Rare Cause Of Intestinal Obstruction Research Articles

Pediatric Cecal Volvulus: A Case Report

Introduction: Cecal volvulus (CV) is rare cause of intestinal obstruction especially in children. There is no established protocol for the treatment of CV due to its rarity. Case Presentation: We present a rare case of CV in a 9-year-old girl. Discussion: The spectrum of intestinal malrotation may give rise to a mobile cecum that may result to CV. Constipation could be a predisposing factor. The clinical presentation which may include abdominal pain, distension, constipation and vomiting depends on the time of presentation. There may be associations with chromosomal abnormalities. Conclusion: Although CV is a rare cause of intestinal obstruction, awareness and high index of suspicion is needed by clinician for early diagnosis and treatment.

Small bowel knots.

Intertwining of bowel loops to form a knot is very rare cause of intestinal obstruction. Among intestinal knots, ileoileal knotting is the most rare, with only a handful of cases reported in literature. We present a rare case of ileoileal knotting and review of small bowel knots. The aim of this review was to summarise the existing evidence on small bowel knots and to postulate the possible mechanisms for knotting. A systematic search was conducted for literature published up to December 2019 using MEDLINE, PubMed and Google Scholar databases, together with the references of the full-text articles retrieved. Papers with case reports of small bowel knots were considered to be eligible for inclusion in the review. A total of 14 case reports were evaluated. There was no clear predilection for age or sex. Mostly cases were from Asia and Africa with no cases from the West. The presenting complaints were abdominal pain (93%), vomiting (64%), abdominal distention (57 %) and obstipation (43%). The bowel was gangrenous in 78% of cases. All underwent exploration, with the majority requiring resection and anastomosis of the involved segment. Ileoileal knotting is a very rare cause of intestinal obstruction. Possible mechanisms include loaded bowel with longer mesentery, vigorous peristalsis, single bulky meal, pregnancy and intussusception. The condition is extremely difficult to diagnose preoperatively and it is usually diagnosed intraoperatively. The standard of treatment is resection of gangrenous part and anastomosis.

Case Report : Caecal Endometrios is Causing Acute Small Bowel Obstruction

<p><strong>Introduction</strong><strong>:</strong> Endometriosis in bowel is rare condition, about 12% of endometriosis cases. Most of bowel endometriosis rising in the rectosigmoid (90% of bowel endometriosis). Incidence of caecal endometriosis is very low (<5% of bowel endometriosis) and almost never causing acute small bowel obstruction(0.1-0.7%). The aim of this paper is to show that although bowel obstruction caused by caecal endometrios</p><p>is is difficult to diagnose as it is rare, and may require laparotomy to make definite diagnosis, but it should be considered in infertile female patient.</p><p> </p><p><strong>Case:</strong> 37 years old woman infertile woman with intestinal obstruction with pre-operative diagnosis total acute small bowel obstruction caused by right colonic mass, with sepsis as the complication. Before the acute small bowel obstruction she complained of chronic right lower quadrant pain with chronic constipation alternate with chronic diarrhea, symptoms that happened both in bowel endometriosis and colorectal malignancy. She also complained of chronic pelvic pain and dysmenorrhea. She has been married for 10 years with no child. The patient was never diagnosed with endometriosis and never seek medical attention for the infertility and the chronic pelvic pain. The patient underwent Abdominal CT Scan, with result: massive small bowel obstruction, and caecal mass that causing acute small bowel obstruction. Diagnosis of Acute small bowel obstruction due to right colonic mass was made and emergency exploratory laparotomy was performed the patient.</p><p> </p><p><strong>Methods:</strong> During the laparotomy, mass at caecum and ileocaecal that causing massive small bowel obstruction was found and standard right hemicolectomy and temporary mucousfistula ileostomy was performed.</p><p> </p><p><strong>Result:</strong> The patient recovered well, discharged on 7<sup>th</sup> day post op. The pathology examination showed ectopic endometriosis lesions in caecum and ileocaecal valve. The histopathology also confirmed with the immunohistochemistry, in which positive ER, PR, CD 10 and CD7 was found the ileocaecal and caecal mass. In the second operation, reanastomosis of the ileum was done 3 months after the first operation. The chronic pelvic pain is decreasing dramatically after the first and second operation.</p><p> </p><strong>Conclusion:</strong> Although bowel obstruction caused by caecal endometriosis is an extremely rare cause of intestinal obstruction but it should be considered as a cause in infertile female patient to reduce morbidity and mortality, to reduce stoma creation and to promote resection completeness.

Ileosigmoid knot during pregnancy: unusual cause of intestinal obstruction

Ileosigmoid knotting also known as compound volvulus or double volvulus, is a rare cause of intestinal obstruction. In this condition the ileum wraps around the base of the sigmoid colon and forms a knot, the condition is serious, generally progressing rapidly to gangrene. The occurrence during pregnancy is very rare and the diagnosis is difficult because of its infrequency and atypical radiographic findings. This report describes a case in a 23-year-old female and through a literature review describes the management of this rare condition.. .because better understanding of the problem, increases probabilities of preoperative diagnosis and improves the prognosis.

Intraperitoneal Inclusion Cyst Presenting as Intestinal Obstruction: A Clinical Dilemma

Peritoneal inclusion cysts have been described in females of reproductive age. It is a rare cause of intestinal obstruction. Causes include pelvic inflammatory disease and prior abdominal surgery. We here present a case of young female of peritoneal inclusion cyst who presented with intestinal obstruction.

Gallstone ileus: Rare life-threatening disease

Gallstone ileus is an uncommon complication of calculus cholecystitis and often presents as a life-threatening emergency. It is more common in the elderly and especially among females. It is a rare cause of intestinal obstruction and accounting for 1%–4% of cases. Patients present with symptoms of intestinal obstruction such as abdominal pain, vomiting, and abdominal distension. Diagnosis can be confirmed by computerized tomography (CT) of the abdomen. Enterolithotomy is the most accepted treatment of choice. We report a case of 55-year-old female who presented with epigastric pain for 8 days duration with multiple episodes of vomiting and progressive abdominal distension. Classical Rigler's triad was observed. CT of the abdomen was suggestive of a gallstone obstructing the small bowel. Enterolithotomy with primary bowel repair was done. A large gallstone of size 5 cm × 3 cm was extracted from the terminal ileum. Postoperative period was uneventful. This case is being reported to highlight the rare incidence of gallstone ileus and its life-threatening surgical emergency, particularly large gallstone causing obstruction, and impending bowel gangrene.

Sigmoid volvulus in a child: An uncommon presentation of Hirschsprung disease

Sigmoid volvulus (SV) is a rare cause of intestinal obstruction in childhood, and it is very uncommon below the age of 20 years and above 70 years. In childhood, SV comprises 4% of all intestinal volvulus. Hirschsprung disease (HD) is a developmental disorder of the enteric nervous system, which is characterized by the absence of ganglion cells in the myenteric and Meissner plexus; rarely, SV may complicate HD. We treated one such patient. Being extremely rare, this association is being reported with a review of the relevant literature.

Gebelikte Nadir Bir Akut Batın Nedeni: İnternal Herniasyon

Internal herniation is one of the rare causes of intestinal obstruction. The most common causes of intestinal obstruction are adhesive bridges, volvulus, and invagination. The classic triad frequently seen in the clinic includes colic type abdominal pain, nausea/vomiting and absences of gas passage and defecation. It is very difficult to diagnose internal herniation during pregnancy due to the inability to see all clinical findings together, to confuse the findings with obstetric pain, and to the possible fetal side effects due to the application of radiological diagnostic methods. Because of high maternal and fetal mortality risk, it is important to make an early diagnosis and perform surgical intervention without any delay if necessary. In all pregnant women presenting with a diagnosis of acute abdomen, intestinal obstruction and the possibility of the internal herniation that may cause this clinical picture should be kept in mind

Cholecystocolonic fistula presenting with intestinal obstruction

A cholecystoenteric fistula is defined as the connection between the gallbladder and the gastrointestinal tract. It's a rare complication of acute or chronic cholecystitis. In most cases, fistula occurs with the duodenum, rarely with the stomach or colon [ [1] Hajjar R. Létourneau A. Henri M. Heyen F. Latulippe J. Poirier M. et al. Cholecystocolonic fistula with a giant colonic gallstone: the mainstay of treatment in an acute setting. J Surg Case Rep. 2018; 2018: jy278 Crossref Google Scholar ]. We report the case of an 83-year-old woman presenting to the emergency department complaining of abdominal pain. The patient’s previous medical history was significant for severe coronary artery disease, and acute cholecystitis treated conservatively due to cardiac comorbidity 5-years ago. The patient underwent an abdominal X-ray showing a distended bowel and a radiopaque body in the pelvis (Fig. 1). Subsequent abdominal CT scan revealed the presence of a cholecystocolonic fistula and intestinal obstruction due to a huge gallstone in the sigmoid colon (Fig. 2). The patient underwent colonoscopy with an unsuccessful attempt to remove the stone due to its size (>5 cm). A subumbilical median laparotomy was then performed and local inspection revealed no signs of ischemia. A longitudinal colotomy on the sigmoid colon was conducted with the extraction of the gallstone; colotomy incision was closed and no colostomy was performed. The postoperative course was complicated by wound infection treated with oral antibiotics and the patient was discharged 16 days after surgery. Cholecystocolonic fistula represents an extremely rare cause of intestinal obstruction. CT scan allows recognizing both the cholecystoenteric fistula and the cause of obstruction. Fig. 2Coronal and sagittal CT scan: black arrows indicate gallstone, white arrows indicate cholecystocolonic fistula. View Large Image Figure Viewer Download Hi-res image

Ileal duplication cyst: a rare cause of intestinal obstruction in infants

Ileal duplication cyst (IDC) is a rare congenital anomaly where there is an abnormal portion of intestine attached to or intrinsic with the normal bowel. A 6-month-old male child presented with obstipation and bilious vomiting at emergency. X-ray abdomen showed multiple air fluid level suggestive of intestinal obstruction. Laparotomy was performed. Diagnosis of IDC was made and resection with primary anastomosis was done. Post-operative period was uneventful, and patient did well during 3 month follow-up checkup. IDC is a rare cause of intestinal obstruction which can present with different clinical symptoms posing a diagnostic dilemma. Diagnostic laparotomy is a suitable approach for both diagnosis and treatment to avoid delays in treatment where imaging method is unavailable for exact diagnosis.

TRANSMESENTERIC HERNIA IN A PERIPARTUM PATIENT: AN UNUSUAL DIAGNOSIS

Congenital transmesenteric hernia is a very rare cause of intestinal obstruction in adulthood. We report a patient who came to the emergency with persistent abdominal pain post-emergency cesarean section and subsequently diagnosed to have acute pancreatitis based on computed tomography findings and elevated pancreatic enzymes. The pain was disproportionate to the diagnosis of pancreatitis and her condition rapidly got worsened requiring multiorgan support. Reimaging revealed obstructed transmesenteric hernia. The patient required immediate surgical intervention. A high index of the suspicion of internal hernia as one of the differential diagnoses of any atypical acute abdomen and early intervention could be lifesaving.

Ileosigmoid Knotting Causing Double Lumen Acute Intestinal Obstruction and Gangrene: Review and A Case Report

Ileosigmoid Knotting is a rare cause of intestinal obstruction. It is also called as compound volvulus or double volvulus. It is caused by the wrapping of the ileum around the sigmoid colon and its mesentery or vice-versa. It is a rapidly progressive condition, leads to acute intestinal obstruction and gangrene in ileum as well as in the sigmoid colon. Early diagnosis and intervention is the key to a better outcome. Due to the rarity and unfamiliarity of this entity, diagnosis is usually made intraoperatively. Surgical removal of the gangrenous segment with either stoma formation or anastomosis is the only hope.An additional systemic search of the literature was done in PubMed, MEDLINE, ISIS, Embase, and CAS searches with the following free text keywords: ileosigmoid knotting, intestinal knotting, compound volvulus and double volvulus in English literature. Around 64 studies were identified, out of which 38 studies were selected for this article after the removal of duplicates and unrelated articles. These case series and reports were reviewed for aetiopathogenesis, presentation, diagnostic modalities, surgical interventions, and outcome.Along with this review article, there was a case report of ileosigmoid knotting in a 38-year-old male patient that presented in the surgical Emergency Department; with complaints of generalised pain and distention of abdomen for two days. Also, he had complained of not passing flatus and motion for two days. On examination, patient had generalised tenderness and bowel sounds were absent. X-ray abdomen showed dilated small and large bowel with multiple air-fluid levels. After resuscitation, an emergency exploratory laparotomy was done, and the diagnosis of ileosigmoid knotting with gangrene of both ileum and sigmoid colon was made intraoperatively. After resection of both gangrenous segment, colocolic anastomosis and double barrel ileostomy was performed. The postoperative course was uneventful, and patient was discharged on 7th postoperative day.

Intestinal Obstruction of Congenital Origin: A Case Report

Congenital bands are rare causes of intestinal obstruction and often leads to diagnostic challenges. Diagnostic delays in cases of mechanical obstruction might lead to irreversible bowel ischemia and perforation. Presently described is a case of an 18 month young child with severe vomiting developed for one day. The child was initially thought to have acute viral enteritis and treated accordingly. Due to the severity, an X-Ray and computed tomography scan were sent which pointed towards the possibility of having congenital bands. He was treated operatively. The child was kept under observation for eleven days and was discharged. Although rare, intestinal obstruction due to congenital bands must be considered when treating a child with severe vomiting. Keywords: case reports, congenital abnormalities, intestinal obstruction, vomiting.

Duplication cyst of the cecum; a rare cause of intestinal obstruction in infants

Duplication cyst of the cecum; a rare cause of intestinal obstruction in infants

Case report of a rare cause of intestinal obstruction: Abdominal cocoon syndrome

Case report of a rare cause of intestinal obstruction: Abdominal cocoon syndrome

Occlusion intestinale sur nœud iléo-sigmoïdien chez une femme en post-partum : à propos d'un cas et revue de la littérature

Introduction: Ileosigmoidal knotting (ISK) is the wrapping of the ileum around the sigmoid colon and its mesentery or vice-versa and is a rare cause of intestinal obstruction in immediate postpartum. Observation: We report a case of ileo-sigmoid volvulus with intestinal necrosis; in which the diagnosis of the ISK was only made during surgical exploration. The treatment consisted in resection of gangrenous small bowel and performed small bowel anastomosis with sigmoidopexy and the postoperative course was uneventful. Through this case, we would like to discuss the diagnostic, therapeutic and prognostic aspects of this rare entity with a literature review. Conclusion: The rapid progression to intestinal necrosis of this type of postpartum occlusion is responsible for high maternal-fetal mortality, which requires rapid and adequate surgical management.

Hernia supravesical como causa de obstrucción intestinal: reporte de un caso

Las hernias abdominales internas son una causa poco frecuente de obstrucción intestinal, que se presentan por el deslizamiento de los órganos intraabdominales, en especial el intestino delgado, a través de defectos congénitos o adquiridos en el mesenterio o en los espacios intraperitoneales. La hernia supravesical interna es una de las presentaciones menos frecuentes de esta entidad y su diagnóstico es intraoperatorio en la mayoría de los casos.
 Se presenta el caso de un paciente de sexo masculino que consultó con manifestaciones de obstrucción intestinal, y fue sometido a cirugía de urgencias, con el hallazgo de una hernia supravesical interna.

Simultaneous Volvulus of Transverse Colon and Cecum in a Patient With Down Syndrome: A Case Report

Volvulus is a rare cause of intestinal obstruction and occurs mostly in sigmoid colon and cecum. It is more common in patients with Down syndrome. In this condition, it is even more challenging to diagnose the cause of intestinal obstruction through history and physical examination alone. Early diagnosis and intervention are critical in this condition to prevent serious side effects. Simultaneous volvulus is a sporadic case in the surgical entity. We report a very rare case of simultaneous volvulus of cecum and transverse colon, its management, and outcomes in a 20-year-old known case of Down syndrome.

2633 A Challenging Case of Ileo-cecal Intussusception in Pregnancy

INTRODUCTION: Intussusception is an extremely rare cause of intestinal obstruction in adults; being reported in up to 1% of cases of obstruction and in contrast to children almost always is secondary to an identifiable lesion forming a lead point. Its incidence is even lower in pregnancy with studies reporting incidence rates ranging from 0.067% to 0.0015%. Rarity of the condition combined with non-specific clinical presentation make diagnosis difficult in adults. This is particularly challenging in pregnant patients due to the overlap of symptoms with pregnancy and limited findings on abdominal examination. High morbidity and mortality for both mother and child warrant prompt investigation and surgery. CASE DESCRIPTION/METHODS: We describe the case of a 39-year-old female who presented in the third trimester with abdominal pain and an episode of hematochezia. Ultrasound findings were suggestive of ileo-colic intussusception that was confirmed with subsequent magnetic resonance imaging. The lead point was formed by an adenocarcinoma of the colon measuring 4 cm. Our patient underwent a right-sided colectomy with primary ileocolostomy. The postoperative course was uneventful for both mother and fetus, and the patient was discharged a week after the surgery. DISCUSSION: Intussusception very rarely presents during pregnancy. Ultrasonography of the abdomen is the initial test of choice in most cases and the findings of single or double anechoic rings surrounding a central echogenic focus is the classic hallmark. CT scanning is considered to be superior in adults with a reported diagnostic yield of over 50%. MRI, however, is the preferred imaging modality in pregnancy as it helps avoid the risk of radiation to the fetus and has comparable sensitivity to CT. Most cases are diagnosed by exploratory laparotomy which itself is associated with a high risk of miscarriage and pre-term birth, with some studies reporting miscarriage rates as high as 8%. Adults almost always require surgery as untreated bowel obstruction carries a maternal mortality of up to 6% and fetal mortality as high as 26%. Surgical reduction of intussusception can be tried but most patients require bowel resection, which is also the procedure of choice if a mass is identified at the leading point. Nearly 50% of these masses will be malignant. This report highlights the importance of abdominal imaging and urgent intervention in suspected cases of intussusception in pregnancy.

Primary and secondary abdominal cocoon- diagnostic and management challenges: retrospective study

Background: Abdominal cocoon is a rare cause of intestinal obstruction characterized by fibro collagenous membrane encapsulating the abdominal contents to varying degrees. The most commonly identified etiology remains to be ‘idiopathic’ and hence it is also known as idiopathic sclerosing encapsulating peritonitis.. Few case reports of abdominal cocoon secondary to gastrointestinal malignancy and tuberculosis have also been reported. The objective of the study was to study the spectrum of clinical presentation, identify the various aetio pathogenesis described and their impact on outcome of surgically managed patients with abdominal cocoon.Methods: The clinical data of twelve different cases of abdominal cocoon presented to a general surgery unit from January 2012 to December 2017 with minimum of 1 year follow up were analyzed.Results: In our series we had 12 patients with cocoon who underwent surgical intervention out of which 8 were primary and 4 were secondary to TB. In primary type one out of eight patients had acute presentation, but in secondary three out of four had acute presentation. In primary 6 out of 7 patient’s pre-operative CT showed cocoon, but in secondary only 1 out of 3 showed cocoon. In patients with primary cocoon 3 out of 8 patients had bowel resection and only one had post-operative morbidity. In patients with secondary cocoon three patients had bowel resection, stoma creation and reoperations with stormy post operative period. All 4 had post-operative morbidity, however all of them received ATT and definitive surgery was performed 1-2 years later with minimal resection and serial images also showed resolution of cocoon formation with ATT. Primary group up to 5 years follow up, there was no recurrence of symptoms. Both groups did not have any mortality.Conclusions: Abdominal cocoon is a rare disorder and the cause may be primary or secondary. In our series tuberculosis is the aetiology for secondary cocoon. Primary cocoon is easier to diagnose, manage and associated with less post operative complications compare to secondary cocoon. Damage control first surgery, nutritional build up and treatment with anti tubercular drugs are needed for management of cocoon secondary to TB for a better outcome in acute presentations. Definitive surgery can be performed once the nutritional status improves with less morbidity.