Partial Intestinal Obstruction Research Articles

Abdominal Cocoon Syndrome (ACS) or Idiopathic Sclerosing Peritonitis: An Extremely Rare Cause of Intestinal Obstruction

Introduction: Abdominal cocoon syndrome is an extremely rare cause of intestinal obstruction in which loops of small bowel are encapsulated by a fibro-collagenous membrane. This condition is also known in the literature as sclerosing peritonitis, and in the majority of cases, it has no known cause. The majority of patients exhibit long-standing signs and symptoms of partial intestinal obstruction. Presentation of case: A 15-year-old female patient presented with complete intestinal obstruction with no known co-morbidity and no history of prior laparotomy. Intraoperatively, the entire small bowel was found to be encapsulated by a dense fibrous sac. The peritoneal sac was excised, followed by lysis of the inter-loop adhesions with appendicectomy done at the same time. Discussion: Most patients with abdominal cocoon syndrome present with features of recurrent acute or chronic small bowel obstruction secondary to kinking and/or compression of the intestines within the constricting cocoon. An abdominal mass may also be present due to an encapsulated cluster of dilated small bowel loops. Conclusions: Abdominal cocoon is a rare condition causing intestinal obstruction, and diagnosis requires a high index of suspicion because of the non-specific clinical picture. Contrast-enhanced CT-scan (CT) of the abdomen is a useful radiological tool to aid in preoperative diagnosis. Peritoneal sac excision and adhesiolysis is the treatment, and the outcome is usually satisfactory.

Neonatal abdominal cocoon arising from atypical sequelae of intestinal malrotation: A case report

Background: Abdominal cocoon (AC) is the partial or complete encasement of the intestines and sometimes other abdominal organs by a fibro-collagenous sac causing varied presentations of intestinal obstruction. It has been found in all age groups from neonates to the elderly although neonatal AC is quite rare and only very few cases have been reported. In neonates, the presentation could mimic other causes of partial or complete intestinal obstruction and preoperative diagnosis is usually difficult. Case Presentation: We report an atypical sequela of intestinal malrotation causing neonatal intestinal obstruction due to omental encasement of the small and large bowel. The diagnosis was made intraoperatively though contrast gastrointestinal series suggested the partial obstruction at the duodenal-jejunal level. The patient made a good postoperative recovery after extraction of the bowel from the cocoon (omental sac), partial omentectomy, and Ladd’s procedure. Conclusion: A neonatal abdominal cocoon caused by an omental encasement in a malrotated intestine is a unique presentation and a rare cause of neonatal intestinal obstruction.

Chronic Intestinal Pseudo-Obstruction: Is There a Connection with Gut Microbiota?

Chronic intestinal pseudo-obstruction (CIPO) is a rare clinical syndrome characterized by severe impairment of gastrointestinal (GI) motility, and its symptoms are suggestive of partial or complete intestinal obstruction in the absence of any lesion restricting the intestinal lumen. Diagnosis and therapy of CIPO patients still represent a significant challenge for clinicians, despite their efforts to improve diagnostic workup and treatment strategies for this disease. The purpose of this review is to better understand what is currently known about the relationship between CIPO patients and intestinal microbiota, with a focus on the role of the enteric nervous system (ENS) and the intestinal endocrine system (IES) in intestinal motility, underling the importance of further studies to deeply understand the causes of gut motility dysfunction in these patients.

INFORMATIVE VALUE OF COMPARATIVE ASSESSMENT OF GENERAL CLINICAL INDICATORS IN PATIENTS WITH DESTRUCTIVE CHOLECYSTITIS

Purpose: comparative assessment of clinical manifestations of the course of destructive calculous cholecystitis before surgical operation. Methods. The study involved 86 patients with destructive cholecystitis (55 women and 31 men). 18 patients with destructive cholecystitis made up group 1, and 14 healthy people formed the control group. Patients with cholecystitis underwent cholecystectomy. The age groups were as following: 18-25, 26-40, 41-60 and 61-75 years. Grouping patients by age and sex enabled to reveal related concomitant diseases and complications of cholecystitis. 48 patients underwent open cholecystectomy, and 38 had laparoscopic cholecystectomy. The study determined the quantitative parameters of various enzymes in blood samples from patients with destructive cholecystitis, and the control group. Results. Standard open cholecystectomy was performed on in 55.8% of cases; consequently, laparoscopic cholecystectomy was performed in 44.2% of cases. A retrospective analysis of the surgical interventions performed has demonstrated 54 (62.8% ) patients had gallstones as a leading cause in the development of cholecystitis; 15 (17.4%) patients had phlegmon, 11 (12.8%) patients had gangrene, 4 (4.7%) patients had polyps, and 2 (2.3%) had gallbladder hypertrophy and complete closure of the lumen. 18 patients who underwent cholecystectomy, had developed various preoperative complications: 13 of them had local peritonitis, 2 patients had partial intestinal obstruction, and 3 were diagnosed as having mechanical jaundice. Local peritonitis was found out as the most common preoperative complication. 16 people had various comorbidities and made 18.6% of all patients. 8 (9.3%) out of 16 of the patients had diagnosis of diabetes mellitus. Conclusion. It should be noted that among all patients who underwent cholecystectomy, various preoperative complications were diagnosed, but local peritonitis was the commonest one. Diabetes mellitus against the background of impaired motility or tone of the intestines, bile ducts and the gallbladder leads to cholestasis and gallbladder inflammation.

Trichobezoars of the stomach and jejunum, complicated by partial obturation intestinal obstruction

The article describes the stages of diagnostics and treatment of a child with the stomach and jejunum trichobezoars, starting from the regional hospital and ending with a children’s medical republican institution. The operation, which was performed 2 days after the child’s hospitalization, consisted in enterotomy, gastrotomy and the trichobezoars extraction. The postoperative period was uneventful. The significant difficulty in trichobezoars recognition in children requires the development of an action algorithm at all stages of the diagnostic process.

Кишкова непрохідність, викликана дивертикулом Меккеля, в дітей

Meckel’s diverticulum is the most common variant of anomalies of incomplete obliteration of the yolk duct. Among the various malformations of the digestive tract, which can cause intestinal obstruction, Meckel’s diverticulum ranks first and is 1.7%. Purpose – to generalize the results of treatment of children with intestinal obstruction caused by Meckel’s diverticulum. Materials and methods. The experience of treating 183 children with Meckel’s diverticulum and related pathology is summarized. The main complications of Meckel’s diverticulum were intestinal obstruction, bleeding from a peptic ulcer, diverticulitis. In 100 children, the diverticulum was asymptomatic and was an accidental finding during surgery on the abdominal organs for other pathologies. Results. Intestinal obstruction caused by Meckel’s diverticulum accounted for 20.8% of all cases and 45.7% of all diverticulum-related complications. Strangulative intestinal obstruction was diagnosed in 18 patients: in 16 Meckel’s diverticulum caused internal compression, in 1 – torsion of the loops of the small intestine around the fixed diverticulum, in 1 – nodulation. In 5 observations, Meckel’s diverticulum caused the phenomenon of partial intestinal obstruction. Intussusception was detected in 15 children (small intestinal in 6 cases and ileocecal in 9). Clinical cases demonstrating the difficulties in diagnosing intesti nal intussusception caused by Meckel’s diverticulum in older children and small bowel entrapment in the mesodiverticular ligament are presented. A method of subserous diverticulectomy and one-step decompression of the small intestine was proposed. Conclusions. Meckel’s diverticulum should be considered as a probable cause of acute intestinal obstruction in children older than 2 years and who have not previously undergone surgery on the abdominal organs. In the surgical treatment of pathology caused by Meckel’s diverticulum, it is possible to use one-time decompression of the small intestine by diverticulotomy and subserous removal of the diverticulum. The research was carried out in accordance with the principles of the Helsinki declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: Meckel’s diverticulum, intestinal obstruction, children.

Inflammatory cap polyp of the sigmoid colon: a case report

BackgroundInflammatory cap polyp is a very rare benign entity of the distal left colon, characterized by inflammatory polyp with a “cap” of fibrinopurulent exudates. They are usually multiple and commonly present with bleeding per rectum or mucoid discharge. Solitary polyp presenting with intermittent intussusceptions is rare.Case presentationWe report the case of a 45-year-old Nepalese male with a solitary inflammatory sigmoid colon polyp. The patient presented with a 1-month history of rectal bleeding, mucoid discharge, and severe colicky abdominal pain due to intussusceptions. On colonoscopy, there was an exophytic mass with surface exudates. Colonic resection and anastomosis were performed, due to recurring partial intestinal obstruction. At a 6-month follow-up, the patient was asymptomatic.ConclusionInflammatory cap polyp is a benign entity, and it should be kept in mind as an important differential diagnosis of exophytic colonic mass with surface exudates.

Laparoscopic Jejunostomy as the standard procedure of Jejunostomy tube placement in upper GI and laryngeal cancers: A case series

Background: Laparoscopic enteral-feeding access is the best option for patients with advanced upper gastrointestinal, oropharyngeal, and laryngeal cancers needing to maintain their caloric intake before surgery or during chemoradiotherapy. Methods: During a laparoscopic procedure by a cystostomy catheter system, a jejunostomy tube was placed for 14 patients. All the patients had a 2-month follow-up for complications and performance of the feeding system. Results: Based on the obtained results, there was no internal leak and peritonitis among the subjects. One patient converted to an open procedure due to perforation during the procedure. In three patients, the extraction of the catheter was encountered during the follow-up period and a replacement was required. One case of wound infection and one case of catheter obstruction occurred among the subjects. Catheter obstruction was easily resolved using warm water and pancreatic enzyme irrigation. There was one patient with partial intestinal obstruction who was managed through nonoperative means. No significant bleeding was encountered during the surgery. Conclusion: Laparoscopic jejunostomy with this method is simple and cost-effective and can be performed within an acceptable timeframe with minimum complications. It is the procedure of choice for upper GI and laryngeal cancer patients, those at increased risk of aspiration, and subjects not candidates of percutaneous endoscopic gastrostomy. Reference

Laparoscopic Versus Open Pre-Treatment Loop Colostomy for Fecal Diversion in Rectal Cancer Patients: Is Laparoscopic Colostomy Better?

Diversion colostomy plays a crucial role in the management of carcinoma rectum in low- and middle-income countries as significant number of patients present with partial intestinal obstruction. The aim of this study was to compare laparoscopic and open approaches for fecal diversion done in patients with adenocarcinoma of the rectum as a pretreatment procedure. The primary end point of our study was time to initiation of neoadjuvant chemo radiation. It was a retrospective study that included all patients diagnosed to have carcinoma rectum and underwent a pretreatment fecal diversion between 2012 and 2014. A total of 55 patients underwent pretreatment diversion colostomy of which 33 were performed via the laparoscopic approach while 22 had open diversion. The time for initiation of neoadjuvant therapy was shorter in the laparoscopic group compared to the open approach (16days vs. 20.5days, P = 0.31). The study concluded that pretreatment diversion colostomy using the laparoscopic approach was a safe option in low- and middle-income countries as it was associated with faster recovery and early initiation of neoadjuvant therapy in patients with partially obstructed locally advanced carcinoma rectum.

Phytobezoar Within Meckel’s Diverticulum Presenting With Partial Intestinal Obstruction

Introduction: Meckel’s Diverticulum (MD) affects approximately 2% of the population. Phytobezoar is defined as a vegetable and fiber-based ball in the gastrointestinal tract. We report a rare case of phytobezoar within MD presenting with partial intestinal obstruction. Case Reports: We hereby present a 20-year-old man who referred to the Emergency Department of a hospital with a two-day history of nausea, vomiting, abdominal pain, and constipation. He underwent a midline laparotomy with surgical exploration, which revealed an MD 60 cm proximal to ileocecal valve containing phytobezoar. Histopathology reported the extracted specimen as an MD without ectopic tissue. Conclusion: Meckel’s diverticulum can be affected by bezoars as well as other parts of the gastrointestinal tract. We recommend that phytobezoar within MD be considered among differential diagnosis of bowel obstruction.

Una patología muy infrecuente: ganglioneuromatosis intestinal. Reporte de un caso

Intestinal ganglioneuromatosis is an unusual pathology, especially in adults. It is associated with multiple endocrine neoplasia type IIb and Von Recklinghausen´s neurofibromatosis. Histologically, it is characterized by hyperplasia of the intramural plexuses of the gastrointestinal tract and enteric nerve fibres. Clinical manifestations include abdominal pain, distension and changes in bowel habits. We report the case of a 38-year-old patient, with a multiple endocrine neoplasia syndrome type IIb, presenting with repeated partial or complete intestinal obstruction that requires partial colectomy. Pathology of the resected colon revealed intestinal ganglioneuromatosis.

Pediatric intestinal pseudo-obstruction: Role of histopathology

Pediatric intestinal pseudo-obstruction (PIPO) is a rare and debilitating clinical disorder characterized by gastrointestinal motility dysfunction, resulting in symptoms suggestive of total or partial intestinal obstruction in the absence of any lumen-restricting or occlusive lesions. It is very similar to other bowel obstruction syndromes, favoring late diagnosis, chronic symptoms, poor nutritional status, poor quality of life and submission to various unnecessary surgeries. The investigation is based on excluding mechanical causes of intestinal obstruction, identifying underlying diseases, assessing possible drug induced disease and understanding the pathophysiological characteristics to determine the most appropriate therapy and prognosis. We report two cases of PIPO with distinct pathophysiology evidenced by histopathology; they were submitted to various surgical procedures and showed no response to clinical treatment, demonstrating the high morbidity and mortality of this disease. Histological evaluation was important in these cases to establish the definitive diagnosis, in addition to demonstrating continuing worsening. PIPO has a great impact on quality of life and high morbidity and mortality rates. Moreover, despite recent advances in its study, it still presents challenges regarding the proper understanding of its etiopathogenesis. In the cases presented, histopathology was essential for understanding the pathophysiology and progression of the disease.

Experimental Models of Partial Intestinal Obstruction in Young Mice: Establishment, and Evaluation

BackgroundPartial small bowel obstruction (SBO) is a common, potentially hazardous, surgical entity caused by numerous factors in humans. A number of techniques have been reported as efficient to simulate partial SBO in murine models. However, there is little data concerning their long-term survival. Our study presents a novel technique and evaluates its long-term efficiency compared with other commonly used techniques. Materials and methodsSixty C57BL/6 mice aged 6 to 8 wk were randomly divided into five intervention groups: ligation, intestinal ring, partial ligation, microclips, and the novel triple suture technique. The ring groups were subdivided into narrow, medium, and wide ring and partial ligation groups were subdivided at 1/3, 1/2, and 2/3 of the lumen. Survival cutoff time was set at 4 wk. Animals were then euthanized and small bowel muscle layer thickness was histopathologically evaluated. ResultsNone of the animals of the ligation and the ring groups reached the cutoff survival time. The mortality rate of the partial ligation and the microclips groups at the 4-week period were 33.3% and 0%, respectively. However, elimination of the performed intervention was revealed at the time of euthanasia and no alterations of the muscle layer were revealed at histopathology. The “triple suture” group had a survival rate of 90% until euthanasia and the sutures were apparent in all cases. Macroscopic evaluation showed small to mild proximal lumen dilatation in 6 of 10 animals. Histopathological evaluation of the specimens confirmed the partial obstruction. ConclusionsThe “triple suture” technique is a new, robust, reliable, and inexpensive technique for experimental long-standing partial SBO, with very low mortality.

Intractable small-bowel obstruction due to urothelial cell carcinoma metastasis to the distal ileum: A rare cause of malignant bowel obstruction

Most patients with partial intestinal obstruction can be managed without surgical intervention. Here, we report the case of a patient who presented with partial intestinal obstruction. He had been diagnosed with high-grade urothelial cell carcinoma (UCC) 1.5 years previously, for which the surgery and adjuvant chemotherapy had been successfully performed. He showed a poor response to medical treatment for the partial intestinal obstruction, and surgery provided only a short-term benefit. Such cases of intractable small-bowel obstruction are infrequent and pose a challenge to clinicians. Although very rare, the possibility of UCC metastasis to the gastrointestinal tract should be considered in the differential diagnosis of refractory intestinal obstruction and history of UCC.

Laparoscopic total extraperitoneal obturator hernia repair in critical challenging patients

AIM AND PERSPECTIVE: Obturator hernia is an uncommon surgical disease, a condition predominantly affected the elderly, emaciated, female patients. Various surgical procedures have been used to treat this disease, including open and laparoscopic approaches; however, in some special conditions, the technique is still challenging. METHODS: The technique details of total extraperitoneal (TEP) repair in the treatment of obturator hernia in critical challenging conditions were described. RESULTS: The challenging obturator patients had high risk of comorbidities, including massive ascites, partial intestinal obstruction, malnutrition, and previous abdominal surgeries. All the procedures were successful; patients had no modality and recurrences and chronic pain. One patient developed wound dehiscence and healed with bedside suture. CONCLUSION: The present report justifies the feasibility of TEP obturator hernia repair in challenging conditions.

A RARE CASE OF THE COMBINATION OF OMPHALOCELE WITH ISOLATED ENTEROCYSTS IN A NEWBORN

The authors describe an extremely rare combination of omphalocele and isolated segments of the small intestine with enetercystomas having their own mesentery. This pathology was manifested by a syndrome of partial intestinal obstruction during 50 days after suturing the anterior abdominal wall because of omphalocele. During relaparotomy, a pair of separated intestinal fragments with hypertension in their inner content was removed. The patient recovered completely.

CHALLENGES IN CHOICE OF THE TREATMENT STRATEGY FOR PATIENTS WITH RECURRENT PSEUDOMYXOMA PERITONEI

Pseudomixoma peritonei is a rare type of peritoneal carcinomatosis accompanied by accumulation of mucus and high recurrence rate and in some cases complicated with intestinal obstruction. In the last 10–15 years, there has been observed a significant improvement in overall survival of patients with recurrent pseudomyxoma, who underwent cytoreductive surgery in combination with intraperitoneal chemotherapy. However, the frequency of recurrences of peritoneal pseudomyxoma after optimal cytoreduction can reach 80–90 % in the first 2 years.The purpose of the study was to analyze the results of combined therapy (cytoreductive surgery and hypothermic intraperitoneal chemoperfusion) in patients with recurrent pseudomyxoma peritonei, who previously underwent cytoreductive surgery.Material and Methods. The study included 43 patients previously undergoing cytoreductive surgery for pseudomyxoma peritonei in the Thoracic Oncology Department of the N.N. Blokhin National Medical Research Center of Oncology.Results. Re-operations were performed in 11 of the 43 patients with recurrent pseudomixoma peritonei after previously performed cytoreductive surgery. Repeated intraperitoneal chemoperfusion with hyperthermia was performed in 6 patients. Of the 11 reoperated patients, 7 had a complete cytoreduction (CC-0), recurrence was detected within 22 to 47 months; 2 patients had CC-1 and recurrence was observed within 12 and 15 months. Optimal cytoreduction (CC0-1) was achieved in 7 of the 11 patients. The maximum follow-up period was 44 months. Recurrence was noted in 9 patients, while the majority of patients had a satisfactory quality of life. Two patients showed signs of partial intestinal obstruction. None of the patients died during the follow-up period. In two patients with optimal (CC-0) cytoreduction, there were no signs of disease progression 9 and 15 months after re-surgery. One-year disease-free survival rate was 51 %.Conclusion. Repeated surgeries for recurrent pseudomyxoma present a great challenge for surgeons due to the difficulty in achieving optimal cytoreduction. Optimal cytoreduction in initial surgery should be considered as the main condition for repeated surgery. Moreover, additional criterion for a favorable prognosis is the time to progression of disease.

Rare Forms of Intestinal Obstruction in Children

The article analyzes two rare cases of acquired intestinal obstruction in children. In the first child at the age of 2 years, who suffered a retrosternal total coloesophagoplasty for extended post-burn chemical esophageal stenosis, early postoperative adhesive intestinal obstruction appeared on the 8th day of the postoperative period, which was eliminated laparoscopically. The next day, against the background of drug stimulation of the intestine, a small intestinal invagination developed, diagnosed with ultrasound examination. Relaparotomy and disinvagination were performed.The second patient, the 15 years old girl, who had suffered from closed abdominal injury and a pancreatic injury, manifested the signs of high partial intestinal obstruction a day after the trauma occurred. Initially, its cause was considered to be hematoma of the omental bursa. Fibrogastroduodenoscopy (FGDS) and X-ray diagnostics did not reveal the cause of intestinal obstruction, but after FGDS procedure the patient’s condition improved within 3–4 days, and then the clinical signs of small bowel obstructive adhesion confirmed by X-ray and laparoscopy. With laparoscopy in the middle section of the small intestine, a hyperinflate “whitish” section about 12 cm long, dense in palpation, was identified, which was the cause of obstruction. Through minilaparotomic umbilical access from the abdominal cavity, a loop of the jejunum with a foreign body inside was exteriorized. With transverse enterotomy trihobezoar 10×4×4 cm was removed from the lumen, which moved from the stomach and led to obstruction of small intestine. The outcome of the treatment was good in both cases.

Challenges in choice of the treatment strategy for patients with recurrent pseudomyxoma peritonei

Pseudomixoma peritonei is a rare type of peritoneal carcinomatosis demonstrating an indolent course and a high rate of recurrence. primary surgical interventions in patients with pseudomixoma peritonei are extensive and traumatic, which worsens the chances for performing re-operation and may increase the rate of postoperative complications. above mentioned circumstances forms a problem in the choice of management for patients with recurrent pseudomyxoma peritonei. in this article we present a clinical case of successful treatment of recurrent disease.Сlinical case. The 62 years female patient in 2006 first noticed pain in the lower abdomen. the examination revealed a tumor near the right appendages. on 28.12.2006 the uterus was extirpated with appendages, appendectomy, resection of the large omentum; 6 courses of chemotherapy (cap) were conducted. in may 2007 and June 2009, repeated cytoreductive operations were performed with subsequent 12 courses of chemotherapy. in 2012 a patient with a relapse of the disease was re-operated at the N.N. Blokhin NmRcof oncology. Re-operation was performed in the volume of removal of bulk of the tumor in the right and left sub-diaphragmatic spaces with resection of both domes of the diaphragm, splenectomy, removal of the remaining part of the large omentum, with subsequent hyperthermic intraperitoneal chemoperfusion with cisplatin. complications were not noted. after 14 months, ctand ultrasound revealed progression of the disease. in 2013 an attempt was made to re-surgical intervention. during re-operation in the abdominal cavity a massive adhesive process was found. given the palliative nature of the intervention and the high risk of progression, the volume of surgery is limited to a biopsy of the tumor mass. later 4 courses of chemotherapy were conducted. during period of follow-up, relapse of tumor was noted with the development of partial small intestinal obstruction, which did not require emergency intervention. at present, 26 months after the combined treatment, the patient’s condition is satisfactory, with no signs of intestinal obstruction.Сonclusion. Performance repeated surgical interventions for pseudomixoma peritonei is a rather difficult task for, due to the fact that with continued growth, it is more difficult to achieve optimal cytoreduction. the basic condition for re-operation should be referred to the initial optimal level of cytoreduction and a long-term disease-free period.

Long-term Results of the Side-to-side Isoperistaltic Strictureplasty in Crohn Disease: 25-year Follow-up and Outcomes.

Review the long-term outcomes of the side-to-side isoperistaltic strictureplasty (SSIS) and its effects on bowel preservation in Crohn disease (CD). The first SSIS was performed 25 years ago as an alternative to resection in the treatment of extensive fibrostenosing jejuno-ileal CD. Prospective study (January 1992-December 2016) of all patients with a SSIS performed by the authors. Long-term outcomes were evaluated radiographically, endoscopically, and histopathologically. Sixty patients [14.4% of patients with jejuno-ileal bowel CD; 31 females; median age 36 (12-69) years] underwent 61 SSIS's for partial intestinal obstruction. Median length of preserved small bowel was 50 (20-148) cm. Associated strictureplasties and bowel resection were performed in 44% and 80%, respectively. Postoperative mortality occurred in 1 (PE on POD#8) and postoperative morbidity in 7 (12%). There were no sutureline dehiscences. SSIS resulted in resolution of preoperative symptoms in all. After a median follow-up of 11 years (range 1 mo-25 yrs), symptomatic recurrence was observed in 61%: 15 patients at the SSIS and 19 away from it (2 cases unclear location; 7 patients with >1 recurrence). Of 15 recurrences at SSIS's, 11 required surgical treatment (revision or strictureplasty in 6, SSIS removal in 5). Fifty-one patients (86%) maintain the original SSIS to date. SSIS is a safe, effective, and durable strictureplasty in patients with extensive fibrostenosing CD of the small bowel. Half the surgical recurrences on SSIS can be managed by subsequent revision or strictureplasty. The majority of patients maintain the original SSIS after a median follow-up of 11 years.