High Intestinal Obstruction Research Articles

Superior mesenteric artery syndrome managed laparoscopically: a case report

BackgroundSuperior mesenteric artery syndrome is a rare condition that has only around 400 reported cases so far. Typically, the superior mesenteric artery branches off the abdominal aorta at 45° to create an aortomesenteric distance of 10–28 mm, with the duodenum passing through. However, if this aortomesenteric angle reduces to less than 25°, the third portion of the duodenum becomes compressed between the SMA and aorta, causing mechanical obstruction.Case presentationThis case report aims to demonstrate the diagnostic difficulties and the laparoscopic management of a 52-year-old Indian male presenting with abdominal pain and vomiting, with associated weight loss. Imaging was further suggestive of high intestinal obstruction, and he was later found to have superior mesenteric artery syndrome.ConclusionTaking into account a significant reduction in morbidity, we propose laparoscopic duodenojejunostomy to be the new procedure of choice for superior mesenteric artery syndrome.

Ladd’s Syndrome in Newborns

Ladd’s syndrome is a violation of intrauterine intestinal rotation. The midgut remains fixed at one point at the origin of the superior mesenteric artery. As a result, conditions are created for the occurrence of a volvulus around the root of the mesentery and acute strangulation intestinal obstruction develops. Ladd’s syndrome includes three features: a high position of the caecum dome, duodenal hyperfixation, and lack of mesenteric fixation. In newborns, this condition is manifested by acute complete high strangulation intestinal obstruction, up to the development of shock. Examination for suspected Ladd’s syndrome should be comprehensive and include a survey abdominal radiography, abdominal ultrasound, gastric and duodenal radiography with oral contrast, irrigography. The article considers clinical cases of Ladd’s syndrome in newborns at the age of 3 and 5 days of life. Echograms made in B-mode using color Doppler sonography are presented. The high informativeness of ultrasound diagnostics for the detection of this syndrome in newborns with a clinic of bile vomiting is shown. In one of the observed cases, a pathognomonic echographic symptom of midgut volvulus was established (a whirlpool sign). In the second observation, a clearly defined vascular ring was not detected due to 180° torsion, which was subsequently confirmed intraoperatively.

Diagnostics and surgical management of periampullary duodenal duplication cysts in children: a report of cases

BACKGROUND: Obstructive variants of chronic duodenal obstruction may be caused by congenital malformations, such as rare periampullary duodenal duplication cysts. This localization of gastrointestinal duplications is the rarest and is not described in the domestic literature.
 AIM: This study aimed to present the experience of the management of periampullary duodenal duplication cysts in children.
 CASES REPORT: Seven children with periampullary duodenal duplication cysts underwent surgery between 2007 and 2022. All patients suffered from prolonged abdominal pain, vomiting of food, and bile. Two children had recurrent pancreatitis, and one child underwent repeated operations for high intestinal obstruction and biliary obstruction in other hospitals. An abdominal cyst was suspected in one patient at another hospital, and the child underwent exploratory laparoscopy, but no formation was found. Ultrasound, gastroduodenoscopy, computed tomography, and magnetic resonance imaging were performed on these children. Ultrasound examination showed a peristaltic cystic formation up to 4 cm in diameter with a double wall. Gastroduodenoscopy showed formation in the second portion of the duodenum in the region of the major duodenal papilla. This formation covers the intestinal lumen by two-thirds and up to nearly complete obturation. The relationship between duodenal duplication and the bile and pancreatic ducts was clarified on magnetic resonance cholangiopancreatography: the relationship was suspected in two children. All patients underwent wide transduodenal excision of periampullary duodenal duplication cyst; in four cases, laparoscopic access was used. No intra- and postoperative complications occurred. Histological examination revealed true duplications in all cases. The children were discharged on days 1112. In the follow-up after 3 months and 10 years, no complications were noted.
 CONCLUSIONS: Periampullary duodenal duplication cysts can be a cause of chronic duodenal obstruction. Transduodenal excision of periampullary duodenal duplication cysts is the optimal treatment, and this operation can be performed laparoscopically.

Superior Mesenteric Artery Syndrome: A Case Study

Superior mesenteric artery (SMA) syndrome (known as Wilkie's syndrome) is a rare cause of upper gastrointestinal obstruction. It is an acquired disorder in which acute angulation of the SMA causes compression of the third part of the duodenum between the SMA and the aorta. This is commonly due to loss of fatty tissue as a result of a variety of debilitating conditions. We report a 25-year-old male who presented with intermittent abdominal pain and intractable vomiting following significant weight loss, he developed acute high intestinal obstruction, which was diagnosis by a CT scan. This case emphasizes the challenges in the diagnosis of SMA syndrome and the need for increased awareness of this entity. This will improve early recognition in order to reduce irrelevant tests and unnecessary treatments.

Retracted: Artificial Intelligence Algorithm-Based Computed Tomography Images in the Evaluation of the Curative Effect of Enteral Nutrition after Neonatal High Intestinal Obstruction Operation.

[This retracts the article DOI: 10.1155/2021/7096286.].

The Wilkie's Syndrome which Disguised As Anorexia Nervosa: A Case Report

Abstract Wilkie's Syndrome (WS), Superior Mesenteric Artery Syndrome or aortomesenteric clamp is an infrequent cause of high intestinal obstruction that is produced by an angular constriction (< 25º) between the superior mesenteric artery and abdominal aorta, resulting in a compression of the third duodenal portion. Its incidence is estimated around 0.013-0.3% in general population, as it is more common in women between 10-39-years. This pathology produces unspecific gastrointestinal symptoms, turning diagnostic suspicion really important, due to its critical complications. The case of a 15-year old woman is presented, who is admitted in an acute child psychiatric hospitalisation unit because she displays eating disorder symptomatology in the previous months. Initially she is suspected for suffering Anorexia Nervosa (AN) but according to the rapid general deterioration that she suffers the case is profoundly studied and eventually diagnosed as a Wilkie's Syndrome case, based on an exhaustive complementary test battery. This case shows the importance of the diagnostic suspicion of this entity and the relevance of making a proper differential diagnosis in Eating Disorders (ED).

A Case of Retroperitoneal Panniculitis with Paralytic Ileus Mimiking a High Intestinal Obstruction

Retroperitoneal panniculitis is a rare, benign and nonspecific inflammatory disease that affects the retroperitoneal adipose tissue. The specific cause of the disease is unknown. The diagnosis is evoked by computed tomography and is rarely confirmed by biopsies. Treatment is based on a few selected immunosuppressive drugs. Surgical resection is sometimes attempted for complicated forms, although the surgical approach is often limited. We report a case of a 22-year-old man diagnosed with retroperitoneal panniculitis complicated by a paralytic ileus and mimicking an acute abdomen. A self-limiting course of disease was obtained by adopting a conservative approach.

The case of the discovery of two bezoars in a teenager with developmental intestinal obstruction

In the article, the authors provide brief information about a rather rare problem of pediatric gastroenterology — bezoars of the gastrointestinal tract. The data on the classifi cation of these pathological formations are presented, the problems of the pathogenesis of the formation of various types of bezoars are briefl y highlighted. Using the example of a clinical case of the detection of two giant bezoars in a teenage girl with high intestinal obstruction, the problem of the complexity of timely diagnosis of this condition in a patient with trichotillomania and trichophagia is discussed. The conclusion is made about the expediency of a comprehensive interdisciplinary approach to this problem in pediatric practice in order to reduce the risks of subsequent severe surgical interventions.

Artificial Intelligence Algorithm-Based Computed Tomography Images in the Evaluation of the Curative Effect of Enteral Nutrition after Neonatal High Intestinal Obstruction Operation.

In this study, CT image technology based on level set intelligent segmentation algorithm was used to evaluate the postoperative enteral nutrition of neonatal high intestinal obstruction and analyze the clinical treatment effect of high intestinal obstruction, so as to provide a reasonable research basis for the clinical application of neonatal high intestinal obstruction. 60 children with high intestinal obstruction treated in the hospital were selected as the research objects. Based on the postoperative enteral nutrition treatment, they were divided into control group (noncatheterization group)-parenteral nutrition support. In the observation group, gastric tube was placed through nose for nutritional support. Then, CT images based on level set segmentation algorithm were used to compare the intestinal recovery of the two groups, and the biochemical indexes and hospitalization were compared. The level set algorithm can accurately segment the lesions in CT images. The segmentation time of the level set algorithm was shorter than that of the traditional algorithm (24.34 ± 2.01 s vs. 75.21 ± 5.91 s), and the segmentation accuracy was higher than that of the traditional algorithm (84.71 ± 3.91% vs. 70.04 ± 3.71%, P < 0.05). The weight of children in the observation group (100 ± 7 g) was higher than that in the control group (54 ± 5 g), and the ICU monitoring time (12.01 ± 2.65 days) and the hospital stay (17.82 ± 3.11 days) were shorter than those in the control group (13.42 ± 2.95 days, 19.13 ± 3.22 days, all P < 0.05). The level set segmentation algorithm can accurately segment the CT image, so that the disease location and its contour can be displayed more clearly. Moreover, the nasal placement of jejunal nutrition tube can effectively improve the intestinal function of children, maintain the steady-state environment of intestinal bacterial growth, and significantly improve the clinical treatment effect, which is worthy of clinical application and promotion.

Prospective multicenter study on the incidence of surgical site infection after emergency abdominal surgery in China

There is still a lack of relevant studies on surgical site infection (SSI) after emergency abdominal surgery (EAS) in China. This study aims to understand the incidence of SSI after EAS in China and discuss its risk factors. All adult patients who underwent EAS in 47 hospitals in China from May 1 to 31, 2018, and from May 1 to June 7, 2019, were enrolled in this study. The basic information, perioperative data, and microbial culture results of infected incision were prospectively collected. The primary outcome measure was the incidence of SSI after EAS, and the secondary outcome variables were postoperative length of stay, ICU admission rate, ICU length of stay, 30-day postoperative mortality, and hospitalization cost. Univariate and multivariate logistic regression were used to analyze the risk factors. The results were expressed as the odds ratio and 95% confidence interval. A total of 953 patients [age 48.8 (SD: 17.9), male 51.9%] with EAS were included in this study: 71 patients (7.5%) developed SSI after surgery. The main pathogen of SSI was Escherichia coli (culture positive rate 29.6%). Patients with SSI had significantly longer overall hospital (p < 0.001) and ICU stays (p < 0.001), significantly higher ICU admissions (p < 0.001), and medical costs (p < 0.001) than patients without SSI. Multivariate logistic regression analysis showed that male (P = 0.010), high blood glucose level (P < 0.001), colorectal surgery (P < 0.001), intestinal obstruction (P = 0.045) and surgical duration (P = 0.007) were risk factors for SSI, whereas laparoscopic surgery (P < 0.001) was a protective factor. This study found a high incidence of SSI after EAS in China. The occurrence of SSI prolongs the patient's hospital stay and increases the medical burden. The study also revealed predictors of SSI after EAS and provides a basis for the development of norms for the prevention of surgical site infection after emergency abdominal surgery.

Clinical case of intussusception of the jejunum into gastroenteroanastomosis after gastric ­resection

Intussusception is one of the varieties of mixed (strangulation and obturation) mechanical intestinal obstruction. It arises as a result of the introduction of the adducting segment of the intestine into the abducting one. Gastroduodenal intussusception is an extremely rare type of high intestinal obstruction. It most often occurs after surgery on the stomach and much less often in non-operated patients. Intussusception of the jejunum into the stomach can occur soon after surgery, but most often, this complication occurs 515 years after the intervention. This paper describes a case of retrograde intussusception that arose 9 years after the Billroth II gastric resection with Braun anastomosis. This clinical case acquaints specialists with the possibility to encounter this pathology in clinical practice and demonstrates the appropriateness of differential diagnostics in cases with similar clinical symptoms.

Laparoscopic treatment of pyloric atresia in a newborn

Introduction. Pyloric atresia is one of the rarest surgical diseases in newborns. Laparotomy is the most common modality for correcting this abnormality. In modern scientific literature, there is only one report on the endosurgical treatment of pyloric atresia. The case of laparoscopic correction of gastric outlet atresia presented in this study is one more reference to the successful care of this condition.Material and methods. The presented clinical case is a newborn boy in whom a prenatal ultrasound examination at the 31st week of gestation revealed polyhydramnios and an enlarged stomach. The baby’s birth weight was 2660 grams. In the first hours of life, the child showed symptoms of high intestinal obstruction in the form of gastric content vomiting. Postnatal ultrasound and X-ray examination confirmed the diagnosis of pyloric atresia. During laparoscopy, performed on the 2nd day of life, the morphological type of anomaly was examined, and the type I atresia of membranous form was established. A laparoscopic membranectomy with Heineke–Mikulicz pyloroplasty was performed. In the final part of this research, early and late outcomes of the performed surgical treatment were analyzed.Results. The surgery lasted for 70 min. Postoperative period was uneventful. Enteral nutrition started on day 3 after the surgery. A complete enteral diet was possible on day 7. The newborn patient was discharged from the hospital on the 9th postoperative day. Histological examination confirmed the pyloric atresia of membranous type. During 12-month follow-up, no complications associated with the surgical procedure were seen.Conclusion. The described case of laparoscopic treatment of type I pyloric atresia in a newborn expands laparoscopy application in pediatric practice.

SÍNDROME DA ARTÉRIA MESENTÉRICA SUPERIOR SÍNDROME DE WILKIE

Introduction: Superior Mesenteric Artery Syndrome / Wilkie Syndrome is characterized by the compression of the third portion of the duodenum, due to the reduction of the aorta angulation with the superior mesenteric artery. A rare disease, with few cases described in the medical literature. Case 01: A 13-year-old male patient, diagnosed with Diamond-Blackfan Anemia and with acute intestinal occlusion for 2 days with previous recurrent episodes of intestinal occlusion. CT showing gastrectasis and dilation of slender loops up to the third portion of the duodenum. Case 02: 18-year-old female patient, without previous comorbidities, with high intestinal obstruction for 7 days, with CT showing duodenal obstruction and reduction of aorto-mesenteric angulation. Discussion: The most prevalent age group occurs between 18 and 35 years. Associated with mainly weight loss and Cast Syndrome. The diagnosis is given by clinical suspicion followed by imaging tests such as upper gastrointestinal tract radiography and contrast abdominal CT. Treatment may be conservative with weight gain or surgical measures, the duodenojejunoanastomosis is the technique of choice. Diamond-Blackfan anemia despite being related to staturo-ponderal alterations no association was identified in the medical literature with Wilkie Syndrome. Conclusion: Differential diagnosis should be made in young patients with repetitive vomiting. Upper Gastrointestinal Endoscopy may delay the diagnosis.

ГАСТРОЭНТЕРИТИЧЕСКАЯ ФОРМА ОСТРОГО АППЕНДИЦИТА С ОБТУРАЦИЕЙ КАЛОВЫМ КАМНЕМ

Clinical observation of atypical form of acute appendicitis that demanded diff erential diagnosis with gastroenteritis, food toxicoinfection, renal colic and high intestinal obstruction is presented. The limitations of imaging diagnostic methods and the value of the clinical situation comprehensive assessment using clinico-laboratorial indicators of the Alvarado scale are demonstrated.

Manejo del Síndrome de Arteria Mesentérica Superior

El síndrome de arteria mesentérica superior o también llamado síndrome de Wilkie, consiste en un diagnóstico de exclusión, una condición que causa un cuadro de obstrucción intestinal alta de forma crónica usualmente debido a un acortamiento del ángulo aorto mesentérico y la distancia aortomesentérica. Su clínica se basa en vómitos postprandiales, llenura postprandial, pérdida de peso y suele acompañarse de condiciones adicionales que causan un franco adelgazamiento del paciente. Su valoración y manejo es multidisciplinario e involucra múltiples especialidades médicas y quirúrgicas. El manejo inicial es médico y nutricional y se basa en lograr un claro aumento de peso, sin embargo, muchas veces es fallido y el paciente requiere de cirugía. Cuando esto sucede la técnica ideal con menos morbilidad asociada y mayor resolución de sintomatología consiste en la duodeno yeyunostomía laparoscópica.

Wilkie’s syndrome. Analysis of 150 cases of the Iberian and Ibero-American medical literature

Willkie’s syndrome or superior mesenteric artery (SMA) syndrome is a rare cause of gastrointestinal obstruction, due to exterior compression of the horizontal part of the duodenum by the SMA. For the study of the clinical, diagnostic and therapeutic characteristics of Wilkie’s syndrome in the Iberian and Ibero-American population, we compiled the reports of 150 cases by Iberican and Ibero-American authors, and we found a predominance of cases in females over males in a ratio of 2.57: 1. Fifty percent of the cases were in patients under 20-years of age, with the highest number of cases in schoolchildren and adolescents. The most frequent symptoms were abdominal pain, vomiting and weight loss. The disease had two forms of presentation: acute with signs of high intestinal obstruction (16.47%), and chronic (83.53%). Diagnostic radiographic studies showed in of the upper gastrointestinal tract narrowing of the horizontal portion of the duodenum and delay in the transit of contrast through the gastroduodenal region, with or without gastroduodenal dilation in 85% of cases. In computed tomographic studies it was observed decreased mesenteric-aortic angle and distance. Upper endoscopic studies showed narrowing of the horizontal part of the duodenum, with or without gastroduodenal dilation in 61.90% of cases. Of the 144 patients that received treatment, 94 cases received medical treatment, with a success rate of 62.77%; and 84 cases required surgical treatment, 59.52% of these, upon admission. The most practiced surgical procedure was laterolateral duodenojejunostomy in 70.24% of cases. We concluded that Wilkie’s syndrome is an entity that results from the reduction of the mesenteric-aortic angle and distance, with two forms of presentation: acute and chronic, that required surgical treatment in 58.33% of cases.

Superior mesenteric artery syndrome masquerading as chronic gastric volvulus in a child with severe acute malnutrition: a case report

Superior mesenteric artery (SMA) syndrome is a rare cause of high intestinal obstruction. It is commonly seen in severely malnourished patients presenting with repeated episodes of vomiting. We report a case of SMA syndrome in a 3 years old male child provisionally diagnosed as chronic gastric volvulus with severe acute malnutrition. The diagnosis of SMA syndrome was confirmed on abdominal exploration. SMA syndrome is a rare case of intestinal obstruction in paediatric age group. Chronic malnutrition is one of the common causes of this entity. There should be a high index of suspicion for this syndrome when we encounter a child with severe malnutrition and recurrent vomiting.

Surgical concept and techniques of recurrent cervical cancer patients accompanied with high risk of intestinal obstruction after radical radiotherapy

Objective: To explore the method of relieving intestinal obstruction in patients with recurrent cervical cancer accompanied with intestinal obstruction after radical radiotherapy. Methods: The data of 10 recurrent cervical cancer patients accompanied with high risk weak constitution and intestinal obstruction after radical radiotherapy from May 2012 to May 2018 were retrospectively analyzed, including preoperative radiotherapy dose, physique and obstruction status, operation time, operation blood loss, postoperative digestive tract patency and diet. All of the 10 patients with cervical cancer recurrence accompanied with intestinal obstruction and disturbance of independent walking after radical radiotherapy. Results: The median fasting time of the 10 patients was 21 days, the median weight was 35.5 kg, the median body mass index (BMI) was 13.3 kg/m(2,) the median value of hemoglobin was 67 g/L, and the median value of platelet was 44×10(9) /L. All of the patients underwent enterostomy. the median operation time was 6.0 min and the median amount of bleeding was 5.0 ml. All of the patients defecated after operation, fed on the first day after operation, and were able to walk on their own 5 days after operation. Conclusions: Although the cervical cancer patients with recurrent intestinal obstruction after radical radiotherapy are extremely weak, some patients still have the opportunity to relieve intestinal obstruction if the treatment strategy and surgical method are appropriate.

Comparison of two examination methods in the diagnosis of acute intestinal obstruction in children

Objective To compare the value of 64-slice spiral CT and digital radiography(DR)in the diagnosis of acute intestinal obstruction in children. Methods Eighty-one children with suspected acute intestinal obstruction were selected. All patients were given DR and CT examinations. The diagnostic accuracy rates of the two examination methods were analyzed by taking surgery or follow-up results as golden standards. Results Among the 81 children patients, there were 58 cases with intestinal obstruction, with a sensitivity of 91.38% in CT and 87.93% in DR, a specificity of 86.96% and 82.61%, respectively, the accuracy rate of 90.12% and 86.42%, respectively, and the consistency Kappa value of 0.763 and 0.679, respectively. McNemar test results showed no significant difference between the two groups(P>0.05). Among 58 children patients with intestinal obstruction, there were 19 cases with adhesive obstruction, 16 cases with intussusception, 11 cases with congenital intestinal obstruction, 5 cases with incarcerated hernia, 3 cases with necrotic enteritis and 4 cases with volvulus, and the accuracy rates of CT and DR for etiology of intestinal obstruction were 91.38% and 75.86%, respectively(P<0.05). Among 58 children patients with intestinal obstruction, there were 48 cases(82.76%)with low intestinal obstruction, 6 cases(10.34%)with high intestinal obstruction and 4 cases(6.90%)with colon obstruction, with the accuracy rates of CT and DR for the obstruction site examination were 94.83% and 82.76%, respectively(P<0.05). Conclusion The accuracy rate of CT in diagnosis of intestinal obstruction is comparable to that of DR, but CT has obvious advantages over DR in the etiology and sites of obstruction.

Torsion of Ileum Due To Giant Meckel's Diverticulum - A Case Report.

BACKGROUND:Meckel’s diverticulum (MD) is detected in approximately 2% of all individuals and only 2-4% MD patients may develop symptoms. Small intestinal obstruction is a frequent complication in adults.CASE REPORT:A 48-year-old male was admitted to emergency department for high intestinal obstruction symptoms. The imaging examinations were failed to detect the underlying causes. A median laparotomy revealed small bowel obstruction (SBO) due to a segment of ileum twisted around a giant MD axis.CONCLUSION:Thus, a giant MD generating torsion of ileum is an unusual complication. Preoperative diagnosis is challenging. Emergency surgery is preferred to make an accurate diagnosis and for treatment.