Ileus Obstruction Research Articles

Presumptive nonthyroidal illness syndrome in pet rabbits (Oryctolagus cuniculus)

Thyroid diseases are rarely diagnosed in pet rabbits and very little is known about the effects of systemic illnesses on thyroid hormone levels in this species. This brief communication compares the results of total thyroxine (T4, n = 44) and free T4 (n = 26) measurements in sick rabbits with total T4 (n = 56) and free T4 (n = 28) measurements from apparently healthy animals. Mean values of total and free T4 were significantly lower in sick animals, indicating nonthyroidal illness syndrome in the pet rabbit. Unlike in the dog, total and free T4 were both decreased to a similar degree in diseased rabbits. Rabbits with fractures and presumed obstructive ileus had particularly low total T4 levels. Total T4 values of rabbits suffering from urinary tract diseases were affected to a lesser extent. The effect of different diseases on free T4 values could not be evaluated on account of the small sample size. This study suggests that, similar to other species, total and free T4 measurement alone might not be sufficient to diagnose hypothyroidism in the pet rabbit due to the existence of nonthyroidal illness syndrome.

Seorang Wanita Muda dengan Tuberkulosis Usus Menyerupai Apendiksitis Akut

Background: Tuberculosis has become a global health problem, with increasing numbers of cases in line with the increasing number of immunocompromised patients. Intestinal of tuberculosis is believed to be a form of extrapulmonary tuberculosis which will occur most often in the future . Case: This case presents a young woman, 20 years old, suspected of acute appendicitis with suspected perforation, had right abdominal pain since 1 month and getting worse since 5 days PTA (prior to admission). The abdomen enlarges and feels hard on the right abdomen after being treated for 3 days. Fever,body weaknes,decreased of appetite, decreased of body weight approximately 7 kg since 2 months PTA. There are nausea, vomiting, diarea with runny mucus since 2 weeks PTA. The chest x-ray, abdominal ultrasound, endoscopy was normal result and plain abdominal radiograph showed that intestinal dilatation and step ladder features suspicious obstructive ileus. Discussion: After 2 months of therapy abdominal symptoms improved and weight began to gradually increase. Intestinal of tuberculosis is a challenge for clinicians to diagnose despite using modern medical techniques because the clinical and laboratory features are not specific especially when active pulmonary infection is absent and there are similarities with other abdominal diseases. The histological features will provide a diagnose. The delay in diagnosis will lead to more severe complications. Conclusion: At present a combination of clinical, radiological and pathological features continues to be the key to diagnosing intestinal tuberculosis. Medical management with antituberculosis drugs will produce a significant resolution of symptoms.

Monophasic synovial sarcoma as a cause of obstructive ileus: A case report.

Synovial sarcoma is a high-grade soft tissue sarcoma, divided histologically into 3 types: Monophasic, biphasic and poorly differentiated. An extremely rare case of obstructive ileus due to monophasic synovial sarcoma in a 54-year-old male patient is reported in the present study. The patient presented to the emergency department with signs and symptoms of obstructive ileus. Computer Tomography (CT)scan showed a pelvic mass (20×17×12 cm) causing obstruction at the sigmoid colon. An exploratory laparotomy through a midline incision was performed. The described mass was unresectable as it was infiltrating major vessels. Therefore, a diverting loop descending colostomy and biopsy of the solid mass were performed. Pathological examination revealed a monophasic synovial sarcoma. The patient was referred to the Department of Oncology and started treatment with doxorubicin and ifosfamide.

Bochdalek Hernia

Background: Bochdalek hernia is a congenital defect on posterolateral diaphragm with an abnormal connection between the thoracic cavity and the abdominal cavity. This disease causes protrusion of abdominal organs into the thoracic cavity. Case: an 8-day-old baby girl admitted to hospital with shortness of breath 24 hours after delivered. The baby was born spontaneously assisted by midwife. Upon born, the baby was crying strongly and meconium came out 2 hours after birth. On physical examination, the abdomen was inspected flat. Darm contour and darm steifung was observed, and peristaltic sound was heard on left lung. Radiological examination demonstrated a diaphragmatic hernia with ileus obstruction. The patient underwent laparatomy and stomach, ileum, transverse colon, and spleen, was found on foramen Bochdalek. Post-surgery chest X Ray showed favourable result. Ten days after treatment, the patient was discharged in a good condition with no respiratory or digestive problems. After 1 months the patient’s condition remained good and there were no respiratory or digestive complaints. Conclusion: In a rare case like Bochadalek hernia, laparotomy performed as a promising attempt to return the anatomic position of organ.

GASTROSCHISIS ASSOCIATED WITH COLONIC ATRESIA - CASE REPORT

We present an extremely rare case of gastroschisis associated with colonic atresia, anomaly seen in only 1.5-5% of all gastroschisis patients. Surgery for this anomaly can be very difficult due to the concomitant inflammation or other anomalies (mesenterium communae, volvulus, etc). Although prolonged intestinal dismotility is expected in these patients, mechanical obstruction must not be excluded in postoperative course, as it is explained in this case. Our case report demonstrates that primary colonic anastomosis is safe and well tolerated surgical procedure for these patients and that obstructive ileus is possible days after primary surgery and must not be overlooked.

Case Report: Inflammatory myofibroblastic tumor causes formation of an ileal conglomerate in a patient previously treated for Wilms’ tumor

Introduction: Inflammatory myofibroblastic tumors (IMTs) are uncommon mesenchymal lesions classified by WHO as neoplasms of uncertain behavior. Morphologically, IMTs are composed of proliferating spindled myofibroblastic cells accompanied by a marked - usually chronic - inflammatory infiltrate. The etiology is unknown, but several theories have been suggested, including an association with Wilms’ tumor. IMTs are rarely diagnosed in adults and have been reported in various organs. IMTs are considered benign but with a potential to recur at their primary site. Case report: A 44-year-old female experienced intermittent severe abdominal pain, loose stools and a visible abdominal bulge. In early childhood the patient had been treated for a Wilms’ tumor. At admission Meckel’s diverticulitis was suspected, but during surgery a tumor in the terminal ileum, creating a conglomerate of small intestinal loops, was observed and completely resected. The pathology report characterized the tumor as a histologically benign inflammatory myofibroblastic tumor. Postoperatively, the patient experienced several complications including an anastomotic leakage and subsequent formation of an abscess and transcutaneous fistula. Discussion: IMTs rarely arise in the small intestine, and to our knowledge the manifestation of a small intestine conglomerate has not been described previously. Making the diagnosis is difficult, and numerous differential diagnoses were possible in this case. Approximately 8-25% of IMTs in the gastrointestinal tract recur locally. Complete surgical resection is the treatment of choice, and re-excision is the preferred therapy for local recurrence. To our knowledge, no guidelines concerning follow-ups are available. Conclusion: IMTs in the terminal ileum can mimic Meckel’s diverticulitis and present with symptoms of obstructive ileus due to the formation of a conglomerate of small intestinal loops. Furthermore, IMTs should be considered as a diagnostic possibility in patients with a past medical history of Wilms’ tumor.

Laparoscopy-Assisted Spleen-Preserving Distal Pancreatectomy for Living-Donor Pancreas Transplantation

BackgroundLiving pancreas transplantation plays an important role in the treatment of patients with severe type 1 diabetes. However, pancreatectomy is very invasive for the donor, and less-invasive surgical procedures are needed. Although some reports have described hand-assisted laparoscopic surgery for distal pancreatectomy in living-donor operations, less-invasive laparoscopy-assisted (LA) procedures are expected to increase the donor pool. We herein report the outcomes of four cases of LA spleen-preserving distal pancreatectomy (Warshaw technique [WT]) in living pancreas donors. Patients and MethodsFour living pancreas donors underwent LA-WT at our institution from September 2010 to January 2013. All donors fulfilled the donor criteria established by the Japan Society for Pancreas and Islet Transplantation. ResultsThe median donor age was 54 years. Two donors underwent left nephrectomy in addition to LA-WT for simultaneous pancreas–kidney transplantation. The median donor operation time for pancreatectomy was 340.5 minutes. The median pancreas warm ischemic time was 3 minutes. The median donor blood loss was 246 g. All recipients immediately achieved insulin independence. One donor required reoperation because of obstructive ileus resulting from a port-site hernia. Another donor developed a pancreatic fistula (International Study Group of Pancreatic Fistula grade B), which was controlled with conservative management. After a maximum follow-up of 73 months, no clinically relevant adverse events had occurred. These results were comparable with those of previous studies concerning living-donor pancreas transplantation. ConclusionThe LA-WT is a safe and acceptable operation for living-donor pancreas transplantation.

Case Report: Inflammatory myofibroblastic tumor causes formation of an ileal conglomerate in a patient previously treated for Wilms’ tumor

Introduction: Inflammatory myofibroblastic tumors (IMTs) are uncommon mesenchymal lesions classified by WHO as neoplasms of uncertain behavior. Morphologically, IMTs are composed of proliferating spindled myofibroblastic cells accompanied by a marked - usually chronic - inflammatory infiltrate. The etiology is unknown, but several theories have been suggested, including an association with Wilms’ tumor. IMTs are rarely diagnosed in adults and have been reported in various organs. IMTs are considered benign but with a potential to recur at their primary site. Case report: A 44-year-old female experienced intermittent severe abdominal pain, loose stools and a visible abdominal bulge. In early childhood the patient had been treated for a Wilms’ tumor. At admission Meckel’s diverticulitis was suspected, but during surgery a tumor in the terminal ileum, creating a conglomerate of small intestinal loops, was observed and completely resected. The pathology report characterized the tumor as a histologically benign inflammatory myofibroblastic tumor. Postoperatively, the patient experienced several complications including an anastomotic leakage and subsequent formation of an abscess and transcutaneous fistula. Discussion: IMTs rarely arise in the small intestine, and to our knowledge the manifestation of a small intestine conglomerate has not been described previously. Making the diagnosis is difficult, and numerous differential diagnoses were possible in this case. Approximately 8-25% of IMTs in the gastrointestinal tract recur locally. Complete surgical resection is the treatment of choice, and re-excision is the preferred therapy for local recurrence. To our knowledge, no guidelines concerning follow-ups are available. Conclusion: IMTs in the terminal ileum can mimic Meckel’s diverticulitis and present with symptoms of obstructive ileus due to the formation of a conglomerate of small intestinal loops. Furthermore, IMTs should be considered as a diagnostic possibility in patients with a past medical history of Wilms’ tumor.

A Case of Primary Ileocecal Lymphoma

Primary lymphoma in gastrointestinal tract is not very common. Ileocecal region is the commonest site for primary lymphoma and diffuse large B cell lymphoma (DLBCL) is the most prevalent subtype. The clinical presentation in this condition is pain in right lower quadrant region and this can very confusing since many diseases can also cause this problem like infection and inflammatory disease. In this paper, we report a case of primary lymphoma subtype DLBCL in ileocecal region that come to emergency department with ileus obstruction. Abdominal computerized tomography (CT) scan and colonoscopy revealed tumour in ileocecal region ascendens colon. Hemicolectomy was performed and the specimen was sent to pathology which revealed non-Hodgkin lymphoma with subtype DLBCL CD20 (+). The patient had undergone of Rituximab, Cyclophosphamide, Doxorubicine, Vincristin, and Prednison (RCHOP) chemotherapy regimen and had complete remission.

Diagnostic and Therapeutic Approach in Intestinal Tuberculosis

Tuberculosis was still a global health problem. Beside lung, tuberculosis also manifest in other organs, one among them is in abdominal organs. Abdominal tuberculosis was a complex disease with unspecific sign and symptoms so that its diagnostic procedure was not rarely inconclusive. We reported a 24 years old woman with chief complain of worsening abdominal pain in all region, accompanied by nausea, vomiting, bloating, and absent bowel movement. She also had a fresh bloody stool. She had an active pulmonary tuberculosis on initiation phase treatment. Physical examination suggest a bowel obstruction sign with distended abdomen and increase bowel sound. Colonoscopy procedure findings was a mass that obstruct bowel lumen in ileocaecal region, suggest for malignancy similar to computerized tomography (CT) scan result, but pathlogic result showed an active colitis without any sign of malignancy. Because of its contradiction, the second colonoscopy was performed and concluded as intestinal tuberculosis, matched with second pathologic examination. Although polymerase chain reaction (PCR) tuberculosis (TB) showed a negative result, a further clinical judgement concluded this as an intestinal tuberculosis case. Patient was finally treated as intestinal tuberculosis with first-line antituberculosis drugs and planned to have colonoscopy evaluation. After general condition was good and obstructive ileus sign was relieved, patient planned for outpatient care.

Acute Presentation of the Neuroendocrine Tumor of the Terminal Ileum with Obstructive Ileus – Case Report

Acute Presentation of the Neuroendocrine Tumor of the Terminal Ileum with Obstructive Ileus – Case Report

THE EVALUATION OF RISK FACTORS OF ANASTOMOTIC LEAKAGE IN PATIENTS WITH COLORECTAL CANCER COMPLICATED BY ILEUS

Background: Obstructive ileus and peritonitis are the most frequent complication of colorectal cancer, manifested in 8-40 % cases. Anastomotic leakage (AL) is a fatal complication in colorectal surgery. In our study, we aim to analyze the safety, outcomes in patients with colon obstruction after resection with new anastomosis technique implementation and to identify prognostic value of each risk factor on development of AL. Methods: A retrospective analysis of prospectively acquired data of 155 consecutive emergency patients with cancer of proximal rectum and sigmoid colon complicated by chronic bowel obstruction in stage of subcompensation and decompensation were included in our study and divided into 2 groups. In the basic group (n=95), primary nonfunctional anastomosis (PNA) was performed after resection of the rectum. In the comparing group (n=60), resection of the colon or rectum with primary anastomosis was performed. Results: Postoperative complications have arisen in 5 (5,3 %) patients of group I and in 11 (18,4%) patients of group II. AL was developed only in 1 patient in the basic group (1,1%) and in 7 (11,7 %) patients of the compared group on the 5th-12th day after operation. We have worked out the rate score of risk factors of AL. А score was given for each AL factor which we had selected for elaboration of this scale. Conclusions: Based on AL risk factors scale we highlighted 5 levels of risk which have significant clinical meaning and help surgeons decide finally how to finish operation in patient with bowel obstruction in order to avoid AL. PNA with preventive transversostoma was shown to provide adequate decompression of the colon, reliable prevention of colorectal AL, avoid complex reconstructive operations and be a good alternative for Hartman’s procedure.

Small Bowel Obstruction Caused by the Ingestion of a Wooden Toothpick: The CT findings and a Literature Review

We present a case in which the accidental ingestion of a toothpick caused duodenal perforation and small intestinal obstruction. A 58-year-old man visited our emergency room with acute abdominal pain. Computed tomography (CT) showed obstructive ileus as well as a foreign body penetrating the duodenum, which was identified as a toothpick and removed endoscopically. Unenhanced CT was superior in detecting the object. The patient has been doing well since the operation.

Epidemiological Aspects of Obstructive Ileus in Cancer the Left Parts of the Colon

Цель исследования На основании ретроспективного и проспективного анализа определить возрастно – половые группыбольных, время доставки в стационар, наличие и тяжесть сопутствующих заболеваний и возможных осложнений, отяг-чающих течение острой кишечной непроходимости на фоне рак левых отделов ободочной кишки.Материалы и методы В основу исследования положен анализ лечения 2200 больных раком левой половины толстой кишкиза 10 лет. Среди пациентов мужчин было 973 (44,2%), женщин – 1227 (55, 8%). Пациентов старше 60 лет было 75,3%.Результаты и их обсуждение Основное количество больных (70,4%) доставлены в течение 48 - 72 часов от момента за-болевания. У 88,7% больных операционно-анестезиологический риск соответствовал IV - V степени. Тяжесть состояния67% больных оценена в 16 баллов и выше. Различные сопутствующие заболевания самостоятельно или в виде сочетанийвстречались у подавляющего большинства (97,7%) пациентов. Кроме острой кишечной непроходимости различные со-четанные осложнения рака были выявлены у 241 (23,7%) больного. Чаще всего опухоль находилась в сигмовидной кишке(39,4%).Выводы Большинство больных (75,3%) старше 60 лет и поступают с комплексной сочетанной патологией, отягчающейтечение основного заболевания. Ранняя и активная догоспитальная диагностика может привести к профилактике раз-вития запущенных форм острой кишечной непроходимости.Ключевые слова Рак ободочной кишки, кишечная непроходимость, эпидемиология.

Gastrointestinal Non-Infectious Complications in Patients on Peritoneal Dialysis

Abstract Gastrointestinal complications are common among patients on peritoneal dialysis. Risk factors for the development of gastrointestinal complications in this patient population include: toxic effects of uremic toxins, frequent use of nonsteroidal anti-inflammatory drugs, Helicobacter pylori infection, angiodysplasia, increased intra-abdominal pressure, use of bioincompatible solution for peritoneal dialysis, increased glucose in solutions for peritoneal dialysis, secondary hyperparathyroidism (hypercalcemia), a disorder of lipid metabolism (hypertriglyceridemia), and the duration of peritoneal dialysis treatment. The most important non-infectious gastrointestinal complications in patients on peritoneal dialysis are: gastrointestinal bleeding, herniation and leaking of the dialysate from the abdomen (increased intra-abdominal pressure), impaired lung function (intra-abdominal hypertension), acute pancreatitis, and encapsulating sclerosis of the peritoneum. Intra-abdominal hypertension is defined as IAP ≥ 12 mmHg. Pouring the peritoneal dialysis solution leads to increased intra-abdominal pressure, which results in the development of hernias, pleuro-peritoneal dialysate leakage (hydrothorax), and restrictive pulmonary dysfunction. Risk factors for the development of acute pancreatitis in this patient population include: uraemia, secondary hyperparathyroidism with hypercalcemia, hypertriglyceridemia, features of the peritoneal dialysis solution (osmolarity, acidity, glucose, chemical irritation, and calcium in the solution for peritoneal dialysis lead to “local hypercalcemia”), toxic substances from the dialysate, the bags and tubing, and peritonitis and treatment of peritonitis with antibiotics and anticoagulants. Encapsulating sclerosis of the peritoneum is rare and is the most serious complication of long-term peritoneal dialysis. It is characterized by thickening of the peritoneum, including cancer, and signs and symptoms of obstructive ileus. Diagnosis is based on clinical, laboratory and radiological parameters. Encapsulating sclerosis of the peritoneum can be indicated by an AR-CA-125 concentration of less than 33 U/min and a concentration of AR-IL-6 greater than 350 pg/min in the effluent of patients with ultrafiltration weakness. Treatment consists of stopping peritoneal dialysis, using anti-inflammatory (corticosteroids) and anticicatricial drugs (tamoxifen), while surgical treatment includes enterolysis and adhesiolysis.

Obstructive ileus caused by phlebosclerotic colitis.

A 57-year-old man with chronic kidney disease and a history of using numerous herbal medications visited Inje University Ilsan Paik Hospital for abdominal pain and vomiting. An abdominal radiograph showed diffuse small bowel distension containing multiple air-fluid levels and extensive calcifications along the colon. Computed tomography showed colon wall thickening with diffuse calcification along the colonic mesenteric vein and colonic wall. Colonoscopy, performed without bowel preparation, showed bluish edematous mucosa from the transverse to the distal sigmoid colon, with multiple scar changes. At the mid transverse colon, a stricture was noted and the scope could not pass through. A biopsy of the stricture site revealed nonspecific changes. The patient was diagnosed with phlebosclerotic colitis. After the colonoscopy, the obstructive ileus spontaneously resolved, and the patient was discharged without an operation. Currently, after 2 months of follow-up, the patient has remained asymptomatic. Herein, we report the rare case of an obstructive ileus caused by phlebosclerotic colitis with a colon stricture.

Intestinal Obstruction and Ileocolic Fistula due to Intraluminal Migration of a Gossypiboma.

Gossypiboma refers, as a term, to a retained surgical sponge. It is considered as a rare surgical complication which can occur despite precautions. We report a case of a 36-year-old woman who was admitted to our surgical department with symptoms of abdominal pain associated with episodes of nausea and vomiting that lasted for 2 months. Six months ago she had undergone a cesarean section in a private clinic. Computed tomography revealed a high-density mass occupying a portion of the intestinal lumen, which was reported as a “calcified parasite.” The patient was subjected to laparotomy. The intraoperative findings included signs of obstructive ileus and ileosigmoid fistula and a large sponge was found at the resected portion of the small intestine. Although gossypiboma is a rare entity, it should be included in the differential diagnosis.

A Rare Case of an Early Postoperative Obstructive Ileus in a Young Female Patient due to a Residual Trichobezoar Mass.

Trichobezoar is a rare cause of small bowel obstruction, whereby a mass forms most commonly in the stomach and duodenum of young females, from ingestion of hair, a condition known as trichophagia. We present a case of recurrent small bowel obstruction due to a residual hair mass that was removed surgically in a young female patient who had a laparotomy and gastrotomy for removal of a large gastric trichobezoar just two weeks prior to the current admission. This case illustrates the importance of a thorough inspection of the whole bowel to ensure that no residual bezoars remain after surgery.

АКТУАЛЬНІ ПРОБЛЕМИ НЕВІДКЛАДНОЇ ХІРУРГІЇ КОЛОРЕКТАЛЬНОГО РАКУ

Здійснено ретроспективний аналіз результатів лікування 136 хворих на ускладнений рак товстої кишки, оперованих у клініці в 2008–2014 рр. Вік пацієнтів перебував у межах 36–94 років (середній – (68,8±12,1 року). У більшості хворих РТК діагностовано в клініці у зв’язку з виникненням того чи іншого ускладнення – 117 (86 %). Домінуючим ускладненням колоректального раку виявилась гостра обтураційна непрохідність – ізольовано у 105 (77,2 %) хворих, у поєднанні з перфорацією пухлини, перитонітом – у 24 (17,6 %) пацієнтів, кишковою кровотечею – в 1 (0,8 %) хворого. Перфорацію пухлини, перитоніт констатовано у 3 (2,2 %) хворих, гостру кишкову кровотечу – в 3 (2,2 %) пацієнтів. У 81,1 % спостережень перитоніт мав дифузний характер. Радикальні операції виконано у 68 (50 %) хворих, паліативні – у 18 (13,2 %), симптоматичні – в 50 (36,8 %) пацієнтів. Відповідно до класифікацією TNM, І стадію пухлини встановлено у 0,7 % оперованих, ІІ стадію – у 31 % хворих, ІІІ і IV стадії, відповідно, – у 31,4 та 37,0 % пацієнтів. Післяопераційні ускладнення розвинулись у 10 хворих (7,3 %) і мали в основному гнійно-септичний характер. Появу третинного перитоніту було визнано у 17 (12,5 %) прооперованих. Релапаротомії виконано 21 хворому (15,4 %), здебільшого з причини перитоніту, ретракції колостом. Середній ліжкодень склав 16,2±7,7. Померли 23 хворі – післяопераційна летальність – 16,9 %. Третинний перитоніт призвів до летального кінця в 15 пацієнтів (88,2 %). Основною причиною смерті визнано поліорганну недостатність як прояв тяжкого сепсису. Основними аспектами проблеми ускладненого раку товстої кишки (УРТК), які потребують комплексного вирішення, є зростання захворюваності, запізніла госпіталізація пацієнтів, потенційований ризик венозних тромбозів та емболій, третинний перитоніт, підвищення фахової онкологічної підготовки хірургів.

Клиническое наблюдение синдрома Bouveret (билиарный илеус)

Background Biliary ileus is a rare cause of acute intestinal obstruction and is 1-4% of all cases of small bowel obstruction. Objective: to Analyze the current data of the world medical literature on the problem of biliary ileus, basic medical diagnostic techniques aimed at improving the provision of health care to patients with this pathology. Materials and methods the authors review the literature and 1 the author nablyudeniya Bouveret syndrome. Discussion Bouveret's Syndrome is a rare form of obstructive ileus due to obstruction of the biliary calculus in the presence of biliodigestive fistula output Department stomachs or 12-p K-CI. The main clinical sign is the presence of signs of intestinal obstruction. The final diagnosis is established during surgical intervention. Mortality after enterotomy with extraction of ureteral stones is about 12%, after an extended intervention - up to 30% Completed surgical treatment, enterotomy, anterolateral. Conclusions despite the fact that the variation of the biliary ileus, Bouveret syndrome, a rare pathology, it is necessary to remember about this cause intestinal obstruction. Special attention should be given to elderly patients with clinic intestinal obstruction.