Gut Obstruction Research Articles

Metastatic colon adenocarcinoma in pregnancy

Colon cancer in pregnancy is rare. Symptoms are nonspecific; hence, patients are often diagnosed at an advanced stage with poor prognosis. We present a 40-year-old multigravid who had recurrent severe abdominal pain. She underwent surgeries at 9 and 21 weeks age of gestation with an initial assessment of ovarian malignancy. Further workup showed metastatic adenocarcinoma to the pelvis with colonic primary. Chemotherapy was subsequently deferred due to COVID-19 infection. She eventually developed partial gut obstruction and underwent bowel diversion with intraoperative fetal monitoring at 31 weeks age of gestation. Although the fetus developed growth restriction, the pregnancy was successfully carried to term with a good outcome. Palliative chemotherapy was started postpartum and she completed eight cycles. Unfortunately, she succumbed to death after 1 year due to pulmonary metastases. Despite challenges in diagnosis and management, this case shows that it is possible to have a good outcome in a pregnancy complicated by advanced-stage colon cancer.

Abdominal cocoon syndrome (ACS): a case report of a Chinese male diagnosed idiopathic ACS with inborn short intestine

Introduction and importance: Abdominal cocoon syndrome (ACS), as a rare cause of mechanical intestinal obstruction, can be divided into primary/idiopathic vs. secondary type. The primary ACS is often asymptomatic and only diagnosed in exploratory laparotomy. The major treatment of surgery can be challenging. Since the gut wall and peritoneum are densely adhered, gut perforation might occur during adhesiolysis. Thus, it is important to have an experienced surgeon to perform the surgery. Case presentation: The authors present a primary ACS case of a 50-year-old man. The patient demonstrated an unbearable upper abdominal pain upon admission. A computed tomography (CT) scan showed a severe bowel obstruction. An exploratory laparotomy was indicated, leading to the diagnosis of ACS, which was considered idiopathic after ruling out secondary factors. An adhesiolysis was performed successfully. Note that the entire intestine measured was only 2.1 m during the surgery. There was no post-surgical complication. The patient was recovered uneventfully. Clinical discussion: The aetiology of primary ACS is unknown. The incidence is comparatively low and considered equal between men and women. As a rare cause of gut obstruction, the suspicion of the diagnosis should be strengthened. Surgery including adhesiolysis and bowel resection remains the major treatment. If adhesiolysis fails, bowel resection will be inevitable. The knowledge and experience of surgeon will be tested. Conclusion: The aetiology of primary ACS should be further explored. And the differential diagnosis of bowel obstruction should cover ACS in order for the surgeon to be prepared before surgery.

Spectrum of Clinical Presentations and Surgical Management of Tuberculous Small Intestinal Obstruction

Background: The causes of acute Intestinal Obstruction vary demographically. In the developing world, tuberculosis account for more than half of all cases of small bowel obstruction. Tuberculosis is a major health burden in developing countries. It can result some medical as well as surgical emergencies. Among the surgical emergencies, small gut obstruction is the burning issue. It can show wide spectrum of presentations. Objective: To find out spectrum of clinical presentations and surgical management of tuberculous small intestinal obstruction. Methods: It was a cross- sectional study conducted in the Department of Surgery, Sher-E-Bangla Medical College Hospital from July 2015 to December 2015. A total of 100 patients were selected by purposive sampling methods. The detail history and clinical examination findings were recorded including patient’s demographic profile and clinical as well as investigation findings. Preoperative findings and post-operative complications were also observed and recorded. Results: According to the result analysis, maximum patients were young adult and the highest patients (54%) came from 21-30 year’s age group followed by 31-40 year’s age group (18%). Among the respondents, 62% were male and 38% were female patients. The male to female ratio was 1.63:1. The results of clinical presentations revealed that all (100%) patients presented with abdominal pain followed by abdominal distension (78%) as small gut obstruction was mostly prevalent. Besides, constitutional features like weight loss and low grade and evening rise of temperature were present in almost all tuberculous patients. Operative findings revealed that single/multiple small bowel stricture in 80% patients followed by bands and adhesion in 14% patients. Strictures as well as perforation were present in case of 11% patients. Maximum operative procedures performed right hemicolectomy with ileo- transverse anastomosis (58%) followed by segmental bowel resection with end ........

The Microplastics Iceberg: Filling Gaps in Our Understanding.

Plastic is an indispensable material in modern society; however, high production rates combined with inadequate waste management and disposal have resulted in enormous stress on ecosystems. In addition, plastics can become smaller particles known as microplastics (MPs) due to physical, chemical, and biological drivers. MP pollution has become a significant environmental problem affecting terrestrial and aquatic ecosystems worldwide. Although the topic is not entirely new, it is of great importance to the field of polymers, drawing attention to specific gaps in the existing literature, identifying future areas of research, and improving the understanding of MP pollution and its environmental impacts. Despite progress in this field, problems remain. The lack of standardized methods for MP sampling, separation, extraction, and detection makes it difficult to collect information and establish links between studies. In addition, the distribution and pathways of MPs in ecosystems remain unknown because of their heterogeneous nature and the complex matrices in which they occur. Second, toxicological tests showed that MPs can be ingested by a wide range of organisms, such as Danio rerio and Eisenia fetida, resulting in gut obstruction, physical damage, histological changes, and oxidative stress. The uptake of MP and their toxicological effects depend on their shape, size, concentration, and polymer composition. Furthermore, MPs can enter the food chain, raising concerns regarding potential contaminations for human and environmental health. This review paper sheds light on the pressing issue of MP pollution and highlights the need for interdisciplinary collaboration between scientists, policymakers, and industry leaders.

Tumor rupture and partial gut obstruction: Atypical presentations in a patient with adenomyosis

A 49-year-old woman, Gravida 8 Para 8 (8007), came in due to vomiting and enlarging abdominal mass. Initial diagnosis was partial gut obstruction and acute kidney injury probably secondary to adenomyosis versus colonic pathology. Ultrasound showed adenomyosis but computed tomography scan showed a uterine mass with possible tumor rupture and mass effects. Emergency hysterectomy was done and showed an ill-defined endometrial mass with multiple areas of rupture. It was diagnosed with malignant but final histopathology revealed extensive adenomyosis with acute inflammation and necrosis with no malignancy identified. Unusual symptoms such as uterine rupture and mass effects can accompany adenomyosis, alongside typical signs like pain and bleeding. Ultrasound aided the diagnosis, although it missed uterine rupture, highlighting its limitations. Magnetic resonance imaging could have been useful. Ultimately, histopathology is the gold standard for diagnosing adenomyosis.

Malrotation in the Adult, a Forgotten Etiology of Partial Gut Obstruction: A Report of Two Cases

Ninety percent of cases of malrotation have shown signs and symptoms of intestinal obstruction by the first year of life. It is thus an often-overlooked etiology in adult patients. Evidence-based recommendations are also limited because of the paucity of cases. This paper discusses the two cases of malrotation from diagnosis to surgical management at a tertiary academic hospital. Both are previously well adult male patients with virgin abdomen who presented with vomiting and signs of intestinal obstruction. During medical decompression, CT scan with triple contrast clinched the diagnosis of malrotation for which Ladd’s procedure was done, with no operative complications. The authors’ experience and previous literature support early decompression, imaging, and surgery for all cases of malrotation regardless of severity of symptoms. Key words: intestinal malrotation, bowel obstruction, Ladd’s procedure

Lacticaseibacillus rhamnosus dfa1 Attenuate Cecal Ligation-Induced Systemic Inflammation through the Interference in Gut Dysbiosis, Leaky Gut, and Enterocytic Cell Energy.

Despite an uncommon condition, the clinical management of phlegmon appendicitis (retention of the intra-abdominal appendiceal abscess) is still controversial, and probiotics might be partly helpful. Then, the retained ligated cecal appendage (without gut obstruction) with or without oral Lacticaseibacillus rhamnosus dfa1 (started at 4 days prior to the surgery) was used as a representative model. At 5 days post-surgery, the cecal-ligated mice demonstrated weight loss, soft stool, gut barrier defect (leaky gut using FITC-dextran assay), fecal dysbiosis (increased Proteobacteria with reduced bacterial diversity), bacteremia, elevated serum cytokines, and spleen apoptosis without kidney and liver damage. Interestingly, the probiotics attenuated disease severity as indicated by stool consistency index, FITC-dextran assay, serum cytokines, spleen apoptosis, fecal microbiota analysis (reduced Proteobacteria), and mortality. Additionally, impacts of anti-inflammatory substances from culture media of the probiotics were demonstrated by attenuation of starvation injury in the Caco-2 enterocyte cell line as indicated by transepithelial electrical resistance (TEER), inflammatory markers (supernatant IL-8 with gene expression of TLR4 and NF-κB), cell energy status (extracellular flux analysis), and the reactive oxygen species (malondialdehyde). In conclusion, gut dysbiosis and leaky-gut-induced systemic inflammation might be helpful clinical parameters for patients with phlegmon appendicitis. Additionally, the leaky gut might be attenuated by some beneficial molecules from probiotics.

Colostomy Delays Cell Loss in the Brain and Improves Juvenile Survival in a Neonatal Rat Model of Hirschsprung’s Disease

Hirschsprung’s disease is a congenital malformation characterized by the absence of enteric ganglia in the distal intestine and gut obstruction. Our previous study indicates the brain pathology during the disease progression. A subpopulation of Hirschsprung’s disease patients is also associated with anomalies of the central nervous system. In the investigation, we studied a rat model of Hirschsprung’s disease, known as spotting lethal (sl/sl) ETB-/- rats, which carries a spontaneous deletion in endothelin receptor B (human gene name: EDNRB) and manifests a similar phenotype as humans with Hirschsprung’s disease. Homozygous mutant sl/sl rats were successfully rescued from premature death by performing colostomy and dramatically survived to their juvenile age. By the body weight measured, their body growth was not revealed to be significantly different between ETB-/- and wildtype ETB+/+ or heterozygous (+/sl) ETB+/- groups while all underwent the same colostomy. Cell loss was investigated in several brain regions by using terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling assay (TUNEL) in ETB+/+, ETB-/-, and ETB+/- rats. Number of TUNEL-positive cells in the cerebellum and the hippocampus of ETB-/- rats was significantly increased compared with that of the ETB+/+ and ETB+/- rats. TUNEL-positive cells were observed in the molecular layer and granular cell layers of the cerebellum. In contrast, no significant difference in the density of TUNEL-positive cells was revealed in the cerebral cortex. These results suggest that either endothelin receptor B sl mutation or colostomy has predominant lasting effects on the cell survival/loss in the cerebellum and hippocampus of adult ETB-/- rats. Our findings provide the information on cellular changes in the brains of patients with Hirschsprung’s disease due to congenital EDNRB mutation as well as clinically relevant interventions.

Sigmoid Volvulus; Frequency of Postoperative Complications of Primary Repair

Many regions of the world, including Pakistan, are affected by sigmoid volvulus, which is the most prevalent cause of major gut obstruction. The ingestion of high-fibre bulky foods, which seem to overburden the sigmoid colon, are two of the most common causes of sigmoid volvulus, along with irregular bowl habits. The most common clinical manifestations are abdominal discomfort, distension, constipation, nausea, and vomiting. The surgery of preference is resection and primary anastomosis since it avoids the need for a colostomy and the following reversal. Objectives: The goal of this study was to investigate the prevalence of postoperative complications after primary surgery in individuals with viable or gangrenous sigmoid volvulus. Place and Duration: This descriptive research was done in the surgical department of Sheikh Khalifa Bin Zaid Hospital (PGMI), Quetta and Fauji Foundation Hospital Rawalpindi for the duration of six months from January 2021 to June 2021. Methodology: The researchers looked at patients who had a large gut obstruction and were suspected of having sigmoid volvulus based on clinical and radiographic evidence. In these individuals, laparotomy and sigmoid colon resection were done, followed by single-layer primary anastomosis to restore colon continuity. A total of 90 individuals were included in the research after informed consent. Results: This research covered a total of 90 patients. With a male to female ratio of 2.5:1, there were 63 (70%) men and 27 (30%) females. Patients varied in age from 35 to 70 years old. The mean age of the patients was 50 + 1.30 years. The majority of the patients were between the ages of 41 and 45. All 90 patients (100%) had stomach discomfort, which was predominantly on the left side, followed by constipation in 84 (93.3 percent) and abdominal distension in 81 (90 percent). In 12 (13.3 percent) of the patients, vomiting was present, and in 3 (3.3 percent) of the patients, bleeding per rectum (due to related haemorrhoids) was evident. In 23 (25.6%) of the cases, various post-operative problems developed. Wound infection was found in 12 (13.3%) of the cases, with 9 men and three females being admitted to the hospital for antibiotics and daily dressings until the wounds healed. All of the wounds healed well. Pelvic abscess occurred in 4 (4.4%) of the patients. Three patients (3.3%) developed an enterocutaneous fistula, which was managed conservatively until the fistula healed. Only one patient (one percent) had ileus Conclusion: When the gut is viable or gangrenous, resection with primary anastomosis is the best treatment option for sigmoid volvulus. Keywords: Sigmoid-Diseases-Surgery, Anastomosis, Surgical methods, Colonic-diseases aetiology, Colonic-surgery

Role of Probiotic for Prevention and Management of COVID-19: A Literature Review

Backgrounds: Coronavirus brought about by SARS-CoV-2 is a continuous worldwide pandemic. SARS-CoV-2 influences the human respiratory tracts’ epithelial cells, prompting a proinflammatory cytokine storm and ongoing lung inflammation. With various patients kicking the bucket day by day, an immunization and explicit antiviral medication regimens are being investigated. The choice to utilize this medication during the COVID-19 pandemic should be founded on cautious thought of the likely as preventive and curative in such context. Methods: A literature review changed into carried out through the PubMed, Science Direct, Medline, and Google Scholar search engines consist of probiotics preventive and management possibility in COVID-19. Results: The probiotics significantly affects the host insusceptible reaction, foundationally, and on invulnerable responses at close by mucosal locales, like the lung. Certain strains of probiotics have improved interferon type I levels, hoisting the number and capacity of antigen-introducing cells, regular executioner cells, and T cells, just as expanding the degree of specific antibodies at the fundamental and mucosal destinations. Conclusion: Probiotics have various advantages and potential in preventing and as the treatment of COVID-19, adjusting the arrangement of human gut microflora, reinforcing gut obstruction work, and defensive invulnerable reactions.

OP08.06: Tumour rupture and partial gut obstruction: atypical presentations in a patient with adenomyosis

OP08.06: Tumour rupture and partial gut obstruction: atypical presentations in a patient with adenomyosis

META-ANALYSIS ON ETIOPATHOGENESIS OF SMALL BOWEL OBSTRUCTION IN THE DEPARTMENT OF GEN. SURGERY P.M.C.H. & K.M.C.H., BIHAR

Background:The small intestine is the longest and convoluted portion in the digestive tract. It starts from pylorus and ends at ileocaecal valve. The small bowel consists of three parts measuring about 5 to 6 meters. The rst 25cm is the duodenum. Out of the rest part of small gut, jejunum th th. constitute the proximal 2/5 and ileum distal 3/5 The jejunum and ileum extend from the peritoneal fold that supports the duodeno-jejunal junction (Ligament of Treitz) down to ileocaecal valve. Material and Methods:All the patients admitted to PMCH, Patna and KMC, Katihar as intestinal obstruction was included for the study. The time period of study was from October 2014 to November 2016 in PMCH and December 2016 to January 2019 in KMC, Katihar. Out of all Intestinal obstruction 59 cases only of adult small gut obstruction were recorded for comparison and conclusive study.Conclusion: Small bowel obstruction remains a frequently encountered problem in abdominal surgery. Although modern day surgical management continues to focus appropriately on avoiding delayed operation, whatever surgery is indicated, not every patient is always best served by immediate operation

Acute Small Gut Obstruction as an Atypical Presentation of Acute Appendicitis without Rupture or Perforation of the Appendix

Acute appendicitis is a very common surgical emergency. It has got diverse presentations and various complications. Here, we report case history of a young male patient with a 2- year history of recurrent abdominal pain, who presented to our center with a 4-day history of increasing abdominal pain, constipation and vomiting. Clinical and radiological evaluation revealed it as a case of acute intestinal obstruction preoperatively. Per-operative findings suggested acute appendicitis without perforation, small gut obstruction by adhesions, appendicular lump or internal herniation. Appendicectomy was done along with other necessary procedures. His post-operative period was uneventful. This case is reported here to highlight that acute appendicitis may present with atypical features like acute small gut obstruction. J Bangladesh Coll Phys Surg 2021; 39: 261-265

Recurrent Small Gut Fecalomas Causing Obstruction- A Case Report

Fecaloma is a mass of hardened faeces difficult to pass through the intestinal lumen. Due to various reasons, a bolus of fecal matter stagnates, accumulates and inspisates in the intestinal lumen, until it becomes big enough to cause intestinal obstruction. Though there are various predisposing factors for the formation of fecaloma but the actual cause of fecaloma formation is still unknown. Small gut fecalomas are very rare. Herein we are presenting a case of 50 year male who underwent laparotomy three times for small gut obstruction caused due to recurrent formation of small gut fecaloma. To our knowledge it is the first case report of recurrent small gut fecaloma obstruction to be reported.

Oxidative damage and decreased aerobic energy production due to ingestion of polyethylene microplastics by Chironomus riparius (Diptera) larvae

Riverine sediments are major sinks of microplastics from inland anthropogenic activities, imposing a threat to freshwater benthic invertebrates. This study investigated the ingestion of three size-classes (SC) of irregularly shaped polyethylene microplastics (PE-MPs; SC I: 32−63 μm; II: 63−250 μm; III: 125−500 μm) after 48 h by dipteran larvae (detritivore/collector) Chironomus riparius, and the consequent effects on neurotransmission, energy allocation and oxidative stress. The tested PE-MPs concentrations (1.25; 5; 20 g kg−1) were within the range of concentrations reported in riverbanks from highly urbanised areas (1 - 9 g kg−1), except for 20 g kg−1 representing the worst-case scenario. After exposure to SC I, larvae presented high amounts (up to ∼2400 particles/organism) of PE-MPs in their guts, with an average size-range of 30−60 μm. In the SC II and III, larvae presented PE-MPs of higher diameter (up to 125 μm) and a visible gut obstruction. The high number of particles in the larval gut (SC I) and/or difficulties for their egestion (SC I, II and III) induced oxidative damage and reduced aerobic energy production. In addition, larvae exposed to SC II and III revealed depletion in their total lipid reserves as a consequence of lacking nutrients, and the ones exposed to SC III presented a decrease in their detoxification capacity.These results highlight that freshwater detritivores with low selective feeding behaviour (e.g., chironomids) are more prone to ingest microplastics, with potentially adverse effects on cellular metabolism, redox status and antioxidant-detoxification defences. These harmful effects at lower levels of the biological organisation may ultimately affect organisms’ physiology and fitness.

Acute Large Bowel Obstruction Following Late Sequelae of Traumatic Diaphragmatic Hernia

A 33 years old patient was admitted in a Military Hospital with the features of acute large gut obstruction. Exploratory laparotomy was done and peroperatively the obstruction was seen in the transverse colon and obstruction seemed to be carcinoma of transverse colon with involvement of left hemidiaphragm which was not negotiable. Transverse loop colostomy with decompression of bowel was done. Subsequently the patient was transferred to tertiary level hospital in Dhaka. In the tertiary hospital, the patient developed left sided massive pleural effusion. With relevant investigation the condition was diagnosed as left sided diaphragmatic hernia. Thoracotomy was done and herniorrhophy was performed after reduction of the content. Post-operative management was stormy and eventful but the condition improved gradually and the patient was discharged in proper time. The patient had history of chest trauma due to RTA he met 4 years back and he received hospital indoor management for 3½ months. The patient was asymptomatic and leading normal active military life before 2nd time admission for acute intestinal obstruction. The patient had past history of trauma to left chest wall 4 years back, presented with acute large gut obstruction and there was diagnostic dilemma. There were management difficulties and post operative events were stormy. The aim of this reporting is to highlight all of these.
 Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 119-120

Treatment Outcome of Patients with Large Gut Obstruction

Treatment Outcome of Patients with Large Gut Obstruction

Jejunal atresia in the newborn: three cases after resection and end-to-end anastomoses

Background:Â Intestinal atresia is a common cause of neonatal intestinal obstruction. Jejunal atresia occurs more frequent than duodenal or colonic atresias while single atresias are most commonly encountered. Jejunal atresia is classified into 4 types: Type I (a mucosal/septal), Type II (a fibrous cord/band), Type III (blind ends are entirely separated without a fibrous cord between them and a large mesenteric defect), and Type IV (combination of atresia type I to III). This study aims to elaborate jejunal atresia in the newborn after resection and end-to-end anastomoses.Case Description:Â We report three cases of jejunal atresia consists of different types: type IV (first case), type IIIa (second case) and type I (third case). Cases were neonates born with signs of upper gut obstruction. Bile-stained vomiting was reported a few hours after birth and failed to pass meconium in the first 24 hours. Postnatal abdominal X-ray showed dilatation of the gaster and no gas present in the pelvic floor. In the third case, it showed a triple bubble sign on abdominal x-ray and a laparotomy revealed the type of jejuno-ileal atresia. Also, the resection on the atresias and end to end anastomosis were performed. Cases were admitted to neonatal intensive care unit with total parenteral nutrition. The first two cases died due to sepsis, while the third case survived.Conclusion:Â Jejunal atresia is a rare disease among newborn. All of the patients have provided resection and end-to-end anastomoses, although 2 of them did not survive.Â

Effects of ginger adjunct to the standard prophylaxis on reducing carboplatin and paclitaxel-induced nausea vomiting: a randomized controlled study.

To determine effects of ginger on reducing the severity of nausea and/or vomiting among gynecologic cancer patients receiving a combined carboplatin-paclitaxel regimen. The research was a randomized, double-blinded, crossover, placebo-controlled trial. Participants were patients with gynecologic malignancies receiving carboplatin-paclitaxel chemotherapy at King Chulalongkorn Memorial Hospital. Either ginger (2 g per day) or placebo was prescribed in adjunct to standard antiemetic prophylaxis, in alternated cycles between groups: in group 1, ginger was prescribed in odd cycles and placebo in even cycles and vice versa in group 2. Patients with gut obstruction or brain or bowel metastasis, those using anticoagulants or other ginger or antiemetic medications, or patients who had ginger allergy were excluded from the study. Statistics were analyzed by STATA version 15.1. Overall, 47 participants were recruited. Mean age was 53.9 years. Seventeen subjects were chemotherapy-naïve. In an acute phase of nausea, ginger therapy significantly reduced the mean nausea score comparing to placebo (P = 0.03). However, in the delayed phase, there were no significant differences between groups. For the acute and delayed phase of vomiting, there was no difference between the groups. No serious adverse effects were demonstrated in the ginger group (P > 0.05). Adjunct ginger therapy on standard nausea and vomiting prophylaxis protocol especially in day 1 has benefit in reducing an acute phase nausea in patients receiving a combined carboplatin-paclitaxel regimen. The benefit on delayed phase nausea and vomiting is still equivocal.

Presentation of Gall Stone Ileus as Gut Obstruction

Gallstone ileus is an uncommon and often life-threatening complication of cholelithiasis. In this case report, we discuss a difficult diagnostic case of gallstone ileus presenting as small gut obstruction with ischemia. A 56-year-old female presented with abdominal pain and vomiting. A CT scan was performed and showed an evolving bowel obstruction with features of gut ischemia with pneumobilia although no frank hyper density suggestive of a gallstone was noted. The patient underwent emergency surgery and a 60 mm obstructing calculus was removed from the patient's jejunum, with a formal tube cholecystostomy. JMS 2018: 21 (2):117-119