Intestinal Occlusion Research Articles

Obstrucción intestinal secundario a vólvulo de sigmoides en un paciente joven. Reporte de un caso

Sigmoid volvulus occurs due to a torsion of the colonic mes¬enteric axis, it has a multifactorial and controversial etiology, and its pathophysiology is not yet clear. Presenting a clinical picture of non-specific onset and later signs and symptoms of intestinal occlusion, its diagnosis is established with computed tomography with a sensitivity and specificity greater than 90%. Management will depend on the clinical condition of the patient. Clinical case: A 29-year-old man with a history of Asperger syndrome. He referred 7 days prior to admission with dif¬fuse cramping pain, associated with abdominal distension and oral intolerance. He went to the hospital for evaluation where a computed tomography was performed with air-fluid levels, torsion of the inferior mesenteric artery with a whirl¬wind appearance. Exploratory laparotomy was performed, finding a dilated and volvulated sigmoid with perforation at the rectosigmoid junction. A sigmoidectomy with colorectal anastomosis was performed. On the fifth day, he presented data of inflammatory response with acute abdomen, enter¬ing exploratory laparotomy finding anastomosis dehiscence, Hartmann procedure was performed. The patient presented septic shock, died 24 hours after surgery. Discussion: The presentation of sigmoid volvulus generally occurs in people older than 70 years, few cases are described in young people and are related to intestinal dysmotility dis¬ease, the patient did not have predisposing factors, the diag¬nosis is established with characteristic images of the disease such as whirlwind image, surgical management is decided by performing resection with colorectal anastomosis. Conclusion: Intestinal occlusion due to sigmoid volvulus is an infrequent pathology in young people and with non-specific symptoms. When faced with a patient presenting evidence of intestinal occlusion, this should be appropriately addressed, especially in patients who have debuted with insidious and persistent symptoms of abdominal pain secondary to intestinal occlusion, whether they are young with or without risk factors.Keywords: Sigmoid volvulus; whirlwind sign; abdominal pain; intestinal obstruction.

Oclusión Intestinal en paciente Renal Crónico secundario a Bezoar de Telas. Reporte de un Caso Clínico.

The “bezoar” are conglomerates of inedible materials ingest¬ed voluntarily or involuntarily, which are not digested and are unable to pass through the intestinal tract. They mainly affect young women or adolescents who present the phenomenon called “pica”, despite the fact that a high prevalence of this phenomenon of “pica” has been registered in patients with chronic kidney disease, it has been little studied. Clinical case: A 35-year-old male with CKD KDIGO-5 under¬going peritoneal dialysis treatment, which was found to have a transoperative “plastic bezoar” (laparotomy for intestinal occlusion) 10 cm from the ileocecal valve. The patient died due to complications of his pathology. Discussion: the clinical case raises the need to search for behaviors such as pica in patients with CKD, as well as to develop the suspicion to the surgeon, since patients generally hide or ignore reporting foreign material phagia. Keywords: Plastic Bezoar, Intestinal Occlusion, Chronic Kidney Disease, pica, dialysis

Intestinal Occlusion Secondary to Meckel's Diverticulum: Clinical Case

Intestinal Occlusion Secondary to Meckel's Diverticulum: Clinical Case

The pathophysiological impact of intra-abdominal hypertension in pigs.

Intra-abdominal hypertension and abdominal compartment syndrome are common with clinically significant consequences. We investigated the pathophysiological effects of raised IAP as part of a more extensive exploratory animal study. The study design included both pneumoperitoneum and mechanical intestinal obstruction models. Forty-nine female swine were divided into six groups: a control group (Cr; n = 5), three pneumoperitoneum groups with IAPs of 20mmHg (Pn20; n = 10), 30mmHg (Pn30; n = 10), 40mmHg (Pn40; n = 10), and two mechanical intestinal occlusion groups with IAPs of 20mmHg (MIO20; n = 9) and 30mmHg (MIO30; n = 5). There were significant changes (p<0.05) noted in all organ systems, most notably systolic blood pressure (SBP) (p<0.001), cardiac index (CI) (p = 0.003), stroke volume index (SVI) (p<0.001), mean pulmonary airway pressure (MPP) (p<0.001), compliance (p<0.001), pO2 (p = 0.003), bicarbonate (p = 0.041), hemoglobin (p = 0.012), lipase (p = 0.041), total bilirubin (p = 0.041), gastric pH (p<0.001), calculated glomerular filtration rate (GFR) (p<0.001), and urine output (p<0.001). SVV increased progressively as the IAP increased with no obvious changes in intravascular volume status. There were no significant differences between the models regarding their impact on cardiovascular, respiratory, renal and gastrointestinal systems. However, significant differences were noted between the two models at 30mmHg, with MIO30 showing worse metabolic and hematological parameters, and Pn30 and Pn40 showing a more rapid rise in creatinine. This study identified and quantified the impact of intra-abdominal hypertension at different pressures on several organ systems and highlighted the significance of even short-lived elevations. Two models of intra-abdominal pressure were used, with a mechanical obstruction model showing more rapid changes in metabolic and haematological changes. These may represent different underlying cellular and vascular pathophysiological processes, but this remains unclear.

Case Report: Intestinal occlusion due to fistulized compressoma from the peritoneal cavity to the colon

BACKGROUND: a retained surgical item is a foreign body that becomes lodged within a body cavity or surgical site unintentionally following surgery. The incidence rate of textilomas varies between 1 in 1 000 to 1 in 1 500 intra-abdominal operations. Up to 30% of patients with retained surgical items may be asymptomatic. Retained surgical items, when lodged in some free space of the abdominal cavity, can migrate as a response of the organism to try to get rid of it. The diagnosis of this entity represents a challenge due to the nonspecific nature of its clinical manifestations and the infrequent occurrence of this diagnostic possibility, which is frequently made incidentally. CASE REPORT: A 24-year-old male patient with a history of laparoscopic cholecystectomy converted to open surgery 3 years ago for acute calculous cholecystitis; he presented a 4-month history of colicky abdominal pain located in the right hypochondrium, in addition to semi-liquid diarrheal stools. He was prescribed different medical treatments for two occasions without improvement and exacerbation of the condition with weight loss, abdominal distension, constipation and irradiation of the pain to the left hemiabdomen. Complementary tests showed leukocytosis and neutrophilia. An abdominal CT scan, performed on suspicion of ureteral lithiasis, showed a mass that appeared to be a fecaloma. EVOLUTION: Rectosigmoidoscopy was performed, with the finding of a mass that totally occluded the intestinal lumen at the level of the sigmoid colon. The mass was removed, and turned out to be a surgical compress. Immediately after the rectosigmoidoscopy, the patient reported improvement and was discharged 12 hours after the procedure without complications and with complete resolution of the symptoms. CONCLUSION: retained surgical materials constitute a health problem that affects the safety of the surgical patient, causing serious consequences to the patient's health and increasing the risk of morbidity and mortality. Intra-abdominal retention of compresses and other types of surgical material may not be considered as a clinical suspicion in the first instance, due to the non-specific nature of the clinical picture; however, whenever there is a surgical history and confusing symptomatology, this diagnostic possibility should be taken into account, and can be confirmed by imaging studies.

Acute Intestinal Occlusion by Ileo-Sigmoid Node: About a Case

The ileosigmoid node is a rare surgical emergency. We report a case of intestinal obstruction by ileosigmoid node that occurred in a young adult patient himself accompanying another patient. Management was early and confirmation was intraoperative.

Congenital Left Paraduodenal Hernia: Report of a Case

Introduction. Internal hernias represent the protrusion of intestinal loops through congenital or acquired openings into the mesentery or peritoneum. One such hernia is the paraduodenal hernia, which is the most common type of internal hernia (53%). Due to the variable and non-specific clinical presentation, the preoperative diagnosis of these hernias is difficult. Despite the available studies, they generally present with intestinal occlusion, making their diagnosis during laparoscopy or laparotomy. Preoperative abdominal computed tomography facilitates diagnosis and timely surgical intervention [3]. Case presentation. This paper presents the case of a 19-year-old male patient with left paraduodenal hernia. He came to the emergency room with severe abdominal pain. Diagnosis was established by computed tomography and a converted surgical procedure was successfully performed. Discussion: Acute intestinal obstruction caused by a left paraduodenal hernia is a rare cause of intestinal obstruction. Conclusion. The patient underwent an exploratory laparotomy and it was found that the herniated intestine was viable, for which it was decided to reduce it and close the defect, obtaining good clinical results in the patient

Severe post-pyloric injury after button battery ingestion: Systematic literature review and case report

BackgroundThe health and safety hazards related to button batteries (BB) have been extensively studied, highlighting that the presence of a button battery in the esophagus is a life-threatening emergency. However, complications related to bowel BB are poorly evaluated and not well known. The objective of this review of the literature was to describe severe cases of BB that have passed the pylorus. Case reportThis case, from the PilBouTox cohort, is the first report of small-bowel occlusion following ingestion of an LR44 BB (diameter: 11.4 mm) by a 7-month-old infant with a history of intestinal resections. In this case, the BB was ingested without a witness. The initial presentation mimicked acute gastroenteritis evolving into hypovolemic shock. An X-ray revealed a foreign body stuck in the small bowel causing an intestinal occlusion and local necrosis without perforation. The patient's history of intestinal stenosis and intestinal surgery were the contributing factor of impaction. Systematic literature reviewThe review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. The research was conducted on September 12, 2022 through five database and the U.S. Poison Control Center website. An additional 12 severe cases of intestinal or colonic injury after ingestion of a single BB were identified. Of these, 11 were related to small BBs (< 15 mm) that impacted Meckel's diverticulum and one was related to postoperative stenosis. ConclusionIn view of the findings, the indications for digestive endoscopy for extraction of a BB in the stomach should include a history of intestinal stenosis or intestinal surgery so as to avoid delayed intestinal perforation or occlusion and prolonged hospitalization.

Gastrointestinal Stromal Tumor in a Patient with Neurofibromatosis Type I: Diagnosis after Intestinal Occlusion Secondary to Adhesions after an Episode of Pancreatitis

Introduction: Gastrointestinal stromal tumors (GIST), although relatively rare, account for 80% of mesenchymal tumors of the digestive tract. They manifest in any part of the alimentary tract and are derived from Cajal cells. They may occur sporadically or be associated with familial syndromes such as neurofibromatosis type I. The clinical picture is variable, and they are often diagnosed incidentally. The diagnosis requires imaging tests associated with histopathological and immunohistochemical analysis. The best strategy for treatment is surgical resection and cases should be analyzed individually to verify additional advantages with the association of systemic therapy. This study aims to present an unusual case of GIST associated with neurofibromatosis type I in a patient with incidental diagnosis after semi-intestinal occlusion secondary to an episode of pancreatitis, in addition to performing a literature review on the subject. Case report: A 49-year-old woman with a history of severe pancreatitis presented with intestinal obstruction approximately 8 months after this episode. Abdominal computed tomography revealed a heterogeneous formation in the mesogastric region, measuring 6.6 x 5.1 x 5.3 cm. She underwent surgical resection and histopathological and immunohistochemical studies confirmed the diagnosis of GIST. Six months after diagnosis, the patient is in good general condition and is on systemic therapy. Conclusion: GIST are rare tumors, but their diagnosis should come to mind in patients with neurofibromatosis type 1 with abdominal masses.

V-043 Laparoscopic TAPP repair for strangulated femoral hernia

Abstract Aim To present a case of a strangulated femoral hernia successfully submitted to laparoscopic transabdominal preperitoneal (TAPP) repair and segmental enterectomy. Material and Methods Video recording of the surgical procedure and patient clinical files. Results A 75-year-old woman with previous medical history of diabetes and dyslipidaemia, went to the Emergency Department with complaints of generalized abdominal pain and absence of bowel moves since the previous day. On physical exam, an incarcerated left femoral hernia was evident. She also presented a renal dysfunction and computed tomography scan revealed a femoral hernia containing a bowel segment with upstream intestinal occlusion. Laparoscopic correction was proposed. Laparoscopy revealed an ischemic loop of bowel incarcerated in the femoral hernia defect, which was manually reduced. Signs of irreversible ischemia were present, but no perforation was evident. TAPP correction was performed with a polypropylene flat mesh of 37.8g/m2 with wide pores. After, the umbilical incision was extended and an extracorporeal segmental enterectomy with totally mechanical anastomosis was made. The patient had a favourable postoperative course with no complications. Conclusions Urgent groin hernia surgery with mesh requiring segmental enterectomy, but without gross peritoneal contamination, is associated with decreased recurrence rates and similar postoperative complications. In experienced centres, laparoscopic surgery may be associated with better results, although randomized multicentre studies are needed.

P-074 SAILING ROUGH SEAS – MANAGING THE COMPLEX RECURRENT INCISIONAL HERNIA PATIENT WITH ADJUVANT TECHNIQUES – CASE REPORT

Abstract Aim Case report regarding the repair of a complex incisional hernia, with loss of domain (LoD), where adjuvant techniques were used. Materials and methods Data from the patient's electronic chart and literature review. Results A 77-year-old female patient is referred for evaluation. She had a multi-recurrent incisional hernia, symptomatic with pain and recurrent episodes of intestinal occlusion. Clinical and imaging evaluation confirmed a complex incisional hernia with LoD, located in the left iliac and flank regions. Abdominal wall muscle blockade was done with botulinum toxin. A progressive pneumoperitoneum catheter was placed laparoscopically, and 11 liters of air were instilled over 13 days. Imaging showed lengthening of the AW muscles. Posterior component separation and transversus abdominis release was performed on the left side, and a retrorectus dissection the right side. A macroporous polypropylene mesh was attached on the left to the twelfth rib, psoas muscle, transverse process of lumbar vertebrae, iliac crest, Cooper's ligament and pubis, and on the right with transfascial sutures. A seroma developed on the post operative period. No other complications occurred. Discussion If a patient never had an AW reconstruction surgery, with a mesh on the retromuscular plane, this option should be offered, by a specialized hernia surgeon, regardless of the number of recurrences. Progressive pneumoperitoneum has existed for many years, but is seldom used. Likewise, botulinum toxin is emerging as a powerful tool to prepare AW reconstruction, but much is still unknow. Heterogeneity in the data is a hinderance to the wide adoption of these techniques.

Gallstone ileus, a rare cause of intestinal occlusion. A case report.

Recurrent gallstone ileus has a recurrence of 2-8.2% with a mortality of 12-20%, secondary to an enteric or cholecystic gallstone. A male patient with a diagnosis of intestinal occlusion secondary to biliary ileus and cholecystoduodenal fistula, performing enterotomy and closure in two planes with drainage placement. Two months after presenting the clinical of intestinal occlusion, medical management began and an abdominal tomography was performed, finding an image suggestive of recurrent gallstone ileus, treated with laparotomy.

Differences Between Right and Left Colon Cancer in Beira Interior.

Introduction Colorectal cancer (CRC) is the second most common cancer in Portugal and worldwide, with a high mortality rate, especially in more advanced stages. In recent decades, there has been a growing interest in the distinction between right colorectal carcinoma (RCC) and left colorectal carcinoma (LCC) due to the different presentation, treatment, and prognosis. Studies show that RCC and LCC have different clinical and biological characteristics, being considered two distinct entities. Material and methods This cross-sectional, descriptive, and comparative retrospective study included data collection at the three hospitals of Beira Interior - Centro Hospitalar Cova de Beira, Hospital Amato Lusitano, and Hospital Sousa Martins - over a 6-year period. Results The proportion of RCC cases was higher. The proportion of women was higher in the RCC group compared to the LCC (46.2%, 121/262 vs. 39%, 76/195). Anemia was statistically higher in the RCC group (p <0.01). On the other hand, intestinal occlusion tends to appear in patients with LCC (p <0.001). The most frequent surgery was elective. The proportion of emergency surgery was higher in the LCC group (LCC vs RCC: 27.2% vs 18.3%; p = 0.03). Discussion and conclusion In both the RCC and LCC groups, the male sex is the most frequently observed in Beira Interior and in Portugal, opposite from the world population, in which the female sex predominates in patients with RCC. The RCC presents alterations in bowel habits more often (p> 0.05). On the other hand, anemia is more common in RCC and intestinal occlusion in LCC, following the current literature. Conducting targeted studies and optimizing the screening and treatment processes are key to reducing mortality associated with CRC.

Laparoscopic Hartmann Procedure-A Surgery That Still Saves Lives.

A Hartmann operation, which is the intervention by which the lower part of the sigmoid and the upper part of the rectum are resected with the closing of the rectal stump and end colostomy, has as its indications: advanced or complicated rectosigmoid neoplasm, moderate biological condition of the patient, peritoneal sepsis, intestinal occlusion and fragile colonic wall, especially in the context of inflammatory changes. The Hartmann procedure can save lives even at the cost of a stoma reversal failure. The cases operated with the Hartmann procedure by an open approach or laparoscopic approach in our clinic, between 1 January 2016 and 31 December 2020, were admitted in this study and their medical records were reviewed, also making a comparison between the two types of approach. Univariate statistical comparisons but also a multivariate analysis was performed. We performed 985 operations for intestinal and colonic occlusion (7.15% of the total operations in the clinic), 531 (54%) were non-tumor occlusions and 454 (46%) were occlusive tumors (88 Hartmann operations). Of these, 7.3% were laparoscopically performed (7 laparoscopic Hartmann operations and 23 diagnostic laparoscopies). A total of 11 cases (18%) also had colonic perforation. We compared laparoscopic Hartmann with open Hartmann and observed the benefits of laparoscopy for postoperative morbidity and mortality. The presence of pulmonary and cardiac morbidities is associated with the occurrence of general postoperative morbidities, while peritonitis is statistically significantly associated with the occurrence of local complications that are absent after the laparoscopic approach. The Hartmann procedure is still nowadays an operation widely used in emergency situations. Laparoscopy may become standard for the Hartmann procedure and reversal of the Hartmann procedure, but the percentage of laparoscopy remains low due to advanced or complicated colorectal cancer, poor general condition both at the first and second intervention, and the difficulties of reversal of the Hartmann procedure.

Intragastric fat and air trapping Sign of Bezoar

The "bezoar" is a rare cause of intestinal occlusion , it corresponds to the unusual accumulation, in the form of solid masse or concretion, of substances of various natures inside the digestive tract and more particularly in the stomach.

Petersen's Hernia. Is it a Calculated Risk?

Hernias as a pathological entity in Surgery are very frequent; while Petersen's hernia is a complication acquired after abdominal surgery independently in any type of digestive anastomosis. The objective is to report a case and carry out a review of the literature. A 47-year-old female with G III obesity, 4 years ago justified bariatric surgery of the Roux-en-Y gastric bypass by laparoscopy, with data of intestinal occlusion and acute abdomen. An emergency exploratory laparotomy was performed, finding Petersen's internal hernia, with reduction without complications with a satisfactory evolution. Petersen's hernia as a practically exclusive complication of Bariatric Surgery has been increasing exponentially in terms of its incidence in recent years, due to the reintroduction of the laparoscopic approach. The difficulty of an early diagnosis causes catastrophic complications, so a delay in the diagnosis, decision and surgical management, has devastating consequences. In terms of surgery, it is a challenge for the medical professional that requires exquisite preparation, character, iron and strict discipline. That is why an omission, an error, a bad decision has catastrophic consequences. And an example of this is Petersen's hernia, as an acquired pathology secondary to a calculated omission or error by the surgeon in the surgical technique, more than costing financial, human resources or the patient's life itself.

Biliary ileus an uncommon cause of intestinal occlusion: case report

Biliary ileus an uncommon cause of intestinal occlusion: case report

A rare case of duplication of the descending colon in a pregnant woman: case report and literature review.

Gastrointestinal duplications are uncommon congenital abnormalities that can occur anywhere throughout the intestinal tract. The small bowel is more interested than the large one. Duplications are schematically classified as spherical and tubular, respectively representing 80% and 20% of cases, with different relationships and communications with the native intestinal wall. Although typically diagnosed during infancy and early childhood, tubular colonic sub-type stays frequently hidden for several years until a complication occurs. we report the case of a T-shaped tubular duplication in a 20-year-old woman at the 30th week of gestation, who underwent an urgent exploratory laparotomy for intestinal occlusion, treated with the resection of the aberrant large bowel. The patient was notable for a long history of constipation and chronic pain. Diagnostic possibilities were limited by the on-going pregnancy. Intestinal duplications are uncommon malformations, and, of these, the T-shaped subtype of the colon is among the rarest ones. In the adulthood, diagnosis is usually established in the operating room during urgent or even emergency surgery performed for abdominal complications. A duplication of the descending colon is extremely rare, and this is, to our knowledge, the only article describing a case found in advanced state of pregnancy.

P449 Minimally invasive IPAA in UC: Preliminary results from a referral center

Abstract Background Minimally invasive approaches in performing restaurative total proctocolectomy in Ulcerative Colitis(UC) have been increasingly adopted. In particular, the robotic approach could be used with more benefits in proctectomy with ileal pouch anal anastomosis (IPAA). In fact, the robotic device seems to potentially overcome all the limitations found in laparoscopic and conventional open surgery. The aim of our study was to compare and evaluate early and late functional postoperative outcomes and complications after IPAA, performed with open, laparoscopic and robotic techniques in UC patients. Methods At our institution, 397 UC patients who underwent restorative proctocolectomy with IPAA during the period 1986-2022, consecutively treated either with open surgery, laparoscopic or robotic techniques were enrolled. The incidence of early (&amp;lt;30 days) and late (&amp;gt;30 days) postoperative complications (intestinal occlusion, haematoma/wound infection, anastomotic dehiscence), hospital stay and an assessment about continence, autonomic nerve damage, incidence of pouchitis and cuffitis was evaluated. Results About the 397 patients, 344 underwent conventional open IPAA, 31 laparoscopically and 22 robotically. Comparable early and late postoperative surgical complications were recorded among the different techniques [early and late complications respectively 24/53 (45,2%) and 146/344(42,4%)] in minimally invasive and open groups. Minimally invasive surgery showed a better outcome regarding wound infections [0/53 (0%)], anastomotic dehiscence and reduced length of stay but open surgery demonstrated a better result on early and late intestinal occlusion [8/53 (15%)vs 22/344 (6,39%)] and anastomotic stenosis [5/53 (9,43%) vs 15/344 (4,36%)]. Lastly, the rate of cuffitis was higher in open surgery than in the minimally invasive group [(3/53 (5,66%) vs 46/344(13,37%)] and within these, robotic approach seems to show better results compared to laparoscopy. Conclusion UC patients undergoing IPAA could benefit from a minimally invasive surgical approach. Our experience confirms that robotics seems to be related to hopeful outcomes both in the short and long term period, even if more studies are needed to refine the promising results.

Meckel's diverticulum presenting with intestinal occlusion due to internal hernia

Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal system. Its incidence is approximately 0.3% to 3% of the population. It is located between 30 and 150 cm from the ileocecal valve. Up to 4% present with complications such as haemorrhage, diverticulitis, perforation, and intestinal obstruction. Clinical record of a patient admitted to the emergency room of an IMSS hospital in Ciudad Juárez, including clinical symptoms, imaging, surgical management and pathological anatomy. Patient presented to the emergency room with a clinical and imaging picture of intestinal obstruction. An exploratory laparotomy was performed, finding an internal hernia secondary to adhesions generated between a Meckel's diverticulum to the right mesocolon. Meckel's diverticulitis is a differential diagnosis to consider in young patients presenting with intestinal obstruction, since its early treatment reduces morbidity.