Features Of Intestinal Obstruction Research Articles

A Teenage Boy with Abdominal Pain and Vomiting

This diagnostic image presented a plain abdominal radiograph and ultrasonographic findings from a case of intestinal ascariasis, which is a relatively common cause of abdominal symptoms in developing countries. The plain x-ray highlighted soft tissue mass within the small bowel which could be accompanied by features of intestinal obstruction. The ultrasound study depicted triple-parallel lines or four-parallel lines which are characteristics of the roundworm.

Jejunal duplication cyst in a female neonate: a case report.

Duplications are the abnormal portion of the intestine, either externally attached to the intestine or intrinsically placed within the bowel lumen. Their prevalence is noted to be around one in 25000 deliveries. The rare gastrointestinal tract duplication may be located in any part of the gastrointestinal system from the oral cavity to the anus. The most common site of enteric duplication cyst (DC) is the terminal part of the ileum. Hence, duplications in jejunum are rare. Hereby, the authors report a case of jejunal DC in a female neonate which was managed successfully via surgery and adequate post-operative care without any complications. Duplications are more frequently single. They are usually located in the mesenteric border of the associated native bowel and may vary in shape and size. Most of them are cystic, followed by tubular and mixed type, with or without other congenital anomalies. More than 80% of the cases present before the age of 2 years as an acute abdomen or bowel obstruction, but many duplications remain silent unless complications occur, and therefore may not be diagnosed until adulthood. Complications of enteric DC include volvulus, bleeding, and, rarely, malignant degeneration. It is important for paediatric surgeons to include DC in the differential diagnosis if a neonate presents with features of intestinal obstruction.

Idiopathic Jejunal Diverticulitis: A Rare Case Report

Acquired jejunal diverticulosis often produces few or no symptoms and is generally picked up incidentally on cross-sectional imaging or intra-operatively. Similar to what is observed in colonic diverticulosis, diverticulitis can lead to more complicated clinical presentations including; perforation, gastrointestinal bleeding or obstruction. Acute diverticulitis is the most common presentation, but other complications can occur, mainly perforation, bowel obstruction and hemorrhage. Diagnosis is often difficult and delayed due to its relative rarity and non-specific clinical symptoms which increase the mortality and morbidity of this pathology. We have discussed a patient who presented to us with features of intestinal obstruction and on investigations and exploratory laparotomy he was diagnosed as a rare case of jejunal diverticulitis. He was managed operatively and patient had uneventful recovery where after CT scan, exploratory laparotomy was done and proximal milking through NG tube was done without resection.

Nonspecific Gastrointestinal Symptoms as the First Sign of Ganglioneuroblastoma Intermixed-Case Report and Literature Review.

Nonspecific gastrointestinal symptoms remain a problem for pediatricians because, out of a thousand trivial cases, there are rare diseases that require in-depth diagnostics and extensive knowledge to identify them. These complaints may be caused by a neoplastic process. We present the case of a 5-year-old boy whose diagnostic pathway lasted about 3 months. He was admitted to hospital due to severe abdominal pain. Physical examination revealed a bloated, hard, and painful abdomen. In the standing X-ray, the features of intestinal obstruction were visualized. An ultrasound examination showed a possible malignant lesion in the location of the left adrenal gland. After the surgical removal of the pathological mass and histopathological examination, the diagnosis of ganglioneuroblastoma intermixed was made. This tumor, along with neuroblastoma, ganglioneuroma, and ganglioneuroblastoma nodular, belongs to neuroblastic tumors (NTs), which originate from primitive cells of the sympathetic nervous system. NTs are quite rare, but they are still the majority of extracranial solid tumors in children, and their symptoms often appear relatively late when the neoplastic process is already advanced. The purpose of this review is to present current information about ganglioneuroblastoma, with a special emphasis on nonspecific gastrointestinal symptoms as first sign of this tumor and its diagnostics.

Laboratory Profiles and Imaging Findings of Abdominal Tuberculosis Patients: Experience of 100 Cases in Bangladesh

Background: Variations of laboratory profiles and imaging findings may occur among the abdominal tuberculosis patients. Objectives: The purpose of the present study was to laboratory profiles and imaging findings of abdominal tuberculosis patients. Methodology: This descriptive cross sectional study was conducted in the Department of Surgery of Rajshahi Medical College Hospital, Rajshahi, Bangladesh from January 2014 to December 2015 for two years. This study included patients who were admitted in surgery units of Rajshahi Medical College Hospital, Rajshahi, Bangladesh who were diagnosed as abdominal tuberculosis with or without associated pulmonary or nodal tuberculosis. Different laboratory tests were performed and were recorded. The imaging techniques like barium meal and Ultrasonography of the abdomen were also performed during diagnosis of the patient. Results: A total number of 100 cases were included in the study. The most common age group was 20 to 30 Years of age group which was 52.0% cases. In this study 18 cases were positive histological examination of intestine for tuberculosis. About 12 cases were node-positive, 6 cases were ADA positive, 20 patients underwent positive colonoscopy, 26 cases were FNAC positive in caecal growth and lymphadenopathy, 12 cases ware positive radiological findings, 3 cases were positive histopathology in which tissue taken by laparoscopy and remaining 3 was confirmed by isolation of organism by smear and culture for AFB of ascetic fluid. In plain X-Ray of abdomen, 48 patients had features of intestinal obstruction, 7 patients had pneumoperitoneam, 4 patients had ground glass opacity with pneumoperitoneam and only 1 patient had calcified lymph node and remaining 40 patients had normal radiological findings. Conclusion: In conclusion most of the abdominal tuberculosis patients are positive in histopathological examination and X-ray of abdomen. Bangladesh Journal of Medical Microbiology, July 2022;16(2):47-52

Jejuno-Jejunal Intussusception in An Adult-An Unusual Presentation of Malignant Melanoma: A Case Report

Background: Small bowel intussusception is common presentation in children and rare in adults but malignant melanoma as primary cause is once in a blue moon event. It accounts for 1% of all bowel obstructions. Jejuno-Jejunal intussusception is a rare mode of metastatic malignant melanoma presentation. It may be metastatic and rarely primary cause of this type of presentation. In literature no such case s reported from our country before and perhaps seventh case of malignant melanoma as primary cause of jejuno-jejunal intussusception in literature. Case Presentation: Here we report a case of a 40 years old male who presented to us with features of intestinal obstruction. On exploration, Jejuno-Jejunal intussusception was found secondary to some mass in jejunum. Resection anastomosis of Jejunum was performed. Histopathological examination of mass revealed metastatic malignant melanoma. On further work up, CT scan abdomen showed multiple enlarged mesenteric lymph nodes and few enlarged bilateral inguinal lymph nodes. Patient post-operative recovery was uneventful and discharged. Conclusion: One should suspect metastatic melanoma as a lead point in cases of jejuno-jejunal intussusception in adults presenting with intestinal obstruction.

ROLE OF MDCT IN THE PREOPERATIVE EVALUATION OF ADULT INTUSSUSCEPTION

Introduction: Intussusception is a condition which occurs when one segment of the intestine "telescopes" inside of another segment . It may or may not be associated with features of intestinal obstruction .The telescoping proximal segment is called intussusceptum and the distal receiving bowel segment is called intussuscipien.Intussusception can occur due to congenital cause like Meckel diverticulum, benign cause like intestinal polyps, intestinal lipomas, hypertrophied lymphnodes, malignant conditions like colorectal carcinoma , lymphomas , metastatic depostis. Depending on the presence or absence of lead point on MDCT,further treatment planning can be done like surgical or non surgical options like water soluble contrast enema/ air enema can be administered . The prese Material and Methods: nt study was conducted in the department of radiodiagnosis, NRI general hospital,chinakakani, Guntur district from 2020 to 2022. A total of 40 patients attending the general surgery department in the age group between 20 to 70 years abdominal symptoms like pain,vomittings,bleeding per rectum, intestinal obstruction were studied. All patients underwent MDCT and the ndings of CT scan are noted. Out Results: of the total 40 patients the most common age group of presentation was 41-50 years(30%). 72% were males and 28% were females.out of 40 patients location of intussusception is ileocaecal in 50%,enteric in 35% ( ileoileal in 20%,jejunojejunal in 13% duodenoduodenal in 2%),colocolic in 15%. Intusussception can be detected by USG in 72% ,not detected by USG in 28% of individuals. Out of 40 patients no evidence of lead point on MDCT detected in 20%,In rest 80% lead point is neoplastic etiology out of which 55% are benign( Lipomas being most common 22%, polyps 20%,carcinoids 8%,GIST 5% ), Malignant being 25% (carcinoma 15%, lymphoma 10 %). In case of adults neoplastic being most common cause sugery is the denitive management in 90% patients , reduction is done in rest 10% patients. Preoperative evaluation of i Conclusion: ntussusception patients with MDCT is very essential to diagnose the presence or absence of lead point and determine appropriate treatment and reduce the rate of unnecessary surgical intervention.

Large umbilical hernia complicating huge uterine fibroid: Case report in a tertiary hospital in Port Harcourt, Nigeria

Background: Leiomyoma, also known as uterine fibroid is a benign tumour of the uterus. The size varies from a pin-head to a massive swelling occupying the whole of the abdominal cavity, depending on its site and duration. Huge uterine fibroid coexisting with umbilical hernia have been reported in the global literature. The aim of this report was to highlight a rare presentation of huge uterine fibroid with a large umbilical hernia, as well as the management and achievement of successful outcome, in a tertiary hospital in Port Harcourt, Nigeria. Case Presentation: A 43-year-old nulliparous woman who presented to the Emergency Department with features of intestinal obstruction, complicating a large umbilical hernia coexisting with a longstanding huge uterine fibroid. She had myomectomy and herniorrhaphy done, and the post-operative period was uneventful. Conclusion: This report not only showcases the unusual presentation of huge uterine fibroid with large umbilical hernia, but also highlight a picture of neglected surgical conditions in our practice. Action is needed from the political, administrative and professional personnel to forestall such occurrences among patients in our sub-region.

CECAL VOLVULUS

Aim- Introduction- To study a case report of caecal volvulus; a rare clinical entity Cecal volvulus is an uncommon cause of intestinal obstruction, and is the axial twisting of the cecum, ascending colon, terminal ileum, and their associated mesenteries as pedicles. It is estimated that it occurs in 2.8–7.1 per million people per year. It is an infrequent cause of intestinal obstruction, accounting for 1−5% of all adult intestinal obstructions; and up to 40% of colonic volvulus. A mobile/non-xed cecum is mentioned as one signicant associated nding in patients with cecal volvulus, and this was seen in about 25% of cadaveric studies.4 Its variable clinical symptoms make it difcult to diagnose early. Case Summary- A 51 years old male presented with features of intestinal obstruction with a history of eight days. X-ray showed features intestinal obstruction with, dilated large bowel loops could be seen with atypical air uid level. A large caecal volvulus was seen with gangrenous caecum and proximal 4 cm of ascending colon. Rest of small bowel was dilated and DJ junction was found on the right of aorta. Resection of cecal volvulus with ileo-ascending anastomoses with proximal loop ileostomy was done. Caecal volvulus is a rare cause of bowel obstruction, mainly caused by an exceedingly mobile c Conclusion- aecum, an embryologic abnormality. Early diagnosis can be difcult due to its unspecic symptoms of small bowel obstruction. The main course of treatment is surgical, and modalities depend on various factors such as patient status and perioperative ndings.

Obturator hernia: A case report of intestinal obstruction with challenging diagnosis and non-standardized treatment.

Introduction and importanceObturator Hernia (OH) is a rare clinical entity that constitue less than 1% of all abdominal hernias. It happens in elderly thin women malnourished. The diagnosis is usually delayed because symptoms are non-specific, and patients commonly have features of intestinal obstruction. There are no international guidelines for treatment and the best surgical approach still unknown.Case presentationWe report a case of strangulated OH in a 75 year woman who consulted in our service for an acute intestinal obstruction. Intra-operatively findings showed loop of ileum entering through a defect in the right obturator canal. The obturator defect was closed by approximation flap of peritoneum and covered by right ovair and fallopian tube.Clinical discussionThis case is reported because of its an uncommon type of abdominal wall hernia with high probability of bowel strangulation and highest morbidity and mortality rates. There are no international guidelines for treatment and the best surgical approach still unknown.ConclusionThe diagnosis of OH should be suspected every time there is an intestinal obstruction of unknown origin in emaciated elderly women. Open or laparoscopic sutured repair surgery and placement of mesh remain the most common method of repair.

Intestinal metastasis from carcinoma cervix: An (un) common occurrence in a common cancer. A series of five cases from a single institution.

Carcinoma cervix usually spreads directly to contiguous structures, such as the vagina, urinary bladder, ureter, and rectum. Intestinal metastasis from cervical cancer is very uncommon and accounts for less than 4% of cases and to date, 24 cases have been reported in Medical literature. These may be asymptomatic or present with features of intestinal obstruction, bowel wall perforation, and mimic acute abdomen. Intestinal metastasis is a late occurrence and carries a poor prognosis, hence a high index of suspicion with prompt diagnosis and management is essential. We report a series of five patients with squamous cell carcinoma (SCC) of the cervix with intestinal metastasis diagnosed in our hospital.

Myxoid liposarcoma of small bowel presenting with intussusception and obstruction: A case report

Gastrointestinal liposarcomas are extremely rare with the most common reported morphological subtype being dedifferentiated liposarcoma and well-differentiated liposarcoma. These tumors are rarely diagnosed preoperatively and diagnosis is only confirmed on histopathological analysis. Treatment of gastrointestinal liposarcomas consists of surgical excision with widely negative margins followed by post-operative irradiation and close follow-up. We report an exceedingly rare case of myxoid liposarcoma of the small bowel (ileum) presenting with an unusual presentation with intussusception and intestinal obstruction. A 42-year-old male presented to the emergency department with features of intestinal obstruction. Contrast-enhanced computed tomography abdomen revealed ileo-ileal intussusception with an endoluminal soft-tissue lesion at the leading edge. The patient was taken for surgical intervention and the involved segment of the bowel along with the lesion was resected and re-anastomosis done. Histological sections of the mass along with immunohistochemistry suggested the pathological diagnosis of myxoid liposarcoma.

Trocar-site hernia following laparoscopic salpingo-oophorectomy in a middle-aged Japanese woman: an initial case report after 40\xa0years of experience at a single center and a brief literature review

BackgroundIn gynecology, the number of laparoscopic surgeries performed has increased annually because laparoscopic surgery presents a greater number of advantages from a cosmetic perspective and allows for a less invasive approach than laparotomy. Trocar site hernia (TSH) is a unique complication that causes severe small bowel obstruction and requires emergency surgery. Its use has mainly been reported with respect to gastrointestinal laparoscopy, such as for cholecystectomy. Contrastingly, there have been few reports on gynecologic laparoscopy because common laparoscopic surgeries, such as laparoscopic salpingo-oophorectomy, are considered low risk due to shorter operative times. In this study, we report on a case of a woman who developed a TSH 5 days postoperatively following a minimally invasive laparoscopic surgery that was completed in 34 min.Case presentationA 41-year-old woman who had undergone laparoscopic salpingo-oophorectomy 5 days previously presented with the following features of intestinal obstruction: persistent abdominal pain, vomiting, and inability to pass stool or flatus. A computed tomography scan of her abdomen demonstrated a collapsed small bowel loop that was protruding through the lateral 12-mm port. Emergency surgery confirmed the diagnosis of TSH. The herniated bowel loop was gently replaced onto the pelvic floor and the patient did not require bowel resection. After the surgical procedure, the fascial defect at the lateral port site was closed using 2-0 Vicryl sutures. On the tenth postoperative day, the patient was discharged with no symptom recurrence.ConclusionsThe TSH initially presented following laparoscopic salpingo-oophorectomy; however, the patient did not have common risk factors such as obesity, older age, wound infection, diabetes, and prolonged operative time. There was a possibility that the TSH was caused by excessive manipulation during the tissue removal through the lateral 12-mm port. Thereafter, the peritoneum around the lateral 12-mm port was closed to prevent the hernia, although a consensus around the approach to closure of the port site fascia had not yet been reached. This case demonstrated that significant attention should be paid to the possibility of patients developing TSH. This will ensure the prevention of severe problems through early detection and treatment.

Inflammatory myofibroblastic tumor presenting as malignant intestinal obstruction: A rare case report

Inflammatory myofibroblastic tumor (IMFT) is an unusual solid tumor of mesenchymal origin seen in children and young adults. It occurs primarily in the lungs with equal gender predisposition. It has been proposed that the development of IMFT occurs after trauma, surgery, or infection with Epstein‒Barr virus and human herpesvirus, related with reactive cytokine production. Because of its rarity, it is important to distinguish IMFT from other colonic tumors. We report a rare case of IMFT in a 50-year-old man who presented with features of intestinal obstruction.

Milk curd syndrome with goat's milk: Revisited

Milk curd syndrome is an infrequent cause of intestinal obstruction in neonates and early infancy. We are adding to the literature an extremely rare case of milk curd syndrome in a 3-month-old infant who was being fed with goat's milk. A 3-month-old infant presented with features of intestinal obstruction. The patient used to pass a few pellets such as small, firm, white-colored stools after every 2 to 3 days often requiring enema. The baby was fed with goat's milk. Abdominal radiographs suggested large bowel obstruction. The conservative treatment with rectal washes failed. Exploration revealed dilated small bowel with the presence of very dense, inspissated, sticky, and white-colored intraluminal material in the terminal ileum and throughout the colon. Multiple attempts were made to milk the contents distally and finally out of the rectum but failed. A transverse loop colostomy was performed and inspissated milk curds were milked out. The outcome was favorable. The diagnosis of milk curd obstruction should be considered in neonates and infants with signs of the terminal ileum or large bowel obstruction fed with unmodified animal milk, for example, goat's milk (as seen in our case) or formula feeds.

SHIITAKE MUSHROOM AS A CAUSE OF BOWEL OBSTRUCTION

Shiitake mushroom, claimed to have major health benefits. It is a popular ingredient in east Asian cuisine. Given that mushrooms are rich in dietary fiber, the undigested fiber can act as a bezoar and may cause small bowel obstruction. Bezoar-induced small bowel obstructions are rare and herein we report a case of intestinal obstruction caused by shiitake mushroom. An elderly patient was admitted with features of intestinal obstruction. Preoperative imaging showed dilated small bowel with suspicious mass in ileum. Patient underwent laparotomy and undigested shiitake mushroom was retrieved at enterotomy. Clinical awareness of the mushroom induced intestinal obstruction and early use abdominal computed tomography (CT) are essential for prompt diagnosis and treatment.

Case report of sclerosing encapsulating peritonitis secondary to tuberculosis

Sclerosing encapsulating peritonitis (SEP) is a visceral encapsulation syndrome of inflammatory origin, seen as an infrequent cause of intestinal obstruction in young patients. It is a condition characterised by complete encapsulation of small bowel loops by a fibrocollagenous membrane, leading to cocoon formation. Histologically, the membrane is composed mainly of organised fibrin, probably derived from the plasma exudation of peritoneal microvasculature. Clinical presentation is related to the development of altered gut motility, resulting in abdominal pain and features of intestinal obstruction. We here discussed about a young patient who presented with features of intestinal obstruction and diagnosed with SEP, secondary to abdominal tuberculosis and was then treated surgically. SEP as a cause of intestinal obstruction is a rare life threatening entity encountered in day to day practice. Definitive diagnosis of this condition is challenging in the pre-operative period and is usually missed and a high index of suspicion is required.

An unusual case of small bowel obstruction secondary to internal herniation of distal ileum through a rent between adhered inflamed vermiform appendix and appendices epiploicae

Intestinal obstruction secondary to an internal hernia is rare and that occurring through a rent between the adhered inflamed vermiform appendix and appendices epiploicae of the proximal caecum is so rare that this case was the first of its kind ever to be reported. Such a cause for obstruction should be suspected in a patient with a virgin abdomen with no history/clinical features of an obstructing external hernia or abdominal tumor. A 28 year old man presented to the ER with features of intestinal obstruction, in whom CECT abdomen revealed multiple dilated small bowel loops with breaking-of seen in the region of the terminal ileum. Surgical exploration revealed internal herniation of the distal ileum through a rent between the adhered inflamed vermiform appendix and the appendices epiploicae of the proximal caecum; reduction of which was sufficient to relieve the obstruction and demonstrate healthy reperfusion. Adhesiolysis, epiploicae appendectomy and appendectomy was done with no other points of obstruction along the small bowel. Due to its rarity, non-specific presentation pattern and limited usefulness of imaging for diagnosis, a high index of suspicion with prompt early surgical exploration is a must for a successful outcome in such cases intestinal obstruction; especially in a virgin abdomen.

Sigmoid volvulus in pregnancy: a case report

IntroductionSigmoid volvulus in pregnancy is a rare cause of intestinal obstruction with high maternal and fetal morbidity and mortality if not diagnosed and managed early.Case presentationA 29-year-old female (Chagga by tribe) presented with clinical features of intestinal obstruction 24 weeks into her second pregnancy. She had symptoms for one week. An emergency laparotomy was performed whereby gangrenous sigmoid volvulus was found; thus, it was resected and Hartmann’s colostomy was raised. Unfortunately, she experienced intrauterine fetal death post-operatively. She was discharged clinically stable.ConclusionEarly diagnosis and management can prevent adverse effects such as bowel ischemia and preterm labor. Because classic clinical and radiological features may not be evident, high degree of suspicion is warranted.

Abdominal cocoon syndrome, a case report of a rare disease entity causing intestinal obstruction.

Introduction and importanceAbdominal cocoon syndrome is a rare condition characterized by small bowel encapsulation by a fibrous membrane or a cocoon-like sac. It is an uncommon cause of intestinal obstruction. Less than 300 cases have been reported from all over the world. This is the first case of such a disease entity to be reported from Sudan.Case presentationA young female patient, presented with features of intestinal obstruction that was managed conservatively. Failure of the conservative management has warranted a laparotomy.Clinical findings and investigationsHer features were suggestive of intestinal obstruction that was confirmed radiologically.Interventions and outcomeLaparotomy revealed a membrane-like fibrous material and extensive multiple loops adhesions, findings consistent with primary sclerosing encapsulating peritonitis (PSEP), also known as abdominal cocoon's disease. The membrane was excised and adhesiolysis was done. Intestinal obstruction was relieved after surgery and the patient showed good outcome.ConclusionsAbdominal cocoon syndrome is a rare cause of intestinal obstruction.Relevance and impactThe takeaway lesson from this case would be that the PSEP should be sought in any patient with no clear cause for obstruction can be identified. A contrast-enhanced CT scan is the diagnostic modality of choice. Finally, we think that the disease is underreported from Africa and more efforts should be carried out to increase patients' access to healthcare especially in rural areas with no access to hospitals in order to bring more cases to light. This case report has been reported in line with the SCARE Criteria (Agha et al., 2020 [17]).