Partial Intestinal Obstruction Research Articles

Partial intestinal obstruction caused by duodenal obstruction by the superior mesenteric artery and abdominal aorta in a middle-aged woman: a case report

Partial intestinal obstruction caused by duodenal obstruction by the superior mesenteric artery and abdominal aorta in a middle-aged woman: a case report

Perforated Meckel’s Diverticulum: A Case Report

Meckel’s diverticulum is a true diverticulum that consists of all layers of bowel normally found in a normal small bowel wall. The three most common presentations in children are intestinal bleeding (30–56%), intestinal obstruction (14–42%), and diverticular inflammation (6–14%). Complications result in more severe symptoms, such as acute abdomen and signs of peritonitis. These presentations are not specific to Meckel’s diverticulum and can be found in many other conditions, making the diagnosis difficult. A five-year-old child came to the emergency department with complaint of acute abdominal pain, especially in the right lower quadrant. The pain was accompanied by vomiting. On physical examination, patient was febrile and signs of peritonitis were found. Abdominal plain film revealed the probability of focal inflammation in the right lower region of the abdomen, with partial intestinal obstruction. Ultrasonography showed a presence of a mass in right iliac region with the size of 24x20x23 mm, with normal appendix. During exploratory laparotomy, a necrotic and perforated Meckel’s diverticulum was found, with associated purulent matter. Diverticulectomy with segmental resection of ileum followed by end-to-end anastomosis were done. Diagnosis of Meckel’s diverticulum requires a high index of suspicion, especially in the pediatric population. It is important for clinicians to be aware of unusual presentations of Meckel’s diverticulum.

Intestinal diverticula in a domestic rabbit (Oryctolagus cuniculus)

Intestinal diverticula are a well-documented phenomenon in humans, but their occurrence and characteristics in domestic rabbits remain underexplored. While pseudodiverticula have been reported in rabbit species, true diverticula—with all layers from mucosa to serosa—are yet to be described. This case report presents a 3-yearold neutered female rabbit with an unusual presentation of true diverticula in the jejunum, leading to diverticulitis and partial intestinal obstruction.

Laparoscopic Sugarbaker repair of parastomal hernia following radical cystectomy and ileal conduit: a single-center experience

PurposeParastomal hernia (PH) is a frequent complication following radical cystectomy and ileal conduit. The purpose of this study was to summarize the clinical experience and technical characteristics of laparoscopic Sugarbaker repair of PH following radical cystectomy and ileal conduit.MethodsWe retrospectively evaluated all patients who underwent laparoscopic treatment of PH following radical cystectomy and ileal conduit at Huashan Hospital, Fudan University from May 2013 to December 2022.ResultsThirty-five patients were included in the study. Median follow up was 32months (IQR, 25–38 months). Three patients presented with a recurrence (8.6%), with a median time to recurrence of 14 months. Out of the 35 patients, Thirty-two underwent totally laparoscopic repair using the Sugarbaker technique, Three patients required open surgery to repair the intestinal injury after laparoscopic exploration. One patient died 9 months post-surgery due to COVID-19. During the follow-up period, two patients developed a peristomal abscess, and one patient experienced partial intestinal obstruction 10 days after surgery.ConclusionSurgical management of PH following radical cystectomy and ileal conduit is challenging. The laparoscopic Sugarbaker technique for repairing PH following radical cystectomy and ileal conduit has low complication and recurrence rate.

Challenges in the diagnosis and treatment of pure non-gestational uterine choriocarcinoma in a child: a case report

BackgroundDiagnosing non-gestational uterine choriocarcinoma in children is challenging because of its rarity and nonspecific imaging findings. Herein, we report a case of non-gestational uterine choriocarcinoma in a child, which was unexpectedly found during exploratory laparotomy and confirmed by histopathological findings. However, the tumor did not respond to chemotherapy.Case presentationA 4-year-old Indonesian female patient was brought into the emergency unit with chief complaint of vaginal bleeding. She had suffered from vaginal spotting 4 months before being admitted to the hospital. Physical examination revealed a distended abdomen in the left lumbar region and a palpable fixed mass with a smooth surface. Abdominal computed tomography scans revealed a large mass (10 × 6 × 12 cm) with fluid density and calcification. Thus, we suspected left ovarian teratoma. The patient’s luteinizing hormone, follicle-stimulating hormone, and lactate dehydrogenase levels were 25.2 mIU/ml, 0.1 mIU/ml, and 406 U/l, respectively. According to the clinical and radiological findings, we decided to perform an exploratory laparotomy and found a tumor originating from the uterus, not the ovarium. We did not observe liver nodules and any enlargement of abdominal lymph nodes. Subsequently, we performed hysterectomy. The histopathological findings supported the diagnosis of choriocarcinoma. The patient was discharged uneventfully on postoperative day 5. Thereafter, the patient underwent nine cycles of chemotherapy, including carboplatin (600 mg/m2 IV), etoposide (120 mg/m2 IV), and bleomycin (15 mg/m2 IV). However, on the basis of the clinical findings of a palpable mass and partial intestinal obstruction, the tumor relapsed soon after the ninth cycle of chemotherapy. Currently, the patient is undergoing chemotherapy again.ConclusionsAlthough pure non-gestational uterine choriocarcinoma is rare, it should be considered as one of the differential diagnoses for intraabdominal tumors in a child, so as to better guide and counsel families regarding the surgical plan and prognosis, respectively. In the present case, the patient’s response to chemotherapy was poor, implying that the treatment of non-gestational choriocarcinoma is still challenging, particularly in the pediatric population.

Liver abscess and tracheal fistula induced by transcatheter arterial chemoembolization for hepatocellular carcinoma: A case report

BACKGROUND Transarterial chemoembolization (TACE) is a standard treatment for intermediate-stage hepatocellular carcinoma (HCC). The complications of TACE include biliary tract infection, liver dysfunction, tumor lysis syndrome, biloma, partial intestinal obstruction, cerebral lipiodol embolism, etc . There are few reports about tracheal fistula induced by TACE. CASE SUMMARY A 42-year-old man came to our hospital with cough and expectoration for 1 mo after TACE for HCC. Laboratory test results showed abnormalities of albumin, hemoglobin, prothrombin time, C-reactive protein, D-dimer, and prothrombin. Culture of both phlegm and liver pus revealed growth of Citrobacter flavescens . Computed tomography showed infection in the inferior lobe of the right lung and a low-density lesion with gas in the right liver. Liver ultrasound showed that there was a big hypoechoic liquid lesion without blood flow signal. Drainage for liver abscess by needle puncture under ultrasonic guidance was performed. After 1 mo of drainage and anti-infection therapy, the abscess in the liver and the infection in the lung were reduced obviously, and the symptom of expectoration was relieved. CONCLUSION Clinicians should be alert to the possibility of complications of liver abscess and tracheal fistula after TACE for HCC. Drainage for liver abscess by needle puncture under ultrasonic guidance could relieve the liver abscess and tracheal fistula.

Intussusception with partial intestinal obstruction as a rare complication of small intestine tumor (clinical case)

A clinical case of small intestine intussusception with partial intestinal obstruction as a rare complication of small intestine tumor in adults is presented. This case demonstrates a variant of clinical signs of intussusceptions, features of preoperative diagnosis and importance of appropriate investigation of small intestine.

Eosinophilic enteritis presenting as intestinal obstruction: case report and review of the literature.

Eosinophilic enteritis (EE) is characterized by intense eosinophilic infiltrate of the gastrointestinal tract. Clinical manifestations depend on the affected segment and intestinal layer. First-line treatment is systemic corticosteroids; surgery is reserved for complications. 84-year-old male patient with a history of right hemicolectomy and two episodes of intestinal obstruction presented to the ED with abdominal pain, distension, nausea, and vomiting. CBC showed leukocytosis and no eosinophilia. Contrast-enhanced CT revealed stenosis with thickening of the distal intestinal wall and partial intestinal obstruction. Colonoscopy found aphthous ulcers. Histopathology reported EE. The patient received budesonide and metronidazole, with resolution within 24 h.

In Vivo Modeling of Complicated Necrotizing Enterocolitis

Introduction: There is no adequate and easily reproducible model of complicated necrotizing enterocolitis (NEC) that allows to study its etiopathogenesis and test various surgical treatment options in an experiment.Objective: To devise a method for in vivo modeling of complicated NEC using laparoscopy.Materials and methods: Our study was conducted at the premises of the Laboratory of Experimental Surgery and Oncology (Scientific Research Institute of Experimental Medicine, Kursk State Medical University) in compliance with international ethical standards and guidelines for humane animal treatment. Fifteen immature male rabbits underwent laparoscopy under inhalation anesthesia and then subserosal injection of damaging solutions (33% H2O2, 10% CaCl2, 4% KCl, 70% C2H5OH, 10% CH2O) into the intestinal wall. In 24 hours, we performed laparotomy, assessed pathological changes visually, and resected the section of the intestinal tube at the injection site. Then we performed a single­layer end­to­end intestinal anastomosis. Histological samples were made from a biopsy specimen. Morphological assessment of the changes was performed.Results: The most pronounced macro­ and microscopic changes were found in the animals injected with hydrogen peroxide. We assessed changes in the abdominal cavity 24 hours since the start of modeling and observed a pattern of partial intestinal obstruction and serous peritonitis. The morphological pattern was characterized by acute circulatory disorder in the intestinal wall with ulcerative necrotic defects and perforations.Conclusions: Based on morphological manifestations we devised a method for modeling complicated NEC using laparoscopy. It is easily reproducible in an in vivo experiment, close to the clinical situation, and allows to simulate typical morphological changes during severe NEC.

Small intestinal strangulation in 60 cattle – clinical, laboratory and ultrasonographic findings, treatment and outcome

BackgroundIntestinal strangulation is constriction of the intestine by a band of tissue, ligament or blood vessel causing partial or complete intestinal obstruction. This retrospective study describes the clinical, laboratory and ultrasonographic findings, treatment and outcome of 60 cows with intestinal strangulation.ResultsThe general condition was abnormal in all cows (60/60), 23.3% (14/60) had nonspecific signs of pain, 40.0% (24/60) had signs of colic and 48.3% (29/60) had signs of somatic (parietal) pain. The most common digestive tract abnormalities were, in decreasing frequency, reduced or absent intestinal motility (100%, 60/60), reduced or absent faecal output (98.3%, 59/60), reduced or absent rumen motility (93.4%, 56/60), dilated small intestines on transrectal palpation (63.3%, 38/60), positive ballottement and swinging auscultation (BSA) and/or percussion and simultaneous auscultation (PSA) on the right side of the abdomen (58.3%, 35/60) and at least one positive foreign body test, most commonly the back grip, in 33.9% (20/59) of the cows. Other common findings were reduced skin surface temperature (67.8%, 40/59), reduced skin turgor (51.7%, 31/60), prolonged capillary refill time (49.2%, 29/59), enophthalmus (48.3%, 29/60) and moderate to severe scleral injection (46.6%, 27/58). The most common laboratory findings were hypokalaemia (58.3%, 35/60), haemoconcentration (57.6%, 34/59), base excess (51.1%, 24/47), hyperproteinaemia (45.8%, 27/59), hyperbilirubinaemia (43.3%, 26/60), acidosis (42.6%, 20/47) and azotaemia (38.3%, 23/60). The principal ultrasonographic findings were subjectively reduced or absent small intestinal motility and dilated small intestines, but the strangulation could not be visualised by ultrasonography. With one exception, all cows underwent a right flank laparotomy to resolve the strangulation by transection or resection of the impinging tissue. Forty-nine (81.7%) cows were discharged and 11 (18.3%) were euthanized before, during or after surgery.ConclusionsWithout laparotomy, intestinal strangulation could be clinically (transrectally) diagnosed in only 10% of the cows. A laparotomy is therefore essential for the correct diagnosis. The prognosis is good with prompt surgical treatment.

Small Intestinal Adenocarcinoma Involving a Submucosal Ectopic Lymph Node: A Case Report.

An 83-year-old male with a 55-year history of Crohn's disease, ileocecectomy 40 years prior, and naturopathic treatment for 25 years, presented with nausea, vomiting, and abdominal pain. Computed tomography of abdomen and pelvis demonstrated partial small intestinal obstruction and a 4.4-cm solid left renal mass. After 3 months of recurrent intestinal obstruction and development of a pericolonic abscess, resection of the ileocolonic anastomosis, abscess, and partial nephrectomy were performed. Histopathology demonstrated chronic active enteritis with fistula tract formation, consistent with Crohn's disease, and moderately differentiated small intestinal adenocarcinoma extending from mucosa into subserosa. A submucosal intestinal lymph node-like structure containing adenocarcinoma demonstrated endothelial venules, open marginal and intermediate sinuses, multiple polarized germinal centers, and partial capsule, consistent with an ectopic lymph node, also called a tertiary lymphoid organ. Twenty mesenteric lymph nodes were negative for carcinoma. The renal mass was a papillary renal cell carcinoma, Stage I. Intestinal tertiary lymphoid organs form in chronic immune activation and have variable structures ranging from simple B and T cell clusters to organized groups with high endothelial venules and lymphatic vessels. Encapsulation of tertiary lymphoid organs is rare, with some sources claiming this entity is never encapsulated. To our knowledge, this is the first report of small intestinal adenocarcinoma involving a submucosal encapsulated tertiary lymphoid organ, the prognostic significance of which is uncertain. We suggest increased awareness of intestinal tertiary lymphoid organs as an entity and further studies to delineate the effect their involvement by adenocarcinoma imparts on survival.

S4023 A Case Report of Partial Small Intestinal Obstruction Secondary to Lupus Enteritis With Bowel Ischemia, Portal Vein Thrombosis and Secondary Antiphospholipid Syndrome

S4023 A Case Report of Partial Small Intestinal Obstruction Secondary to Lupus Enteritis With Bowel Ischemia, Portal Vein Thrombosis and Secondary Antiphospholipid Syndrome

Alterations of gut microbiota in a mouse model with partial small intestinal obstruction.

Changes in the gut microbiota of patients with partial small intestinal obstruction (PSIO) have not been widely clarified. We aimed to explore bacterial diversity in a PSIO mouse model. A PSIO mouse model was established using male C57BL/6 mice, and feces samples from the distal ileum and ileum epithelium tissues were collected. MiSeq sequencing of the 16S rRNA gene was conducted to characterize microbiota diversity and composition. RNA sequencing for differences in transcriptomic programming of the ileum tissue was performed between the PSIO and (Control) Ctrl groups. Bacterial diversity in the PSIO group was significantly lower than that in the controls. Pseudomonadota was predominant in the feces of the PSIO group. Unclassified_Muribaculaceae (p = 0.008) and Akkermansia (p = 0.007) were more abundant in the Ctrl group than those in the PSIO group. Furthermore, Escherichia_Shigella (p = 0.008) was more predominant in the feces of the PSIO group. The Kyoto Encyclopedia of Genes and Genomes pathways related to metabolism were depleted in the PSIO group. Pathways associated with intestinal fibrosis, including extracellular matrix-receptor interaction, focal adhesion, phosphoinositide 3-kinase (PI3K)-Akt signaling pathway and transforming growth factor (TGF)-beta signaling pathway, which were enriched in ileum epithelial tissue in the PSIO group. PSIO can lead to changes in the predominant intestinal bacterial groups. Depleted functional profiles of the gut microbiota were identified in the PSIO group. Functional pathways associated with intestinal fibrosis were activated by PSIO. The potential regulation by the microbiota needs to be explored in the future.

Patent Prolapsed Vitellointestinal Duct in Neonate: Sonographic and Magnetic Resonance Evaluation

Omphalomesenteric duct can result in various forms of anomalies due to the failure of its absorption. Various presentations can be in the form of patent vitelline duct, Meckel’s diverticulum, sinus tract, fibrous band, umbilical polyp prolapsing over the umbilicus or enteric fistula. It is important to diagnose these various anomalies in neonates with ultrasonography (USG) and magnetic resonance imaging (MRI) which are radiation free modalities. We present the case of a 20-day-old male baby who was having partial intestinal obstruction, umbilical discharge and slight herniated content from the umbilicus. The neonate underwent USG and MRI studies and was diagnosed with prolapsed vitellointestinal duct. In general, diagnosis of patent prolapsed vitellointestinal duct is difficult on clinical examination on the first look. USG and MRI help in the confirmation of the diagnosis as the anatomical details are well delineated by these modalities and in addition to being radiation hazards-free. This helps in early management as these types of pathologies can lead to many fatal complications.

Mesenteric lipoma in a child: A case report

Lipoma is a benign tumor of mature fat cells. It quite rarely occurs in the intestinal mesentery in children. Mesenteric lipomas usually do not cause gastrointestinal symptoms unless they affect the intestinal passage. However, as the mass grows, symptoms suggestive of partial intestinal obstruction, such as abdominal pain, vomiting, and abdominal distension, may be observed, or total intestinal obstruction may develop due to volvulus. In our study, a case with mesenteric lipoma with acute abdominal findings was presented. A four-year-old male patient presented with abdominal pain and vomiting. On physical examination, the patient was agitated and dehydrated, the abdomen was distended, and there was widespread tenderness; however, the mass was not palpable. Computed Tomography (CT) revealed a suspicious appearance for leiomyosarcoma with a size of 102x79x87 mm in fat density containing septa. In the exploration, a 120x120x70 mm encapsulated, lobular mass was detected 50 cm proximal to the ileocecal valve, covering the 10 cm ileal segment. The mass was excised totally together with a 10 cm small intestine segment, and ileal anastomosis was performed. The diagnosis of mesenteric lipoma was confirmed histopathologically. As a result, mesenteric lipoma, which is rare in children, is a benign pathology, and its treatment is total surgical excision. In children with signs of intestinal obstruction, mesenteric lipoma should be considered in the differential diagnosis, whether the mass is palpated or not.

Distal intestinal obstruction syndrome in a child with cystic fibrosis

The aim of the study – to analyze the clinical case of a child with distal intestinal obstruction syndrome in cystic fibrosis. A 9.5 year old patient was admitted to the Gastroenterology Department of the Republican Specialized Scientific and Practical Center of Pediatrics with complaints of an increase in abdominal circumference, increased peristalsis, weakness, lethargy, swelling in the limbs, loose stools, and weight loss. From the anamnesis: from the age of 6 years it was observed periodic vomiting, not associated with food intake. At the age of 8 years, the condition worsened, bloating joined the vomiting. At the place of residence, the diagnosis was made “Acute intestinal obstruction. Volvulus of the sigmoid colon”. Over the next 6 months, the condition was relatively satisfactory, and then stool disorders began – 3–4 times a day and bloating. Considering the presence of steatorrhea, changes in the pancreas on ultrasound and MSCT, the child was referred to a geneticist, the result of a sweat test was 86.0 mEq/l. The diagnosis was made: Cystic fibrosis, mixed form. Syndrome of distal intestinal obstruction. Partial intestinal obstruction. Severe PEI, celiac disease and HIV were excluded. On the background of the therapy, the child’s condition improved relatively. Within a month after discharge, the condition was satisfactory, and then worsened again. After 3 months, the girl was re-hospitalized with the same complaints. After consulting the surgeons, recommendations were given to perform the operation due to the appearance of signs of partial lower intestinal obstruction, but the relatives signed a voluntary refusal of the operation, the child was taken home against receipt. The girl was discharged with the final diagnosis: Cystic fibrosis, mixed form, severe course. Syndrome of distal intestinal obstruction. Partial lower intestinal obstruction. Syndrome of exudative enteropathy, severe PEI. The girl died 2 weeks after discharge. Distal intestinal obstruction syndrome (DIOS) may be misunderstood by those who are not familiar with cystic fibrosis. Pediatric gastroenterologists, surgeons should be alert when this condition is detected in combination with other symptoms indicating cystic fibrosis.

Duodenal Stenosis: A Case Report

Background: Congenital duodenal stenosis in pediatric patients was often underreported due to its non-conspicuous signs and symptoms. Diagnosing duodenal stenosis is often challenging as this disease causes partial intestinal obstruction and thus presents with more indolent and atypical clinical manifestations. This case report aims to describe the atypical case of pediatric duodenal stenosis which presented with recurrent vomiting and poor weight gain as well as highlight some of the diagnostic challenges.
 Case: A 7-month-old girl was admitted to the emergency room with chief complaint of recurrent vomiting in the last 2 days prior to hospital admission. Patient had a history of recurrent bilious vomiting at the age of 3 days old with a frequency of 3-4 times a day and were admitted to the hospital for 2 weeks. Parents also reported of poor weight gain in the last 3 months. Abdominal X-Ray series showed dilatation of the small intestines immediately after pylorus and stack of coins sign. Esophageal endoscopic evaluation showed signs of severe GERD with a pyloric gap as well as a suspicion of a duodenal web
 Discussion: Congenital obstruction at the duodenum may occurs due to intrinsic or extrinsic etiology. Failure of duodenal re-canalization during the 8-10th week of embryological development is thought to be the main cause of intrinsic duodenal obstruction (atresia, stenosis or duodenal web). The appearance of clinical manifestation of duodenal stenosis depends on the degree of stenosis itself.
 Conclusion: Congenital duodenal stenosis may present with atypical presentations in neonates which requires clinicians to be fully aware of this diagnosis to ensure timely therapy. The main management of duodenal stenosis is surgery, however fluid administration, decompressing as well as other supportive treatment are equally crucial to ensure better outcome for the patient.

A case of successful treatment of a neuroendocrine tumor of the small intestine complicated by partial intestinal obstruction

The incidence of neoplasms of the small intestine does not exceed 3% in the structure of all tumors of the gastrointestinal tract. Among them, the frequency of neuroendocrine tumors is about 30%. Due to the absence of pathognomonic symptoms, such tumors are usually detected at the stage of surgical complications such as intestinal obstruction or intestinal necrosis. In such a situation, the oncological process is already either locally widespread or generalized. Therefore, timely diagnosis of tumors should be based not only on the complaints and anamnesis, allowing to suspect the development of complications, but also on the use of modern imaging methods.
 A clinical case demonstrating the difficulties of timely diagnosis of a neuroendocrine tumor of the small intestine is presented.

Management of Pelvic Pain in Patients with Crohn's Disease-Current Overview.

Crohn's disease (CD) is a subtype of chronic inflammatory bowel diseases (IBD) with characteristic skip lesions and transmural inflammation that may affect the entire gastrointestinal tract from the mouth to the anus. Persistent pain is one of the main symptoms of CD. This pain has multifactorial pathogenesis, but most often arises from intestinal inflammation itself, as well as from gut distention or partial intestinal obstruction. Some current evidence also suggests sensitization of sensory pathways, as well as modulation of those signals by the central nervous system, which highlights the impact of biopsychosocial factors. To date, most studies have focused only on the pain located in the abdomen, while pelvic pain has rarely been explored, despite it being a common symptom. The aim of this study is to provide an abbreviated summary of the current state of knowledge on the origins and treatment of pelvic pain in CD.

Etiologies, Clinical Presentation and Outcome of Adult Patients Presenting with Bowel Obstruction on a Virgin Abdomen

Context: Generally in Africa, BO remains the leading cause of acute abdomen. We therefore sought to study the current etiological factors of intestinal obstruction on a virgin abdomen or unhealed abdomen at the central hospital of Yaoundé in order to better understand the main causes and to better anticipate and improve the diagnosis, management and the evolution of intestinal obstruction on a virgin abdomen. Method: The patients were prospectively included from June 2021 to May 2022, these patients were recruited from the digestive and emergency surgery units of the Yaoundé Central Hospital during the study period and who met the inclusion criteria, with suspicion of partial or total intestinal obstruction or those with an intraoperative confirmed diagnosis were enrolled. Results: We recruited 73 patients including 43 (60.3%) men and 29 (39.7%) women whose mean age was 42.5 years with extremes ranging from 16 to 70 years. Most of them consulted after 72 hours, i.e. 65.2% of cases due to self-medication or even prior consultations in the lower level center at the Central Hospital of Yaoundé. The patients retained for this work presented in majority the symptoms according to the abdominal pains, the stop of the materials and gases; meteorism and vomiting. Abdominal wall hernias with incarcerated intestinal loops were the most common cause of intestinal obstruction in an unscarred abdomen in adults at 38.4% of cases, followed by digestive tumors 23.3% and adhesions 17.8%. Exceptionally, a cluster of roundworms was found as the cause of intestinal obstruction in two of our patients. Complications occurred in 25 patients or 31.5% of cases and were dominated respectively by nausea and hematoma (36%), local infections (24%) and malaria (24%). Death occurred in 5 of our patients, or 6.8% of cases, and was mostly caused by hypovolemic shock (40%) and pulmonary embolism (40%). Conclusion: Intestinal obstructions on the abdomen without scarring remain the prerogative of young adults and are caused by strangulated hernias with incarcerated intestinal loops, tumors and adhesions. The rate of complications remains high and they are dominated by infectious pathology. Their mortality is clearly improving.