Intestinal Prolapse Research Articles

Clinical application of middle descending colon-double lumen ostomy with distal stoma narrowing in the treatment of anorectal malformation

BackgroundAnorectal malformations (ARMs) are the most common congenital anomaly of the digestive tract. And colostomy should be performed as the first-stage procedure in neonates diagnosed with intermediate- or high-type ARMs. However, the most classic Pe˜na’s colostomy still has some disadvantages such as complicated operation procedure, susceptibility to infection, a greater possibility of postoperative incision dehiscence, difficulty of nursing and large surgical trauma and incision scarring when closing the stoma. We aimed to explore the effectiveness of middle descending colon-double lumen ostomy (MDCDLO) in the treatment of high and intermediate types of anorectal malformations.MethodsWe retrospectively reviewed the data of patients who underwent MDCDLO for high or intermediate types of ARMs between June 2016 and December 2021 in our hospital. The basic characteristics were recorded. All patients were followed up monthly to determine if any complication happen.ResultsThere were 17 boys and 6 girls diagnosed with high or intermediate types of ARMs in our hospital between June 2016 and December 2021. All 23 patients were cured without complications such as abdominal incision infection, stoma stenosis, incisional hernia, and urinary tract infection in the postoperative follow-up time of 6 months to 6 years except one case of proximal intestinal prolapse was restored under anesthesia.ConclusionMDCDLO offers the advantages of simplicity, efficiency, safety, mild trauma, and small scarring in the treatment of high and intermediate types of anorectal malformations.

Omphalocele with intestinal prolapse through a patent omphalomesenteric duct: A case report

Omphalocele with intestinal prolapse through a patent omphalomesenteric duct: A case report

A Rare Case of Intestinal Prolapse through Vault after Total Abdominal Hysterectomy

A Rare Case of Intestinal Prolapse through Vault after Total Abdominal Hysterectomy

Intestinal prolape of an omphalo-mesenteric fistula

Intestinal prolapse through a persistence of the omphalo-mesenteric duct or vitelline duct is a very rare clinical entity. It is a complication of the omphalo-mesenteric fistula which requires emergency surgery. The authors report a case emphasizing the clinical and therapeutic aspects.

A Case of Post-abdominal Injury with Intestinal Prolapse Closed Using an Abdominal Dressing Kit

A Case of Post-abdominal Injury with Intestinal Prolapse Closed Using an Abdominal Dressing Kit

Delayed mesh infection and mesh penetrating the transverse colon and small intestine after abdominal incisional hernia repair

The occurrence of late-onset mesh infection and mesh invasion into the intestine after abdominal incisional hernia repair is extremely rare. Herein, we describe the first case of late-onset mesh infection and mesh penetrating the transverse colon and small intestine 5 years after incisional hernia repair using an expanded polytetrafluoroethylene mesh. The symptom was drainage from the reddish wound, and computed tomography scan revealed intestinal prolapse with local wall thickening. The mesh removal and small intestine and colon resection were conducted because the small intestine and transverse colon formed a mass containing the mesh inside. The events were caused by the lack of mesh fixation, and the dislodged mesh penetrating the intestinal tract caused the infection. For mesh infections in which conservative treatment is not effective, mesh removal and organ excision should not be delayed regardless whether there is a strong adhesion of the abdominal cavity.

A Caecal Lipoma with Pseudomalignant Features and Colo-colonic Intussusception

Gastrointestinal lipomas are rare benign non-epithelial tumours, usually single and slow growing. Most of colonic lipomas were detected incidentally during surgery, endoscopy or autopsy with incidence ranges from 0.2% to 4.4%. While lesion measures smaller than 2cm in diameter are usually asymptomatic, a larger lesion more than 2cm, can cause symptoms such as intestinal obstruction, rectal bleeding, intussusception, constipation, diarrhea or prolapse. Pre-operative diagnosis is challenging as symptoms and imaging mimic malignancy. Direct visualization of the submucosal lipoma can be done by endoscopy. It is seen as smooth, rounded yellowish polyps with a thick stalk or broad-based attachment. Its typical features are the “tent sign” (elevation of the mucosa over lipoma with biopsy forceps), “cushion sign” or “pillow sign” (pressing forceps against the lesion results in depression or pillowing of the mass) and the “naked fat sign” (extrusion of yellowish fat at the biopsy site). In some cases, with large sized flat shaped lesion and ulceration may lead to an impression of malignant lesion. If the endoscopic biopsy is not taken at accurate site, for example at inflamed mucosal of adjacent tissue, it can give false impression of “nonspecific colitis”. We describe a patient with persistent diarrhea and hematochezia who underwent open right hemicolectomy for the presumptive endoscopic and imaging diagnosis of caecal adenocarcinoma. However, histological examination confirmed benign caecal lipoma.International Journal of Human and Health Sciences Vol. 05 No. 01 January’21 Page: 122-126

Ultrasound guided hydrostatic reduction of intussusception: suitability and effectiveness with factors affecting its successful outcome

Background: Intussusception being the leading cause of acute abdomen in childhood, its timely and accurate diagnosis assumes utmost significance in reducing the morbidity and mortality. Childhood intussusceptions are still managed surgically in our region; however, non-operative reduction has now become the gold standard of treatment worldwide. In this study, authors desired to evaluate the suitability and effectiveness of hydrostatic reduction of intussusception under ultrasound (USG)-guidance and to scrutinize the factors affecting the successful outcome.Methods: Ours was a prospective study carried out at a tertiary care centre in central Kashmir. All except those with clinical features of bowel gangrene, intestinal prolapse and peritonitis underwent ultrasound-guided hydrostatic reduction (USGHR). A maximum of three attempts were allowed.Results: Mean age of the patients was 11.2±8.8 months with age range of 3-50 months. 69.1% (n=38) of the patients presented within 24 h of being symptomatic while 30.9% had delayed presentation (>24 h). The success rate of USGHR was 81.8% (n=45). Late presentation, age and gender of the patients had no influence on successful outcome of the procedure, p >0.005. The duration of hospital stay between those who had successful hydrostatic reduction and those who afterwards underwent operative reduction or resection achieved statistical significance, p=0.0015. Authors attained a 66.2 % (45/68) reduction in operative management using USGHR as the main modality of treatment.Conclusions: USGHR is a simple, safe and effective non-operative method of treating intussusceptions in children in a limited resource setting.

Transition process to experience with elimination intestinal stoma: repercussions on body image

Objective: to know the process of transition and adaptation to the experience with elimination intestinal stoma. Methods: a descriptive-exploratory, mixed study conducted between May and July 2018 through a semi-structured interview and application of the body image scale with 13 people with a stoma, at the postoperative return in a federal hospital in the south of the country. The data analysis was by thematic categories and simple descriptive analysis. Results: The data showed a parity between the genders, mean age of 60.5 years, most parts married, with low education level, and away from work activities. The leading generator causes of stoma were neoplasias, stomas with more than six months, and temporary. The most frequently identified complications were intestinal loop prolapse and dermatitis. The most significant changes occurred in the food pattern, clothing, social behavior, and body image reflexes. The premorbid body subscale had an average of 22.23 points, and the subscale morbid body had an average of 15.15 points. Conclusion: The condition of being a person with a stoma has an impact on the way the individual sees their body. It is essential to highlight that individuals at risk of maladaptation are identified and addressed as early as possible.

Sonographic guided hydrostatic saline enema reduction of childhood intussusception: a prospective study

BackgroundThe management of childhood intussusception in our sub-region is still via surgical intervention. Currently, the gold standard of treatment is non-operative reduction. We sought to assess the suitability of hydrostatic (saline) reduction of intussusception in children in our institution.Materials and methodsA prospective study was conducted between January 2016 and June 2017 in all children with ultrasound confirmed intussusception at a tertiary teaching hospital in Nigeria. All children excluding those with signs of peritonitis, bowel gangrene and intestinal prolapse were selected for ultrasound-guided hydrostatic reduction (USGHR). We allowed a maximum of three attempts at reduction.ResultsThe age range was 3 months to 48 months with a mean of 10.8 ± 9.1 months. Forty percent (N = 18) presented after 24 h of onset of symptoms. The success rate of hydrostatic reduction with saline enema was 84.4% (N = 38). Two (4.4%) perforations occurred during the procedure. Three (7.5%) patients had recurrent intussusception within six months. The duration of symptoms greater than 24 h, age and sex of patients did not influence successful reduction p > 0.05. The duration of admission between those who had successful non-operative reduction and those who subsequently had operative reduction and or resection attained statistical significant difference, p = 0.001. There was no mortality. We achieved a 68% decrease in the operative reduction of intussusception using USGHR as the primary modality of treatment.ConclusionOur study found out that USGHR is a suitable alternative for the treatment of childhood intussusception.

Omental and deep inferior epigastric artery perforator flap coverage after heart transplantation to manage wide left ventricular assist device exposure with pocket infection

Infection is a serious potential complication after left ventricular assist device (LVAD) implantation. In general, infection of the device pocket, with device exposure, should be managed by early device removal and heart transplantation. However, because of the small number of donors in Japan, accelerating access to heart transplantation is often difficult and the LVAD can be widely exposed during the waiting period. We report our experience of successful heart transplantation in a patient with a widely exposed LVAD with pocket infection. A 48-year-old man suffered from heart failure due to idiopathic dilated cardiomyopathy. An LVAD was implanted, but postoperative infection led to blood pump exposure. Heart transplantation was performed 4months after LVAD exposure, at which time the epigastric skin defect measured 14 × 8cm. The skin defect could not be closed after heart transplantation, so it was covered by an omental flap with split-thickness skin grafts. 7 days postoperatively, the peritoneal suture broke and the intestinal tract prolapsed outside the body. Reintroduction of the prolapsed intestinal tract and deep inferior epigastric artery perforator (DIEP) flap coverage of the omental flap were performed. The postoperative course was uneventful. There have been no reports of the management of wide skin defects in the presence of infection when heart transplantation is performed. Omental flap placement was useful for controlling long-lasting infection. An omental flap placed in a patient with a wide epigastric skin defect should be covered by durable skin flap, such as a DIEP flap, to avoid intestinal prolapse.

Occurrence of common surgical affections in calves and goats at Jhenidah Sadar Upazila of Bangladesh

The occurrences of different surgical affections are very common in Bangladesh. The aim of this study was to determine the occurrence of most common surgical affections and their risk factors in calves and goat at Jhenidah Sadar Upazila of Bangladesh during the period from July to December 2011. Thirty seven (37) calves and twenty two (22) goats were used for this study. All animals were brought to hospitals with the complaints of surgical conditions. In this study we found umbilical hernia (59.5%), umbilical abscess (10.8%), atresia ani (8.1%), intestinal prolapse (2.7%), fracture of jaw (2.7%), necrosis of eyeball (2.7%), congenital polypus (2.7%), naval myiasis (5.4%) and abscess (5.4%) in calves. In case of goats, gid disease (36.4%), testicular hernia (4.5%), subcutaneous cyst (13.6%), atresia ani (4.5%), myiasis (9.1%), block of urethra (4.5%), fracture (9.1%), stitch abscess (9.1%), abscess (4.5%) and hematocele (4.5%) were recorded. The young, male and crossbred calves were showed more affections than that of adult and female. It was also found that the young male goats were more significantly (p<0.05) prone to surgical affections than that of adult and female. The male calf with 1-3 months of age (84.6%) were higher than that of male with age <1 month (70.8%). In both calf and goat, the female were found comparatively lower rate of surgical affections than male. However, further extensive work is very imperative to identify the specific cause as well as any factors that may influence region to region. Asian Australas. J. Biosci. Biotechnol. 2016, 1 (2), 394-397

Intestinal prolapse through omphalomesenteric fistula, a rare cause of neonatal occlusion: A case report

Abstract Acute intestinal obstruction secondary to omphalomesenteric fistula is a very rare condition. Omphalomesenteric fistula is a consequence of a defect in involution of the vitelline duct between the fifth and ninth week of intrauterine development. We are reporting on a case of neonatal intestinal obstruction due to a prolapse of small bowel through an omphalomesenteric fistula. A newborn baby aged 15 days was admitted in emergency with acute intestinal obstruction lasting for two days. The physical examination found prolapse of small bowel through a persistent omphalomesenteric duct. He received surgical treatment with favorable evolution. The scarcity of the reason during the neonatal period should draw the attention of pediatric surgeons because of its potential complications.

出血性ショックを伴う腹部刺創に対し，IABO併用下のDCS後に下腿コンパートメント症候群を呈した1例(A complicated case of lower leg compartment syndrome after damage control surgery (DCS) with intra–aortic balloon occlusion (IABO) for severe abdominal stab injury under severe hemorrhagic shock)

要旨腹部刺創による出血性ショック症例に対して，大動脈閉塞バルーンカテーテル（intra–aortic balloon occlusion; IABO），Damage Control Surgery（以下DCS）を施行後，下腿コンパートメント症候群（Lower Leg Compartment Syndrome; LLCS）を呈した1例を経験したので報告する。症例は43歳男性で，腹部を刺し倒れているところを発見され，当院に救急搬送された。来院時ショック状態を呈し，腹部超音波検査にてMorison窩に液体貯留を認め，外表上，腹部2ヶ所の刺創より腸管脱出を認めた。初期輸液に反応せず，気管挿管及び，右大腿動脈からIABOを挿入し，濃厚赤血球の急速輸血を開始した。来院から約35分で緊急開腹術を施行した。開腹すると，複数箇所の腸管損傷を認め，刺入創先端は後腹膜に達していた。可及的な腸管切除後，後腹膜部位からの出血のコントロールが困難となり，deadly triadを認めたため，ガーゼパッキングを実施して速やかに閉腹した。初回術後，Intra–abdominal pressure（以下IAP）は最高値40mmHgを示したため，abdominal compartment syndrome（以下ACS）と判断し，術後約24時間でsecond look operationを施行し，腸管吻合を実施した後，閉腹した。その後IAPは16mmHgまで速やかに改善した。しかし初回緊急手術から約48時間後，右下腿の色調変化と，下腿コンパートメント圧の上昇（最大80mmHg）を認めた。血清クレアチニンキナーゼ（CK）は62100IU/Lまで上昇した。右LLCSと診断し，減張切開を行い，速やかにコンパートメント圧は低下した。しかし一部筋壊死を認めたため，術後13日目に，壊死筋部のデブリードマンを要した。術後経過は良好で，第53病日に独歩退院した。本症例におけるLLCSの成因として，IABOやDCSに伴う下腿虚血・還流障害が一因と考えられた。

How do we understand the disagreement in the frequency of surgical site infection between the CDC and Clavien-Dindo classifications?

To clarify the discrepancy in the incidence and severity of surgical site infections (SSI) for radical cystectomy between reports based on the CDC guideline and those using the Clavien-Dindo classification we evaluated 449 consecutive patients who underwent radical cystectomy for bladder cancer between 1990 and 2012. Of the 115 (25.6%) patients with SSI defined by the CDC guideline, 89 could be analyzed. We compared the SSI rates and severity defined by the CDC guideline and Clavien-Dindo classifications. There were 58 patients with superficial SSI, 16 with deep SSI, and 15 with organ/space SSI according to the CDC guideline. All patients with organ/space SSI were judged as "not having SSI" by the Clavien-Dindo classification. They were classified as having "intestinal prolapse", "intestinal fistula", "abdominal abscess" and "pelvic abscess." There was a significant association between the treatment duration and depth of SSI based on the CDC guideline by Spearman's rank-correlation coefficient (p < 0.001, r = 0.614) and with the grade of complications (p < 0.001, r = 0.632) in the Clavien-Dindo classification. Multivariate analysis showed that patients with grade III SSI in the Clavien-Dindo classification needed a significantly longer treatment duration. It is necessary to be aware that a discrepancy can occur automatically due to the different natures of the definitions. Using the CDC guideline, we can effectively estimate the future treatment period when SSI occurs. With the Clavien-Dindo classification, grade III SSI requires a longer treatment duration.

Prolapse of the Small Intestine from the Uterine Perforation at Dilatation and Curettage

Dilatation and curettage (D&C) sometimes causes uterine perforation, which usually does not cause a serious problem. Here, we report uterine perforation caused by D&C, in which the small intestine prolapsed from the uterus, requiring intestinal resection. D&C was performed for missed abortion at 9 weeks. After dilating the cervix, forceps grasped tissue that, upon being pulled, resulted in the intestine being prolapsed into the vagina. Laparotomy revealed a perforation at the low anterior uterine wall, through which the ileum had prolapsed. The mesentery of the prolapsed ileum was completely detached and the ileum was necrotic, which was resected. The uterus and the intestine were reconstructed. Although intestinal prolapse is considered to be caused by “unsafe” D&C performed by inexperienced persons or even by nonphysicians in developing countries, this occurred in a tertiary center of a developed country. We must be aware that adverse events such as uterine perforation with intestinal prolapse can occur even during routine D&C.

Uterine Perforation With Bowel Infarction In a Case of Unsafe Abortion

Every year worldwide about 42 million women with unintended pregnancies choose abortion, and nearly half of these procedures, 19 million, are unsafe. Some 70,000 women die of unsafe abortion annually, making it one of the leading causes of maternal mortality (13%). Of the women who survive unsafe abortion, 5 million will suffer longterm health complications. Unsafe abortion is thus a pressing issue. Both of the primary methods for preventing unsafe abortionless restrictive abortion laws and greater contraceptive useface social, religious, and political obstacles, particularly in developing countries, where most unsafe abortions (97%) occur. Even where these obstacles are overcome, women and health care providers need to be educated about contraception and the availability of legal and safe abortion, and women need better access to safe abortion and post abortion services. Otherwise, desperate women, facing the financial burdens and social stigma of unintended pregnancy and believing they have no other option, will continue to risk their lives by undergoing unsafe abortions. According to the World Health Organization (WHO), every 8 minutes a woman in a developing nation die of complications arising from an unsafe abortion. The fifth United Nations Millennium Development Goal recommends a 75% reduction in maternal mortality by 2015. WHO deems unsafe abortion one of the easiest preventable causes of maternal mortality and a staggering public health issue. We report a case of a 21 years female who presented with uterine perforation with small intestinal prolapse through uterine perforation that required repair of uterine perforation with resection anstomosis of small gut after a unsafe abortion of a 16 weeks pregnancy.&#x0D; JCMCTA 2012 ; 23 (2): 50-52

Perineale Rekonstruktion nach zylindrischer Rektumexstirpation

In advanced lower rectal cancer tubular abdomino-perineal resection (APR) in combination with simultaneous extended distally pedicled vertical rectus abdominis muscle flap (VRAM) facilitates a more radical tumor resection. Additionally a prolapse of small intestine into the pelvis can be blocked and a perineal defect coverage can be achieved. 4 patients have been treated with an interdisciplinary one stage combined tubular APR and extended VRAM. In all cases a R0 resection and a complete defect closure could be achieved.The extended VRAM is an appropriate technique to close the pelvic defect because it originates from a non irradiated area, has a monitor island, and the donor site does not handicap the patient as much as local flaps. This interdisciplinary approach facilitates a more radical tumor resection and thus reduces the risk of recurrence.

Intestinal prolapse through a persistent omphalomesenteric duct causing small-bowel obstruction

Persistent omphalomesenteric duct as a cause of small-bowel obstruction is an exceptional finding. A neonate presented with occlusion due to intestinal prolapse through a persistent omphalomesenteric duct. Remnants of the duct were successfully resected, and the postoperative course was uneventful. We discuss the presentation of omphalomesenteric duct and its management.

Unusual lower genital tract injury caused by bull’s horn: prolapse of small intestine through vagina—first case report in literature

Unusual lower genital tract injury caused by bull’s horn: prolapse of small intestine through vagina—first case report in literature