Rare Cause Of Bowel Obstruction Research Articles

Robotic transabdominal preperitoneal repair for bilateral obturator hernia: a video vignette.

Obturator hernias (OHs) are a rare cause of bowel obstruction that requires immediate surgical intervention to prevent morbidity and mortality. Patients with OHs present with acute intestinal obstruction secondary to incarceration, with a high morbidity and mortality rate due to delayed diagnosis and treatment. Although several surgical approaches have been reported, a standard approach for OH treatment has not yet been established. Here, we report the case of a 74-year-old woman who presented with bilateral OHs. The patient presented at our institution with pain in the left lower quadrant. Computed tomography revealed preperitoneal fat in both obturator foramen. Robotic transabdominal preperitoneal (R-TAPP) bilateral OH repair was performed, and a mesh was placed over both obturator foramen. The patient recovered without postoperative complications and was discharged on postoperative day 2. This suggests that the R-TAPP approach is safe for OH repair without incarceration.

Barnard syndrome with Rigler triad: a rare cause of bowel obstruction.

Barnard syndrome with Rigler triad: a rare cause of bowel obstruction.

Adult sigmoid intussusception as a rare presentation of advanced adenocarcinoma: a case report

Adult bowel intussusception is a rare clinical entity resulting in 1-5% of intestinal obstructions. It occurs more often in the small intestine and it’s secondary to a pathologic condition in 90% of cases. Its clinical picture can be unspecific, and the diagnosis is often made intraoperatively. We describe an uncommon clinical presentation of this rare clinical entity. A 69-year-old female presented in our emergency room with severe abdominal pain and rectorrhagia. The abdomen computed tomography scan revealed a colonic intussusception and a mass suggestive of a malignancy, as confirmed by rectosigmoidoscopy. The patient underwent the Hartmann procedure. A histopathological examination revealed an advanced colorectal adenocarcinoma as the lead point of the intussusception. Adult sigmoid intussusception is a rare cause of bowel obstruction, and it is often cancer-related. Symptoms can be nonspecific, and diagnosis is best made by CT imaging and endoscopic investigations which allow for planning surgery.

A brief review of diagnostic properties of point-of-care ultrasound for adult bowel intussusception: Making the case for ultrasound.

Undifferentiated abdominal pain in adults is a common chief complaint in acute care clinics and emergency departments worldwide, representing up to 10% of visits to emergency departments. Many patients have a non-specific presentation and an initial workup with labwork, urine analysis or X-ray might not reveal a specific diagnosis. Although bowel intussusception is a primarily pediatric disease, adult intussusception is a recognized but rare cause of bowel obstruction often requiring surgical intervention. However, recent data from advanced multi-detector computed tomography imaging shows that milder or recurring cases in adults have been underrecognized. Multi-detector computed tomography is still the imaging gold standard for detecting intussusception in adults, but new data showed that sonographers with basic training using the point-of-care ultrasound approach have a reasonable accuracy in detecting this pathology. As the point-of-care ultrasound for undifferentiated abdominal pain is an emerging core skill in the acute care setting, knowledge of sonographic signs of intestinal intussusception should be included in the skill set of physicians. Sonographic findings in adults mimic pediatric cases, but different location patterns and higher malignancy rates exist in adults. In this manuscript, we will review the current literature on adult intussusception and summarize key knowledge of intestinal intussusception in adults. We will present four adult patients diagnosed with different types of adult acute bowel intussusception using the point-of-care ultrasound and describe a focused scanning approach with typical sonographic findings.

Cecal volvulus with intestinal malrotation: a rare cause of bowel obstruction

Introduction:Cecal volvulus is a rare cause of acute abdomen in adults. It accounts for less than 1% of intestinal obstructions and 25-30% of cases of colonic volvulus. Congenital intestinal malrotation is a complex disorder due to incomplete or faulty rotation and fixation of the gut during the fetal life.Cecal volvulus associated with intestinal malrotation is a very rare presentation. Over 16 cases were reported in the literature. Case report:A 44-year-old man with no medical history, presented to the emergency department with a 2-day history of abdominal pain and bloating. On clinical examination, the abdomen was distended and tympanic to percussion, with diffuse abdominal tenderness. Abdominal X-ray (standing) showed a distended large intestine with an airfluid colonic level. CT scan showed a markedly dilated cecum measuring up to 14 cm, which were located in the left hypochondrium. A “whirl sign” and a superior mesenteric pedicle swirl were also noted. Emergency surgery was performed. Intraoperative exploration revealed a cecal volvulus with a largely distended hypermobile cecum located in the left hypochondrium, with preischemic signs within its wall. All the small gut was right-sided and the large gut left-sided, suggestive of mesenterium commune and intestinal malrotation. A right hemicolectomy withileo-transverse anastomosis was done. The postoperative course was uneventful. The patient is on regular follow up and is doing well. Conclusion:We describe a rare case of surgical management of cecal volvulus associated with intestinal malrotation in a middle-aged patient with no medical history. This case highlights the importance of early diagnosis by physical examination and radiological findings to prevent serious complications. Emergent surgery was the key to this successful management and surgical resection could offer better results with lesser recurrence rate. Bangladesh Journal of Medical Science Vol. 22 No. 02 April’23 Page : 445-448

Sclerosing Encapsulating Peritonitis: A Rare Cause of Bowel Obstruction.

Sclerosing encapsulating peritonitis (SEP), also referred to as abdominal cocoon syndrome, is a rare cause of bowel obstruction characterized by a thickened fibrous peritoneum that encapsulates the intestines. The exact etiology is idiopathic but may be associated with long-term peritoneal dialysis (PD). In the absence of risk factors for adhesive disease, preoperative diagnosis can be difficult and may require operative intervention or advanced imaging to diagnose. Thus, the inclusion of SEP in the differential diagnosis for bowel obstruction is essential for early detection. Existing literature is focused on renal disease as an origin, but it can be multifactorial. Here, we discuss a case of sclerosing encapsulating peritonitis in a patient without known risk factors.

Food Bolus Ileus as a Cause of High-Grade Bowel Obstruction: A Case Report

Small bowel obstruction is often caused by previous surgical scar or cancer. High grade bowel obstruction secondary to food bolus impaction is very rare especially in a young patient who has otherwise no medical or surgical history. We are presenting a unique case in a young male who presented with acute abdomen with initial CT scan suggestive of Meckel’s diverticulitis. During exploratory laparotomy, patient was found to have a severe degree of bowel obstruction with one definitive transition point caused by food bolus impaction. Food bolus ileus is a rare cause of bowel obstruction requiring surgical intervention. However, definitive intervention should not be delayed when patients present with concerning clinical signs.

Caecal endometriosis causing colo-colic intussusception: a rare cause of bowel obstruction

Intussusception refers to telescoping of a segment of bowel into adjacent bowel. Only 5% occurs in adults. Causes include neoplasm and inflammatory causes. Caecal endometriosis causing colo colic intussusception is extremely rare condition. A 45-year-old menstruating female presented with complaints of diffuse abdominal pain with vomiting for 10 days. No history of menstrual abnormalities. P/A-mass of 8×5 cm was palpable in right lumbar and umbilical region with mild tenderness. Cect abdomen-colo colic intussusception involving ascending colon and right 2/3rd of transverse colon with no obvious lead point. Patient was taken up for emergency laparotomy and it revealed 1) Intussusception of caecum into ascending colon extending upto hepatic flexure, 2) Multiple black colored nodules over lateral pelvic wall, small bowel, omentum, mesentery, ascending sigmoid colon, 3) Anterior surface of rectum was found to be adherent to posterior surface of uterus and pouch of Douglas inaccessible, 4) Multiple nodes were identified within mesentery. Laparotomy proceeded and gentle manual reduction of intussusceptum was done and growth palpable within caecum, suspecting the growth to be malignant right hemicolectomy with ileocolic end to side anastomosis done. Post operative period uneventful, HPE-endometriosis caecum. Intussusception in adult is rare entity and endometrial mass in caecum acting as lead point has been infrequently reported. Clinical and radiological investigations are of little help in diagnosing endometriosis. Hence, high clinical suspicion is required in patients with previous history of endometriosis.

CECAL VOLVULUS

Aim- Introduction- To study a case report of caecal volvulus; a rare clinical entity Cecal volvulus is an uncommon cause of intestinal obstruction, and is the axial twisting of the cecum, ascending colon, terminal ileum, and their associated mesenteries as pedicles. It is estimated that it occurs in 2.8–7.1 per million people per year. It is an infrequent cause of intestinal obstruction, accounting for 1−5% of all adult intestinal obstructions; and up to 40% of colonic volvulus. A mobile/non-xed cecum is mentioned as one signicant associated nding in patients with cecal volvulus, and this was seen in about 25% of cadaveric studies.4 Its variable clinical symptoms make it difcult to diagnose early. Case Summary- A 51 years old male presented with features of intestinal obstruction with a history of eight days. X-ray showed features intestinal obstruction with, dilated large bowel loops could be seen with atypical air uid level. A large caecal volvulus was seen with gangrenous caecum and proximal 4 cm of ascending colon. Rest of small bowel was dilated and DJ junction was found on the right of aorta. Resection of cecal volvulus with ileo-ascending anastomoses with proximal loop ileostomy was done. Caecal volvulus is a rare cause of bowel obstruction, mainly caused by an exceedingly mobile c Conclusion- aecum, an embryologic abnormality. Early diagnosis can be difcult due to its unspecic symptoms of small bowel obstruction. The main course of treatment is surgical, and modalities depend on various factors such as patient status and perioperative ndings.

Adult Intussusception Secondary to COVID-19 Infection: A Case Report and Literature Review

Intussusception is a rare cause of bowel obstruction in adults. In pediatric intussusception the most prevalent etiologic factor is viral infections, however in adults the majority of cases are associated with malignancy. We describe the case of a 37-year-old woman that presented to hospital with right lower quadrant abdominal pain, nausea, and vomiting 3 days after the initial diagnosis of COVID-19 and was diagnosed with intussusception without another identified cause. The aim of this report is to raise awareness of this extra-respiratory COVID-19 manifestation in adults and guide further decisions regarding less invasive management in such patients.

S3409 Features of Recurrent Mechanical Obstruction With Nonobstructive Duodenal Neuroendocrine Tumor

Introduction: Neuroendocrine tumors (NET) are a rare cause of bowel obstruction which is usually mechanical in nature. We present an unusual case of bowel obstruction in a patient with NET where no mechanical obstruction was found despite extensive work up. Case Description/Methods: A 56-year-old male was admitted after 9-10 admissions to another facility with bowel obstruction and 50-pound weight loss over 10 months. His symptoms included abdominal pain, distention, and vomiting. He had no prior abdominal surgeries. Previous CT abdomen revealed small bowel obstruction with transition point in the terminal ileum. Current CT showed gastric outlet obstruction (Figure A). Formerly he was managed nonoperatively with nasogastric tube (NGT) decompression. Prior esophagogastroduodenoscopy and colonoscopy did not reveal an obstruction. NGT output was 2.5 L. Push enteroscopy, video capsule endoscopy did not reveal any mechanical obstruction. MR enterography showed two right mesenteric nodules, larger of which was 2.1 x 2.3 cm in size. These were moderately FDG avid on PET-CT. Endoscopic ultrasound biopsy revealed a well differentiated NET. The lesions were intensely somatostatin receptor positive on Gallium-68 DOTATOC PETCT (Figure 1B). Pancreatic polypeptide was 2145 pg/mL (0-435), chromogranin A 1458 ng/ml (0-103), serotonin 278 ng/mL (50-200), and gastrin 208 ng/mL (0-100). He underwent partial duodenal resection with primary repair and peripancreatic lymph node resection. No obstructive pathology was found intraoperatively. Histopathology confirmed well differentiated NET with metastatic peripancreatic nodes. He has had no admissions over the past 3 months and has gained 33 pounds. Discussion: NET are rare tumors and use of appropriate diagnostic modalities are key to timely diagnosis. Despite improvement and availability of diagnostic modalities, most patients have metastatic disease at diagnosis. NET presenting with bowel obstruction usually have an obstructing tumor. We wish to bring to light the unusual presentation of NET with mechanical obstruction on imaging but extensive negative work up for an actual obstructing lesion. It is possible that mesenteric inflammation and edema secondary to NET may have caused recurrent obstruction in this case. NET can present with mechanical obstruction and are often missed on conventional imaging. Gallium-68 DOTATOC PETCT may be a reasonable investigation in a patient with unexplained recurrent gastrointestinal obstruction.Figure 1.: A, CT abdomen with dilated stomach and duodenum and decompressed distal small bowel suggestive of gastric outlet obstruction (arrow) (B) Ga-68 DOTATOC PET/CT scan showing somatostatin receptor positive peripancreatic nodules consistent with metastatic neuroendocrine tumor (chevron).

S1981 Adult Intussusception: Finding a Lead on a Rare Case

Introduction: Bowel intussusception is defined as a telescoping proximal loop within the distal loop of bowel, obliterating the bowel lumen. Although over 95% of cases occur in the pediatric population; intussusception in adults is strongly associated with tumors, with malignancy rates accounting for approximately half of all adult cases. Case Description/Methods: A 37-year-old female with no known past medical history presented to the Emergency Department complaining of suddenly worsening non-localized abdominal pain and distension. She reports a 5-day history of intermittent generalized cramps abdominal pain, which causes her to wake up several times throughout the night. Associated symptoms include anorexia, non-bloody emesis, and constipation, followed by small volume loose stools. Her physical exam was significant for generalized abdominal tenderness. Initial laboratory work-up with CBC, CMP, lipase and CRP were unrevealing except for a low serum bicarbonate (19). CT abdomen with contrast demonstrated a large colonic intussusception from the ascending colon to the splenic flexure, with suggestion of a large polyp or mass in the splenic flexure as a possible lead point (Figure). The patient underwent an exploratory laparotomy with right hemicolectomy and lymphadenectomy. Pathology of the resected colon was consistent with a Plasmablastic neoplasm involving the ileocecal valve. All surgical margins and 27 resected lymph nodes were negative. Discussion: Adult intussusception is a rare cause of bowel obstruction (< 1% on adult causes) that carries a high risk of complications, if not emergently identified and treated. Nonspecific abdominal pain is the most common clinical presentation of Adult Intussusception. The triad of red current jelly stool, colicky abdominal pain, and a palpable sausage-shaped mass; classically seen with children, is rarely present in the adult presentation. Due to high rates of malignancy, adult cases are traditionally treated with a large en-bloc resection. Early diagnosis of intussusception in adults requires a high level of clinical suspicion. Failing to recognize this may lead to complications such as bowel ischemia and perforation. Treatment in adults requires urgent operative management with oncologic resection and further investigation.Figure 1.: Left: Coronal CT revealing large colonic intussusception with lead point (yellow arrow). Right: Sagittal CT demonstrating target sign (green arrow).

S1968 Pregnancy With a Twist: A Case of Sigmoid Volvulus in the Third Trimester

Introduction: Sigmoid volvulus is a rare cause of bowel obstruction in the general population and particularly in pregnancy. Here, we present a case of a young woman in her third trimester presenting with acute sigmoid volvulus. Case Description/Methods: A 27-year-old woman with no prior medical history who was 31 weeks pregnant presented with 4 days of progressive abdominal pain and distension with associated obstipation, nausea, vomiting and decreased oral intake. Her surgical history was pertinent for prior cesarean section and right laparoscopic salpingectomy. Her vital signs are normal. Her abdomen is distended and tender to light palpation with guarding and rebound tenderness. CBC and CMP are within normal limits. A computed tomography (CT) scan of the abdomen and pelvis showed large bowel distension up to 10.5 cm with air fluid levels and twisting of the mesentery at the sigmoid colon. Based on these findings, she was diagnosed with sigmoid volvulus. The patient was emergently taken to the operating room for endoscopic sigmoid volvulus reduction. A therapeutic colonoscopy revealed a sigmoid volvulus with health appearing mucosa which was successfully traversed and detorsion was performed. A nasogastric tube was placed in the rectum with the proximal tip near the hepatic flexure for decompression.The patient’s abdominal pain improved significantly after colonic decompression. Three days later, she underwent definitive open sigmoidectomy with primary anastomosis. Three days later, the patient had vaginal bleeding along with contractions and had breech vaginal delivery of a male infant ( Figure). Discussion: Sigmoid volvulus in pregnancy is rare but should be included within the differential diagnosis for abdominal pain as a delay in diagnosis or late presentation can result in significant morbidity and mortality for mother and fetus. Delays in diagnosis are associated with high rates of morbidity and mortality for the mother and fetus. Maternal complications include sepsis, peritonitis, and bowel perforation. Fetal complications include pre-term delivery, intrauterine death, and neonatal sepsis. Endoscopic decompression is successful in 75-95% of cases. Elective surgery is recommended after endoscopic detorsion. Finally, it is important to have a multi-disciplinary approach with colorectal surgeons and obstetricians in the management of sigmoid volvulus in pregnancy.Figure 1.: Sagittal view of abdomen and pelvis CT Scan.

58 The Unfolding Situation of Caecal Volvulus: A Review of 36 Cases

Abstract Aim Caecal Volvulus is a rare cause of bowel obstruction. However, there has been a steady rise in the number of cases over the decades. The demographic profile of patients developing Caecal Volvulus has changed to a much older population. We conducted a retrospective review to find the incidence, demographic profile, management, and outcomes of Caecal Volvulus patients in our institution during the last nine years. Method A total of 38 patients were diagnosed with Caecal Volvulus at Worcestershire Acute Hospitals NHS Trust between 01.01.2011 to 31.03.2020. Results Most of our patients were females (78%) with a median age was 76 years. The majority (86%) had at least one medical comorbidity, and 36% had a previous abdominal operation. Abdominal pain was the main complaint in 94% of patients. All patients had a CT scan to confirm their diagnosis. Most of our patients (84%) underwent surgery. Open right hemicolectomy was the most commonly performed operation (87%). Out of the six patients who did not undergo surgery, three responded to bowel rest and nasogastric tube decompression; one patient underwent successful colonoscopic decompression. In contrast, two patients, unfortunately, passed away. The median length of hospital stay was 9 days, with a 30-day mortality of 3%. Conclusion Caecal Volvulus remains a rare cause of bowel obstruction. Most of our patients were old, frail and had medical comorbidities. More than a third of them had undergone previous abdominal surgery. Early CT scan followed by surgery was associated with low mortality.

788 Caecal Duplication Cyst: An Unexpected Cause of Bowel Obstruction in a 12-Year-Old

Abstract We report the case of a rare cause of bowel obstruction in a 12-year-old girl who presented with a short history of abdominal distension and vomiting after a month of unexplained urinary frequency and weight loss. Abdominal radiographs demonstrated small bowel obstruction with an unknown pelvic mass. A raised CA125 suggested a possible ovarian lesion and a magnetic resonance scan was interpreted as supportive of this pathology. Intra-operatively a 120x90x70mm cystic mass was found attached to the caecal serosa, immediately adjacent to the ileocaecal valve. There was an associated 180-degree twist of the terminal ileum and ascending colon. A limited right hemicolectomy was performed, and histopathology confirmed the diagnosis of a caecal intestinal duplication cyst. Post-operatively she has recovered well, with resolution of her obstructive and urinary symptoms. Given the unusual age of presentation, uncommon location of the cyst and the diagnostic challenges incurred, the authors wish to share their experience of managing an atypical duplication cyst.

EP-555 The telescoping sigmoid – a rare presentation of acute large bowel obstruction

Abstract Background Adult bowel intussusception is a rare cause of bowel obstruction (1–5%) and requires urgent treatment, usually emergency surgery. Aim We wish to highlight the diagnosis and management of the rare entity of acute bowel obstruction secondary to intussusception with our adult patient with sigmoid colon intussusception. Case presentation We present a 65 years old male who attended with constipation, abdominal discomfort and per-rectal bleeding. Clinical examination revealed multiple subcutaneous lipomas, mild LUQ tenderness and large ‘lump’ 10 cm from anal verge on rigid sigmoidoscopy. CT abdomen/pelvis showed intussusception of the sigmoid into the rectum with a large ‘polyp’ as the lead point. On- table Flexible sigmoidoscopy was unsuccessful in reducing the intussusception. We proceeded to laparotomy with reduction of intussusception, high anterior resection with end- to- end stapled anastomosis. He made an excellent recovery. Post-operative histology which was reviewed in detail in MDT did not reveal any neoplastic/lipomatous lesion to account for the intussusception. The patient was very well on outpatient review. Conclusion Adult bowel intussusception is rare (5% of all intussusceptions), especially in the left colon. When it does occur, it is usually secondary to lipoma, neoplasm, or nodal mass acting as a lead point. These patients can be diagnostically challenging due to lack of clear obstructive symptoms on presentation. Early diagnosis (via a CT scan) and treatment of adult colonic intussusception (usually via surgery) is necessary to avoid serious complications such as bowel perforation/peritonitis. Postoperative histology review is also imperative to plan any appropriate further management.

Ileo-sigmoid knotting in a female Ethiopian patient, a case report.

IntroductionIleo-sigmoid knotting is a very rare cause of bowel obstruction. The diagnosis can be challenging and may not be suspected pre-operatively. A high index of suspicion, especially in areas of the “sigmoid belt” region, can be helpful.Case presentationA 40-year-old ethnic Amhara female patient presented with symptoms and signs of bowel obstruction. She presented in shock and after resuscitation, laparotomy revealed gangrenous ileum twisted around the sigmoid colon (‘ileo-sigmoid knotting’). The gangrenous ileal segment was resected, with end-to-end ileo-ileal anastomosis. The patient had a smooth postoperative course and was discharged on the 4th post-operative day.ConclusionsTwisting of the ileum around the sigmoid colon is pathognomonic of ileo-sigmoid knotting. Prompt resuscitation and surgical intervention in the shocked patient with an acute abdomen and evidence of intestinal obstruction could be life-saving.

Ileosigmoid knotting: Case report and literature review

Objective: Ileosigmoid knotting (ISK) is the wrapping of the ileum around the sigmoid colon and its mesentery or vice-versa. ISK is a rare cause of bowel obstruction in general and rare during pregnancy. Case: We present a case of ISK, a Pregnant lady 29th weeks gestation, which was treated successfully in our institution – Khoula Hospital – Muscat - Sultanate of Oman.

Hernia interna por divertículo de Meckel: Una causa rara de obstrucción intestinal

Meckel's diverticulum is the remnant of the omphalomesenteric duct and is considered the most common congenital hernia secondary to a Meckel's diverticulum, a rare cause of bowel obstruction. Keywords: Meckel’s diverticulum; intestinal obstruction; omphalomesenteric duct; congenital gastro-intestinal malformation.

The Unfolding Situation of Caecal Volvulus: A Retrospective Analysis of 36 Cases From a Single Center.

BackgroundCaecal volvulus (CV) is a rare cause of bowel obstruction. However, there has been a steady rise in the number of cases over the decades. The demographic profile of patients developing CV has changed to a much older population. We conducted a retrospective review to determine the incidence, demographic profile, management, and outcomes of CV patients in our institution during the last nine years.MethodologyA retrospective audit of all patients diagnosed with CV at Worcestershire Acute Hospitals NHS Trust between 01 January 2011 and 31 March 2020 was performed. Patients admitted with any other type of volvuli such as sigmoid volvulus, small bowel volvulus, and gastric volvulus were excluded.A systematic search of the electronic medical records for all patients admitted under the International Classification of Diseases, Tenth Revision code K562: volvulus was performed for the study duration. It yielded a total of 1,019 patients. After excluding all patients who did not have either a CV or caecal bascule, we included 36 patients in the final analysis.ResultsMost of our patients were females (78%) with a median age was 76 years. The majority (86%) had at least one medical comorbidity, and 36% had a previous abdominal operation. Abdominal pain was the main complaint in 94% of patients. All patients had undergone a computed tomography (CT) scan to confirm their diagnosis. Most of our patients (84%) underwent surgery. Open right hemicolectomy was the most commonly performed operation (87%). Out of the six patients who did not undergo surgery, three responded to bowel rest and nasogastric tube decompression; one patient underwent successful colonoscopic decompression. In contrast, two patients, unfortunately, passed away. The median length of hospital stay was nine days, with a 30-day mortality of 3%.ConclusionsCV remains a rare cause of bowel obstruction. Most of our patients were old, frail, and had medical comorbidities. More than one-third of patients had undergone previous abdominal surgery. Early CT scan followed by right hemicolectomy was associated with low mortality.