflammatory bowel disease or diverticulitis, radiation injury, ischemia, and pseudo-obstruction can also cause colonic obstruction. These are benign conditions; however, delayed diagnosis of acute intestinal obstruction owing to these causes can cause critical complications, such as perforation. Therefore, high levels of clinical suspicion and appropriate treatment are crucial. There are variable treatment options for colonic obstruction, and endoscopic treatment is known to be a less invasive and an effective option for such. In this article, the authors review the causes of benign colonic obstruction and pseudo-obstruction and the role of endoscopy in treating them.

Clinical study and management of acute intestinal obstruction

Background: The etiology of acute intestinal obstruction, which is one of the commonest surgical emergencies, varies between countries, and has also changed over the decades1.The current study aims to review the various causes, clinical features and the outcome of surgical procedures in relation to etiological factors in 50 intestinal obstruction patients admitted at Government General Hospital, Kurnool (Oct 2014 – Oct 2016). Methods: This was a prospective study of 50 patients admitted with a diagnosis of acute intestinal obstruction at GGH, Kurnool between Oct 2014–Oct 2016. Data related to the objectives of the study were collected and analysed by comparing with various standard studies. Results: Acute intestinal obstruction was the diagnosis in 3% of all patients admitted, with a M: F ratio of 1.38:1. The commonest age group affected was 31-40 years. In our patients, the main cause of obstruction was obstructed hernia (36%), due to lack of awareness among the rural population. Adhesions and bands (26%) were the second most common cause of intestinal obstruction followed by sigmoid volvulus (12%), TB abdomen (8%) and malignant obstruction (6%). Surgery was the mainstay of treatment, with herniorraphy, adhesiolysis and resection - anastomosis being the most commonly performed procedures. Post-operative complications noted were – wound infection (12%), respiratory infection (6%) and prolonged ileus (6%). In the present study of 50 cases, 5 patients (10%) died due to septicemia and MODS. Conclusion: This study demonstrates that the pattern of intestinal obstruction differs from the Western world with obstructed hernias rather than adhesions being the most common cause. Majority of the patients need timely surgical relief of obstruction to avoid the development of peritonitis, sepsis and multi-organ failure.

A prospective study of serum C-reactive protein and D-lactate levels for early prediction of strangulation in intestinal obstruction

Background: Intestinal obstruction is one of the commonest clinical problems encountered in surgical practice. One of the grave complications of intestinal obstruction is strangulation, which requires an emergency laparotomy for management. This study was conducted to emphasise the significance of early estimation of rise in serum C-reactive protein and D- lactate levels.Methods: Hospital based prospective study was performed on 50 patients admitted in J.L.N. Hospital, Ajmer in various surgical units with diagnosis of acute intestinal obstruction and underwent explorative Laparotomy.Results: CRP test sensitivity was 85.00%, specificity was 80.67%, PPV was 73.91% and NPV was 88.89% to detected the obstruction with strangulation when using a cutoff value of 60 mg/L. D-lactate test sensitivity was 80.00%, specificity was 90.00%, PPV was 84.30% and NPV was 87.10% to detected the obstruction with strangulation when using a cutoff value of 4.5 mmol/L.Conclusions:Serum CRP and D-lactate can be useful and reasonable markers for predicting strangulation in cases of acute intestinal obstruction in an emergency setting.

Acute intestinal obstruction due to extrinsic compression by previa myoma and ectopic pregnancy: a case report

BackgroundAcute intestinal obstruction during pregnancy is a rare digestive surgical emergency with significant maternal and fetal mortality. Diagnosis is difficult, often delaying the management. Here, we report an exceptional association of mechanical acute intestinal obstruction due to compression by previa uterine leiomyoma, and a ruptured ectopic pregnancy.Case presentationThis is the case report of a 43-year-old primiparous black woman from a rural area, who was admitted to the surgical emergency department for acute intestinal obstruction.At examination on admittance, our patient had a bad general condition with clinical anemia. She had an occlusive syndrome that had been evolving for 3 days. A physical examination of her abdomen showed a widespread distension with an irregular and polylobed solid mass occupying the whole of the lower-umbilical and hypogastric area. A rectal examination found an empty rectum, and the mass was perceptible in Douglas’s pouch. At the vaginal examination, we found the same mass and a finger holster was clean. The diagnosis of intestinal occlusion by a tumor was retained. The laparotomy revealed a distended intestine, a ruptured right tubal ectopic pregnancy and a polymyomatous uterus. The most massive previa leiomyoma was adhering and compressing the rectal and sigmoidal hinge. A total hysterectomy was performed and histopathological examination of specimens confirmed myoma and ectopic pregnancy. The surgical follow-up was uneventful, and our patient was discharged on postoperative day 12.ConclusionsThe etiological diagnosis of acute intestinal obstruction during pregnancy is not easy, especially in the context of a low-income country where the means of biological and radiological diagnosis are lacking. A laparotomy is required before diagnosis of acute surgical abdomen and its management will depend on the intraoperative findings and the condition of the patient.