Bowel Necrosis Research Articles

A Rare Case of Superior Mesenteric Artery Thrombosis With Gangrenous Bowel in a Patient With Mitral Valve Replacement in a Hypocoagulable State

A Rare Case of Superior Mesenteric Artery Thrombosis With Gangrenous Bowel in a Patient With Mitral Valve Replacement in a Hypocoagulable State

Portal venous gas in a domestic shorthair cat with large cell lymphoma

AbstractPortal venous gas is defined as air within the portal venous system, whereas pneumobilia is defined as gas within the biliary tract. This report describes an 11.5‐year‐old female spayed domestic shorthair being managed for large cell lymphoma. While being hospitalised, the patient was noted to have evidence of portal venous gas on diagnostic imaging. The case study highlights common underlying causes of portal venous gas and pneumobilia in addition to diagnostic options and findings for evaluation. The most common cause of portal venous gas is bowel necrosis. Ultrasound and computed tomography scan are the most sensitive diagnostic methods in differentiation. Being familiar with the radiographic signs of and potential underlying causes of portal venous gas and pneumobilia may allow for more prompt investigations of potentially life‐threatening underlying causes. If recent surgical manipulation to the hepatobiliary/hepatoenteric system is not present and there is no history of trauma, then further diagnostic workup should be performed to evaluate for an underlying cause. Treatment of portal venous gas and pneumobilia is based on treating the suspected underlying cause.

A Study Of Association Of Intra-Abdominal Pressure With Severity And Outcome In Patients Of Emergency Laparotomy

Introduction: The present study is done to study the association of intra-abdominal pressure with intra-operative findings and postoperative surgical complications in patients of emergency laparotomies so that timely and appropriate interventions can be planned and administered. Methods: The study was done on 84 patients. The intra-abdominal pressure was measured indirectly by measuring the pressure within the urinary bladder via Foley's catheter. Results: There was positive association between the higher grades of IAP and intra-abdominal contamination and gangrenous bowel, the mean value of IAP being 20.4 mmHg. A statistically positive association was also observed between preoperative IAP and post-operative complications, the mean IAP ≥19mmHg. Conclusion: There is a significant positive association of raised pre-operative intra-abdominal pressure with intra-operative finding of gangrenous and edematous bowel and postoperative surgical complications.

Sodium Polystyrene Sulfonate-Induced Massive Bowel Necrosis With Distant Extraintestinal Crystal Deposition: A Case Report and Review of the Literature

Sodium Polystyrene Sulfonate-Induced Massive Bowel Necrosis With Distant Extraintestinal Crystal Deposition: A Case Report and Review of the Literature

Calciphylaxis Induced Isolated Bowel Gangrene in a Septic Deceased Donor Renal Transplant Recipient

Calciphylaxis Induced Isolated Bowel Gangrene in a Septic Deceased Donor Renal Transplant Recipient

Biallelic and monoallelic variants in EFEMP1 can cause a severe and distinct subtype of heritable connective tissue disorder.

Variants in EFEMP1, encoding Fibulin-3, were previously reported as a rare cause of heritable connective tissue disorder (HCTD) with recurrent hernias and joint hypermobility. We report three new cases with biallelic or monoallelic EFEMP1 variants and severe hernia phenotypes. Two male siblings of 10 and 13 years old presented with marfanoid habitus, recurrent inguinal and umbilical hernias, generalized joint hypermobility, and scoliosis. Parents and halfsiblings reported joint hypermobility and umbilical hernias. The eldest boy died at age 16 from incarcerated gastrointestinal herniation complicated by gastric and bowel necrosis with perforation. Autopsy revealed widespread intestinal diverticula. Immunohistochemistry of skin and fascia tissue did not reveal any abnormalities, including normal staining of elastic fibers. Both siblings harbored compound heterozygous likely pathogenic EFEMP1 variants (c.1320 + 2T > A, p.? and c.698G > A, p.Gly233Asp). An unrelated 58-year-old male had marfanoid features, high myopia, recurrent diaphragmatic and inguinal hernias, and chronic gastrointestinal dilatation with severe malabsorption. Both his dizygotic twin-brother and mother had recurrent hernias and high myopia. This man died at 59 years of age, and autopsy showed extensive diaphragmatic herniation, bowel diverticula, and pulmonary emphysema. A heterozygous EFEMP1 splice-variant (c.81 + 1G > A, p.?) was identified, causing exon skipping leading to a start-loss. Targeted genome reanalysis nor RNA-sequencing revealed a second variant at the other allele. The reported individuals expand the clinical and pathological phenotypes of EFEMP1-related disease, a distinct entity within the spectrum of HCTD. The severe and recurrent hernias, gastrointestinal dilatation, and diverticulosis result in an increased risk for life-threatening complications, demanding early recognition and close monitoring.

Massive enteric necrosis caused by histiocytic sarcoma embolism: a case report

BackgroundHistiocytic sarcoma (HS) is a rare disease characterized by the presence of neoplastic histiocytes. We herein report an unusual case of HS that caused massive tumor embolism-related transmural necrosis of the small intestine.Case presentationA 64-year-old man presented with multiple nodules in the lungs, bone, mediastinum, and subcutaneous tissues that were incidentally detected on preoperative computed tomography for early transverse colon cancer. Approximately two months later, the patient presented with signs of peritoneal irritation suggestive of small intestinal necrosis. Emergency surgery was performed and the necrotic small intestine was resected. Pathological examination revealed small bowel necrosis due to multifocal HS embolism. The postoperative course was uneventful. The patient was unsuccessfully treated with chemotherapy for HS and died 122 days postoperatively.ConclusionsHS can cause massive enteric necrosis due to tumor embolism. Clinicians should be aware of this rare presentation of HS.

Unusual causes of Small bowel obstruction: a review of the literature and revisited cross-sectional imaging checklist.

Intestinal obstruction is a common surgical emergency with high morbidity and mortality. Patients presenting with features of small bowel obstruction need urgent evaluation to avoid complications such as bowel gangrene, perforation, or peritonitis. Imaging is necessary in most cases of suspected bowel obstruction, to take an appropriate decision, for apt patient management. Among the common causes of small bowel obstruction, adhesions, external herniae, malignancies, and Crohn's disease top the chart. Imaging helps in determining the presence of obstruction, the severity of obstruction, transition point, cause of obstruction, and associated complications such as strangulation, bowel gangrene, and peritonitis. This review is based on the cases with unusual causes of bowel obstruction encountered during our routine practice and also on the extensive literature search through the standard textbooks and electronic databases. Through this review we want our readers to have sound knowledge of the imaging characteristics of the uncommon yet important causes of bowel obstruction. We have also revisited and structured a checklist to simplify the approach while reporting a suspected case of small bowel obstruction. Imaging plays a key role in the diagnosis of small bowel obstruction and in determining the cause and associated complications. Apart from the common causes of small bowel obstruction, we should also be aware of the uncommon causes of small bowel obstruction and their imaging characteristics to make an accurate diagnosis and for apt patient management.

Presentation and management of post-esophagectomy or Gastrectomy Hiatal Hernia.

Hiatal hernia may development after esophagectomy or Gastrectomy. Post- esophago-gastric hiatal hernia is a rare but challenging condition. Nearly half of reported cases involve emergent situations, underscoring the urgency of addressing this condition. However, there is currently no consensus on the optimal treatment approach for this type of hernia. All consecutive patients who underwent repair for Post- esophago-gastric hiatal hernia over the past five years were retrospectively reviewed. Patient characteristics and perioperative data were collected. The primary outcomes, repair methods, and surgical results following post-esophago-gastric hiatal repair were analyzed. A total of eight patients with post-esophago-gastric hiatal hernia were included in this study. All patients presented with emergent conditions, specifically bowel obstruction. Laparoscopic repair was successful in four cases, with a conversion rate to open surgery of 50% (4 out of 8). Primary suture was performed in three cases, while biological mesh repair was carried out in four cases, and one case was left unrepaired. Bowel gangrene and perforation occurred in one case. The most notable postoperative complications included wound infection and pleural fluid collection. Importantly, there were no instances of hernia recurrence during the follow-up period, which ranged from 2 to 55 months, with a 100% follow-up rate observed. Post-esophago-gastric hiatal hernia is a rare yet significant condition, often presenting emergently and linked to higher morbidity and mortality rates. Therefore, symptomatic patients warrant surgical repair, and immediate intervention should be provided to those with acute-onset symptoms and clinical signs of bowel obstruction. Primary suture repair, with or without biological mesh, appears to be a durable method of repair.

Congenital trans-mesentric internal hernia: a rare cause of acute intestinal obstruction in adult

Introduction and Importance: Internal hernia is responsible for 0.6–5.8% of all small intestinal obstructions. Only 8% of internal hernias are of the congenital trans mesenteric variant. Urgent surgical intervention should be considered in individuals who exhibit intestinal obstruction before the development of irreversible bowel ischemia and necrosis. Case Presentation: The authors report a 38-year-old male patient who presented to the emergency department with abdominal pain, distension, and vomiting for the last three days. After an explorative laparotomy, it was confirmed that there was a trans mesenteric hernia defect with strangulated distal ileal loops. End-to-end ileo-ileal anastomosis was done. Clinical Discussion: Early recognition and subsequent surgical treatment permit proper management and prevent complications. There should be a differential diagnosis. In this case, there is no prior history of abdominal surgery, and the patient presents with recurrent abdominal pain and intestinal obstruction. Conclusion: Early diagnosis and emergency laparotomy can save the intestine before gangrene, lowering morbidity and mortality, correcting the mesenteric defect to prevent recurrences, and enhancing clinical outcomes because many studies have shown that some cases are missed before radiological investigation. Laparotomy is still the method of choice for acute cases of incarceration with bowel obstruction, strangulation, and ischemia. The entire mesentery needs to be evaluated, and all mesenteric defects need to be sutured to prevent recurrence.

Ogilvie syndrome with caecal perforation following cesarean section: a rare case report from Jordan

Introduction: Ogilvie syndrome is a rare condition characterized by acute colonic dilation. In 1948, H. Ogilvie first described it in medical literature. Its incidence is estimated at 100 cases per 100 000 per year in the US. Both abdominal distention and pain are considered major symptoms. Presentation of case: A 32-year-old woman, 36+1 weeks pregnant, experienced labour pain and was admitted to the hospital. Upon examination, she was in labour, but the foetus was in a breech position, necessitating a caesarean section. After 36 h later, she returned to the emergency department with severe, 1-day-old diffuse abdominal pain, accompanied by moderate bilious vomiting and significant abdominal distension. Abdominal CT with contrast revealed pneumoperitoneum, abdominal wall emphysema, and pneumatosis intestinalis involving the caecum and ascending colon, suggesting bowel necrosis. Emergency laparotomy revealed a caecal perforation, which was closed surgically without resection. Clinical discussion: Ogilvie syndrome is more common in males but can occur in females for several reasons, including pregnancy, caesarean section, pelvic surgeries, and trauma. Several factors contribute to the occurrence of this syndrome, such as pelvic fractures and cardiac events. Surgery may be required if there is suspicion of bowel perforation or ischaemia. Conclusion: OS is a rare condition in women, often seen after childbirth or pelvic surgery, with an unclear cause but believed to be related to autonomic nervous system imbalance. Patients with abdominal pain and distension, without evidence of obstruction, should be evaluated for pseudo-obstruction using abdominal pelvic CT, and treatment may involve conservative measures, medication, and colonoscopic decompression.

Patent vitello-intestinal duct with a rare presentation of reverse intussusception with appendicular agenesis: A case report

Background: Vitello-intestinal duct (VID) is found in approximately 2% of newborns, with patency in about 6%. Failure of obliteration leads to some anomalies, most commonly Meckel’s diverticulum. Protrusion of the small bowel is one of the rare presentations. Case Presentation: A 10-month-old male infant presented with a prolapsed, irreducible polypoid-shaped loop of intestine protruding from the anterior abdomen. On exploratory laparotomy, patent VID was confirmed with appendicular agenesis and reverse intussusception. Gangrenous bowel was resected, followed by end-to-end ileo-ileal anastomosis, with a favorable outcome. Conclusion: Patent VID with ileal intussusception and prolapse is a rare entity, which can be easily diagnosed clinically. A high index of suspicion is needed for any associated gut anomaly in these cases, like appendicular agenesis.

EP112 - An Unusual Case of Seed Bezoars Intestinal Perforation

Abstract Introduction Seed bezoars are a distinct subgroup of phytobezoars, caused by the accumulation of indigestible vegetable or fruit seeds in the intestinal lumen. Intestinal obstruction due to plant seeds is seldom encountered because of their relatively smaller size, and intestinal perforation is even rarer. Case Report We report a case of a 64-year-old hypertensive, diabetic and cardiac patient who came to surgical emergency department with generalized abdominal pain and vomiting for 3 days. She was tachycardiac, tachypneic and hypotensive at the initial presentation. Abdominal examination revealed tense, rigid abdomen with absent bowel sounds. Bilateral air under diaphragm was seen on an erect abdominal radiograph. Laboratory workup showed leukocytosis and metabolic acidosis. Laparotomy was performed after resuscitating the patient. Operative findings revealed gross contamination and gangrenous small bowel starting from about 8 feet distal to DJ flexure till 15 cm proximal to ICJ. There was a 2 x 2 cm perforation about 8.5 feet distal to DJ flexure secondary to obstructed seed bezoar (1 each of apricot, peach, and mango pickle seeds and 4 java plum seeds). Gangrenous small bowel was resected, and loop ileostomy was fashioned. She underwent cardioversion for ventricular tachyarrhythmias during the surgery. Post-operatively, she remained on ventilatory support in ITU but could not survive due to cardiac arrhythmias. Conclusion Although intestinal obstruction and perforation occur rarely due to phytobezoars, this should always be considered in the differential diagnosis, and early therapeutic intervention should be considered in morbid patients.

D-Lactate as Predictive Tool for Assessing Bowel Gangrene in Patients Admitted with Acute Intestinal Obstruction in Surgical Wards of Government Medical College Thiruvananthapuram

D-Lactate as Predictive Tool for Assessing Bowel Gangrene in Patients Admitted with Acute Intestinal Obstruction in Surgical Wards of Government Medical College Thiruvananthapuram

Refining Diagnostic Accuracy for Bowel Necrosis in Closed-Loop Small Bowel Obstruction.

Refining Diagnostic Accuracy for Bowel Necrosis in Closed-Loop Small Bowel Obstruction.

Establishment of a postoperative bowel adhesion model in Rats

Postoperative adhesive bowel obstruction is a frequent cause of hospital admission in a surgical department. Emergency surgery is needed in a majority of patients with bowel ischemia or peritonitis; most adhesive bowel obstruction can be managed non-operatively. Many studies have investigated benefits of using oral water-soluble contrast to manage adhesive bowel obstruction. Treatment recommendations are still controversial. Intestinal adhesions commonly occur in patients after abdominal surgery, often between intestines, between intestines and the abdominal wall, or within the peritoneum. Adhesions can lead to symptoms such as abdominal pain, constipation, and bloating, and may result in serious complications such as intestinal obstruction, bowel necrosis, acute peritonitis, and sepsis, which can be life-threatening. Therefore, reducing the occurrence of intestinal adhesions is crucial for abdominal surgery. To minimize adhesions, endoscopic techniques can be employed to reduce the abdominal opening area and thus decrease the probability of adhesion formation. However, this approach requires specialized equipment and surgical skills, making it somewhat challenging. Alternatively, anti-adhesion products can be used to lower the risk of adhesion formation. In this study, a murine cecal abrasion adhesion model was established and will be simulated common adhesion scenarios observed in patients after abdominal surgery. The efficacy of anti-adhesion gel materials will be then evaluated to assess their anti-adhesion properties. The record of gross adhesion severity assessment was performed. The adhesion status between the cecum and abdominal wall was observed on postoperative days 3 and 14. The results was shown that three days post-surgery operation, the group exhibited more severe adhesions upon gross examination. By day 14 post-surgery operation (at animal sacrifice), the histopathological analysis revealed that the group exhibited thicker fibrous tissue thickness, increased neovascularization, and higher collagen accumulation in the peritoneum. Therefore, based on the results of this experiment, a postoperative bowel adhesion rat is reliable and can be safely used to test the efficacy of novel anti-adhesive formulations to prevent intra-abdominal adhesions by using this model.

A Prospective Study on Lactate Dehydrogenase Levels in Acute Intestinal Obstruction as a Marker of Bowel Gangrene.

Background Intestinal obstruction continues to be one of the most common causes of emergencies presenting to the surgical department. A thorough clinical examination along with relevant investigations continue to be best modality for timely management and prompt decision-making in such cases. Objectives The aim of this study was to identify patients of intestinal obstruction with elevated levels of serum lactate dehydrogenase (LDH) and correlate elevated LDH levels with bowel viability. Materials and methods The study comprised 46 cases of intestinal obstruction and their serum LDH values measured prior to surgical intervention/first day of admission. The intra-operative bowel viability was noted and compared with LDH values obtained, and their correlation was studied along with other variables of the patient. Results In our study, it was found that a serum LDH level of >800 IU/L signified an abnormal bowel with increased risk of bowel gangrene, as indicated by a sensitivity of 75% and a specificity of 94%. Gangrenous bowel was found to be more associated with causes such as superior mesenteric artery/vein thrombosis, volvulus, and habits such as alcoholism and tobacco consumption. Elevated LDH levels, however, do not correlate with the length of the affected gangrenous bowel, with the duration of presentation of symptoms, or as a predictor of mortality. Conclusion Serum LDH can be used as a good predictor of gangrenous bowel in cases of intestinal obstruction.

Neonatal intestinal obstruction secondary to Meckel's diverticulum with associated band and ileal stricture: A case report

Background: Symptomatic Meckel’s diverticulum is exceptionally rare in neonates, often presenting as intestinal obstruction or perforation. The differential diagnosis may encompass more prevalent conditions like intestinal atresia, malrotation, or Hirschsprung's disease. Case Presentation: We present a case of a 21-day-old female who presented with intestinal obstruction. Exploratory laparotomy revealed Meckel's diverticulum with a mesodiverticular band causing closed-loop obstruction along with three passable strictures in the ileum. Surgical resection of the affected bowel and the creation of an ileostomy were performed due to bowel ischemia and hemodynamic instability. Conclusion: Early diagnosis and prompt surgical intervention are pivotal in managing neonatal Meckel's diverticulum, reducing risks of bowel necrosis and complications.

Management of Ileosigmoid Knotting: A Literature Review

Ileosigmoid knotting (ISK) is a rare double-segment intestinal obstruction form. Urgent surgery is the unique solution in the management of ISK. In surgical treatment, detorsion alone is generally used in patients with viable bowel, while cases with gangrenous bowel require resection. ISK recurrence is uncommon. However, due to the recurrence risk of sigmoid volvulus, the role of recurrence-reducing procedures is unclear. In this review, urgent treatment of ISK as well as the techniques and patient selection criteria of recurrence-reducing management are discussed.

Biomarkers In Prediction of Acute Mesenteric Ischaemia: a prospective multicentre study (BIPAMI study): a study protocol

BackgroundAcute mesenteric ischaemia (AMI) is a life-threatening disease where early diagnosis is critical to avoid morbidity and mortality from extensive irreversible bowel necrosis. Appropriate prediction of presence of bowel necrosis is currently not available but would help to choose the optimal method of treatment.The study aims to identify combinations of biomarkers that can reliably identify AMI and distinguish between potentially reversible and irreversible bowel ischaemia.MethodsThis is a prospective multicentre study. Adult patients with clinical suspicion of AMI (n = 250) will be included. Blood will be sampled on admission, at and after interventions, or during the first 48 h of suspicion of AMI if no intervention undertaken. Samples will be collected and the following serum or plasma biomarkers measured at Tartu University Hospital laboratory: intestinal fatty acid-binding protein (I-FABP), alpha-glutathione S-transferase (Alpha- GST), interleukin 6 (IL-6), procalcitonin (PCT), ischaemia-modified albumin (IMA), D-lactate, D-dimer, signal peptide-CUB-EGF domain-containing protein 1 (SCUBE-1) and lipopolysaccharide-binding protein (LBP). Additionally, more common laboratory markers will be measured in routine clinical practice at study sites.Diagnosis of AMI will be confirmed by computed tomography angiography, surgery, endoscopy or autopsy.Student’s t or Wilcoxon rank tests will be used for comparisons between transmural vs. suspected (but not confirmed) AMI (comparison A), confirmed AMI of any stage vs suspected AMI (comparison B) and non-transmural AMI vs transmural AMI (comparison C). Optimal cut-off values for each comparison will be identified based on the AUROC analysis and likelihood ratios calculated. Positive likelihood ratio > 10 (> 5) and negative likelihood ratio < 0.1 (< 0.2) indicate high (moderate) diagnostic accuracy, respectively. All biomarkers with at least moderate accuracy will be entered as binary covariates (using the best cutoffs) into the multivariable stepwise regression analysis to identify the best combination of biomarkers for all comparisons separately. The best models for each comparison will be used to construct a practical score to distinguish between no AMI, non-transmural AMI and transmural AMI.DiscussionAs a result of this study, we aim to propose a score including set of biomarkers that can be used for diagnosis and decision-making in patients with suspected AMI.Trial registrationNCT06212921 (Registration Date 19–01-2024).