Mechanical Intestinal Obstruction Research Articles

Studying of capacity of the inflamed intestinal wall to accumulate tienam preparation in experiment

Objective. Using experimental pattern of mechanical ileus, to study the capacity of nonchanged and inflamed intestine to accumulate a tienam preparation.
 Materials and methods. The experiment was conducted on 60 laboratory animals in two stages. On the first stage the content of tienam in the blood, parenchymatous organs and in the nonchanged intestinal wall was determined. On the second stage the content of the tienam components was determined in the blood, parenchymatous organs and in the wall of inflamed suprastenotic part of intestine. In both series the preparation was injected intravenously in accordance to scheme, calculated for the animals body mass. The quantity of tienam preparation in the investigated material was determined, using the method of a highly effective liquid chomatography.
 Results. The experimental investigation conducted have shown, that the tienam preparation components in nonoperated animals are accumulated in therapeutic doses in the blood, liver and kidneys. In the animals, in whom mechanical ileus was simulated, he tienam components were revealed only in parenchymatous organs and in the blood. In the inflamed intestinal wall the tienam components were not revealed even while injection of a dose, prevailing a middle therapeutic one in 2.5 times.
 Conclusion. Imipenem and cilastatin, which are included into tienam preparation, while secondary injections in a dose, prevailing a middle therapeutic one in 2.5 times, were not revealed in the wall of the inflamed intestine in experimental mechanical ileus.

Acute mechanical intestinal obstruction due to foreign body ingestion

Introduction: Foreign body ingestion is usually occurs accidenatlly and is a common condition in childhood, but it is rarely seen in adults and is frequently encountered in people with mental retardation and psychiatric disease. The outcome is usually defecation of the ingested materials but rarely requires surgial intervention. Case Report: A 33-year-old male patient was admitted to the emergency department with the complaint of constipation as a result of swallowing about 1000 plastic buttons yesterday. His acute mechanical intestinal obstruction was alleviated with conservative treatment and the patient discharged with recommendations.Conclusion: The number, shape, size and time of ingestion determine the mode of treatment. There are three main principles in treatment. Endoscopic retraction, conservative follow-up and surgical intervention. In addition to, tomography should be considered as an option for foreign bodies that can not be visualized with direct radiography.

2629 A Benign Tumor With a Malignant Course

INTRODUCTION: Mesenteric fibromatosis is a rare, locally invasive, non-metastasizing intra-abdominal fibroma with a high rate of recurrence. These tumors pose a diagnostic and therapeutic challenge due to its rarity and wide-ranging clinical presentation. CASE DESCRIPTION/METHODS: A 43-year-old man with a medical history of hypertension and no prior surgeries who presented with acutely worsening diffuse abdominal pain with associated bloating, nausea, and vomiting for 2 days. Physical exam revealed abdominal tenderness with deep palpation with the absence of peritoneal signs. MRI revealed a large liver mass with central necrosis suspicious of hepatocellular carcinoma, however, the biopsy was consistent with a hemangioma. Colonoscopy visualized a colonic mass with difficulty maneuvering the scope through the entire colon raising concern for primary versus metastatic colon cancer. Tumor markers were unremarkable. Gastrografin radiography demonstrated a high-grade obstructing annular mucosal lesion at the splenic flexure. He underwent left hemicolectomy with colostomy placement. Pathology demonstrated a spindle cell neoplasm with a fascicular architecture surrounded by abundant collagen fibers with no necrosis. Further histological staining was positive for vimentin, beta-catenin, and desmin conforming to mesenteric fibromatosis. DISCUSSION: Mesenteric fibromatosis is part of the clinical-pathologic spectrum of deep fibromatosis encompassing a group of benign fibroproliferative processes that are locally aggressive and have the capacity to infiltrate or recur, but not metastasize. Most cases manifest sporadically, however, there is a link with familial adenomatous polyposis (FAP), specifically Gardner syndrome. In addition, they can be locally aggressive showing recurrence even after excision. Mesenteric fibromatosis may be confused radiologically and histologically with a gastrointestinal stromal tumor (GIST), however immunohistochemical profile is helpful in differentiation. Mesenteric fibromatosis is typically negative for CD34 and CD117, which are almost universally positive in GISTs. This case illustrates the difficulty in diagnosing mesenteric fibromatosis, and a secondary lesion can complicate diagnosis. Mesenteric fibromatosis with intestinal involvement can be easily confused with other primary gastrointestinal tumors, especially with mesenchymal origin such as GIST. Hence, it should be considered in the differential diagnosis of mechanical intestinal obstruction as well as intra-abdominal masses.

1537 Colonic Gallstone Obstruction in the Setting of Cholecystocolonic Fistula

INTRODUCTION: Gallstone ileus is a relatively rare complication of cholelithiasis, estimated to account for approximately 1%-4% of all cases of mechanical intestinal obstruction. Cholecystoenteric fistulas form as a result of an inflamed gallbladder adhering to adjacent small bowel or colonic tissue, opening a channel by which gallstones can enter the intestinal tract. Fistula formation is most commonly to the duodenum (32.5-96.5%) but can also infrequently occur in the colon leading to gallstone impaction past the ileocecal valve. CASE DESCRIPTION/METHODS: Our patient is a 63 year old female who presented to the emergency room with one week of nonradiating stabbing left lower quadrant abdominal pain and constipation. She reported associated anorexia, and nausea without emesis. She was afebrile and hemodynamically stable. On exam, she was tender to palpation in the lower quadrants. No stool was present in the rectal vault. She had a negative Murphy's sign. Labs revealed WBC count 18.6 thousand/mcL, normal AST, normal ALT, and alkaline phosphatase 158 unit/L. Computed tomography (CT) scan abdomen/pelvis revealed gallbladder wall thickening with pneumobilia, cholelithiasis, normal common bile duct, and a large curvilinear hyperdensity in the distal colon (A). This was suspected to be a displaced gallstone in the sigmoid colon related to a fistula between the gallbladder and hepatic flexure (B). Removal of the stone was attempted by flexible sigmoidoscopy with snare and basket but was unsuccessful. She was then taken for exploratory laparotomy, transverse colotomy with extraction of 5 × 3.4 cm gallstone, loop transverse colostomy, and ventral hernia repair (C). She received IV antibiotics for 5 days and was discharged home. DISCUSSION: This case highlights a rare etiology of colonic gallstone obstruction in a patient without risk factors including underlying malignancy, colonic stricture, or diverticulum. Optimal surgical management of gallstone ileus with associated fistula is still being defined as few cases have been reported in the literature. One large retrospective survey found enterotomy with stone extraction to be associated with improved survival outcomes and decreased postoperative complications compared to surgery with fistula closure and bowel resection. Our patient had stable gallbladder changes and persistent cholecystoenteric fistula on CT scan over the next three months and expressed several gallstones through her colostomy without requiring further surgery.

Delayed Presentation of Diaphragmatic Rupture due to Penetrating Trauma: Acute Mechanical Intestinal Obstruction

Delayed Presentation of Diaphragmatic Rupture due to Penetrating Trauma: Acute Mechanical Intestinal Obstruction

A flexible skin-mounted wireless acoustic device for bowel sounds monitoring and evaluation

Conventional methods of intestinal inspection play an essential role in the assessment of bowel diseases and other relevant health issues, yet fail to obtain intestinal conditions in real time because of radiation limits and operation inconvenience. Herein, a flexible, skin-mounted device is developed for long-term, real-time monitoring, and for the evaluation of bowel sounds based on the integration of a three-dimensional printed elastomeric resonator with flexible electronics. The device is capable of being flexibly attached to abdominal surfaces without performance degradation during breathing. Clinical tests conduct in a normal volunteer and in patients with mechanical intestinal obstruction or paralytic ileus illustrate the usefulness of the device in capturing the characteristics of bowel sounds. Furthermore, a demonstration of collection and classification of bowel sounds by the flexible device based on machine learning methods can serve as a reference for possible applications of the system in the auxiliary diagnosis of bowel problems.

A large superior mesenteric artery aneurysm and ileal obstruction: a rare presentation of polyarteritis nodosa in an infant.

Polyarteritis nodosa (PAN) is a rare form of vasculitis that occurs in childhood and affects small- and medium-sized arteries. Large aneurysms due to PAN can induce fatal complications like rupturing or occlusion of the affected arteries. Here, we report a case of a 4-month-old girl with PAN complicated by a large superior mesenteric artery aneurysm and ileal obstruction. We controlled her blood pressure to prevent the artery from rupturing. A combination of prednisolone, intravenous cyclophosphamide, and plasma exchange reduced the inflammation. She developed mechanical ileus due to ileum stricture and underwent bowel resection. Histopathological examinations revealed reparative arteritis around the healed ulcer. Her postoperative course was uneventful without further dilatation of the aneurysm. This case highlights the importance of intensive immunosuppressive therapy and appropriate blood pressure control in pediatric patients with PAN complicated by large aneurysms. Mechanical ileus can develop and may require surgical management even after remission of vasculitis.

Single-Layer Sutures in Abdominal Cavity Surgery.

The aim of our study was to evaluate of short-term outcomes of 4210 patients who underwent open abdominal surgery with used either single-layer, absorbable, or continuous sutures. Seromuscular anastomosis were presented (without mucosa). Fluid therapy: GDT and zero-balance GDT were also discussed. Anastomosis leakage developed in 6 patients. They were treated by creating a stoma. Simultaneously, septic shock was treated. Re-anastomoses were performed after some time and after sepsis was suppressed. Results of treatment with use of double-layer sutures, which was is use before 1978, were presented. Analysis of 536 patients treated at the same time was conducted and 53 patients with anastomosis leakage was identified. Out of this group, 2 patients survived. Based on the literature review, the methods for performing anastomosis. Attention was paid to the advantages of single layer over multi-layer sutures: effectiveness, simplicity and lower cost of treatment. The occurrence of mechanical ileus was less frequently observed since ceasing to employ peritoneoplasty, and preoperational preparation of gastrointestinal tract in patients had a beneficial influence on their postoperative course. Postoperative complications were discussed mainly based on additional examinations such as TC and MRI. The attention was focused on the importance of medical observation and clinical examination by an experienced surgeon in order to identify postoperative complications. Antibiotic treatment in cases of postoperative complications was presented, as well as fluid therapy: GDT, zero-balance GDT and the procedures employed in cases of complications such as: anastomosis leakage, mechanical ileus, inter-peritoneal abscess. Anastomotic stenosis was not observed in this group of patients.

Mechanical small bowel obstruction due to appendiceal tourniquet: a case report and review of literature

BackgroundAcute appendicitis is known to cause intestinal obstruction. The presentation is commonly due to functional obstruction, but on very rare occasions it presents as mechanical obstruction, especially closed loop.Case presentationWe report a case of a 59-year-old Egyptian man who presented with symptoms suggestive of intestinal obstruction. On examination, he was afebrile with distended tender abdomen with no obvious hernias. There was no history of previous abdominal surgery. Laboratory investigations were within normal range except for elevated serum creatinine levels. Plain erect X-ray and computed tomography scan of his abdomen indicated mechanical small bowel obstruction.Preoperative preparations with administration of intravenously administered fluids and antibiotics were done for exploratory laparotomy. The operation was approached through a midline incision, revealing dilated small bowel loops with a terminal ileal loop occluded by a ring of his appendix. The appendicular tip was adherent to small bowel mesentery by adhesive band (appendiceal tourniquet). Release of the band with simple appendectomy was done; a segment of ileal bowel loop was congested but regained its viability after 5 minutes’ application of gauze soaked in warm saline. His abdomen was closed in layers and one drainage tube left in situ. Paralytic ileus was the only postoperative complication which was relieved after 2 days. He was started on orally administered fluids on the third postoperative day, and discharged on the fifth postoperative day.ConclusionAcute appendicitis should be suspected as a cause of mechanical intestinal obstruction in an elderly patient with no obvious diagnostic cause, and can be managed with simple appendectomy when an early intervention is made.

A case of intussusception developed at the site of ileocolic anastomosis after laparoscopic right hemicolectomy

BackgroundIntussusception is a relatively common condition seen in children. In comparison, adult intussusception is rare and usually occurs as a complication in patients with organic diseases. It is responsible for 1% of all bowel obstructions, in most of intussusceptions a malignant tumor is involved. Herein, we present an extremely unusual case of intussusception that occurred as a complication at the site of a functional end-to-end anastomosis.Case presentationA 57-year-old female patient was diagnosed with tumors in the ascending and descending colon and was referred to our department. Laparoscopic hemicolectomy and laparoscopic descending colectomy were performed. The mechanical intestinal obstruction occurred on the 9th day postoperatively, and computed tomography scan revealed intussusception at the site of the ileocolic anastomosis. Endoscopic reduction was attempted, but the procedure was challenging. Surgery was then performed and revealed that the site of ileocolic anastomosis firmly adhered to the side wall and right retroperitoneum. However, the intestine in the oral side of the anastomosis was not fixed. Examination of the anastomotic site revealed that the ileum had passed through the anastomosis and prolapsed into the transverse colon. The ileocolic anastomosis was resected. End-to-end anastomosis was performed, and surgery was then completed. No neoplastic lesions were observed in the resected tissue of the lead point of intussusception. The postoperative clinical course was favorable, and the patient was discharged on the 11th day after the second round of surgery.ConclusionsThere are no reports the anastomosis is involved as part of the intussception, as observed in the present case. Intussusception should thus be considered as one of the causes of postoperative mechanical intestinal obstruction.

Clinical and Ultrasonographic Observations of Omental Affections as Uncommon Causes of Mechanical Ileus in Cattle

Clinical and Ultrasonographic Observations of Omental Affections as Uncommon Causes of Mechanical Ileus in Cattle

Chestnut-phytobezoar causing small bowel obstruction in a child with Dravet syndrome

Abstract An 11-year old girl with Dravet syndrome presented with recurrent vomiting and abdominal tenderness and distension. Subsequent investigations including ultrasound and gastrointestinal fluoroscopy series showed signs of small bowel obstruction within the right hypogastric abdominal region. Laparotomy revealed three chestnut-phytobezoars in the distal jejunum as cause of intestinal obstruction. This is the first reported case about a mechanical ileus related to a chestnut-phytobezoars in a pediatric patient.

Intestinal Obstruction due to Bezoar in Elderly Patients: Risk Factors and Treatment Results.

Purpose Bezoars are foreign particles from the accumulation of indigestible materials in the gastrointestinal system and a rare cause of mechanical intestinal obstruction. We aimed at investigating differences in risk factors for the development of intestinal obstruction associated with bezoar in elderly patients. Methods Hospital records of patients who underwent surgery associated with phytobezoar between January 2004 and May 2016 were retrospectively evaluated. Patients were divided into two groups [<65 years (Group 1) and ≥65 years (Group 2)]. Data were examined regarding presence of comorbidity, history of abdominal surgery, operation time, bezoar site, surgical technique, length of hospitalization, morbidity, and mortality. Results Of 121 patients enrolled, 48 (39.7%) were male and 73 (60.3%) were female (range: 24-86 years). Group 1 consisted of 69 patients aged < 65, while Group 2 consisted of 52 patients aged ≥ 65. Comorbidity was reported in 52 (42.9%) patients (mostly diabetes mellitus, 20.7%), while 60 patients (49.6%) had history of abdominal surgery (mostly peptic ulcer, 27.3%). No statistical differences were found between the two groups in terms of sex, bezoar site, surgical technique preferred, history of abdominal surgical intervention, pre- and postoperative CT examination, morbidity rates, and length of hospitalization. But, ratio of peptic ulcer operations history, presence of total comorbidity, and time of surgery decision was higher in Group 2 patients. Conclusion In bezoar-related intestinal obstruction, duration and outcome of treatment are not affected by age distribution. Possibility of bezoar should primarily be considered in elderly patients with history of peptic ulcer operation.

Acute colonic pseudo-obstruction after cesarean section: a retrospective analysis of 11 cases

Objective To summary the risk factors, clinical characteristics and treatment of acute colonic pseudo-obstruction (ACPO) after cesarean section(CS). Methods The case group enrolled 11 patients who were diagnosed with ACPO after cesarean section in the First Affiliated Hospital of University of Science and Technology of China from January 2006 to January 2018. Another 55 patients without ACPO after CS, performed within two weeks' difference from the case group, were randomly selected as the control group. Clinical data of all subjects were analyzed retrospectively. Potential clinical risk factors were statistically analyzed. T test, Chi-square test and logistic regression analysis were used for statistical analysis. Results In the case group, the abdominal distension presented on 2 d (n=1), 3 d (n=7), 4 d (n=2) and 17 d (n=1) respectively after CS, and all cases experienced abdominal pain and nausea. Vomiting was reported in some cases. Plain abdominal X-ray images revealed pneumocolon with colon pouch. The maximum diameter of cecum was 6 to 12 cm. Air-liquid levels were observed in two patients. All patients underwent fasting, gastrointestinal decompression, intravenous fluid infusion, correction of electrolyte imbalance, hypertonic saline enema and prophylactic antibiotic treatment. The disease condition lasted two to six days in these patients. Conservative treatment was successful in eight patients and failed in the other three who later went for operations. The maximum cecal diameters in the three patients who underwent surgery were all ≥9 cm, among whom one case progressed quickly and laparotomy was tempted to rule out mechanical intestinal obstruction. In this case, the pressure was successfully reduced by placing a thoracic catheter through the anus after the failure of intestinal puncture trying to release the gases. One patient underwent colostomy due to positive signs of peritoneal irritation after a failure of four-day conservative treatment. One patient suffered a relapse after having been treated conservatively for five days, and then underwent surgeries of resection of ileocecum, distal closure of the colon ascendens plus terminal ileostomy due to intestinal perforation. Multivariate logistic regression analysis showed that higher postoperative leukocyte count (OR=1.38, 95%CI: 1.12-1.71, P=0.003) and postoperative body temperature >38 ℃ (OR=6.47, 95%CI: 1.06-39.61, P=0.044) were the risk factors for ACPO after CS. Conclusions Elevated leukocyte count and body temperature >38 ℃ were two high-risk factors for ACPO after CS. ACPO is characterized by acute onset, and the first choice is conservative management. Active surgical treatment would be required if conservative treatment fails, especially when the maximum diameter of the cecum is ≥ 9 cm, which may increase the incidence of intestinal necrosis or perforation. Key words: Cesarean section; Postoperative complications; Colonic pseudo-obstruction; Intestinal perforation

Gallstone Ileus – A single center case series

Introduction: Gallstone ileus is a rare complication of cholelithiasis that accounts for 1−3% of mechanic ileus of the small bowel. It is characterized by bowel obstruction secondary to gallstone impaction that results from a migration due to the existence of a bilioenteric fistula. Gallstone Ileus is more common in the elderly with more comorbidities which leads to a high morbidity rate. Consequently, a debate exists regarding the appropriate surgical strategy for emergency treatment of gallstone ileus. The aim of the present study was to evaluate different surgical approaches based on the authors’ recent experience and to analyze the clinical outcome. Case Series: Six patients were included, all females, with a mean age of 82 years. All patients had comorbidities, specially, cardiovascular diseases. Three of them had previous history of biliary pathology. Diagnosis was confirmed through computed tomography (CT) scan in five cases. The stone was in the ileum in three, jejunum in two, and duodenum in one patient; the mean stone size was 2.5 cm. Four patients were submitted proximal to enterotomy with the removal of the gallstone, one to gastrotomy and one to cholecystectomy and a cholecystoduodenal fistula closure. During the postoperative period, complications were recorded in three subjects, one patient died due to cerebrovascular accident. Conclusion: The main key in guiding patients with gallstone ileus is the timely diagnosis which is currently facilitated with the support of the use of CT scan. Taking into consideration the age and comorbidities of these patients, the surgical management should be as conservative as possible.

Uterine Gangrene and Mechanical Intestinal Obstruction in a Teenager Following Unsafe Abortion

Uterine Gangrene and Mechanical Intestinal Obstruction in a Teenager Following Unsafe Abortion

Gallstone Ileus: An Uncommon Cause of Acute Abdomen

Gallstone ileus is a rare cause of acute abdomen, representing less than 1% of intestinal obstruction. It is due to mechanical small bowel obstruction (SBO) by a migrated gallstone. we report this observation to illustrate the imaging findings especially in CT scan. A 62-year-old woman was admitted to emergency for acute bowel obstruction. The CT scan has confirmed jejunal bowel distension with fluid levels upstream endoluminal formation which was rounded and well limited, measuring 5 cm of long axis. This training was slightly hyperdense with hypodense areas of fat density. Moreover, there was aerobilia with multiple fistulas between the duodenum (D1) and gallbladder, which was empty. The triad of aerobilia, small bowel obstruction and migrant gallstone was suggestive of gallstone ileus diagnosis. The patient was operated with good evolution. Gallstone ileus is an uncommon presentation of gallstone disease. It is frequently observed in elderly patients with a history of cholelithiasis or cholecystitis. Early diagnosis is crucial and would avoid morbidity and mortality related to this disease. CT scan shows the classical triad of Rigler with pneumobilia, an ectopic stone and mechanical ileus. CT may improve the diagnosis providing important information regarding the exact number, size, and location of ectopic stones and the site of intestinal obstruction or direct visualization of a biliary–enteric fistula, to help clinicians in the therapeutic management of patients.

The torsed intraabdominal testis presenting with a mechanical large intestinal obstruction – A maiden case report

Torsion of an intraabdominal testis is a well-known complication and is usually associated with a testicular malignancy. Torsed intraabdominal testis compressing the large bowel leading to a mechanical gut obstruction is still an unreported entity. A 27 years old young patient presenting with nonspecific abdominal pain after 48 hours of delay. Due to features of gut obstruction, an emergency laparotomy was done. A large torsed intraabdominal testis was found with an empty right scrotum which was compressing the sigmoid colon leading to a complete gut obstruction. Interestingly, two of his siblings also were also suffering from undescended testicles.

Discussing treatment strategies for acute mechanical intestinal obstruction caused by phytobezoar: A single-center retrospective study.

This study aims to discuss management strategies regarding phytobezoar induced ileus based upon clinical results. In the present study, between December 2012 and December 2018, a total of 25 patients who were diagnosed with phytobezoar were evaluated retrospectively. Patients who had acute mechanical intestinal obstruction due to phytobezoars at different segments of gastrointestinal (GI) tract were included in this study. The clinical data (such as clinical findings, laboratory results, radiological evaluations, treatment methods) of the patients were examined. Twenty five patients were included in this study. Of the 25 patients, 13 were women (52%). The median age was 60 (31-84) years, and the overall median length of the stay was 7 (2-28) days. Previous abdominal surgery had been recorded for 13 patients (72%). Two patients (8%) were followed up conservatively, whereas 20 (80%) patients had needed surgical intervention. One (4%) patient underwent surgery for distal ileal obstruction due to the pieces of bezoar that crumbled with previous endoscopic intervention. Three of the patients had complications, such as surgical site infection, wound dehiscence and paralytic ileus in the postoperative period. There were no differences between milking and gastrotomy/enterotomy groups according to the length of stay and postoperative complications. One patient died on the 13th postoperative day due to multi-organ failure. The mortality rate was 4%. Phytobezoars, which are common with many other different surgical entities, can be located at any segment of the gastrointestinal tract and may cause obstruction, strangulation and/or even perforation. Contrast-enhanced CT scan must be performed in case of suspicion and to rule out any other causes of acute mechanical intestinal obstruction. Conservative and endoscopic procedures may be useful for selected patients, but the surgical treatment may be needed for the vast majority of the patients with phytobezoar. The surgery is safe for phytobezoar if the enterotomy site is chosen wisely.

Acute Intestinal Obstruction in an Adult Patient Due to Ladd’s Band: A Case Report

Introduction: In adult patients some adhesions between intestinal segments and malignities are common in the ethiology of mechanic intestinal obstruction whereas congenital anomalies are seen rare. In this case report we present a 60-year-old patient presents with mechanical bowel obstruction symptoms and diagnosed as Ladd's bands. Case presentation: A 60-year-old male applies emergency servise with vomiting and nausea. According to the laboratory and radiological tests the paient was diagnosed as mechanical bowel obstruction and underwent exploratory laparatomy. In exploration Ladd's band was seen and cut for releasing the herniated intestinal segments. Discussion: Congenital anomalies of intestinal rotation are often seen in infants and children therefore this pathology can be missed in adult patients. We must be aware of these pathologies on the way of diagnosis of the patients with mechanical bowel obstruction.