Intestinal Obstruction In Adults Research Articles

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: We 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.

A prospective observational study on etiology and management influencing outcome in operatively managed cases of acute intestinal obstruction in adults

Background: Acute intestinal obstruction (IO) is an important cause for acute abdomen in surgery which presents as abdominal pain, vomiting, distension, and constipation depending on the level and extent of obstruction of gastrointestinal tract. Early diagnosis of acute IO with understanding of various etiologies, use of better diagnostic techniques, and skillful operative management and good postoperative care, carries a good outcome. Aims and Objectives: The objective of the study was to find out the prevalence of various etiologies of acute IO and to study the various post-operative morbidity and mortality. Materials and Methods: This was a hospital-based observational study in the Department of General Surgery of Calcutta National Medical College and Hospital among patients with a diagnosis of acute IO during the study period of December 2016-April 2018. Results: Acute IO commonly affects male with a male: female ratio 7:3 and the most common occurrence in the age group of 40–59 years (30%). The most common etiology was obstructed/strangulated hernia (36%), followed by large bowel neoplasm (18%), adhesion (16%), intestinal tuberculosis (12%), and volvulus (10%). The most common surgical procedure performed was the resection of gangrenous bowel and creation of stoma (30%), followed by prosthetic repair of hernia (28%). The mortality rate of the present study was 12%. The morbidity rate was 46%attributing mainly to respiratory complications (30.4%) and surgical site infections (26.08%). Conclusion: This study demonstrates that the pattern of IO differs from the Western world with obstructed hernias being the most important cause and also emphasizes the fact that intestinal tuberculosis assumes a prominent role.

Intestinal intussusception due to Vanek’s tumour: A rare cause of intestinal obstruction in adults

Intestinal intussusception due to Vanek’s tumour: A rare cause of intestinal obstruction in adults

A clinical case of small intestinal intussusception caused by metastatic melanoma

Intestinal obstruction is observed in about 9.0 % of patients with acute surgical pathology of the abdominal cavity. The disease occurs at any age, but more often between 25–50 years. Mixed intestinal obstruction is only 3–7 %. The most common form of mixed intestinal obstruction is intestinal invasion. The most common cause of intussusception in adults is an intestinal tumor. Early diagnosis and the optimal amount of surgical treatment are the main components of successful treatment of the patient.
 Aim: to familiarize practitioners with a rare case of intestinal obstruction in adults and its management strategies in a surgical hospital.
 Materials and methods. The patient was treated in the surgical department of the Communal Non-Profit Enterprise “City Hospital No. 7” Zaporizhzhia City Consul. The patient underwent preoperative preparation and surgical intervention.
 Results. The patient underwent an emergency median laparotomy under total intravenous anesthesia with artificial lung ventilation. During the examination of the abdominal cavity, multiple distended loops of the small intestine were visualized. During the revision, at a distance of 1.5 meters from the ligament of Treitz, a volumetric formation of the small intestine of dense-elastic consistency, represented by small-intestinal invasion, up to 10 cm long, was detected. The proximal sections of the small intestine are distended, light purple in color. The sections of the small intestine that were distal to the site of invasion were inflamed. Manual disinvagination of the small intestine was performed. The visual examination showed that the intestine was viable. There was a tumor was found on the antrumeral margin, measuring 1.8 × 2.5 cm, dense in consistency, finely tuberculated, dark purple heterogeneous in color, infiltrating and deforming the wall of the small intestine. Resection of the invaded area of the small intestine with the tumor was performed with the imposition of a small-small intestinal anastomosis “side to side” with two-row nylon sutures.
 Conclusions. In this clinical case, it was possible to establish the final diagnosis and determine further surgical strategy only intraoperatively. Only early diagnosis of melanoma will allow avoiding the complications identified in this patient.

Bochdalek Hernia Revealed by Intestinal Obstruction in Adult: Case Report

The Bochdalek hernias is a type of congenital diaphragmatic hernia (CDH) that is characterized by the persistence of a diaphragmatic breach. These hernias are most often diagnosed in the perinatal period and are rare in adults. However, acute intestinal obstruction can be a rare revealing mode in adults, and strangulated Bochdalek diaphragmatic hernia is the subject of this article. The article discusses the embryology and pathophysiology of Bochdalek hernias, as well as their clinical presentation, diagnosis, and treatment. We report a case study of a 25-year-old patient with a chronic pain in the left hypochondrium radiating to the left pulmonary hemifield, which was diagnosed as a strangulated Bochdalek diaphragmatic hernia.

SMALL BOWEL INTUSSUSCEPTION CAUSED BY METASTASIS FROM A LOWER LIMB LIPOSARCOMA

Abstract Introduction Liposarcoma represents one of the most frequent types of soft tissue sarcomas, constituting a heterogeneous group of lesions. There are four different subtypes: well-differentiated; dedifferentiated; myxoid and pleomorphic. Its main locations are the retroperitoneum, extremities, trunk and the cervical area. Clinical case A 90-year-old male with a pleomorphic liposarcoma in the left thigh in 2012, local recurrence from a dedifferentiated liposarcoma in 2018 and 2021, presented to our emergency department with abdominal pain and vomiting. CT scan revealed an image of intestinal intussusception in the distal jejunum due to a 5 cm intraluminal polyp. Emergency laparotomy revealed a change in the distal jejunum caliber caused by the intussusception finding a 5 cm polypoid mass. We made an intestinal resection with a L-L anastomosis. Histopathological examination showed evidence of metastasis from dedifferentiated liposarcoma. Discussion A sarcoma is a malignant tumor, an infrequent type of cancer from connective tissue. The liposarcoma is the most frequent subtype and the dedifferentiated type can occur as dedifferentiation from other subtypes. The most common sites of metastasis include the lung, liver, and bone. Metastasis to the small bowel is rare with few reported cases. Intestinal intussusception is an infrequent cause of mechanical intestinal obstruction in adults. Etiology is diverse and it is often caused by benign lesions in the small bowel and malignant lesions in the colon. The diagnostic technique of choice is the CT scan with contrast and treatment usually requires surgery. Intestinal reduction is controversial because of the risk of perforation or tumor spread.

Case report on colo-colic intussusception

Background: Intussusception is a serious condition in which part of the intestine slides into an adjacent part of the intestine. It is rare in adults, and symptoms of the disorder often overlap with the symptoms of other disorders; it is more challenging to identify. Case Presentation: A 55-year-old female patient was admitted with complaints of colicky abdominal pain and loose stools mixed with blood. The erect abdominal X-rays revealed dilated large bowel distension. A digital rectal examination revealed red currant jelly stools, and the anal canal was found to be ballooned. Colo-colic anastomosis surgery was performed. The histopathological examination of the resected specimen diagnosed it to be mucinous adenocarcinoma of the colon. Conclusion: Colo-colonic intussusception is a rare cause of intestinal obstruction in adults.

Invaginación intestinal secundaria a tumor de Vanek: una causa infrecuente de obstrucción intestinal en el adulto

Invaginación intestinal secundaria a tumor de Vanek: una causa infrecuente de obstrucción intestinal en el adulto

“An observational study of intestinal obstruction in adults”

Background: Mechanical intestinal obstruction is a common surgical emergency. The causes of intestinal obstruction include hernias, postoperative adhesions, malignancy, strictures etc. The etiology of this condition varies in different parts of the world and within same country. Methods: This prospective descriptive study was conducted in department of surgery at a tertiary care teaching hospital. All the adult patients, irrespective of sex with diagnosis of dynamic intestinal obstruction undergoing exploratory laparotomy were included in the study. Laparotomy findings were recorded and in the postoperative period patients were followed up for detection of complications and treatment. Results:45 patients were treated for mechanical intestinal obstruction. Mean age was 49.5 years and male to female ratio was 1.81:1. Most common cause of small bowel obstruction is Small bowel adhesions i.e. 13 patients (39.39%) ; while the most common cause of large bowel obstruction is malignancy arising from different parts of large bowel i.e. 66.67% of patients (8 patients) Wound infection was the commonest postoperative complication. There were 12 deaths in this study giving mortality rate of 26.6%. Conclusions: Bowel Adhesion is the leading causes of mechanical intestinal obstruction in our region.

Anaesthesia Management for Acquired Internal Hernia A Rare Cause of Subacute Intestinal Obstruction

Internal hernia are a rare cause of subacute intestinal obstruction in adults. Internal hernia has reported autopsy incidence of 0.2 – 0.9 % and is cause of small bowel obstruction in 0.6 – 5.8 % of cases. In this case report we present successful anaesthetic management of a 39-year-old Indian male with internal hernia presenting as subacute intestinal obstruction who underwent exploratory laparotomy under combined spinal epidural anaesthesia. This case provides that combined spinal epidural can be an effective technique for gastrointestinal surgery with spontaneous respiration in short stature patients. Keywords: Internal hernia, Sub­acute intestinal obstruction, Combined spinal epidural anaesthesia

PATTERN, MANAGEMENT AND OUTCOME OF ACUTE INTESTINAL OBSTRUCTION AT CHITWAN MEDICAL COLLEGE TEACHING HOSPITAL

Background: Acute intestinal obstruction is one of the commonly encountered emergencies in surgical practice. Gynecological surgery, especially adnexal surgery and hysterectomy has a higher incidence of bowel obstruction as compared to bowel surgery. Conservative management can be done in patients with post-operative adhesive bowel obstruction if there is no evidence of ischemia, bowel necrosis, or perforation. Therefore, a correct diagnosis is essential for appropriate management. We conducted a study to evaluate the etiology, clinical presentation as well as management and outcome of patients presenting with Acute intestinal obstruction at our center. Methods: This was a retrospective study of all the patients with a diagnosis of Acute intestinal obstruction from January 2015 to December 2019. The diagnosis of Acute intestinal obstruction was made by a combination of clinical and radiological parameters. The data were analyzed using Statistical Package for Social Sciences (SPSS) for Windows version 16. The data were expressed in number and percentage. Results: During the study period, 178 patients were admitted with the diagnosis of Acute intestinal obstruction. Abdominal pain and vomiting were the main complaints seen in 98.3% (n=175) and 84.8% (n=151) respectively. Hernia (n=49, 27.5%) was the most common cause of acute intestinal obstruction in adults, and Intussusception (n=15, 8.4%) was the leading cause of Acute intestinal obstruction in a pediatric age group. Majority of the patients’ needs (n=148,83.1%) operative intervention to relieve the obstruction. The overall mortality rate was 6.7% (n=12). Conclusions: Hernia was the most common cause of Acute intestinal obstruction in adults while intussusception was the commonest in the pediatric age group.

BURKITT LYMPHOMA CAUSING ILEOCOLIC INTUSSUSCEPTION AND BOWEL OBSTRUCTION IN AN ADULT: A CASE REPORT

BURKITT’S LYMPHOMA CAUSING ILEOCECAL INTUSSUSCEPTION AND BOWEL OBSTRUCTION IN AN ADULT: A CASE REPORT INVAGINACIÓN ILEOCECAL Y OBSTRUCCIÓN INTESTINAL SECUNDARIAS A LINFOMA DE BURKITT EN UN ADULTO: A PROPÓSITO DE UN CASO Background. Burkitt's lymphoma is a rare and aggressive tumor that constitutes less than 5% of lymphomas. Intussusception is rare in adults, accounting for only 5% of occlusions. Case presentation. We present the case of a 33-year-old man with an ileocecal intussusception due to Burkitt's lymphoma. The rarity of this form of presentation is highlighted and a review is made of the current diagnosis and treatment. Conclusions. Intussusception due to Burkitt's lymphoma is an entity to consider in the differential diagnosis of intestinal obstruction in adults, although it is an extraordinarily rare finding. Key words: Burkitt’s lymphoma, intussusception, bowel obstruction.

English

BACKGROUND The commonest surgical emergency worldwide in adults is Acute intestinal obstruction. The commonest aetiology was found to be different in India and the western world and middle east. In the former it was obstructed inguinal hernia and in the later it was adhesions. Among the different diagnostic modalities radiology was accurate in 60 % of the patients. Demography reeled different aetiological factors and diagnostic methods adopted. Aims and Objectives of the Study- To elaborate the demography, clinical features, diagnosis and final outcome in the Adult intestinal obstruction. METHODS 57 patients who underwent exploratory laparotomy for Adult acute intestinal obstruction (AAIO) were studied for their demography, clinical presentation, diagnostic methods adopted and operative findings were noted. The final outcome in the management of AAIO were elaborated. RESULTS The mean age of the patients was 47.30 ± 6.74 years with the youngest patient aged 36 years and the eldest was aged 54 years. Adhesions was the commonest cause for intestinal obstruction in 25 / 57 (43.85 %) obstructed inguinal hernia in 19 / 57 (33.33 %) patients and tumours in 09 / 57 (15.78 %) patients. The mortality rate was 19.29 % (11 / 57) and the complication rate was 35.08 % (20 / 57). Radiological diagnosis was accurate in 26.31 % (15 / 57) of the patients. CONCLUSIONS The major aetiological agent was adhesions in the Adult Acute Intestinal obstruction followed by obstructed inguinal hernias and tumours. The change in the causative factor similar to the western literature was observed. CT abdomen must always be chosen as first choice for diagnosing AAIO before undertaking the surgery. Presence of strangulated bowel during surgery had grave mortality (p value - 0.001). Presence of shock was another factor contributing to the mortality (p – value - 0.021). KEY WORDS Intestine, Obstruction, CT Scan Abdomen, and Abdominal Emergencies

Prospective study of acute intestinal obstruction in adults based on etiology and severity indicators

Background: Intestinal obstruction is a common clinical entity in surgeons practice. In a large number of patient, therapeutic options are surgery versus conservative treatment; the choice of the treatment, that is, surgical versus conservative depends mainly on the surgeon’s assessment, and, therefore, is a clinical challenge to decide. Aims and Objectives: The purpose of our study is early detection of strangulated bowel obstruction based on a clinical, laboratory, and radiological parameters, a severity indicator score developed by combining these parameters. Materials and Methods: It was a hospital-based prospective observational study of 100 patients between April 2019 and October 2020 who presented with intestinal obstruction. Clinical, laboratory, and radiological parameters were noted and scoring was done as per severity scores. Results: Common cause of obstruction in this study was adhesions 41%, tuberculosis 13%, malignance 8%, and mesenteric ischemia 6% followed by intussusception and volvulus. Patients who had score <3 were managed conservatively, while 90.9% of patients having a score of three or more where operated on, which was statistically significant. Conclusion: Evaluation of the patient is not only to confirm the diagnosis but also timely management of strangulation and prevention of ischemia of gut to improve morbidity and mortality. This study used a severity scoring system of clinical parameters and laboratory and radiological investigation to help in the decision-making of treatment in a case of intestinal obstruction.

Spontaneous ileoileal intussusception as a rare cause of intestinal obstruction: a case report

Intussusception is a rare cause of intestinal obstruction in adults. It often occurs secondary to inflammatory bowel disease, postoperative adhesions, benign or malignant lesions, or iatrogenic causes. In few cases, it occurs idiopathically or spontaneously. The most sensitive imaging method for its diagnosis is computed tomography. The reduction can be applied in selected cases; however, the definitive treatment is surgical resection. In this study, we presented a case of spontaneous ileoileal intussusception in a 25-year-old female patient.

Cecal volvulus in rural Kenya: delayed presentation contributes to high mortality

BackgroundCecal volvulus, which is a torsion involving the cecum, terminal ileum, and ascending colon around its own mesentery, results in a closed-loop obstruction. It is a rare reported cause of adult intestinal obstruction. This study aimed to review the clinical presentation, management, and outcomes at a rural, resource-limited referral center.MethodsWe performed a retrospective review of all patients with a diagnosis of cecal volvulus between January 1st, 2009 and December 31st, 2019 at Tenwek Hospital in Bomet, Kenya. The outcome of survival was compared by the time to presentation. Mortality was also compared with prior reports of intestinal obstruction at our institution.ResultsThirteen patients were identified with a mean age of 52 years and a mean symptom duration of 5 days. All patients presented with abdominal pain and distension. Seven patients (54%) presented with perforation, gangrene, or gross peritoneal contamination. Identified risk factors were Ladds bands with malrotation, adhesions, and a sigmoid tumor. Procedures included primary resection and anastomosis (7), damage control (3) with anastomosis on second-look in 2 of these, simple surgical detorsion (1), and surgical detorsion and cecopexy (2). There were four mortalities (31%), of which all had delayed presentation with perforation and fecal contamination. Delays to presentation were associated with mortality (p = 0.03). Cecal volvulus resulted in increased perioperative mortality compared to all intestinal obstructions presenting to the institution (p < 0.0001).ConclusionsCecal volvulus carries a high risk of mortality. A high index of suspicion and early consideration in the differential diagnosis of intestinal obstruction should be considered to reduce the mortality associated with the delay in preoperative diagnosis.

The Clinico-histopathological Spectrum of Tumors and Tumor-Like Lesions in Adult Intussusception.

Intussusception is an uncommon cause of intestinal obstruction in adults. The etiology of this disease differs from the children. Thus, its management depends on the possible etiology and is different from pediatric cases. We aimed to study the clinico-histopathological spectrum ofthe tumors and tumor-like lesions in the intussusception in adults. A retrospective review of the adult (> 18years) intussusception cases was performed. The clinical data and follow-up were obtained. The histopathology was reviewed along with the special stains and immunohistochemistry for ascertaining a histopathological diagnosis. Fifteen cases of adult intussusception were identified from 107 resected specimens of adult intestinal obstruction. The mean age was 44.5years with a male/female ratio of 1.1:1. A definitive pathology could be ascertained in 80% of the cases (n = 12/15). Eight cases had benign non-neoplastic etiology (53.3%) (33.3% tumor-like lesions) while seven cases (46.7%) had neoplastic etiology (20% benign neoplastic; 26.7% malignant neoplastic). All cases of colonic or enterocolic intussusceptions were associated with neoplasia whereas 90% of the enteric intussusceptions occurred due to benign non-neoplastic causes. CONCLUSIONS: Non-neoplastic causes are predominant in the enteric intussusceptions while neoplastic causes are more commonly associated with colonic or enterocolic intussusceptions. The post-operative histopathological examination concludes on the adequacy of the index surgery or the provision of further management if required.

Inverted Meckel’s diverticulitis manifesting as intussusception: unusual case of intestinal obstruction in adults

Meckel’s diverticulum can manifest with various complications such as obstruction, intussusception, inflammation or diverticulitis, perforation, haemorrhage and fistula, and commonly manifests in children. Adult intussusception due to inverted Meckel’s diverticulum is an uncommon aetiology of intestinal obstruction but should be suspected in individuals. Imaging such as contrast-enhanced computed tomography aids in the diagnosis but it is not confirmatory to diagnose inverted Meckel’s diverticulum as a leading point. Resection of the intussusception segment is the definitive treatment. We present the case of a young man who presented in emergency with complaints of intestinal obstruction and ileo-ileal intussusception was the aetiology of for the same diagnosed on contrast-enhanced computed tomography of the abdomen. On exploration we discovered an inverted Meckel’s diverticulum to be the leading point for intussusception.

Intestinal Intussusception as Crohn’s Disease Debut

Intussusception is a rare cause of intestinal obstruction in adults, occurring only in 5% of cases. Clinical case: a 22-year-old male patient with intestinal obstruction secondary to ileocolic intussusception as the onset of inflammatory bowel disease, who underwent en bloc resection of the affected segment. Keywords: Intussusception; Crohn’s disease

A rare case of adult ileo-colic intussusception: Hamartomatous polyp as a lead point with concurrent appendiceal neurofibroma in Neurofibromatosis Type 1

Intussusception is a rare cause of adult intestinal obstruction and unlike in children, adult intussusception is commonly caused by a lead point, requiring surgical intervention in most cases. Hamartomatous polyp is a non-neoplastic growth of tissue containing mature cells, distributed in an abnormal manner. It is often associated with intestinal polyposis syndromes such as Peutz-Jeghers syndrome and Juvenile polyposis. In the current case, we report an extremely rare case of ileo-colic intussusception secondary to a lead point of an isolated ileal hamartomatous polyp in an elderly gentleman with Neurofibromatosis type-1. Patient was successfully treated with ileo-colic resection involving the intussuscepted segment of bowel. There was an incidental finding of a nodule in the appendix and the histology confirmed this as a neurofibroma. Post-operative recovery of the patient was unremarkable.