Rare Cause Of Intestinal Obstruction Research Articles

A case report on cocoon abdomen

Abdominal Cocoon is one of the rare causes of intestinal obstruction. A complete or partial small bowel encapsulation caused by thick fibro collagenous membrane. Cocoon Abdomen is otherwise called Sclerosing Encapsulating Peritonitis (SEP). This SEP is divided into two: abdominal cocoon (AC) also known as idiopathic or primary sclerosing encapsulating peritonitis, which is extremely a rare and secondary sclerosing encapsulating peritonitis, which is a common one. Symptoms are nonspecific and preoperative diagnosis was extremely difficult. Surgery is very essential to take membrane samples that confirm diagnosis and for treatment.

One-step approach by enterolithotomy as surgical treatment of biliary ileus associated with bridle: case report and literature review

Gallstone ileus is a rare cause of intestinal obstruction, more common in adults and in the context of late complications due to gallbladder stones. The pathophysiology describes long-term inflammatory processes of the gallbladder, with biliodigestive fistula development and passage of the gallstone into the intestine, impacting the terminal ileum in most cases. It manifests with data of intestinal obstruction in patients with a chronic history of gallbladder lithiasis. The ideal imaging study is a computed tomography (CT) scan of the abdomen to identify pneumobilia, intestinal obstruction and the lithiasis impacting on the bowel. The surgical approach depends on the context of each patient through laparoscopy or laparotomy in order to perform enterotomy and extraction of the stone or by performing also the management of the fistula and cholecystectomy at the same surgical time. Management must be individualized for each patient. We present the case of a patient in her tenth decade of life with a history of recurrent biliary colic without management, who was admitted to the general surgery department with data of probable intestinal occlusion. Imaging studies were performed, with radiographic evidence of distension of the small bowel loops and tomography with findings suggestive of biliary ileus. Due to the clinical context and comorbidities of the patient, laparotomy with enterotomy and extraction of the stone was performed.

Case Report: The Diaphragmatic Hernia: A Rare Cause of Intestinal Obstruction

We present the case of a 22-year-old patient, with congenital diaphragmatic hernia, diagnosed at an advanced stage due to an occlusive syndrome observed on the CT scan, revealing colonic distension upstream of a strangulated Bochdalek's diaphragmatic hernia. The patient underwent laparotomy, where the hernia was reduced, and the diaphragmatic rupture was closed. The purpose of this article is to highlight a rare cause of intestinal obstruction, which is strangulated diaphragmatic hernia, when the diagnosis and detection of complications are confirmed through CT scan, allowing for early management.

A Case Report on Cecal Volvulus: Approach to Management

Cecal volvulus is a rare cause of intestinal obstruction caused by axial twisting of the cecum that occurs in 1–1.5 % of all intestinal obstruction, with an incidence of 2.8–7.1 cases per million annually. Cecal volvulus is potentially life-threatening without prompt surgical intervention. A 57-year-old woman presented with severe abdominal pain and distention. Laboratory examinations revealed normal white blood cell count with neutrophilic predominance. Diagnosis of acute cecal volvulus was made from a “whirl sign” on abdominal computed tomography. An exploratory laparotomy confirmed the diagnosis of cecal volvulus and a segmental ileocolic resection with primary anastomosis was carried out. The patient was discharged improved and returned to her normal activities of daily living. Conclusion: The management of volvulus involves a series of stepwise decisions that must be performed rapidly. Due to the fact that this condition is relatively uncommon makes it more critical for surgeons to maintain a solidified algorithm tailored to the disease process in order to amplify chances of successful outcome. In this case, the diagnosis of acute cecal volvulus was made from a “whirl sign” on abdominal computed tomography. An exploratory laparotomy confirmed the diagnosis of cecal volvulus and a segmental ileocolic resection with primary anastomosis was carried out. The patient was discharged, improved. Key words: Cecal volvulus, ileo-colectomy, whirl sign

Delayed presentation of gallstone ileus due to spilled gallstones: A case report

Introduction: Gallstone ileus is a rare cause of intestinal obstruction and very few cases have been reported of spilled gallstones during a cholecystectomy resulting in a delayed presentation of gallstone ileus. Although complications from unretrieved gallstones are rare, there is a variety of post-operative complications described in the literature. Most complications occur within the first few months but can occur up to 10 years after the procedure. If complications arise, they may lead to significant morbidity and management may result in an invasive intervention, including a laparotomy. Case Report: An 83-year-old female underwent laparoscopic cholecystectomy for acute cholecystitis, during which several large gallstones spilled and an attempt at retrieval was made. Six years later, she presented to the emergency department with a small bowel obstruction due to gallstone ileus caused by an unretrieved spilled gallstone. She underwent laparotomy, and the gallstone was retrieved from the terminal ileum. Conclusion: Gallstone ileus can occur because of unretrieved spilled gallstones from a cholecystectomy. Although complications from unretrieved gallstones are rare, this case report highlights the importance of considering this as a differential diagnosis when patients present with symptoms consistent with intestinal obstruction after a cholecystectomy. It is important to attempt to retrieve spilled gallstones during cholecystectomy, but if this is not feasible, this should be documented, and patients should be informed of the potential risks of unretrieved stones although rare.

Acute Intestinal Occlusion: Think About Supra Bladder Internal Hernia

Internal hernia of the supravesical fossa is a rare cause of intestinal obstruction [1]. This pathology arouses great interest among radiologists and surgeons due to its diagnostic difficulty, even with the advancement of different imaging techniques, particularly computed tomography [2]. We present the case of a patient without a history of laparotomy who presented with acute intestinal obstruction. Computed tomography examination revealed a strangulated left supravesical internal hernia. Diagnostic confirmation was obtained by laparoscopic exploration.

Colonic atresia in a newborn: a rare case report

Colonic atresia is a rare cause of intestinal obstruction, and the transverse colon is the rarest site of colonic atresia. Our case was an index case of colonic atresia to be first operated on and effectively managed by the collaboration of paediatricians and surgeons in the Bundelkhand region of Uttar Pradesh. A 5-day-old male baby presented with complaints of abdominal distension, bilious vomiting, and failure to pass meconium and was diagnosed as a case of colonic atresia. The present case and the pertinent literature were discussed with an emphasis on surgical management along with medical post-op care. Colonic atresia must be considered an important cause of distal intestinal obstruction in neonates, and other causes of congenital small left colon should be ruled out.

[A rare cause of intestinal obstruction: sock ingestion].

Although most foreign bodies leave the gastrointestinal tract spontaneously without causing serious injuries such as bleeding and obstruction, they can sometimes occlude the intestine and may present with symptoms of ileus. A 14-year-old boy with cerebral palsy was admitted to our center due to persistent bilious vomiting. A foreign body (sock) was seen in the jejunal loops at laparotomy. Enterotomy and enterostomy were performed.

Gallstone Ileus: A Stone In The Way

Gallstone ileus, a rare complication of cholelithiasis, is caused by an impaction of gallstones within the gastrointestinal tract leading to mechanical intestinal obstruction. Here in, we describe a case of gallstone ileus in a 62-year-old woman successfully treated with enterolithotomy. The patient was discharged home after an uneventful post-operative period. Gallstone ileus is an uncommon complication of gallstones and a rare cause of intestinal obstruction, with often delayed presentation and non-specific symptoms. The preferred approach is enterolithotomy. Elective cholecystectomy after the acute episode is controversial.

Intestinal Obstruction after Cesarean Delivery: Consider Cecal Volvulus: A Case Report

Cecal volvulus is a rare cause of intestinal obstruction. It is diagnosed after the realization of an abdominal CT scan in front of an intestinal obstruction syndrome. The reference treatment is surgery. We present a case of a young patient with intestinal obstruction on a cecal volvulus. A surgical exploration showed a caecum bascule without signs of complication. A right hemicolectomy was performed.

Ileo-sigmoid knotting: A case series of 25 patients

Introductionand importance: Ileosigmoid knotting (ISK), also known as double volvulus or compound volvulus is a rare cause of intestinal obstruction in which small bowel or sigmoid colon wrap around each other, causing double loop obstruction and frequently leading to bowel strangulation. This study aimed to determine the characteristics, presentation, morbidity, and mortality associated with ISK at University Hospital. MethodsA retrospective medical record review of all patients operated for ISK between January 2018 and January 2023. A data collection format that was tested on five patients was used to collect data on sociodemographic characteristics, clinical presentation, preoperative investigations, preoperative stabilization, intraoperative findings, type of surgical procedure performed, and patients’ treatment outcomes. OutcomesA total of 29 patients were operated on for ISK during the study period. Of these, the medical records of 25 patients were retrieved, reviewed, and analyzed. Males were commonly affected with a male-to-female ratio of 2:1(16:9). The peak age for ISK was between 30 and 50 years. The mean age of the patients was 42.6 years (SD ± 15.9) and ranged from 20 to 70 years. Only one of the patients had comorbidity (retroviral infection). The average duration of illness was 1.6 days (SD ± 0.65), and the majority (23, 92%) presented within 48 h. Four-fifth (20, 80%) of patients are from the rural areas and the majority of them (15 (75%)) presented later than 24 h, while 3 (25%) of patients from urban settings presented within 24 h. Abdominal pain was present in all patients followed by vomiting (24, 96%), abdominal distention (22, 88%), and failure to pass feces or flatus (15, 52%). Four (16%) of the patients were in shock at the presentation. The leading abdominal findings were guarding (25, 100%), tenderness (24, 96%), rebound tenderness (21, 84%), and hyper-tympanic abdomen (11, 44%). On digital rectal examination, a stool was found in more than half (17, 68%), followed by an empty rectum (7, 28%) and blood in 2 (8%) of the patients. Preoperative imaging (plain abdominal x-ray) was done in 13 patients with symptoms of obstruction and with no features of diffuse peritonitis. ConclusionThe performance of prompt, individualized surgical treatment in conjunction with the use of advanced measures of critical care to combat the disastrous consequences of multiple organ failures may contribute greatly to improving the survival rate of victims of this dreadful entity.

Intestinal intussusception due to Vanek’s tumour: A rare cause of intestinal obstruction in adults

Intestinal intussusception due to Vanek’s tumour: A rare cause of intestinal obstruction in adults

Cecal Volvulus: Case Series Study

Cecal volvus (CV) is considered to be a rare cause of intestinal obstruction, it occurs when the ascending colon and the terminal ileum are twisted around their mesenteric pedicle, resulting in a closed-loop obstruction, CV counts about 1- 1,5% of all intestinal obstructions [1]. Its clinical features are those of the other forms of intestinal obstruction which make the imaging screening crucial for a prompt diagnosis in order to reduce the high mortality rate due to the intestinal necrosis or perforation [2]. We report a case series of 6 patients who were admitted mostly for abdominal pain and vomiting and for whom radiological investigations confirmed a cecal volvulus which was successfully managed by the surgical teams, no recurrence has been noted so far.

Congenital Left Paraduodenal Hernia: Report of a Case

Introduction. Internal hernias represent the protrusion of intestinal loops through congenital or acquired openings into the mesentery or peritoneum. One such hernia is the paraduodenal hernia, which is the most common type of internal hernia (53%). Due to the variable and non-specific clinical presentation, the preoperative diagnosis of these hernias is difficult. Despite the available studies, they generally present with intestinal occlusion, making their diagnosis during laparoscopy or laparotomy. Preoperative abdominal computed tomography facilitates diagnosis and timely surgical intervention [3]. Case presentation. This paper presents the case of a 19-year-old male patient with left paraduodenal hernia. He came to the emergency room with severe abdominal pain. Diagnosis was established by computed tomography and a converted surgical procedure was successfully performed. Discussion: Acute intestinal obstruction caused by a left paraduodenal hernia is a rare cause of intestinal obstruction. Conclusion. The patient underwent an exploratory laparotomy and it was found that the herniated intestine was viable, for which it was decided to reduce it and close the defect, obtaining good clinical results in the patient

Clinical Outcome of Arthroscopic Reconstruction of ACL with Lateral Extra-Articular Tenodesis (Let) to Reduce Anterolateral Rotatory Laxity

A gallstone ileus is a rare cause of intestinal obstruction, caused by the migration of a gallstone through an entero-biliary fistula and its impact in the digestive system, most often in the ileocecal valve. We report here the case of a 60-year-old woman who was admitted for a biliary ileus at the sigmoid level, which is an even rarer cause of intestinal obstruction. The fistula was located between the colon and the gallbladder. The gallstone was surgically removed by colotomy, without treating the fistula and afterwards. The follow-up was without complications. Surgical closure of an enterobiliary fistula is an option that should be considered, but it may result in higher morbidity. Therefore, we chose not to do it, especially considering that spontaneous fistula closure can occur.

A RARE CASE OF SPONTANEOUS INTERNAL HERNIA

Internal hernias are a rare cause of intestinal obstruction and most commonly iatrogenic, resulting from previous surgical interventions, abdominal trauma or inammation. Occasionally, they may occur spontaneously. We report the case of a 70-year-old femaleadmitted to the emergency room with acute abdominal pain, abdominal distension consistent with intestinal obstruction. Computed tomography (CT) scan of abdomen and pelvis revealed acute intestinal obstruction and emergency laparotomy revealed herniation of distal jejunal and proximal ileal loop through a supra-mesocolon space into lesser sac, resulting in strangulation. Both radiologists and surgeons must be aware of rare internal hernia subtypes, to avoid delays in diagnosis and treatment. Abdominal CT is the rst-line imaging of choice, providing useful diagnostic hallmarks. Nevertheless, surgical exploration is typically essential to conrm the diagnosis, identify the defect and assess bowel viability.

Gallstone Ileus, A Rare Yet Deadly Cause of Small Bowel Obstruction

Introduction:Gallstone ileus is a rare cause of intestinal obstruction. It commonly affects older patients with significant medical conditions. This disease has a high mortality rate (12-17%), hence should be an important diagnosis to consider, especially as the geriatric population grows worldwide.Method: Case Report:84-year old gentleman, with diabetes and ischemic heart disease, presented with diarrhea, vomiting and fever for one day. He was febrile, tachycardic and hypotensive. There was lower abdominal tenderness with guarding. Labs done revealed metabolic acidosis with a raised lactate along with raised inflammatory markers. Impression was intra-abdominal sepsis, with a need to rule out mesenteric ischemia. He underwent CTAP which revealed gallstone ileus. The gallbladder was collapsed and pneumobilia was present in keeping with fistulation. Dilated small bowel loops were present with a transition point at the distal jejunum or proximal ileum, where there are two gallstones. Patient underwent exploratory laparotomy. There was an obstructing large gallstone 100cm from the DJ flexure. After removal of gallstone and decompression, the bowel was pink with areas of bruising. Patient was hypotensive intra-operatively likely contributed by septic shower, requiring dual vasopressors. He was transferred to the ICU post-operatively and developed cardiogenic shock with type 2 respiratory failure precipitated by sepsis. He demised on Day 2 post-operatively.Results:Gallstone ileus is caused by intestinal impaction of a gallstone that has migrated through a cholecystoenteric fistula. The classic radiologic sign of gallstone ileus is Rigler's triad. This is only picked up 15% of the time on plain abdominal x-rays. Early CT scans can reveal Rigler triad up to 80% of the time. Surgical management remains the cornerstone of treatment.Conclusion:Gallstone ileus remains a diagnostic challenge as patients present with non-specific signs and symptoms. It is prudent for emergency physicians to consider this disease in elderly patients who present with small bowel obstruction.

Ileosigmoid Knot: Uncommon Cause of Intestinal Obstruction

The ileosigmoid node is a rare cause of intestinal obstruction. Its ethiopathology remains poorly understood. The diagnostic approach is similar to that of occlusions in general but remains difficult, due to its rarity and clinical-radiological atypia. In the majority of cases the diagnosis is made intraoperatively. Hartmann colectomy should be preferred to ideal colectomy because of its high morbidity and mortality. The prognosis essentially depends on the time of admission, the general condition of the patient, the presence or absence of loop necrosis and the circumstances of the surgical intervention. We report the case of an occlusion with ileosigmoid node according to the experience of the hospital ibn tofail Marrakech.

Gallstone ileus of the sigmoid colon: case report.

Here the authors report the case of a 74-year-old woman who was admitted to Compiegne Hospital in France for a gallstone ileus with the sigmoid colon as the impaction site, which is an even more rare cause of intestinal obstruction. The enterobiliary fistula was between the colon and the gallbladder.The gallstone was removed surgically with a colotomy, without treating the fistula, and after a failed endoscopic attempt to extract the stone. The follow-up was without complications, and a colposcopy showed spontaneous closure of the fistula after 6 weeks. The surgical closure of an enterobiliary fistula is an option that should be considered, but it can lead to higher morbidity. That is why the authors opted out of it, especially considering that spontaneous closure of the fistulae can happen, as it did in our case.

Evaluation of the location, number and diameter of bezoars in patients with a history of previous gastrointestinal surgery.

Bezoars are foreign bodies developed due to the swallowing of indigestible substances in the stomach that accumulate in the lumen of the gastrointestinal tract. This study aimed to compare the location, size, and diameter of bezoars between patients with and without a history of previous gastrointestinal surgery and between operated and non-operated patients retrospectively. A total of 188 patients who presented to our gastroenterology clinic and in whom bezoar was suspected on clinical examination and the diagnosis confirmed through abdominal CT scans were included in the study. The patients were divided into two groups; patients with a history of previous gastrointestinal surgery were assigned to Group 1 (n = 70), and those who had no history of previous surgery (n = 118) to Group 2. The mean age was found as 56.16 ± 15.75years in Group 1 and 57.71 ± 15.95years in Group 2. The mean bezoar width was significantly higher in Group 1 (p = 0.049). The mean bezoar length was significantly higher in Group 1 (p = 0.004). Considering localization of bezoars, the rate of patients who underwent enterotomy (80%) was statistically significantly higher than the patients who underwent gastrotomy (23.50%), gastrotomy + milking (28.60%) and milking (44.70%) in the operations performed in the jejunum. Bezoars are a rare cause of intestinal obstruction. The median width and length of the bezoars were significantly higher in patients with a history of previous gastric surgery. There was no significant difference in other parameters. The most common localization was jejunum.