Features Of Intestinal Obstruction Research Articles

Acute abdomen: An unusual presentation of disseminated <i> Penicillium marneffei</i> infection

Varied clinical presentations of Penicillium marneffei, an opportunistic pathogen in HIV disease has been rarely described in literature. We report a patient with advanced AIDS who presented to us with prolonged fever and had features of an acute abdomen. On radiologic imaging he had features of intestinal obstruction and mesenteric lymphadenitis. A diagnosis was made possible by endoscopic biopsies of the small bowel and bone marrow culture which grew P. Marneffei. He was treated with intravenous amphotericin for 2 weeks followed by oral itraconazole. This case is reported for its rarity and unusual presentation and to sensitise clinicians and microbiologists to consider this as an aetiology in patients with advanced HIV/AIDS who present with acute abdomen, more so in patients from a distinct geographic region--South-East Asia.

Intestinal Malrotation with Midgut Volvulus Presenting as Acute Abdomen in Children: Value of Diagnostic and Therapeutic Laparoscopy

Intestinal malrotation is a developmental anomaly of intestinal fixation and rotation caused by a disruption in the normal embryologic development of the bowel. Normal rotation takes place around the superior mesenteric artery. Incomplete rotation and midgut volvulus is the commonest type of anomaly. Intestinal obstruction is the commonest presentation in symptomatic cases. Between 2000 and 2006, 73 children with acute abdomen underwent a diagnostic laparoscopy procedure. In this paper, we report 7 cases (9.5%) of midgut malrotation with volvulus and acute abdomen. Age range was between 7 and 12 years; there were 4 females and 3 males. They all presented with features of intestinal obstruction. A diagnosis of malrotation was established in only 1 patient, whereas the other 6 were diagnosed on laparoscopy. A laparoscopic Ladd's procedure was successfully performed for all cases. There were no postoperative complications. Intestinal malrotation occurs at a rate of 1 in 500 live births. The Ladd's procedure is the operation of choice. In 1995, the first report of laparoscopic surgery for malrotation was published. Since then, many studies were reported. Laparoscopy is a well-established diagnostic and treatment modality for this condition, even in the presence of volvulus. Our study shows the diagnostic value of laparoscopy in acute abdomen in children. The other advantages include less postoperative pain, a better cosmesis, especially in children, early return of bowel movement, and early discharge.

C S F pseudocysts peritoneal cavity following V P shunt surgery: Report of three cases in children and review of literature

Abdominal cerebrospinal fluid (CSF) pseudocyst is an uncommon complication following ventriculo-peritoneal (VP) shunt. The following report's our experience with three cases of CSF pseudocyst in children. VP shunt was done earlier for communicating hydrocephalus following tubercular meningitis (TBM) in all cases. Clinical presentation was with progressive abdominal distension and features of intestinal obstruction. Clinically we were able to diagnose all cases as CSF pseudocyst peritoneal cavity. Ultrasound examination confirmed the clinical findings in all. CT scan of abdomen and pelvis showed a large unilocular CSF pseudocyst with shunt catheter within it on one patient (case 3). Ultrasound guided aspiration of cyst was done in case 1 alone, but failed to resolve the symptoms. All patients needed formal exploration. Near total cyst excision, adhesiolysis and relocation of peritoneal end of VP shunt catheter in right supra hepatic space was done in all. Two patients who developed shunt tract infection needed shunt removal. The follow up period is 6-8 months.

Fat Necrosis Of Omentum As A Cause Of Intestinal Obstruction

Omental fat necrosis is a rare cause of non specific abdominal pain. We report a forty seven year old lady who presented with symptoms of intestinal obstruction which was due to fibrous band related to fat necrosis of omentum. She made a remarkable recovery following excision of the band. We believe our case to be the first reported case of intestinal obstruction due to omental fat necrosis. INTRODUCTION Omental fat necrosis is a rare cause of non specific abdominal pain. We report a forty seven year old lady who presented with symptoms of intestinal obstruction which was due to fibrous band related to fat necrosis of omentum. We believe our case to be the first reported case of intestinal obstruction due to omental fat necrosis. CASE REPORT Forty seven year old lady presented with two days symptoms suggestive of intestinal obstruction. She has been suffering from chronic constipation for twenty years. Examination revealed mild diffuse distention of abdomen and periumbilical tenderness. Radiographs and barium meal follow through revealed dilated loops of small bowel (Figure 1). CT scan of abdomen and pelvis showed location of the caecum in the left hypochondrium, indicative of malrotation (Figure 2). Figure 1 Figure 1:Barium meal follow through showing dilated bowel loops. Fat Necrosis Of Omentum As A Cause Of Intestinal Obstruction 2 of 4 Figure 2 Figure 2 : CT scan showing fibrous band with malrotation Exploratory laparotomy confirmed the mobile caecum in the left hypochondrium and a thick omental band constricting the terminal ileum which was released. Histopathology of the band revealed fat cells surrounded by foamy macrophages and multinucleated giant cells indicative of fat necrosis (Figure 3,4). She made a remarkable recovery following the laparotomy. Figure 3 Figure 3 : Low power view showing fibrosis and a cellular infiltrate around degenerate fat cells. Figure 4 Figure 4 : High power view shows fat cells surrounded by foamy macrophages with several multinucleate giant cells. DISCUSSION Liu and Lawal in their review suggested that the etiology of intestinal obstruction include adhesions, hernia, volvulus, intussusception, tumour and foreign bodies.1,2 Omental fat necrosis is a rare condition and predominantly present with abdominal pain. Radiological investigations in the form of ultrasonography and CT scan may reveal a fatty oval shaped mass with thickening of the parietal peritoneum.3 Arnosky and co workers in their series of 563 patients with acute abdominal pain, reported that the incidence of abdominal fat necrosis was only 1.1%.4 In our case fat necrosis had resulted in a thick fibrous band which had constricted the terminal ileum causing features of intestinal obstruction. CONCLUSION Omental fat necrosis, though rare, should be considered in the differential diagnosis of patients presenting with non specific abdominal pain and symptoms suggestive of intestinal obstruction. CORRESPONDENCE TO Mr Vijaykumar A. Korwar Room 3, Flat 3, Pickard House Dewsbury & District Hospital Dewsbury WF13 4HS Ph - 00441924512173 Fax00441924512026 Email: drvijaykorwar@yahoo.com

Synchronous adenocarcinoma and carcinoid tumor of the terminal ileum in a Crohn's disease patient

BackgroundSeveral malignancies have been described in association with inflammatory bowel diseases, the most common being adenocarcinoma. Carcinoid tumor and Crohn disease has also been previously reported, however the coexistence of both neoplasms is quite rare and the clinical diagnosis is very difficult. Here we report what we believe to be the fourth case of a mixed adenocarcinoid tumor coexisting with Crohn's disease.Case reportThe patient presented with clinical and radiological features of intestinal obstruction. Laparotomy showed a stricturing lesion in the last 6 cm of the terminal ileum with proximal dilation. Only the histology of the resected surgical specimen proved the presence of a mixed adenocarcinoid tumor involving the terminal ileum.ConclusionCarcinoid tumor should be suspected in elderly patients with Crohn's disease presenting with intestinal obstruction and laparotomy should be considered to exclude malignancy.

Acquired ileal atresia in infancy: report of two cases

Two infants, aged 3 months and 4 months, with acquired ileal atresia in the distal ileum are described. Both of them presented with features of intestinal obstruction following a diarrhoeal episode. In both patients the time interval between the onset of symptoms and detection of atresia at surgery was very short, i.e. 2 weeks. In our opinion, strangulation with subsequent resorption of gangrenous gut could have been the underlying mechanism in both patients. However, a short interval between initiation of symptomatology and detection of atresia prompted us to postulate a thromboembolic phenomenon as the cause of these lesions. While in one patient intussusception was noted on sonography, in the other there was no clear-cut aetiology present except for a high-lying caecum with a long mesentery that might have led to volvulus. We have reviewed the pertinent literature of this very rare sequela of gut inflammation.

Endoscopic Totally Extraperitoneal Repair for Occult Bilateral Obturator Hernias and Multiple Groin Hernias

An obturator hernia is a rare hernia that is bilateral in about 6% of patients. Most patients present with chronic pelvic pain although a few patients may present with features of intestinal obstruction. Only about 10% of obturator hernias are diagnosed preoperatively. A 65-year-old female patient with chronic obstructive pulmonary disease presented with bilateral groin swellings associated with local pain and heaviness. She also suffered from recurrent episodes of abdominal distension. She was diagnosed to have bilateral direct inguinal hernias and a left femoral hernia. At endoscopy under epidural anesthesia she was found to have a direct inguinal, an indirect inguinal, and a femoral hernia on the left side and an indirect inguinal hernia on the right side. Additionally, the endoscopic totally extraperitoneal approach to inguinal hernias identified hitherto undiagnosed bilateral obturator hernias. The hernias were reduced and polypropylene mesh was placed bilaterally covering the myopectineal orifice and pelvic floor bilaterally. The patient was discharged the next day and is symptom-free on followup at eight months. Endoscopic repair of groin hernias allows the surgeon not only to diagnose and treat unsuspected groin hernias but also allows identification, dissection, and repair of coincidental occult pelvic hernias like obturator hernias at the same time.

Cryptosporidium Gastroenteritis in Four Immunocompetent Children Presenting with Features of Intestinal Obstruction

Cryptosporidium Gastroenteritis in Four Immunocompetent Children Presenting with Features of Intestinal Obstruction

Abdominal cocoon in children: A report of four cases

Abdominal cocoon is a rare cause of intestinal obstruction. The authors report four cases (3 boys, 1 girl; age range, 6 to 8 years) that presented with features of intestinal obstruction. There was no history of previous surgery, peritonitis, or prolonged drug intake in any of these cases. One patient presented with acute intestinal obstruction and gangrene of bowel. The etiology, preoperative diagnosis, and management of this condition are discussed.

Limitations of surgery in intraabdominal Burkitt's lymphoma in children

The role of surgery in intraabdominal Burkitt's lymphoma is a controversial subject, and different views are expressed. In the authors' institution, 41 children (30 boys and 11 girls) have been treated who had intraabdominal Burkitt's lymphoma. A study was undertaken to assess the limitations of surgery in the treatment of intraabdominal Burkitt's lymphoma. An uniform policy was made to resect the tumor if possible or to debulk tumor irrespective of the spread of disease, and if this was not possible to perform only a biopsy. Thirty-nine children had laparotomy and various operative procedures, and in 2 children no laparotomy was performed, but tissue was obtained for histopathologic examination from cervical lymph nodes and jaw. Twelve children underwent complete resection of the intraabdominal tumor. There were no deaths in this group, and 10 of 12 children are long-term survivors. In 15 patients, debulking of the tumor was carried out. In 4, the tumor had perforated the bowel and caused widespread intraperitoneal deposits and sepsis. There were 3 deaths during the immediate postoperative period, 2 caused by peritoneal sepsis and 1 caused by surgical trauma in advanced disease. Three of 15 patients have survived for more than 2 years. Lastly, in 14 children only a biopsy was performed. Notable features in this group were that 6 patients had extraabdominal disease and another 6 presented initially with features of intestinal obstruction. In the latter group, intestinal bypass procedures were performed but no debulking was attempted. Five of 14 patients died after surgery, whereas 3 were long-term survivors. Patients were administered a chemotherapy regimen consisting of cyclophosphamide, vincristine, Adriamycin, and prednisolone. None of the deaths in this series were attributable to tumor lysis syndrome. Our results confirm that when Burkitt's tumor was localized or mobile, resection resulted in a good outcome, but debulking in the presence of wide-spread disease did not enhance survival. In patients with widespread disease due to advanced tumor, it is desirable to limit the surgery to tissue biopsy only.

Immunoproliferative small intestinal disease and primary small intestinal lymphoma. Relation to alpha chain protein.

Forty-three patients with immunoproliferative small intestinal disease and primary small intestinal lymphoma were studied prospectively. Eighteen patients in whom alpha-chain protein was detected in the serum had significantly more features of malabsorption, and disease was localized more commonly in the jejunum. In all of these patients, a diffuse lymphoplasmacytic infiltrate was found in the intestine; in three patients lymphoma was found only in mesenteric lymph nodes. Twenty-five patients with lymphoma in whom alpha-chain protein failed to be detected had significantly more features of intestinal obstruction, and disease was found more commonly in the ileum. Five of these patients had lymphoma associated with a diffuse mucosal infiltrate that was indistinguishable from the first group. In patients available for follow-up, no difference was found in cumulative survival over 30 months in the two groups, with approximately 40% mortality at 6 months.

Scleroderma (Progressive Systemic Sclerosis) with Severe Bowel Involvement. Treatment by Extensive Resection of the Small Intestine

A 48-year-old man with previously diagnosed scleroderma with bowel involvement was admitted to hospital with severe malnutrition attributed to malabsorption. Shortly after this, he developed features of intestinal obstruction followed by paralytic ileus. Due to failure to respond to medical treatment, operation was carried out. On two occasions adhesions were divided, but the bowel failed to function. At a third operation the proximal half of the small bowel below the duodeno-jejunal flexure was excised. Following this the patient made a good recovery. Small bowel involvement in scleroderma is discussed. Malabsorption is probably related to bacterial proliferaiton in the small bowel secondary to stasis and may be helped by antibiotic drugs. Other disturbances resulting in inability of the bowel to propel its contents may comprise syndromes of obstruction and paralytic ileus. Although management of scleroderma bowel involvement is usually medical, surgical treatment may be indicated under certain circumstances. It may be life-saving.

Clinico-Pathological Correlation of Abdominal Lymphadenopathy

Abdominal lymphadenopathies are not uncommon in our population that we encounter during laparotomy done for various reasons. Many times patients present with chronic abdominal pain, even features of intestinal obstruction where mesenteric tuberculosis remains at the background. This study was done with an aim to see the clinico- pathological relation of incidental findings of abdominal lymphadenopathy found during laparotomy which was done for other causes. doi: 10.3329/taj.v21i2.3791 TAJ 2008; 21(2): 126-131

Uncommon cause (fecolith or enterolith) of small intestinal obstruction in the adult

Intestinal obstruction due to fecolith is a rare cause of small bowel obstruction. A 40 years old lady presented with the features of intestinal obstruction of 6 days duration. She had H/O laparatomy for DU perforation and hysterectomy. Clinical examination and investigations pointed to intestinal obstruction because of intestinal adhesions from previous surgeries. Conservative treatment did not give relief to the patient. Diagnostic laparoscopy revealed ascites and moderate adhesion A lump with hard consistency was detected in the terminal ileum. A diagnosis of lymphoma was made and hemicolectomy was planned. After mobilizing the caecum and part of ascending colon laparoscopically, small transverse incision was made in RIF. Whole mass and caecum was delivered through the wound. The mass in the ileum was felt moving proximally on traction. The mass was pushed proximally and enterotomy was made to take out the lump. It was a 6 x 4 x 2 cm fecolith (fig-3). There was no other abnormality or cause of intestinal obstruction except mild adhesion at the terminal ileum.DOI: 10.3329/pulse.v3i1.6555Pulse Vol.3(1) July 2009 p35-37

Radiological Diagnosis of Intestinal Obstruction by Means of Direct Radiography

1. A series of 188 cases investigated and followed up is described and tabulated. Of these, 151 were cases of suspected intestinal obstruction, and 37 cases of post-operative distension. 2. Relevant anatomical and physiological features are discussed and normal radiological appearances described. Pathological features of intestinal obstruction are mentioned and for the purposes of this paper obstructions are classified as mechanical and adynamic (or neurogenic) obstructions. 3. A routine technique of a supine and an erect radiograph of the abdomen using a postero-anterior projection where possible, and using intensifying screens and a moving grid at an anode-film distance of 36 to 48 inches, is recommended. Techniques for difficult cases are mentioned. 4. The appearances of mechanical obstruction of the bowel are (a) stasis within the bowel as shown by the presence of fluid levels, and (b) distension of bowel by gas. 5. The site of the obstruction can be localised as being distal to the most distal part o...

A clinical study of acute intestinal obstruction : Meyer, Karl A. and Brams, William A.Illinois M. J., Jan., 1927, li, 43

INTRODUCTION : Intestinal obstruction is defined as any hinderance to the passage of intestinal contents. It may be classified as dynamic and adynamic obstruction. Dynamic obstruction is one of the most serious and frequently encountered emergencies presenting as acute abdomen. The present study is conducted with objectives to find out the frequency of various etiological factors of intestinal obstruction and to evaluate the morbidity and mortality in adult patients presenting with intestinal obstruction. AIMS AND OBJECTIVES : 1. To study incidence and various etiology of intestinal obstruction. 2. To study the various modes of presentation, importance of early diagnosis and management. 3. To study the role of imaging studies in determining site and etiology. 4. To study the morbidity and mortality rate in acute intestinal obstruction. MATERIALS AND METHODOLOGY : All patients who presented with symptoms and signs of bowel obstruction, admitted and managed surgically from June 2014 to June 2016 in the Department of General Surgery are included in this study. Diagnosis is based on the history, clinical findings, and supported by ultrasonography and radiological studies (plain x-rays) in all patients. Final diagnosis is made at exploratory laparotomy. Inclusion Criteria : 1. All patients presenting to emergency department with features of intestinal obstruction and are treated surgically. 2. Patients in the age group 15 to 75 years. 3. Patients who are haemodynamically stable. Exclusion Criteria : 1. Patients presenting with subacute intestinal obstruction and treated surgically. 2. Paediatric age group patients. CONCLUSION : This study on acute intestinal obstruction was aimed at studying the age and sex distribution, various etiologies, clinical presentations, treatment and outcomes of acute intestinal obstruction. Acute intestinal obstruction remains to be one of common surgical surgeries. Males are commonly affected mostly during their fifth decade. Obstructed/strangulated inguinal hernia remains to be the most common cause followed by adhesions. They usually present with abdominal pain with multiple air fluid levels in their X-ray abdomen erect view. The initial management of patients with acute intestinal obstruction should focus on aggressive fluid replacement, decompression of the obstructed bowel, and on prevention of aspiration. Surgery remains the cornerstone of treatment. Earlier diagnosis and timely intervention are associated with excellent prognosis. Delayed diagnosis leading to strangulation and increased age are associated with poor outcomes.