Bowel Prolapse Research Articles

Omphalocele with Double Prolapse of Ileum through Patent Vitellointestinal Duct: A Rare Presentation

Although Meckel’s diverticulum is the most common vitellointestinal duct (VID) anomaly, patent vitellointestinal duct (PVID) is the most common symptomatic embryological defect. Patient may present with the anomaly itself or due to complications like intestinal obstruction secondary to volvulus, intussusception or adhesions. Prolapse occurs if the diverticulum is wide-mouthed enough to allow bowel to come out or due to increased intra-abdominal pressure like cry or cough. Bowel prolapse through PVID is rare and double prolapse of proximal as well as distal loop in a newborn is extremely rare. Omphalocele with prolapsing bowel through PVID as found in our index case is even rarer in literature. The pediatric surgeon should be familiar with these varied manifestations in the newborn because the prolapsed bowel can progress to gangrene and complications if not identified and operated upon early.

Parietal Peritoneum Closure to Treat Bowel Evisceration Following Uneventful Cesarean Delivery

Abstract Background: Bowel evisceration after cesarean delivery is a rare but serious complication needing repeat laparotomy. The current technique of nonclosure of the peritoneum might be a predisposing factor. In addition, importance should be given to suturing techniques and avoidance of excessive dissection of muscle from rectus fascia. Case: A multigravida female with a previous cesarean scar underwent repeat section at 38 weeks of gestation. She had no intraoperative or postoperative complaints. A few hours after stitch removal on the seventh postoperative day, the patient had a sense of “something giving way,” and presented to the emergency room with total small bowel prolapse arising out of the cesarean wound. Immediate bowel reduction was performed with the patient under general anesthesia, with closure of the parietal peritoneum and application of tension sutures. Results: Her stitches were removed on postoperative day 10, and she had complete healing of the wound. Conclusions: Although peritone...

Chronic pelvic pain in Spanish women: prevalence and associated risk factors. A cross-sectional study

Objective: To determine the prevalence of chronic pelvic pain (CPP) symptoms and associated risk factors in Spanish women. Design: A cross-sectional study. Setting: in Malaga and its province in Spain. Population: women aged 18-65 years using non-probability sampling by quotas (n = 940), stratified by age and county. Materials and Methods: All the participants completed the CPPQ-Mohedo, a self-administered validated questionnaire able to discriminate between patients with and without CPP. Results: Taking a CPPQ-Mohedo score of ≥ 6 as an indication of CPP symptoms, the prevalence of CPP symptoms was 26.8% in the general population in women aged 18-65 years. After adjustment for age, those women who exercised had a lower CPPQ-Mohedo score than those who did not exercise (mean difference -3.02 ± 4.27). Higher (worse) scores were associated with the following factors: lifting and/or moving heavy loads during activities of daily living (3.57 ± 4.51), laxatives and/or a high-fiber diet (4.71 ± 5.07), history of recurrent urogenital infection (vulvovaginitis, cystitis; 4.40 ± 5.22), pelvic trauma (4.77 ± 4.55), irritable bowel (5.10 ± 5.50), anal fissure (7.46 ± 6.50) or uterine prolapse (13.66 ± 2.36). Conclusions: The prevalence of CPP symptoms in Spanish women is high and is associated with risk factors that should be addressed by multidisciplinary preventive, diagnostic, and therapeutic strategies. More prevalence studies are needed to determine the true situation concerning chronic pelvic pain in Spain.

Dehiscencia de cúpula vaginal tras histerectomía laparoscópica: a propósito de un caso

Vaginal vault dehiscence after total hysterectomy with small bowel prolapse through the vagina is a rare complication, especially in premenopausal women. Appropriate management includes early diagnosis and surgical treatment. The combination of an abdominal and vaginal approach may facilitate repair.We present the case of a premenopausal woman with prolapse of the small bowel through vaginal cuff dehiscence 7 months after total laparoscopic hysterectomy.

Maternal death as a complication of uterine perforation with associated bowel prolapse per vaginum following attempted termination of pregnancy at a peripheral hospital: A case report

Introduction: Induced abortion is a procedure carried out to terminate a pregnancy for varied indications. It can, however, be complicated by severe complications including bowel injury and in some cases death. complications are common when the procedure is carried out by the untrained or poorly trained personnel. case report: this is a case of uterine perforation associated with bowel prolapsed through the vagina following an attempted termination of a missed abortion at eighth week and six days in a 25-year-old G3P2+0 (with 2 living children). the procedure was carried out by paramedics at a local General Hospital. Misoprostol was first used to induce abortion. When it failed, oxytocin infusion was used and when it also failed, dilatation and curettage was attempted which resulted in the complications mentioned and the patient subsequently died on the fourth postoperative day of an exploratory laparotomy. this case showed how poorly or untrained personnel are still using all means available to terminate pregnancies even in our hospitals resulting in serious complications. conclusion:

Prolapse of the small bowel through perforated uterus following an unsafe abortion - A case report

Prolapse of the small bowel through perforated uterus following an unsafe abortion - A case report

Neglected Intussusception Presenting as Transanal Prolapse of Small Bowel

Although transanal prolapse of intussusception in infants is well recognized, it is rarely reported and confusion with rectal prolapse often results in delayed diagnosis and treatment. This report highlights the problems of delayed diagnosis and the morbidity and mortality associated with this condition. The authors report a case of 9 mo old boy who presented with prolapsing small bowel mimicking rectal prolapse.

Evisceration of Small Bowel After Cauterization of an Umbilical Mass

The omphalomesenteric duct (OMD), a temporary structure essential to fetal development, normally involutes completely by week 8 or 9 of gestation. On occasion, the OMD persists, the clinical presentations of which vary widely. We describe a case of a 6-week-old male with a patent OMD remnant that was initially treated as an umbilical granuloma, which then potentially allowed for prolapse of the small bowel through the umbilical ring. The patient required resection of the incarcerated bowel but had an otherwise uneventful and complete recovery.

Total Laparoscopic Hysterectomy versus Vaginal Hysterectomy at the University Hospital of the West Indies: A 5-year Retrospective Study

To compare the outcomes of total laparoscopic hysterectomy (TLH), a relatively new procedure, with vaginal hysterectomy (VH), a well-established procedure, in a university teaching hospital. A retrospective chart review of all patients who underwent TLH at the University Hospital of the West Indies between January 2007 and December 2011 was conducted. Chart review was also conducted of a group of patients who underwent VH during this time period. The groups were compared with respect to demographic data and intraoperative and postoperative outcomes. Statistical analysis was undertaken using the SPSS software, version 12.0 (SPSS, Chicago, IL). The Student unpaired t-test was used to analyse continuous variables, and the Chi-square test and Fisher exact test for categorical variables, when appropriate. A p-value of < 0.05 was considered statistically significant. Ten patients underwent TLH, and were compared with 22 women who underwent VH. There was no statistically significant difference between groups in uterine weight, estimated blood loss, postoperative analgesic requirement, or length of hospitalization. Total laparoscopic hysterectomy took significantly longer to perform (209.9 vs 145.6 minutes, p = 0.004). One patient in the TLH group had to be brought back to the operating theatre after three months because of bowel prolapse secondary to vault dehiscence. With the exception of one case of bladder injury in the VH group, there were no significant differences between the groups in terms of intraoperative and postoperative complications. Total laparoscopic hysterectomy, notwithstanding its learning curve, is as safe as VH However, TLH was associated with a significantly longer operative time.

Accuracy of assessing Pelvic Organ Prolapse Quantification points using dynamic 2D transperineal ultrasound in women with pelvic organ prolapse

We determined the relationship between clinical assessment of female pelvic organ prolapse (POP) using the validated Pelvic Organ Prolapse Quantification (POP-Q) and dynamic 2D transperineal ultrasound (TPUS). Women attending the urogynecology clinics between July and October 2009 were recruited. Prolapse was assessed using the POP-Q. Points Ba, Bp and C (anterior, posterior and middle compartments, respectively) were measured. TPUS was performed at maximum Valsalva by another clinician. As the TPUS probe compresses the prolapse that extends beyond the hymen, these women were excluded. A reference line was drawn parallel to the inferoposterior margin of the pubic symphysis, perpendicular to which the leading edge of descent was measured. The offset measured from the curved array of the probe to the reference line was added to the prolapse quantification on ultrasound (US) scan to make it objectively comparable with the POP-Q reference of the hymen. Points Ba, Bp and C on POP-Q were then compared with points of maximum descent achieved on TPUS. One hundred and fifty-eight women had a POP-Q and TPUS; 20 scans (12.6 %) were not analysable, and 41 women had prolapse beyond the hymen. Ninety-seven women were thus analysed. The correlation between 2D TPUS (with/without the addition of the offset) and POP-Q was statistically significant (p value <0.0001) for all three compartments. The proportion of correct predictions was 59.6 %, 61.5 % and 32.6 % for bladder, bowel and middle-compartment prolapse, respectively. These findings suggest that the accuracy of pelvic floor US staging is limited and that clinical assessment remains the gold standard.

Neglected Intussusception Presenting as Transanal Prolapse of Small Bowel

Although transanal prolapse of intussusception in infants is well recognized, it is rarely reported and confusion with rectal prolapse often results in delayed diagnosis and treatment. This report highlights the problems of delayed diagnosis and the morbidity and mortality associated with this condition. The authors report a case of 9 mo old boy who presented with prolapsing small bowel mimicking rectal prolapse.

Une complication rare mais grave des avortements provoqués clandestins : l’évisceration iléale per vaginum

The authors report one case of bowel prolapse through uterus following induced abortion. The eviscerated bowel was completely gangrenous, devoided from its mesentery and entrapped in the uterus wall. The treatment was a bowel resection and ileo-ileum anastomosis; the uterus was evacuated of retained products of conception and then sutured. The patient recovered uneventfully; fertility prognosis is expected to be poor because of abortion sequelae. If the abortion law still remains in Ivory Coast, more effort should be directed at reducing the incidence of unwanted pregnancy. This could be best archived by a better information on contraception and better health education programs.

Extraperitoneal vs. intraperitoneal route for permanent colostomy: a meta-analysis of 1,071 patients

Parastomal hernia is a common complication after colostomy construction. Whether an extraperitoneal route for colostomy creation can reduce the risk of parastomal hernia remains controversial. A meta-analysis was performed to evaluate the value of extraperitoneal route in the prevention of parastomal hernia and other postoperative complications related to colostomy. A literature search of Medline, Embase, Ovid, and Cochrane databases from the years 1966 to 2010 was performed. Studies comparing extraperitoneal colostomy with intraperitoneal colostomy were identified. Extraperitoneal colostomy was performed to prevent colostomy-related complications. Data on the following outcomes were sought: incidence of postoperative colostomy complications including parastomal hernia, prolapse, and bowel obstruction. Seven retrospective studies with a combined total of 1,071 patients (250 extraperitoneal colostomy and 821 intraperitoneal colostomy) were identified. There was a significantly lower rate of parastomal hernia (odds ratio, 0.41; 95% confidence interval, 0.23-0.73, p = 0.002) in the extraperitoneal colostomy group. However, the occurrences of bowel obstruction and prolapse were not significantly different between the two groups. A limitation of the study lies on the meta-analysis of observational studies. Extraperitoneal colostomy is associated with a lower rate of postoperative parastomal hernia as compared to intraperitoneal colostomy. Prospective randomized controlled trial is warranted to further determine the role of extraperitoneal route in the prevention of parastomal hernia.

Beckenboden-Fragebogen für Frauen

The aim of this study was to integrate and validate an additional post-treatment module including improvement and satisfaction scales to the validated German pelvic floor questionnaire. The questionnaire contained the domains bladder, bowel prolapse, and sexual symptoms. It was completed by 55 patients before and after specific pelvic floor rehabilitation. A post-therapy module with improvement and satisfaction scales was integrated and tested psychometrically. Missing data did not exceed 4%. Improvement and satisfaction correlated significantly with bladder and bowel domain scores. Test-retest reliability showed moderate to good agreement. The questionnaire was sensitive to change with a large effect size. The improvement of bladder symptoms in 91% of the women correlated with the domain score. The validated German pelvic floor questionnaire including a post-treatment module assesses symptoms, improvement and satisfaction in a reliable and reproducible fashion.

The integral system.

The Integral System is a total care management system based on the Integral Theory which states ‘prolapse and symptoms of urinary stress, urge, abnormal bowel & bladder emptying, and some forms of pelvic pain, mainly arise, for different reasons, from laxity in the vagina or its supporting ligaments, a result of altered connective tissue’. Normal functionThe organs are suspended by ligaments against which muscles contract to open or close the their outlet tubes, urethra and anus. These ligaments fall naturally into a three-zone zone classification, anterior, middle, and posterior.DysfunctionDamaged ligaments weaken the force of muscle contraction, causing prolapse and abnormal bladder and bowel symptomsDiagnosisA pictorial diagnostic algorithm relates specific symptoms to damaged ligaments in each zone.TreatmentIn mild cases, new pelvic floor muscle exercises based on a squatting principle strengthen the natural closure muscles and their ligamentous insertions, thereby improving the symptoms predicted by the Theory. With more severe cases, polypropylene tapes applied through “keyhole” incision using special instruments reinforce the damaged ligaments, restoring structure and function. Problems that can be potentially addressed by application of the Integral System Urinary stress incontinenceUrinary urge incontinenceAbnormal bladder emptyingFacal incontinence and “obstructed evacuation” (“constipation”)Pelvic pain, and some types of vulvodynia and interstitial cystitisOrgan prolapse ConclusionsOrgan prolapse and symptoms are related, and both are mainly caused by laxity in the four main suspensory ligaments and perineal body. Restoration of ligament/fascial length and tension is required to restore anatomy and function.

A Small bowel prolapse through ruptured vaginal vault secondary to increased intra-abdominal pressure: A rare complication managed successfully through a multidisciplinary team approach

A Small bowel prolapse through ruptured vaginal vault secondary to increased intra-abdominal pressure: A rare complication managed successfully through a multidisciplinary team approach

Recurrent ileostomy prolapse: is it a solved problem?

Dear Editor, End ileostomy, introduced by Brooke [1] in 1952, has become a popular procedure in colorectal surgery. Reported postoperative complication rates range from 5 to 100% [2]. The most common complications include prolapse, necrosis, parastomal hernia and peristomal skin erosions. Stomal prolapse, as a long-term complication, occurs in 22% of adults and 38% of children [3]. It is caused by the invagination of proximal redundant bowel through the distal part in patients with ileostomy or colostomy. A loop stoma poses a greater risk of prolapse than an end stoma. Loop colostomy is more prone to prolapse than is ileostomy. Prolapse rates ranging between 3 and 42% have been reported [4, 5]. Immediate postoperative stomal prolapse is very rare. We present a case of small bowel obstruction caused by prolapse and intussusception through end ileostomy in a 36-year-old woman who underwent urgent laparotomy due to Crohn’s disease of the terminal ileum close to the ileocaecal valve. The patient was diagnosed with Crohn’s disease in 2008. She was treated conservatively (Salofalk, Metypred, PPI, Scopolan). Despite increasing symptoms of obstruction, the patient was not treated surgically. She slowly deteriorated and lost weight. At admission in July 2008, the patient’s BMI was 14.5 (body weight 42 kg), and her serum albumin level was 2.28%. The patient presented with signs and symptoms of small bowel obstruction. After a short-term preparation, the patient underwent laparotomy. At laparotomy, a 19-cm-long loop of distal ileum was found to be narrowed, inflamed, edematous, congested, thickened and causing ileal obstruction. The ileum, 11 cm in diameter and 30–40 cm long, was distended and inflamed. Proximal small bowel loops looked normal. The patient underwent partial resection of the diseased ileum. End ileostomy was performed to avoid primary anastomosis, because the patient was considered high-risk, with hypoalbuminemia and malnourishment. It was difficult to perform end ileostomy with eversion due to extensive inflammation. In addition, the everted ileostomy was fixed with through-and-through u-sutures to prevent de-eversion. The free edge of the ileal mesentery was sutured to the lateral parietal peritoneum. On postoperative day 2, a marked prolapse (30 cm) of small bowel through the ileostomy occurred. Manual reduction of the prolapse was unsuccessful. The patient was taken to the operating room (OR), where the prolapse was reduced under general anesthesia. On postoperative day 6, marked prolapse of at least 30 cm in small bowel recurred. The patient underwent laparotomy, and the prolapse and ileal intussusception were reduced. The terminal 40 cm of the ileum was thickened and distended up to 9–11 cm. A modified Reymond’s intestinal plication [6] of 4 ileal loops, each about 15 cm long, was performed. A single row of interrupted 3–0 Vicryl stitches (Ethicon Inc., Cincinnati, USA) was placed on mesentery approximately 1 cm away from its attachment to the bowel. The fixation of the terminal 60–70 cm of ileum prevented a subsequent prolapse and intussusception of the narrowed proximal ileal loops into a wide and stiff terminal ileum. On the day following this procedure, the patient began to tolerate a normal diet, and she was discharged 1 week later. At 2-week follow-up, the patient was in very good condition with an almost normal looking ileostomy. The preventive procedure used in our case of a 36-year-old female patient with 2 episodes of early postoperative ileostomy prolapse resembles the Nobel procedure that has been used in a similar case described by Irving et al. [7] in 1955. As this was the first case of this nature I encountered in my 47-year surgical practice, I have the following 2 questions: Is it better to perform end or lateral ileostomy in a wide, inflamed, stiff ileum? How can the invagination of peristaltic and narrow proximal small bowel into the distended terminal ileum be prevented? Any comments and remarks concerning the aforesaid questions will be greatly appreciated.

Prolapse of bowel via patent vitello intestinal duct—a rare occurrence

This report describes the presentation of prolapse of small bowel through the patent omphalomesenteric or vitello intestinal duct in a child. In spite of diagnosing the anomaly earlier, there was delay in surgical intervention that led to prolapse of the small bowel through patent remnants, which was life threatening. The patient presented to us with questionable viability of prolapsed bowel. Early surgery is recommended for this entity. As this is a very rare occurrence, it is being reported with a brief review of the relevant literature.

A Case of Rectal Rupture Associated with a Small Bowel Prolapse Through the Anus

A Case of Rectal Rupture Associated with a Small Bowel Prolapse Through the Anus

Spontaneous fecal fistula in a neonate

A 19-day-old male neonate was brought to us with a left upper quadrant abdominal wall defect through which bowel was prolapsing, with a double intussusception appearance typical of a patent omphalomesenteric duct. However, the history showed that the defect was not congenital, the child had a normal umbilicus, and at surgery the lesion was shown to be a mid jejunal perforation with prolapse of bowel along both the ascending and descending limbs. Histology revealed presence of inflammation and no heterotopic tissue. We believe this is the first ever report of such a fecal fistula and we speculate on the cause of this entity.