Diagnosis Of Mechanical Intestinal Obstruction Research Articles

2629 A Benign Tumor With a Malignant Course

INTRODUCTION: Mesenteric fibromatosis is a rare, locally invasive, non-metastasizing intra-abdominal fibroma with a high rate of recurrence. These tumors pose a diagnostic and therapeutic challenge due to its rarity and wide-ranging clinical presentation. CASE DESCRIPTION/METHODS: A 43-year-old man with a medical history of hypertension and no prior surgeries who presented with acutely worsening diffuse abdominal pain with associated bloating, nausea, and vomiting for 2 days. Physical exam revealed abdominal tenderness with deep palpation with the absence of peritoneal signs. MRI revealed a large liver mass with central necrosis suspicious of hepatocellular carcinoma, however, the biopsy was consistent with a hemangioma. Colonoscopy visualized a colonic mass with difficulty maneuvering the scope through the entire colon raising concern for primary versus metastatic colon cancer. Tumor markers were unremarkable. Gastrografin radiography demonstrated a high-grade obstructing annular mucosal lesion at the splenic flexure. He underwent left hemicolectomy with colostomy placement. Pathology demonstrated a spindle cell neoplasm with a fascicular architecture surrounded by abundant collagen fibers with no necrosis. Further histological staining was positive for vimentin, beta-catenin, and desmin conforming to mesenteric fibromatosis. DISCUSSION: Mesenteric fibromatosis is part of the clinical-pathologic spectrum of deep fibromatosis encompassing a group of benign fibroproliferative processes that are locally aggressive and have the capacity to infiltrate or recur, but not metastasize. Most cases manifest sporadically, however, there is a link with familial adenomatous polyposis (FAP), specifically Gardner syndrome. In addition, they can be locally aggressive showing recurrence even after excision. Mesenteric fibromatosis may be confused radiologically and histologically with a gastrointestinal stromal tumor (GIST), however immunohistochemical profile is helpful in differentiation. Mesenteric fibromatosis is typically negative for CD34 and CD117, which are almost universally positive in GISTs. This case illustrates the difficulty in diagnosing mesenteric fibromatosis, and a secondary lesion can complicate diagnosis. Mesenteric fibromatosis with intestinal involvement can be easily confused with other primary gastrointestinal tumors, especially with mesenchymal origin such as GIST. Hence, it should be considered in the differential diagnosis of mechanical intestinal obstruction as well as intra-abdominal masses.

Acute mechanical intestinal obstruction in children at zinder national hospital, Niger: Aetiologies and prognosis.

Background:To describe the aetiological and prognostic aspects of acute mechanical intestinal obstruction (AMIO) in children at Zinder National Hospital (Niger).Materials and Methods:This was a cross-sectional study on a period to January 2013–June 2015. The database included all children under 15 years of age with a surgical diagnosis of mechanical intestinal obstruction. P < 0.05 was considered statistically significant for analysis.Results:AMIOs represent 21.78% (n = 78) of child digestive surgical emergencies (n = 358). Median age was 12 months (range: 1 day–15 years). Fifteen (19.23%) were neonates and sixty children (76.92%) had ≤60 months. The sex ratio (male/female) was 2.8. The mean time from onset to presentation was 39.96 ± 36.22 h. Intussusception and strangulated hernias were the main causes of AMIO with, respectively, 43.59% (n = 34) and 29.48% (n = 23). Anorectal malformations represent 17.95% (n = 14) of cases of AMIO. Intestinal resection was made in 22.08% and colostomy in 19.23% of patients. The average length of hospital stay was 6.44 ± 4.30 days. The post-operative complications were recorded in 26 patients (33.33%), mostly surgical site infections. Overall mortality of AMIO was 15.38% (n = 12). It was higher in the neonates (33.33%) (P = 0.032). Deaths were associated with delay of admission (P = 0.0005) and waiting time for surgery (P = 0.019).Conclusion:Intussusception and strangulated hernia are the most common cause of AMIO in children. Diagnostic and therapeutic delays, lack of paediatric intensive care and post-operative complications are prognostic factors.

Recurrence of primary squamous cell carcinoma of the ileum diagnosed by elevation of serum SCC: report of a case.

Primary squamous cell carcinoma of the intestine is extremely rare. This report describes a patient with primary squamous cell carcinoma of the small intestine. A 72-year-old Japanese woman was referred to our hospital because of a diagnosis of intestinal obstruction. She underwent laparotomy owing to the diagnosis of mechanical intestinal obstruction due to a pelvic mass after conservative treatment. The affected ileum was resected, and histopathological examination revealed proliferation of differentiated squamous cell carcinoma at the submucosal area with no adenocarcinoma component. At the 4thmonth after the operation, the level of serum squamous cell carcinoma (SCC) antigen was elevated. At 6months after the operation, the serum SCC value was further elevated, and enhanced CT revealed two new pelvic tumors with enhancement at the mesentery and free space. A second laparotomy was performed 8months after the operation. Histopathological examination showed differentiated squamous cell carcinoma as in the first operation. The level of serum SCC decreased at the 28th postoperative day. Chemotherapy including carboplatin and paclitaxel was performed as an adjuvant regimen. The patient has experienced no recurrence of squamous cell carcinoma for 55months.

Ileosigmoid knotting in pregnancy

Aim: Ileosigmoid knotting (ISK) is a rare event in pregnancy. This study reviewed the clinical outcomes of 3 pregnant patients with ISK and compared the characteristics of these pregnant women with 16 nonpregnant women. Materials and methods: The clinical records were reviewed retrospectively. Results: Three pregnant patients accounted for 4.2% of 72 total ISK patients and 15.8% of 19 female ISK patients. The ages of the patients were 35, 38, and 31 years (mean: 34.7 years). All of the patients were multiparous. Two patients (66.7%) were in the 3rd trimester and 1 (33.3%) was in the 2nd trimester. The mean duration of symptoms was 36.0 h. The main symptoms and signs were abdominal pain/tenderness, obstipation, and distention in all of the patients (100.0%), in addition to vomiting, hypo/akinetic bowel sounds and empty rectal vault in 2 (66.7%) and hyperkinetic bowel sounds, muscular guarding with rebound tenderness, and melenic stool in 1 (33.3%). Each patient had a preoperative diagnosis of mechanical intestinal obstruction, and all of the patients received emergency surgery. The outcomes were as follows: 33.3% maternal mortality, 66.7% fetal mortality, and 33.3% surgical morbidity. Conclusion: ISK in pregnancy is a rare occurrence. It is generally seen in multiparous women and in the 3rd trimester. Abdominal pain, distension, and obstipation are the main clinical features. An accurate diagnosis is difficult to obtain preoperatively, and patients are usually diagnosed with a nonspecific intestinal obstruction. After resuscitation, emergency surgery is needed. For gangrenous cases, resection of the ileum with primary anastomosis and resection of the sigmoid with colostomy are preferred, whereas detorsion is the treatment of choice for cases that are not complicated by gangrene. The prognosis of this disease is poor.

Gossypiboma Causing Mechanical Intestinal Obstruction: A Case Report

Introduction. Gossypiboma (GP) is a term used to express the mass resulting from forgotten cotton sponge in operations. Rarely, a transmural migration may occur into the gastrointestinal lumen without creating any defect by GP. Laparotomy or endoscopic removal may be required, by the way it can be taken out of the body itself by intestinal ways. In this study, we reported a case of mechanical intestinal obstruction causing GP. Case. The fifty-one-year-old female patient admitted to the emergency department with the complaints of mechanical intestinal obstruction and had a history of open cholecystectomy 20 years ago. There were the findings of intestinal obstruction in abdominal plain radiography and computerized tomography. The sponge that obstructed the lumen completely 40 cm proximal to the ileocecal valve was identified in the laparotomy with the diagnosis of brid ileus. The small intestine was closed over double-fold after removal of sponge. Transmural migration of abdominal-remained sponge was thought to be occurred without creating a defect after cholecystectomy. Postoperatively, the patient was discharged without having any problems at 4th day of hospitalization. Conclusion. Although it is a rare situation in routine clinical practice, GP should be considered as a differential diagnosis in the patients who had a diagnosis of mechanical intestinal obstruction, and laparotomy was applied before. As GP may lead to situations which cause mortality, all precautions should be taken to prevent it.

Preoperative diagnosis of mechanical intestinal obstruction: analysis of 127 cases

Preoperative diagnosis of mechanical intestinal obstruction: analysis of 127 cases

Application of three-dimensional reconstruction technique of 16 slice spiral CT in diagnosis of mechanical intestinal obstruction

目的 探讨16层螺旋CT三维重建对机械性肠梗阻的诊断价值.方法 回顾性分析38例经手术证实为机械性肠梗阻,且X线和16层螺旋CT检查资料齐全的病例,把X线、二维CT及三维CT所见与手术病理结果对照并进行对比分析.结果 三维CT诊断肠梗阻的准确率为100%,病因诊断正确率92%(35/38),包括肠肿瘤16例,肠粘连6例,肠套叠5例,肠扭转2例,腹外疝3例和肠石3例.结论 16层螺旋CT三维重建对机械性肠梗阻的显示、诊断及制定治疗方案具有重要的临床意义。

Value of CT in the diagnosis of mechanical intestinal obstruction

目的 探讨螺旋CT对机械性肠梗阻的诊断价值.方法回顾性分析34例经手术证实为肠梗阻,且X线和CT资料齐全的病例,把CT所见与手术病理结果对照.结果 26例(约76%)手术结果与CT表现相符.包括肠肿瘤10例,肠粘连5例,肠套叠5例(含3例肿瘤),肠扭转2例,炎性病变3例,3例肠壁缺血即肠绞窄(含2例肠扭转).结论 CT能确诊肠梗阻,快速显示梗阻部位和病因,提示肠绞窄,有利于临床治疗方案的制订。

ACUTE OBSTRUCTION OF THE SMALL BOWEL

The physiologic and pathologic abnormalities caused by acute obstruction of the small bowel have been studied in many clinics and laboratories. The result has been a better understanding of the problem, but the mortality rate for these lesions is still high. A survey of 198 patients with this lesion, observed in the University Hospital in the years 1934 to 1947, has been made and subjected to critical analysis, with the hope of improving the diagnosis and treatment in similar cases in the future. In all patients included in the study the diagnosis of mechanical intestinal obstruction and its causation was confirmed by operation or necropsy. Patients with primary paralytic ileus and those with nonoperative relief of obstruction have been excluded. It is now recognized 1 that the fluids lost by vomiting and other mechanisms, together with the absent intake of food and drink, result in profound dehydration from water and