Mechanical Small Bowel Obstruction Research Articles

TAKOTSUBO SYNDROME AND SMALL BOWEL OBSTRUCTION: WHEN THE HEART–GUT AXIS GOES HAYWIRE

Abstract Case Report A 66 years old woman was admitted to our emergency department for the onset of intense epigastric pain, nausea and asthenia after breakfast. She had a history of hypertension, dyslipidemia, COPD and deep venous thrombosis with MTHFR gene mutation. Moreover, she had a positive family history for coronary artery disease (CAD). On arrival, she was apyretic, hemodynamically stable, complaining chest and persisting epigastric pain. A mild and diffuse abdominal tenderness was noted without peritoneal signs. The ECG showed sinus tachycardia, ST elevation (STE) in leads D1, aVL, V2 and V3 and ST depression in leads D3, aVR and V1. Blood test revealed a marked increase of PCR with leukocytosis and elevation of Hs–cTnI (840 ng/L) while serum electrolytes were normal. Bed–side echocardiography revealed apical and mid–ventricular akinesia with a severe reduction of left ventricular ejection fraction (LVEF). InterTAK score was 62 (62,6% probability of Takotsubo syndrome – TTS). An urgent coronary angiography (CA) revealed non– obstructive CAD, while ventriculography showed a typical apical ballooning and hyperkinetic base of the LV suggestive of TTS. Subsequently, the CT abdomen showed extra–luminal free fluid and a dilated proximal small bowel (SB) with air–fluid levels and a bubbly pattern of gas in the wall. These radiological findings were consistent with a mechanical SB obstruction, complicated by mesenteric venous thrombosis and intestinal pneumatosis. Exploratory laparotomy revealed SB necrosis as consequence of bridle–mediated obstruction and therefore an ileum resection was performed. The patient clinically improved post–operatively with a complete recovery of the LVEF. Discussion We described a rare presentation of SB obstruction which induced a TTS in a setting of severe psychophysical stress. The management of this emergency situation in which cardiac injury and acute abdomen occurred simultaneously can be challenging. The consulting cardiologist needs to quickly decide whether to prioritize the heart with urgent CA or the gastroenteric condition with surgery. Despite the likelihood of TTS can be high (even calculating InterTak score), new STE and positive troponins can’t be disregarded especially in patients with significant risk factors as seen in our case. Therefore, the strong evidence of a possible acute coronary syndrome may trump a life–saving treatment for SB obstruction.

Endo the line: stricturing terminal ileum endometriosis

Endometriosis is the implantation and proliferation of endometrial tissue outside the uterus, and while involvement of the small bowel is rare, it is particularly unusual for it to present with terminal ileum stricture mimicking Crohn’s ileitis. We present the case of a 38-year-old female with recurrent mechanical small bowel obstruction with transition point in the terminal ileum. She was struggling with infertility issues and was not previously known to have endometriosis. The presumptive diagnosis was Crohn’s disease due history of previous anal fissure, high faecal calprotectin level, and imaging findings of terminal ileitis with stricture, despite lacking tissue confirmation from colonoscopy. She underwent laparoscopic ileocolic resection with histology showing endometrial stricture and secondary mucosal inflammation, without any established features of Crohn’s disease. This case demonstrates the potential diversity in presentation of endometriosis, including small bowel manifestations that can mimic Crohn’s ileitis. If endometrioma can be confidently diagnosed based on characteristic imaging features or tissue sample, unnecessary treatment may be avoided, whilst appropriate specialist management improves endometriosis symptoms and fertility outcomes.

The Gallstone Ileus, a Retrospective Study and Review of the Literature

Introduction: Gallstone ileus (GI) is a rare complication of cholelithiasis and is one of the most irregular forms of all mechanical bowel obstructions. It is, however, a more common cause of non-strangulating mechanical small bowel obstruction, accounting for 1% to 4% of all patients and up to 25% in the elderly.
 The diagnosis is often delayed since symptoms may be intermittent, and investigations may fail to identify the cause of the obstruction. As a result, gallstone ileus continues to be associated with relatively high rates of morbidity and mortality.
 The cornerstone of healing is the removal of the stone that represents obstruction. As is the case with cholelithiasis, women are more frequently affected.
 Material and Methods: This article aims to review the incidence of gallstone ileus in our country in the literature, addressing the pathophysiology, clinical presentation, radiological findings, and treatment options. A literature search was done on gallstone ileus for 2005-2018.
 Results: The patients in the study presentation were both genders and older. They all came to INP because of abdominal pain and general nausea. All had CRP elevation present. Leukocytosis was present in only 2/3 of patients. AST was elevated in one patient and ALT in 2. All changes in laboratory parameters indicate the instability of marker changes and, consequently, the unreliability of use alone without other diagnostic methods. A CT scan was performed on all three patients, but one still needed to be uploaded to the system at the time of writing.
 Conclusions: Ileus due to gallstones is a rare disease. It is an uncommon cause of mechanical small bowel obstruction. It is a rare complication of chronic cholecystitis and occurs when a gallstone passes through a fistula between the gallbladder and small bowel before becoming impacted at the ileocecal valve. The use of radiological imaging is invaluable in the diagnosis of gallstone ileus. These authors recommend a low threshold for investigation. There is evidence for using AXR as a quick first-line investigation; however, CT scanning is a powerful and gold-standard tool to diagnose the condition and guide its management.

193 A rare cause of small bowel obstruction- Obturator Hernia

Abstract Obturator hernias are clinically challenging to diagnose, and the incidence reported in the medical literature is between 0.05% to 2.2%. This is commonly seen in thin, elderly female patients. Computed tomography is the gold standard for diagnosis. The mortality has been reported as 12-70%. Here, we present a 90-year-old female with complaints of abdomen pain, distention, vomiting and bowels not opening for a few days. She had a background of severe frailty, poor mobility and comorbidities such as hyperlipidaemia and mild cognitive disorder. On clinical examination, her abdomen was distended on examination with diffuse tenderness. Her blood investigations were normal, apart from CRP 26mg/L. Her abdominal X-Ray showed dilated loops of small bowel in the central abdomen. Computed tomography of the abdomen and pelvis showed high-grade mechanical distal small bowel obstruction with a transition point to probably in the right iliac fossa. She had an emergency laparotomy and was found to have an obturator hernia with bruised but viable small bowel. Hernial contents reduced. Postoperatively she developed hospital-acquired pneumonia, for which she was treated with antibiotics and later discharged. It is a rare case with a high chance of getting missed on clinical examination. In case of diagnostic uncertainty, CT should be promptly performed. Knowledge about this rare acute surgical condition is required for clinical suspicion, appropriate investigation and diagnosis, as the mortality is high.

Unenhanced CT-based predictive model to identify small bowel necrosis in patients with mechanical small bowel obstruction

ObjectivesTo investigate the diagnostic value of unenhanced CT in mechanical small bowel obstruction (SBO) with small bowel necrosis, and to establish a predictive model.MethodsFrom May 2017 to December 2021, the patients with mechanical SBO admitted to our hospital were retrospectively collected. Taking pathology-confirmed small bowel necrosis as the gold standard, the experimental group was composed of patients with small bowel necrosis confirmed by pathology, and the control group was composed of patients with no intestinal necrosis confirmed by surgery or successful conservative treatment with no recurrence of intestinal obstruction during 1-month followed-up.ResultsA total of 182 patients were enrolled in this study, 157 patients underwent surgery, of which 35 patients were accompanied with small bowel necrosis and 122 patients were not (33 patients with ischemic findings at surgery without necrosis). Finally, there were 35 patients in the experimental group and 147 patients in the control group. Multivariable logistic regression showed that increased attenuation of small bowel wall (P = 0.002), diffuse mesenteric haziness (P = 0.010), difference of CT value between mesenteric vessel and aorta (P = 0.025) and U-/C-shaped small bowel loop (P = 0.010) were independent risk factors for the diagnosis of mechanical SBO with small bowel necrosis. Through internal verification, the area under curve (AUC) of the predictive model reached 0.886 (95%CI: 0.824–0.947), and the calibration result was moderate.ConclusionMultiple features (increased attenuation of small bowel wall; difference of CT values between mesenteric vessel and aorta; diffuse mesenteric haziness; and U-/C-shaped small bowel loop) of unenhanced CT have clinical value in the diagnosis of mechanical SBO with small bowel necrosis. The predictive model based on these four features could achieve satisfactory efficiency.

Mechanical Small Bowel Obstruction Incidence, Causes, Signs, and Symptoms in Al – Yarmouk Teaching Hospital

Objectives: To assess causes, signs & symptoms of mechanical obstruction of the small bowel. Background: Mechanical obstruction of the small bowel is a common clinical and surgical condition, often presenting with signs and symptoms like those seen in other acute abdominal disorders controversy remains as to which patients with small bowel obstruction need immediate surgical intervention and which may be managed conservatively. Patients and Methods: A prospective study to assess incidence, causes, signs, and symptoms among ninety-two patients undergoing surgeries due to mechanical small bowel obstruction in Al-Yarmouk Teaching Hospital. In a period between October 2016 and October 2017 patients have divided into two groups 1 patients had surgery during the first 24hr from the start of signs & symptoms and a group of 2 patients had surgery after 24hr since the beginning of signs & symptoms. Results: Among ninety-two patients included in this study the result was 54 male (58.7%) and 38 female (41.3%). Patients with the previous scar were 62 cases (67.4%). The most common causes of MOSB were adhesions (63%), obstructed hernia (29.3%) most common type was inguinal hernia (16.3%), tumors (4.34%) and other causes were Crohn’s, bezoar, and intussuscept. Conclusion: Mechanical obstruction. The small bowel is a severe condition and moderately common in cases of acute abdomen adhesions were the commonest cause of MOSB also a high incidence of strangulation was seen in obstructed hernia, and patients generally present with abdominal pain, nausea and emesis, abdominal distension, and progressive obstipation, the clinical finding of high fever. Localized or generalized severe abdominal tenderness, rebound tenderness, severe leukocytosis, or metabolic changes suggest possible complications of bowel necrosis, perforation, or generalized peritonitis. MSBO is usually suggested by plain abdominal radiographs and confirmed by a CT scan.

Broad ligament hernia: A rare condition causing small bowel obstruction

Dear Editor, Small bowel obstruction (SBO) is a condition characterized by intraluminal flow blockage caused by several etiologies. Postlaparotomy adhesion, incarcerated hernia, and neoplasm are the top 3 causes of SBO. Internal herniation, though rare, accounts for approximately 1% of SBO. Broad ligament hernia is an even more unusual form of internal herniation, reported in 4%–5% of internal herniation cases. Here, we report a case of broad ligament herniation, leading to strangulated SBO. A 68-year-old multiparity woman without history of abdominal surgery presented to the emergency department with acute onset of lower abdominal pain. The pain was intermittent, colicky, located on the infraumbilical region, lasting for 6 hours before she sought medical attention, and did not respond to analgesics. At triage, vital signs were relatively stable, except blood pressure of 188/81 mm Hg. Physical examination showed tenderness over the left lower quadrant and hypoactive bowel sound. Hemogram, liver function, and renal function were within normal limits, except for a slightly elevated serum lactate level of 13.2 mg/dL. Supine kidney, ureter, and bladder radiograph showed a mildly dilated bowel loop. The initial impression was ileus, and she was kept on bowel rest with intravenous fluid repletion after an enema. After 24 hours of medical treatment, her symptoms persisted with several vomiting bouts. Muscle guarding over the left lower quadrant of abdomen was noted. Contrast-enhanced computed tomography showed disclosing diffuse loop dilatation of the small intestine with the transitional zone in the pelvic region and a moderate amount of ascites. Under the impression of SBO, she underwent emergent exploratory laparotomy. Internal herniation of the small intestine into a 3-cm defect in the left broad ligament was found, resulting in strangulation of the small bowel measured approximately 40 cm in length. The nonviable segment of the small intestine was resected and anastomosed via hand-sewn method. In addition, the defect of the left broad ligament was repaired, and the right-sided broad ligament was examined as well. The patient had an uneventful postoperative recovery and was discharged on postoperative day 9. There are several classification systems regarding broad ligament herniation, which is summarized in Supplementary Data, https://links.lww.com/FJSS/A4. Computed tomography is the imaging modality of choice. Mechanical SBO with double transitional zone, bowel loops herniated beside the uterus with slight deviation of uterus to the contralateral side, enlargement of the distance between the uterus and one of the ovaries, and presence of free fluid in the pelvis would lead to suspicion of broad ligament herniation.[1] A standard therapeutic intervention has not yet been established.[2] Diagnostic laparoscopy could be performed if the preoperative diagnosis is uncertain. Once the broad ligament defect with internal herniation has been found, it can be managed with the laparoscopic approach. However, laparoscopic surgery is contraindicated in the following situations: when the diameter of small bowel is greater than 4 cm, there is evidence of bowel ischemia, history of severe adhesion, or presence of inflammatory bowel disease.[3] In conclusion, broad ligament hernia should be considered one of the differential diagnoses in a multiparity woman without previous surgical history, presenting with SBO. Early diagnosis and timely surgical intervention may reduce the likelihood of morbidity and mortality.

Bowel obstruction secondary to internal hernia in a hereditary angioedema patient: a case report

BackgroundGastrointestinal attacks are frequent symptoms in patients diagnosed with hereditary angioedema (HAE). Cases of self-limited bowel intussusception and unneeded exploratory laparotomy due to lack of knowledge about HAE have been reported. Furthermore, after the introduction of C1-esterase inhibitor (C1-INH) concentrate, the recommended medication for HAE attacks, treatment has become typically medical in nature. We share a rare case where operative exploration was indicated to resolve a mechanical small bowel obstruction secondary to an HAE attack.Case reportAn 80-year-old woman with HAE presented with lower left abdominal pain, vomiting, and nausea. Computed tomography (CT) showed edema of the small bowel and stomach as well as possible signs of mechanical small bowel obstruction. The patient was treated with C1-INH concentrate but showed only mild signs of relief, warranting diagnostic laparoscopy. Intraoperative findings showed internal herniation and strangulation of the small bowel caused by adhesions forming a band. After surgical intervention, no bowel resection was needed.ConclusionAlthough C1-INH concentrate remains the principal treatment for HAE, gastrointestinal attacks may potentially cause surgical emergencies.

MESODIVERTICULAR BAND OF MECKELS DIVERTICULUM CAUSING INTERNAL HERNIATION ANDINTESTINAL OBSTRUCTION IN A GERIATRIC MALE

Background - Meckels diverticulum is a congenital malformation caused by malabsorption of the yolk intestine. It has been reported that the left and right yolk arteries, which are nutrient vessels, can become mesodiverticular bands and cause intestinal obstruction in symptomatic Meckels diverticulum.Intestinalobstruction due to meso-diverticular band of Meckels diverticulum is one of the rarest complications of Meckels diverticulum.Mesodiverticular band is a rarely reported cause of small bowel obstruction in Meckels diverticulum in geriatric population in medical history. Case report - We present a 78 years old male presenting as acute intestinal obstruction caused by meso-diverticular band adhesion causing obstruction. Xray abdomen showed multiple air fluid levels suggestive of intestinal obstruction and emergency laparotomy was done which showed that the cause of intestinal obstruction was mesodiverticular band adherent to Meckels diverticulum causing internal herniation and obstruction in intestinal loops. Adhesiolysis was done and Meckels diverticulum was resected along with the mesodiverticular band. The patient recovered well. Summary - The mesodiverticular band of Meckels diverticulum causing mechanical small bowel obstruction is a rare complication of this congenital anomaly. It should be considered in the differential diagnosis of a small bowel obstruction.

Appendiceal Tourniquet, an extremely rare condition with an equally rare presentation: A case report and an integrative review

Small bowel obstruction is a common surgical emergency and needs timely intervention to prevent the development of complications. Acute appendicitis is a very rare, uncommon, and unnoticed cause of intestinal obstruction. Although functional obstruction due to paralytic ileus is common in acute appendicitis, mechanical obstruction is a fairly uncommon complication of this extremely prevalent disease. Furthermore, a normal appendix causing full-blown small bowel obstruction due to the tourniquet effect on the terminal ileum is exceptionally rare and the diagnosis is often overlooked. This work report on an extremely rare case of mechanical small bowel obstruction caused by a normal appendix forming tourniquet around an ileum loop. A 40-year-old male patient presented with clinical manifestations of small bowel obstruction, and the appendiceal tourniquet was discovered to be the cause during laparotomy. The patient was subjected to an appendectomy. The histopathological examination of the specimen reported normal appendiceal morphology. The case is unique in that it is the first report of a mechanical small bowel obstruction caused by an appendiceal tourniquet with normal histopathology.

Mechanical Small Bowel Obstruction Due to Gastroesophageal Pacemaker Lead, Solved by Assisted Laparoscopy - Case Report and Literature Review

The use of implanted medical devices such as gastric pacers to treat a great variety of diseases, has gained ground over time. Even though these devices are useful as in cases of gastroparesis, gastroesophageal reflux or morbid obesity, they have risks and complications that can be life threatening. Extrinsic intestinal obstruction may be caused by the lead of an abdominally implanted pacemaker, and should be considered in patients with suggestive signs and symptoms of bowel obstruction and treated promptly to avoid further damage. We present the case of a 76-year-old patient with bowel obstruction caused by the lead of a gastric pacemaker solved by laparoscopic surgery

S3344 The Hunt for the Lost Intragastric Balloon and Its Complications

Introduction: Obesity is a global pandemic on the rise, affecting about 40% of adults in the United States. There is a need for minimally invasive methods to aid current standard of care practices. The intragastric balloon (IGB) is a temporary therapy for weight loss, with the FDA approving several devices including the ObalonⓇ in the recent years. In 2021, AGA published clinical practice guidelines on Intragastric Balloons in the management of obesity. Serious adverse events are relatively rare in patients receiving IGB treatment, and include injury to the gastrointestinal (GI) tract, such as perforation (0.3%), esophageal mucosal injury (0.8%), gastric ulcer/bleeding (0.76%), and gastric outlet/bowel obstruction (0.12%). Case Description/Methods: A 47-year-old female with a medical history including two intragastric balloon placements (ObalonⓇ) one year ago, presented with severe acute abdominal pain. Patient’s BMI was 28 kg/m2. Routine labs were unremarkable and vitals were stable. Initial CT Abdomen/pelvis with contrast showed gastric and duodenal thickening; however, imaging failed to comment on a foreign object and location. A gastroscopy was performed subsequently showing one Obalon balloon found in the gastric fundus. The balloon was cut with a needle knife, collapsed and withdrawn with rat tooth forceps. To locate the second balloon, repeat imaging showed dilated bowel loops with a deflated ObalonⓇ lodged in the distal ileum, 7 centimeters proximal to ileocecal valve, resulting in mechanical small bowel obstruction. A colonoscopy was deferred due to concern for risk of perforation given the small bowel obstruction. Subsequently, the patient underwent laparoscopic enterectomy with approximately 5 cm of bowel on either side of the enterotomy with creation of anastomosis and foreign object retrieval. (Figure) Discussion: Intragastric balloons are a minimally invasive therapy for weight loss in conjunction with lifestyle modifications in the war against obesity. We present a rare, yet crucial case report of IGB complication resulting in small bowel obstruction and subsequent need for surgical intervention. IGBs are meant to be a short term, temporary tool for weight loss in obese patients generally BMI ≥ 30. This case highlights the importance of a timely removal, risk of severe complications, and emphasis on the importance of assessing proper indication for placement.Figure 1.: (A) Coronal view of CT scan showing dislodged Intragastric Balloon in the distal ileum (red arrow); (B) XR Abdomen showing radiopaque density overlying the left hemisacrum (red arrow) and dilated small bowel loops; (C) XR Abdomen Complete w/ Decub/Erect showing radiopaque foreign body in the right mid abdomen and second foreign body in the stomach (red arrows).

Ileocecal valve-sparing surgery for duplication cysts in the terminal ileum: two case reports and literature review

BackgroundDuplication cysts close to the ileocecal valve are usually treated with ileocecal resection. However, loss of the ileocecal valve will lead to problems, especially in infants. Mucosectomy of the cyst would be a better alternative that preserves the ileocecal valve. We report two cases of duplication cyst in the terminal ileum successfully treated with mucosectomy.Case presentationCase 1. A 3-month-old boy with bilious emesis and abdominal distention was referred to our hospital with a diagnosis of small bowel obstruction caused by an abdominal cyst. Computed tomography revealed a cystic mass compressing the terminal ileum and causing mechanical small bowel obstruction. His general condition deteriorated quickly; emergency laparotomy was performed. Although the small intestines were dilated and partially twisted, there was no necrosis. Following intestinal decompression, a cystic mass adjacent to the terminal ileum was confirmed on the mesenteric side. Cyst mucosectomy was performed to preserve the ileocecal valve. Case 2. A 5-month-old boy with sudden onset of hematochezia was referred to our hospital with a diagnosis of intussusception. Following unsuccessful contrast enemas, emergency surgery was performed. A cystic mass adjacent to the terminal ileum was confirmed; there was no intussusception. Cyst mucosectomy was performed. Both patients had an uneventful postoperative course.ConclusionsCyst mucosectomy, which preserves the ileocecal valve, is safe and effective for treating duplication cysts in the terminal ileum.

Gall stone ileus: An uncommon cause of small bowel obstruction at an unusual age: A Case report

Gallstone ileus is a rare complication of cholelithiasis. It is an uncommon cause of a mechanical small bowel obstruction. Repeated episodes of cholecystitis results adhesion of the gallbladder to the small bowel (usually duodenum) with eventual formation of cholecystoenteric fistula via which gallbladder stone enters the small bowel. It is most commonly seen in elderly females hence linked with high morbidity & mortality. Computed tomography (CT) imaging have made it easier to diagnose gallstone ileus effectively. Surgical intervention results in prompt relief of obstructive symptoms by removing stone & repairing fistula. Here is a case of gall stone ileus in a 27-year-young gentleman who presented to us with history of acute abdomen & without any comorbidities or biliary manifestation.

Can minimally invasive surgical techniques reduce the incidence of postoperative adhesions?

<br><b>Introduction:</b> Postoperative intra-abdominal adhesions are a clinical condition that may develop after any abdominal surgery and constitute the leading cause of mechanical small bowel obstructions.</br> <br><b>Aim:</b> This study investigates factors which influence the formation of postoperative adhesion and evaluates the efficiency of applying minimally invasive surgical techniques in reducing adhesion.</br> <br><b>Material and methods:</b> Patients who underwent surgery to diagnose obstructive ileus in our clinic between January 2015 and January 2020 were analyzed retrospectively. Demographic data of the patients, operation details time between the operations and history of hospitalizations, postoperative mortality and morbidity, as well as the severity of complications were recorded. The patients included in the study were divided into groups according to the surgical technique applied in the first operation (laparoscopy/ laparotomy), the abdominal incision line (upper/lower/total), and the etiology of the primarily operated lesion (benign/malignant).</br> <br><b>Results:</b> One hundred eighteen (118) patients were included in the study. The mean age of patients was 61.2 ± 10.8 (39-82) years. Age, ileus history, time to the onset of ileus, length of hospital stay and the number of complications were shorter in the laparoscopy group as compared to the laparotomy group and the difference was found to be statistically significant. In addition, when patients were categorized according to the abdominal incision line, fewer hospitalizations and more frequent postoperative complications due to ileus were observed in the sub-umbilical incision group (p < 0.05).</br> <br><b>Conclusions:</b> Postoperative adhesion formation is currently one of the clinical conditions which pose a challenge to both the patient and the clinician due to its incidence and recurrence. However, adhesion formation can be reduced by applying minimally invasive surgical methods, especially laparoscopic surgery and precise maneuvers during surgery.</br&gt.

Hyperplastic polyp of the ileum causing intestinal intussusception

In this study, the management of an adult patient with a mechanical small bowel obstruction caused by intussusception due to hyperplastic polyp is presented. A 25-year-old man presents to the emergency department for abdominal pain accompanied by nausea and vomiting. In the abdominal examination, the patient had sensitivity in all abdominal quadrants. Contrast-enhanced abdominal computed tomography (CT) showed enlargement of the intestinal loops, air-fluid levels, and intertwined intestinal segments in the pelvic region. On exploration with a midline incision, it was observed that the 40-cm ileal segment, starting 70 cm proximal to the ileocecal valve, was invaginated into the distal ileal segment with its mesentery. After 40 cm ileal resection, bowel reconstruction was performed with a side-to-side anastomosis with a linear stapler. The patient was discharged on the seventh postoperative day without any complications. In the histopathological evaluation of the resection material, there was a hyperplastic polyp measuring 20 × 15 mm. According to the pathology result, no additional intervention was considered for the patient.

Correction of enteral distress syndrome in acute intestinal obstruction

On the basis of a comprehensive assessment of the functional state of the intestine in acute mechanical small bowel obstruction, to justify adequate schemes of its protection. A clinical and laboratory study of 48 patients with acute small bowel obstruction developed against the background of abdominal adhesions, strangulated abdominal hernia was conducted. The first group (n=25) of patients who underwent laparotomy, removal of intestinal obstruction (adhesiolysis and/or herniation, hernial gate plastic surgery), intestinal intubation, standardized therapy after surgery. The second group (n=23) - patients, therapy included Remaxol (Polysan Pharmaceutical Plant, Petersburg): 400.0 enterally intraoperatively through a probe after nasointestinal intubation, evacuation of stagnant contents and intestinal lavage with isotonic saline solution; 400.0 - intravenously for 5 days. A number of indicators of homeostasis (endogenous intoxication, oxidative stress), structural and functional state of the intestine were evaluated. It was found that the inclusion of remaxol in complex therapy (intraoperatively and in the early postoperative period) leads to the optimization of the treatment process of patients with acute intestinal obstruction. The number of complications according to the Clavien-Dindo classification decreased from 17 (first) up to 5 (second group) (χ2=3.988, p=0.046). Hospital stay decreased from 12.8±1.1 to 10.1±0.8 bed days (p<0.05). The effectiveness of the developed scheme is based on its ability to correct the phenomena of enteral distress syndrome relatively quickly, which was confirmed by laboratory and instrumental methods. The most important manifestation of this was a significant decrease in the phenomena of endogenous intoxica tion against the background of a significant decrease in the activity of peroxidation of membrane lipids - triggers of catabolic intestinal lesions. Studies document the effectiveness of the developed treatment regimen for patients with acute intestinal obstruction. The inclusion of remaxol parenterally and enterally makes it possible to significantly optimize the course of the early postoperative period. One of the main objects of its implementation was the relatively rapid restoration of intestinal function, reduction of manifestations of enteral distress syndrome. This provided rapid relief of endogenous intoxication and, as a result, prevented the progression of the systemic inflammatory response syndrome, which together determined the optimization of the early postoperative period.

EP.TU.193Omental band - A unusual cause of mechanical small bowel obstruction in a virgin abdomen

Abstract Introduction The small bowel obstruction in a non-operated abdomen is rare, and the most common causes are hernia and neoplasm. The complete mechanical small bowel obstruction due to an omental band in a patient with no previous abdominal surgery is rare, and less than five cases have been reported in the literature. Case presentation We report a 65 year old male patient presented to the emergency department with complaints of abdominal pain, distension, vomiting and obstipation for four days. On clinical examination, his abdomen was distended, diffusely tender, guarding. The blood investigations showed elevated White blood cells and neutrophils with normal CRP and the Serum lactate. The Abdominal X-ray was suggestive of SBO. The Computed tomography of the abdomen and pelvis showed marked dilatation of the jejunum, the ileum is entirely collapsed, the impression of a double beak sign in the mid-abdomen which would suggest closed-loop obstruction due to a possible internal hernia. We proceeded with emergency diagnostic laparoscopy converted to laparotomy, which showed omental band causing closed-loop proximal small bowel obstruction. The bowel loops appeared congested with the constriction band due to omental band. The omental band was divided, and the obstruction was relieved. Postoperatively patient recovered well and was discharged on day three post-op. Discussion The timely diagnosis and intervention could prevent complications like strangulation, ischemia and gangrene. Though the omental band is rare, it should still be suspected as an aetiology in patients without prior abdominal surgery.

798 A Rare Complication and Unexpected Pathology Following an Anterior Exenteration – A Case Report

Abstract We present a case report of an unexpected pathology in addition to a rare complication in a 62-year-old female following an anterior exenteration and an abdominal wall reconstruction. Initial biopsies characterised the malignancy as a potential urachal adenocarcinoma, but the final pathology revealed a solitary endometrial adenocarcinoma metastasis from endometrial cancer 6 years previously. Due to the nature of the tumour, an abdominal wall resection was required, and reconstruction involved a pedicled thigh flap. Post-operatively the small bowel herniated under the flap and this resulted in true mechanical small bowel obstruction. The loop of herniated bowel is visible on CT imaging in the area of the proximal thigh. The patient returned to theatre for an emergency laparotomy and the abdominal wall defect was closed instead with a surgical implant derived from animal tissue. The patient made an excellent recovery, was discharged home, and continues to do well. This patient is an example of excelling in adversity.

Fibroid expulsion: a unique presentation of mechanical small bowel obstruction\xa011\xa0years after uterine artery embolization: a case report

BackgroundUterine artery embolization in the treatment of uterine leiomyoma has been rarely associated with dislodgement and expulsion of infarcted uterine fibroids through the vagina, peritoneum, or bowel wall, predominantly occurring within 6 months of uterine artery embolization.Case presentationWe present the case of a 54-year-old African American woman who underwent uterine artery embolization 11 years prior and developed mechanical small bowel obstruction from the migration of fibroid through a uteroenteric fistula with ultimate impaction within the distal small bowel lumen. Small bowel resection and hysterectomy were curative.ConclusionsUteroenteric fistula with small bowel obstruction due to fibroid expulsion may present as a delayed finding after uterine artery embolization and requires heightened awareness.