Mechanical Intestinal Obstruction Research Articles

Single-stage laparoscopic treatment of a cholecystoduodenal fistula with perforated small bowel ileus and fibrinous purulent peritonitis. A single case study

Gallstone ileus is a rare complication of recurrent cholecystitis and one of the rarest causes of mechanical bowel obstruction, with an increasing incidence in the elderly. We present a case of multiple small bowel perforations of the jejunum due to gallstone obstruction and the incidental finding of high‑grade appendiceal mucinous neoplasia of the appendix. To our knowledge, this is the first such case to be described and completely resolved by a laparoscopic approach.
 An 83‑year‑old woman presented to our emergency department with severe vomiting, constipation, and deterioration of her general condition. A computed tomography scan revealed thickening of the gallbladder with a continuous aerobe to the duodenum, a mechanical obstruction of the small intestine at the transition to the ileum, and a thickened and calcified appendix. Due to a high suspicion of gallbladder perforation with the formation of a bilio‑duodenal fistula, the patient underwent an emergency exploratory laparoscopy, which revealed a small bowel perforation in three segments with marked local fibrinous, purulent, and stercoral peritonitis of the left hemiabdomen. The gallstone was retrieved through the perforated small bowel, and a partial small bowel resection and a cecal wedge resection were performed laparoscopically. Small bowel continuity was restored with an anisoperistaltic side‑to‑side jejuno‑jejunostomy. The patient was discharged on postoperative day eight.
 Despite advances in imaging, gallstone ileus remains a diagnostic challenge. Because the disease occurs predominantly in elderly patients, gallstone ileus remains associated with high morbidity and mortality. It remains unclear from the literature whether the optimal surgical management of bilioenteric fistula is best resolved by a single‑stage or a two‑stage approach.

Direct peritoneal resuscitation in a patient with gastrointestinal tuberculosis with an open abdomen

Rationale/objectivesThis case report aims to illustrate the methodology involved in the management of a patient with gastrointestinal tuberculosis with an open abdomen with direct peritoneal resuscitation. We present a 49-year-old malnourished male, in septic shock, who presented with mechanical intestinal obstruction from gastrointestinal tuberculosis (GITB) and required delayed abdominal closure. Direct peritoneal resuscitation (DPR) was employed as an adjunct to shorten the interval to closure by reducing organ edema and inflammatory cytokine levels. MethodsThis is a case report describing the procedure of direct peritoneal resuscitation and its use in non-trauma related surgeries requiring delayed abdominal closure. ResultsThe patient recovered well from the surgery with the abdomen closed after nine days from the first procedure. ConclusionDirect peritoneal resuscitation is a viable adjunct in patients requiring delayed abdominal closure.

Long-Term Survival in 241 Cases of Intussusception in Cattle and Factors Associated with Mortality.

Intussusception is a frequent cause of mechanical ileus in cattle. Long-term survival has never been described and risk factors for mortality are scarcely documented. A retrospective cohort study on 241 cattle was conducted to determine survival of intussusception and identify risk factors for mortality. Clinical records were matched with the national cattle identification database. Information on possible predictors including clinical examination, ultrasonography, blood-gas analysis and surgery were collected. Survival analysis and decision tree analysis were used. Overall survival was 44.8% until discharge. Of all animals, 39.0% could complete their life cycle and were eligible for slaughter. Male animals and cattle < 226 days old experienced a significantly higher mortality risk (hazard ratio [HR] = 2.1; 95% confidence interval [CI] = 1.4-3.0 and HR = 2.4; 95% CI = 1.7-3.4, respectively). The final model consisted of heart rate (>95 beats per minute) and packed cell volume (<36.5%) with sensitivity and specificity of 60.4% and 49.4%, respectively. A second model consisted of sex (male) and time to referral (>4.5 days) with sensitivity and specificity of 88.0% and 65.6%, respectively. The long-term prognosis for intussusception in cattle appears to be fair. Factors identified in this study may aid in the decision-making process in cases with presumed intussusception to perform the surgery or opt for euthanasia.

Sigmoid Lipoma as an Exceptional Cause of Intussusception and Bowel Obstruction in Adults: A Case Report and Review of Literature

This case report describes a 60-year-old man who presented with acute abdominal pain with marked abdominal distention and red rectal bleeding. A contrast-enhanced abdominal CT scan was performed, which revealed a recto-sigmoid intussusception on lipoma, causing mechanical intestinal obstruction. The patient underwent a partial reduction of the intussusception with partial sigmoid resection and end colostomy. And histologic evaluation confirmed the diagnosis of colonic lipoma. Intussusception of the colon is uncommon in adults and is often associated with malignancy, but other nonmalignant causes such as lipoma may also present with obstructive symptoms, abdominal pain, and rectal bleeding. However, it should be a differential diagnosis of such situations.

Abdominal cocoon syndrome (ACS): a case report of a Chinese male diagnosed idiopathic ACS with inborn short intestine

Introduction and importance: Abdominal cocoon syndrome (ACS), as a rare cause of mechanical intestinal obstruction, can be divided into primary/idiopathic vs. secondary type. The primary ACS is often asymptomatic and only diagnosed in exploratory laparotomy. The major treatment of surgery can be challenging. Since the gut wall and peritoneum are densely adhered, gut perforation might occur during adhesiolysis. Thus, it is important to have an experienced surgeon to perform the surgery. Case presentation: The authors present a primary ACS case of a 50-year-old man. The patient demonstrated an unbearable upper abdominal pain upon admission. A computed tomography (CT) scan showed a severe bowel obstruction. An exploratory laparotomy was indicated, leading to the diagnosis of ACS, which was considered idiopathic after ruling out secondary factors. An adhesiolysis was performed successfully. Note that the entire intestine measured was only 2.1 m during the surgery. There was no post-surgical complication. The patient was recovered uneventfully. Clinical discussion: The aetiology of primary ACS is unknown. The incidence is comparatively low and considered equal between men and women. As a rare cause of gut obstruction, the suspicion of the diagnosis should be strengthened. Surgery including adhesiolysis and bowel resection remains the major treatment. If adhesiolysis fails, bowel resection will be inevitable. The knowledge and experience of surgeon will be tested. Conclusion: The aetiology of primary ACS should be further explored. And the differential diagnosis of bowel obstruction should cover ACS in order for the surgeon to be prepared before surgery.

A Case of Mechanical Intestinal Obstruction Combined with Hepatic Portal Vein Gas Accumulation

A Case of Mechanical Intestinal Obstruction Combined with Hepatic Portal Vein Gas Accumulation

A Rare Presentation of Intestinal Obstruction: Gall Stone Ileus

Gallstone ileus is a mechanical intestinal obstruction due to gallstone impaction within the gastrointestinal tract.1 It is an unusual complication of cholelithiasis, occurring in fewer than 0.5 percent of patients.2 Typically as a result of the formation of cholecysto-duodenal fistula, surgical removal of the gallstone is the mainstay of treatment in order to relieve the intestinal obstruction. Objective: To know about this rare diagnosis so that one can keep it as a differential diagnosis for intestinal obstruction and thus manage accourdingly. Keywords: Intestinal obstruction, Gallstone ileus, Bouveret’s syndrome, Cholecystoduodenal fistula, Bilio-enteric fistula.

Acute mechanical intestinal obstruction due to lung cancer metastasis

Acute mechanical intestinal obstruction due to lung cancer metastasis

Ileus conditions after rectal and Hartmann's resections.

Bowel obstruction is one of the most common postoperative complications in pelvic surgery. In most cases, adhesive mechanical ileus of the small bowel is the cause. In procedures such as Hartmann's resection or abdominoperineal rectal resection, it seems that the large wound area on the pelvic walls and pelvic floor and the dead space after the removed rectum with mesorectum contribute to the ileus condition. The aim of this paper was to identify the risk factors for ileus after selected pelvic procedures and to map the possible ways of prevention and treatment of these complications. We performed retrospective simple analysis of a set of 98 patients who underwent elective abdominoperineal resection of the rectum, pelvic exenteration or Hartmann's resection for rectal cancer between 2017-2022. Postoperative complications were recorded, especially bowel obstruction, and perineal wound or rectal stump healing complications. In all 9 patients, who needed reoperation, we searched for risk factors for ileus known from the literature. We also described the management of ileus. In the group of 9 patients subjected to detailed analysis, 8 risk factors were most common: male gender, obesity, history of radiotherapy, open surgery, requirement of adhesiolysis in primary surgery, large blood loss, difficult dissection, and impaired healing of the rectal stump/perineum. A total of 8 (88.9%) patients had a combination of 4 or more of the mentioned risk factors. Our results confirm the impact of risk factors known from the literature; furthermore, they indicate a connection with the formation of a dead space in the pelvis and with complications of the rectal stump or perineal wound healing. Some of the risk factors cannot be changed, and current preventive measures cannot completely prevent the formation of adhesions. It is therefore advisable to look for other materials and methods that would ideally limit the formation of adhesions and at the same time fill the dead space and thus separate it from the perineal wound.

Online Instructional Module Improves Student Ability to Evaluate for Radiographic Small Intestinal Obstruction in Dogs

Radiographic diagnosis of mechanical small intestinal obstruction in dogs is a common and important skill for the small animal practitioner; however, developing skills in this area is challenging. Feedback and practice are both essential to increasing accuracy in interpretation, which can be maximized with focused, self-paced training. We aimed to characterize the efficacy of a self-paced, online module in improving student skill and confidence in interpretation of radiographic small intestinal obstruction in dogs. An instructional module was developed using a series of abdominal radiographs of dogs with and without small intestinal mechanical obstruction; the module allows students to form a diagnosis and then provides feedback on each case. Before and after using the module, 32 veterinary students completed a survey and 20-case abdominal radiograph quiz. This quiz presented 20 abdominal radiograph cases and asked if each radiographic series demonstrated small intestinal mechanical obstruction and the student's confidence level in the diagnosis. Prior to completing the module, average quiz accuracy was 64%; this accuracy increased to 83% after completing the module. Student confidence in their diagnosis also increased post-module completion. On surveys, students had a low initial confidence in their ability to accurately interpret normal versus small intestinal obstruction via abdominal radiographs; confidence improved on the post-module survey. Students made positive comments regarding the module and reviewed it positively as a learning experience. This instructional module appears to be a successful way to teach and reinforce radiographic interpretation skills for small intestinal obstruction in dogs.

INCIDENCE OF ABDOMINAL TUBERCULOSIS IN CASES OF THE INTESTINAL OBSTRUCTION WITH ITS CLINICAL COURSE AND MANAGEMENT

Objective: Intestinal obstruction occurs due to the failure of passage of contents through intestine. It can be because of a mechanical or functional pathology. Main causes of intestinal obstruction may vary from country to country or among zones within a specific country. The aim of this study was to evaluate the etiology, presentation, management strategies, and patients with acute mechanical intestinal obstruction and to find incidence of abdominal tuberculosis at a tertiary care hospital in Punjab, North India. Methods: This prospective study was conducted in the Department of Surgery, Rajindra Medical College Hospital, Patiala, Punjab, India, between November 2020 and September 2022. A total of 100 patients were enrolled in our study who were diagnosed to have intestinal obstruction. Observation and Results: The most common age group affected was 21–50 years (63%). Intestinal obstruction was diagnosed with males preponderance (66%). Abdominal pain, constipation, and vomiting were the most common presenting symptoms and abdominal distension was the most common physical finding on the clinical examination. The most common radiological finding was multiple air fluid levels seen on X rays. The main cause of obstruction was Adhesions and Bands followed by Ileocecal tuberculosis. About 13% patients diagnosed with abdominal tuberculosis. Patients showed good response to anti-tubercular therapy. About 6% mortality rate was reported. Conclusion: Adhesions and bands were the main causes of acute intestinal obstruction in our region. An algorithmic diagnostic approach based on different radio investigations, biopsy, and appropriate management with a rational combination of anti-tubercular therapy can reduce the morbidity of this easily curable yet potentially lethal disease.

Small bowel volvulus (SBV) due to multiple adhesion in the small intestine: A case report

Introduction: Small bowel volvulus (SBV) is a rare but significant cause of small intestinal obstruction. Ischemia or even infarction is frequently the result. Morbidity and death rates rise when surgical intervention and diagnosis are delayed. Volvulus is a special form of mechanical intestinal obstruction. It happens when a loop of small intestine twists abnormally around the axis of its mesentery. An acute abdomen is a clinical presentation. The bowel itself may become constricted, strangulation of the blood supply, or both may be the source of the symptoms. Case Description: A-49-year old female patient was delivered to the emergency department because of severe pain around her abdomen that lasted for one day with a bloated abdomen. Other symptoms she complained of were nausea, vomiting, fever and constipation since one day before hospitalization. She was transferred to the medical ward and initially diagnosed with abdominal pain due to severe dyspepsia. After four days, her complaints were not improved, and she was diagnosed with intraabdominal obstruction and decided to undergo an emergency laparotomy. During surgery, there was a small bowel volvulus due to multiple adhesion in the small intestine, which caused all of her symptoms. After total 8 days of hospitalization, the patient was finally discharged. Conclusion: Diagnosing SBV can be difficult, especially if the sign of ileus obstruction is not yet fully developed. Early diagnosis and suspicion are pivotal in SBV because a delay in the surgical treatment can be disastrous.

Gallstone Ileus: A Stone In The Way

Gallstone ileus, a rare complication of cholelithiasis, is caused by an impaction of gallstones within the gastrointestinal tract leading to mechanical intestinal obstruction. Here in, we describe a case of gallstone ileus in a 62-year-old woman successfully treated with enterolithotomy. The patient was discharged home after an uneventful post-operative period. Gallstone ileus is an uncommon complication of gallstones and a rare cause of intestinal obstruction, with often delayed presentation and non-specific symptoms. The preferred approach is enterolithotomy. Elective cholecystectomy after the acute episode is controversial.

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.

A duodenal diverticulum in a deerhound

AbstractA 23‐month‐old, spayed, female deerhound experienced an acute onset of anorexia and regurgitation. The initial regurgitant contained leaves and grass, but over the next 24 hours, it changed to dark brown granular material consistent with digested blood. Radiography revealed a dilated segment of bowel caudal to the liver, suggesting mechanical or functional intestinal obstruction. Exploratory laparotomy revealed a roughly spherical, 6‐cm diameter diverticulum in the proximal duodenum, which was removed by resection and anastomosis. The dog made an uneventful recovery. To date, duodenal diverticula have been reported predominantly in young Boxers. This is the first report of a duodenal diverticulum in a deerhound.

Acute intestinal pseudo-obstruction secondary to Sjogren’s syndrome in pregnancy: a case report and literature review

BackgroundIntestinal pseudo-obstruction (IPO) is a rare disease, and its clinical manifestations can resemble mechanical intestinal obstruction leading to unnecessary and potentially harmful surgery. Certain autoimmune diseases have been associated with IPO, however, cases secondary to Sjögren’s syndrome (SjS) are especially rare.Case presentationWe described the first case of SjS-associated acute IPO in pregnancy, which was successfully treated with combined immunosuppressive therapy and resulted in an uneventful caesarean delivery.ConclusionsWomen with SjS is likely to experience more complications during pregnancy, and IPO rather than the classic symptoms could be the first sign of SjS flares. IPO should be suspected in patients with unrelenting symptoms of small bowel obstruction, and a multidisciplinary approach can provide optimal management of such high-risk pregnancies.

P-089 OBTURATOR HERNIA: A RARE CASE OF INTESTINAL OBSTRUCTION REQUIRING SEVERAL TYPES OF TREATMENT

Abstract Background Obturator hernia is infrequent (incidence 1%). This condition usually occurs in older, multiparous women. Case Report We report two cases of this pathology: The first one deals with a woman that presents insidious abdominal pain, who underwent an abdominal CT scan compatible with mechanical intestinal obstruction secondary to present the ileum trapped in a right obturator hernia. Treatment consisted of a laparoscopic approach creating a peritoneal flap, hernioplasty with polypropylene mesh and closure of the flap with V-lock 3/0. The last one is about an elderly woman who presents nausea and vomiting accompanied by severe pain in the left lower limb. An abdominal CT scan was performed, which revealed a distal jejunal loop into the left obturator accompanied by intestinal obstruction. Open henioplasty was performed due to significant adhesive syndrome. The hernia sac was reduced, preperitoneal plug was placed and the orifice was closed with vycril suture. Discussion Diagnosis is complex due to the characteristics of the patients. There are 3 signs of strangulated hernia: obturator neuralgia, pain in the medial thigh due to obturator nerve compression and the absence of the adductor reflex in the thigh. The most accurate diagnostic test is the CT scan. Three treatment techniques are described: transabdominal, extraperitoneal and laparoscopic. Conclusion Despite of obturator hernia is not a frequent cause of intestinal obstruction, we should consider the laparoscopic approach as an option with fewer postoperative complications, when possible.

OC-123 COMPARISON OF COMPLICATION RATES BETWEEN INTRA- AND EXTRAPERITONEAL HERNIA REPAIRS

Abstract Aim With the emergence of new laparoscopic techniques, Intra-Peritoneal-Onlay-Mesh (IPOM) has fallen out of favor for repairing abdominal wall hernias due to reported complications, including adhesions and bowel injury, our aim is to compare complication rates in our center between intra- and extraperitoneal techniques. Material &amp; Methods A retrospective analysis was conducted on data from our certified hernia center from 2018 to 2021. All patients who underwent an umbilical, epigastric or incisional hernia-repair were included. The primary outcome measures were complications, including bowel injury and adhesions. Results A total of 188 patients underwent a hernia repair. 74 (39%) patients hat an umbilical hernia, 22 (12%) an epigastric hernia and 92 (49%) had an incisional hernia. Most patients (110–58%) were treated with laparoscopic IPOM, 14 (7,4%) of them underwent an open IPOM. 46 (25%) had hernias repaired with direct suture and the remaining patients were treated with other techniques, including open sublay and mini or less open sublay (MILOS). After an average follow-up of 36months, only two (1%) patients developed a mechanical ileus, one after laparoscopic and one after open IPOM surgery. Bowel lesions occurred in two (1%) patients who underwent open IPOM and direct suture hernia repairs. There was no difference in complications between the different surgical techniques. Conclusion Our study suggests that the different techniques for hernia repair have similar rates of complications. Further research is needed to determine the most effective and safe approach for hernia repair.

Gallstone Ileus with A Typical Clinical Presentation: A Case Repor

Introduction: Gallstone ileus is a rare complication of cholelithiasis, described as a mechanical intestinal obstruction due to the impaction of one or more large gallstones within the gastrointestinal tract. It is caused by the passage of a gallstone from the bile ducts into the intestinal lumen through a fistula. The most frequent type of fistula is located between the gallbladder and the duodenum. Clinical Case: A 60-year-old male was admitted with a diagnosis of DM 2 / hypovolemic shock / upper gastrointestinal bleeding. Began 24 h before admission, presented asthenia, adynamia, hyporexia, tolerating only a liquid diet, 3 vomits of gastric contents and one melenic evacuation. level of care for surveillance and diagnostic protocol, upon admission to this hospital he presented vomiting in coffee grounds and hypotension that responded to intravenous fluids. An exploratory laparotomy was performed, finding: obstruction of the small intestine by a gallstone of approximately 7 cm in diameter at 170 cm from the angle of Treitz, reactive appendicitis, and abundant inflammatory reaction fluid; Enterolithotomy + primary closure was performed with the Heineke-Mikulikcz technique and a Penrose drain was placed into the pelvic cavity. Discussion: Intestinal obstruction caused by gallstones is rare, this event occurs more frequently in the elderly. The clinical picture is often diffuse and requires a high index of suspicion. Conventional radiography can be of great help for its diagnosis, but also Abdominal Ultrasound and Computerized Axial Tomography. Surgical treatment can range from enterotomy and lithotomy, which is the simplest, to enterotomy with lithotomy plus cholecystectomy, and fistula treatment, which is a complex procedure.

A Rare Cause of Acute Mechanical Intestinal Obstruction: Spontaneous Posterior Rectus Sheath Hernia—Case Report

A Rare Cause of Acute Mechanical Intestinal Obstruction: Spontaneous Posterior Rectus Sheath Hernia—Case Report