Signs Of Intestinal Obstruction Research Articles

Ileal Stenosis Occurred 3 Months after Blunt Abdominal Trauma

We present a case of ileal stenosis with delayed presentation 3 months after car accident. Ileal stenosis after blunt abdominal trauma is a rare clinical entity. We present CT and small bowel series 3 months after trauma. Image showed segmental thickening of intestinal wall and proximal bowel dilation. At surgery, a stenotic bowel loop was adjacent to a fibrotic mesentery. Histological examination showed ulcers, inflammatory cells and fibroblasts infiltrated to the muscularis mucosae, submucosa, and mesentery. The most likely cause, supported by most authors, implicates an injury to the mesentery. Post-traumatic ischemic bowel stenosis may result from even small tears and contusions of mesentery. Posttraumatic intestinal stenosis should be included in the differential diagnosis in a patient with a history of blunt abdominal trauma and signs of intestinal obstruction.

Apple-peel atresia presenting as foetal intestinal obstruction

Apple-peel atresia or Type 3 jejuno-ileal atresia (JIA) is an uncommon cause of foetal intestinal obstruction. Bowel obstruction in the foetus is diagnosed on the prenatal ultrasonography only in 50% cases. We report a case in which foetal intestinal obstruction was diagnosed on prenatal ultrasonography. The child showed signs of intestinal obstruction on day one after birth, for which an exploratory laparotomy was performed. Type 3 JIA was found for which resection of atretic segments with jejuno-ascending colon anastomosis was preformed.

Interparietal Herniation: A Rare Cause of Intestinal Obstruction

An interparietal hernia is a rare form of hernia seen in the inguinal region. Its pathogenesis is not well understood. It frequently causes intestinal obstruction. We presented a case of interparietal herniation, who presented with acute symptoms and signs of intestinal obst ruction. The male patient was referred to our department with acute signs of intestinal obstruction for three days. His physical examination revealed acute abdomen and intestinal obstruction. The ultrasound and computed tomography depicted an intra-abdominal mass of unknown origin. At operation, a loop of ileum was found incarcerate d in an interparietal hernia. Reduction, resection and anastomosing of the segment were facilitated. The preperitoneal type of defect was closed with sutures. Interparietal hernias are rare, and represent a problem in the differential diagnosis of conditions functional in the inguinal region. It is more frequent in the males, and mostly presents with intestinal obstruction. Preoperative diagnosis of obstructing interparietal hernia is difficult. Once considered, its diagnosis and treatment is straightforward. doi:10.4021/jmc38w

Omental incarceration may cause hydrocele and this hydrocele confused simple or scrotal hydrocele

The recommended approach to hydrocele repair in children is inguinal. Recently, a transscrotal approach has been recommended for hydroceles in children. This report describes our experience with hydrocele with omentum incarceration. This retrospective study reviewed the records of ten children who underwent inguinal hydrocele repair with omentum incarceration in our clinic. The mean age of the patients was 4.5 years (range 1.5-16). Hydroceles were located on the right side in all patients. Scrotal erythema, inguinal pain, signs of intestinal obstruction and hernia sac were not determined. Hydrocele repairs were made by inguinal approach in all patients. The procesus vaginalis was rougher than normal and noted as the hernia sac. Thus, the hernia sacs were opened and omental incarceration was defined in all cases. Omentum protruded into the abdomen in all cases. A high ligation was performed and the distal parts of the sacs were fenestrated. In the light of our experience, a scrotal approach to hydrocele repair in children would be difficult in cases of incarceration with hernia. Omental incarceration may cause hydrocele, and this hydrocele can be confused with normal hydrocele. Therefore, we would continue to recommend an inguinal approach for childhood hydroceles.

Obstrução intestinal por Pythium insidiosum em um cão: relato de caso

Relata-se um caso de pitiose intestinal em um Husky Siberiano, de um ano de idade, macho atendido em um Hospital Veterinário Escola com sinais de obstrução intestinal. Ao exame físico, notou-se massa cilíndrica na região abdominal cranial, posteriormente confirmada por meio de radiografia e ultrassonografia. Durante a laparotomia exploratória, constatou-se massa extraluminal envolvendo o jejuno e alterações na parede do órgão. Realizou-se a ressecção da porção afetada do intestino e, posteriormente, anastomose. O exame histológico do tecido evidenciou inflamação piogranulomatosa acentuada. Na coloração de prata metenamina de Grocott, hifas septadas foram observadas. O diagnóstico de infecção por Pythium insidiosum foi confirmado por meio da imunoistoquímica. Após a cirurgia, o animal restabeleceu a defecação; no 30° dia pós-cirúrgico, foi relatada ainda presença de diarreia. O tratamento com itraconazol e terbinafina foi instituído durante 60 dias. Após dois anos do procedimento cirúrgico e do tratamento com antifúngicos orais, o cão não apresentou recidiva.

Gallstone Ileus in Underlying Stenosis of the Sigmoid Due to Recurrent Diverticulitis – a Rare Complication of Cholelithiasis

Gallstone ileus is a rare complication of cholelithiasis and an uncommon cause of intestinal obstruction. It accounts for about 1-4% of all mechanical bowel obstructions. The clinical symptoms and signs of gallstone ileus are mostly nonspecific. An 82-year-old woman with recurrent diverticulitis of the sigmoid was admitted because of cramping right upper abdominal pain and signs of large bowel obstruction. Abdominal ultrasound revealed pneumobilia and severe diverticulitis of the sigmoid with signs of ileus. Endoscopic retrograde cholangiography visualized the cholecystoenteric fistula. In addition, computed tomography (CT) scan revealed two stones 3 cm in diameter leading to nearly complete obstruction of the sigmoid. The patient underwent an open cholecystectomy, closure of the cholecystoenteric fistula, and sigmoidectomy. This case report demonstrates that relative stenoses of the sigmoid due to recurrent diverticulitis may predispose to the impaction of foreign bodies. Gallstone ileus is a rare but important differential diagnosis of intestinal obstruction. Ultrasound and CT scans are very helpful in diagnosing gallstone ileus. The treatment is surgical. Unfortunately, surgical therapy of this rare complication is associated with a high morbidity and mortality rate due to multiple comorbidities and age-related problems of these patients. The management of patients with gallstone ileus should be individualized.

Colon carcinoma in children and adolescents: prognostic factors and outcome—a review of 11 cases

Carcinoma of the colon and rectum is rare in the pediatric age group, and usually presents with an advanced stage disease bearing a poor prognosis. Colorectal carcinoma should be considered in children with signs of intestinal obstruction, alteration in bowel habits, gastrointestinal bleeding and chronic abdominal pain. We performed a retrospective study to evaluate the clinical characteristics, and prognosis of these patients. Between 1974 and 2007, 11 patients were identified and treated for colorectal carcinoma at the Oncology Unit. The medical records were studied to analyze the age, sex, clinical presentation, diagnostic procedures, extent of disease (Dukes staging), treatment, histological types, and outcome. There were seven boys and four girls ranging from 7 to 17 of age. Predisposing diseases and syndromes were encountered in three children, (1 with Turner's syndrome and two with adenomatous familial polyposis). Abdominal pain, acute intestinal obstruction, rectal bleeding and weight loss were the commonest symptoms. Surgical procedures were done in 11 patients (incomplete resection with segmental resection in 4 patients, complete resection in the other 4, and biopsy alone in 3 patients).The predominant histological type was mucinous carcinoma. Seven patients received adjuvant chemotherapy, all of whom did not survive. Two patients died shortly after initial surgery, and two patients are alive, and well. Colorectal carcinoma in children is very uncommon and could be easily misdiagnosed, resulting in advanced stage disease at diagnosis. Because radical surgery which is the mainstay of treatment is possible only in patients with early stage disease, a high level of awareness and early diagnosis are critical.

Intestinal obstruction due to an anomalous congenital band

We report a case of a 20-year-old male who presented with symptoms and signs of intestinal obstruction. The patient reported no previous history of abdominal surgery or trauma while clinical and radiographic examinations were not diagnostic. An open laparotomy was subsequently performed and the intraoperative findings were consistent with a congenital band extending from the antimesenteric wall of the jejunum to the root of mesentery. The band was ligated and divided with an uneventful postoperative course. Congenital bands are extremely rare. Their exact incidence is still unknown and usually observed in childhood. This case, therefore, represents an unusual surgical problem in an older individual in which the diagnosis was clinically unexpected.

Mucosal Atrophy in Celiac Disease: Extent of Involvement, Correlation With Clinical Presentation, and Response to Treatment

Wireless capsule endoscopy provides an opportunity to study the macroscopic features in celiac disease by providing a magnified view of the intestinal mucosa. In this study, we evaluated the following: (1) the distribution of atrophy in untreated celiac disease, (2) the correlation between extent of changes and clinical manifestations, (3) the accuracy and interobserver agreement of wireless capsule endoscopy assessment, and (4) the effect of gluten withdrawal. Thirty-eight consecutive patients with untreated biopsy-proven celiac disease underwent wireless capsule endoscopy. Each subject was invited to undergo repeat testing after at least 6 months of gluten withdrawal. The video images of each patient were reviewed independently by 2 investigators. Thirty-five (92%) subjects had visible atrophy detected by capsule endoscopy. Twenty-two (59%) subjects showed an extensive enteropathy, 12 (32%) had enteropathy limited to the duodenum, and only 1 had a jejunal enteropathy. No association was shown between the extent of the lesion and clinical manifestations. Capsule endoscopy had a better overall sensitivity for the detection of atrophy as compared with upper endoscopy (92% vs 55%, P = .0005), with a specificity of 100%. The overall interobserver agreement for the 2 reviewers was relatively high (% total agreement, 86.5%). After gluten withdrawal, the extent and the pattern of atrophy improved both qualitatively and quantitatively. Celiac disease affects a highly variable portion of the small intestine starting at the duodenum. The extent of visible enteropathy does not explain differences in clinical presentation. Most subjects with visually detected villous atrophy showed a clinically significant improvement after gluten withdrawal.

GALL STONE ILEUS

Gallstone ileus (GSI) is an uncommon cause of intestinal obstruction. Theformation of a fistula between the gall bladder and the bowel wall may allow a gallstone to enter the intestinal tract.Plain abdominal films, abdominal ultrasound and abdominal computed tomography aid in the diagnosis. Surgery is thetreatment of choice in cases of gallstone ileus rate. We describe the case of a 68-year-old man who presented withsymptoms and signs of intestinal obstruction. Diagnostic evaluation revealed a large gallstone impacted in the ileum.The patient was scheduled for exploratory laparotomy. At the time of surgery stone was found in the sigmoid colon.It was milked down and brought out through the rectum.

Utility of Contrast Enema for Detecting Anastomotic Strictures After Total Proctocolectomy and Ileal Pouch–Anal Anastomosis

The purpose of our study was to determine the utility of contrast enemas for detecting clinically relevant anastomotic strictures after total proctocolectomy and ileal pouch-anal anastomosis and to facilitate management by defining a critical anastomotic caliber at or below which obstruction is likely to develop after ileostomy closure. Our radiology database revealed 42 patients with contrast enemas after total proctocolectomy and ileal pouch-anal anastomosis who fulfilled our exclusion criteria. The initial postoperative contrast enemas were reviewed blindly to determine the diameter of the ileoanal anastomosis. The diagnosis of a stricture was made only if the patient had signs of intestinal obstruction after ileostomy closure with confirmation on follow-up contrast enema or sigmoidoscopy and clinical improvement after anastomotic dilatation. The data were then correlated to determine if there was a critical anastomotic caliber at or below which such strictures were likely to develop. Using this threshold value, the sensitivity and specificity of routine contrast enemas for detecting clinically relevant anastomotic strictures were then determined. Six (14%) of the 42 patients who underwent total proctocolectomy and ileal pouch-anal anastomosis had strictures at the ileoanal anastomosis on contrast enemas. The mean diameter of the anastomosis was 5.8 mm in the six patients with anastomotic strictures versus 15 mm in the 36 patients without strictures (p = 0.0002). If an anastomotic diameter of 8 mm is defined as the critical caliber at or below which clinically relevant strictures are present, the sensitivity of contrast enemas for detecting strictures at the ileoanal anastomosis was 100% (six of six patients) and the specificity was 92% (33 of 36 patients). Routine contrast enema after total proctocolectomy and ileal pouch-anal anastomosis is a sensitive test for detecting clinically relevant strictures at the ileoanal anastomosis when an anastomotic diameter of 8 mm or less is used as the threshold value for diagnosing these strictures. Such patients may need dilatation procedures to decrease the risk of anastomotic obstruction after ileostomy closure.

Errant Migrant: An Unusual Cause of Abdominal Pain

A 7-YEAR-OLD GIRL presented to the accident and emergency department with severe colicky abdominal pain of 6 days’ duration with no signs of intestinal obstruction. She was otherwise stable with a respiratory rate of 25 breaths/min, blood pressure of 98/60 mmHg, and a pulse rate of 60 beats/min. She was afebrile, and the white cell counts were not elevated. Abdominal examination was nonspecific with no specific area of localization of pain. An electrocardiogram showed atrioventricular (AV) dissociation with a ventricular rate of 60 per minute.

Gallstone ileus - an unusual presentation in an underweight older women

Gallstone ileus is an uncommon and peculiar complication of cholelithiasis in an older population. Perioperative mortality rates are high as this condition is difficult to diagnose, often lead to delay in treatment and high percentage older patients have multiple co-morbidities. Atypical presentations are common in older patients, most of who present to medical rather than surgical units, further delaying definitive treatment. We discuss a 79 year old female patient who presented with severe dehydration due to gastrointestinal symptom with no typical clinical signs of intestinal obstruction.

Sealing of Gastrointestinal Anastomoses with a Fibrin Glue-Coated Collagen Patch: A Safety Study

Sealing of anastomoses has previously been tested with several methods, including sealing with liquid fibrin glue. Sealing with a collagen patch coated with fibrin glue components has never been systematically examined. The aim of the present study was to determine the safety of sealing gastrointestinal anastomoses with a collagen patch coated with fibrin glue. The study is a prospective, experimental animal study comparing sealed and unsealed gastrointestinal anastomoses. Laparotomy was performed in 11 pigs under general anesthesia. In each pig two anastomoses were performed on the small intestine. One of the anastomoses was sealed with a collagen patch coated with fibrin glue components (TachoSil®). The other anastomosis contained no sealing. The pigs were observed for 1 to 6 weeks. The observation period was followed by in vivo examination under general anesthesia and included observation for anastomotic leakage, signs of present or former peritonitis, abscess, adhesions to the anastomoses, and signs of intestinal obstruction. In addition, the anastomotic diameter was measured with barium and radiography. Finally, bursting pressure was measured in each segment. After the pigs were sacrificed, the bowel segments were microscopically examined. There were no differences between the sealed and the unsealed anastomoses with respect to abdominal pathology, in vivo bursting pressure, or degree of stenosis. The collagen fleeces were in situ in all anastomoses. Microscopically, we found no difference in healing or signs of infection.

Intestinal Obstruction Caused by Abdominal Cocoon in Intestinal Malrotation: Report of a Case

The abdominal cocoon is a rare condition of unknown etiology that primarily affects adolescent girls living in tropical and subtropical regions. It is seldom suspected preoperatively, and the patients usually present with the typical symptoms and signs of intestinal obstruction. This paper reports a 46-year-old male who presented with vomiting and intermittent epigastric pain for several hours. Intestinal obstruction with echogenic materials in the lumen was found on abdominal sonography, and computed tomography of the abdomen showed small intestinal obstruction coupled with suspected colonic malrotation. Exploratory laparotomy showed a huge cystic mass measuring 20×30 cm, with small intestinal loops encased in a transparent, fibrous capsule, located in the upper and mid-abdomen. The whole small intestine was located on the right side, and the large bowel on the left side of the abdominal cavity. Lysis of adhesions and the cystic wall was easily done, which successfully freed the entrapped bowel loops. Other than dilatation, the intestinal loops looked grossly normal, therefore no resections were done. Histology of the specimen from the capsule and adhesions revealed only fibrosis and congestion. The postoperative course was smooth and uneventful, and the patient was discharged 16 days after surgery. Now, at the time of this writing, 15 months after the operation, the patient is living a normal life. The purpose of this case report is to remind the readers that this disease can occur even in adult males.

Malignant peripheral nerve sheath tumor arising from the colon in a newborn: report of a case and review of the literatures

A malignant peripheral nerve sheath tumor (MPNST) is a rare neoplasm arising from peripheral nerve sheath. Here, we report the first case of MPNST arising in the colon and also the youngest case of MPNST in the gastrointestinal tract. The patient was a 2-day-old neonate with symptoms and signs of intestinal obstruction. The patient had no family history or stigmata of neurofibromatosis type 1. A computed tomographic scan revealed a 5-cm-sized mass in ascending colon causing intestinal obstruction, and emergent right hemicolectomy was performed. The microscopic examination showed atypical spindle cells with hyperchromatic nuclei and high mitotic activity. The results of immunohistochemical staining, which showed positivity for S-100 and vimentin as well as negativity for smooth muscle actin, CD34, and c-Kit, supported the final diagnosis of MPNST. Genetic analysis of the patient revealed no abnormalities. After surgery, the patient recovered uneventfully and has been free of the disease for 17 months.

Diagnosis and Management of Adult Patients With Chronic Intestinal Pseudoobstruction

Chronic intestinal pseudoobstruction (CIP) is a motility syndrome that presents with symptoms and signs of intestinal obstruction and radiographic evidence of dilated bowels, but no anatomic obstruction can be found. It primarily is a disorder of small bowel motility, but it can occur anywhere in the gastrointestinal tract. This review will focus on the diagnosis and treatment of adult patients with CIP. The clinical presentation of CIP is variable, and its incidence is rare. It is a disorder with a multitude of etiologies, many of which are poorly understood. To properly manage the patient, clinicians should be aware of the various symptoms, signs, and systemic diseases that are associated with CIP. Diagnostic studies are needed to confirm the diagnosis, identify the etiology, and search for coexisting motility dysfunction. The management goals of CIP are to restore proper nutrition and fluid balance, relieve symptoms, improve intestinal motility, and treat complications.

Inguinal hernia and hydrocele

Inguinal hernia and hydrocele in childhood result from incomplete closure of the patent processus vaginalis. Differentiation between the two conditions is important because management differs markedly. An inguinal hernia is intermittently present, becoming more obvious on straining or crying; a hydrocele is a more constant swelling that usually transilluminates. Inguinal herniae are at significant risk of incarceration (particularly in younger babies) and may warrant early surgery. Hydroceles usually resolve spontaneously during the first years of life and surgery may be delayed until three years of age. Incarceration of an inguinal hernia presents with pain, erythema and later with signs of intestinal obstruction. Reduction of the mass should be attempted; failure prompts urgent transfer to a Specialist Paediatric Surgical Unit. Surgical technique is similar for hernia and hydrocele. Repair of an incarcerated hernia is challenging, with a high risk of damage to the vas deferens and testicular vessels. Complications may result from incarceration, with consequent damage to bowel or testicular vessels. The most significant complications are recurrence (about 4%) and testicular atrophy (about 6%). Exploration of the contralateral inguinal region during unilateral herniotomy is controversial. The incidence of a metanchronous contralateral hernia is <10%; prospective exploration is reserved for those at increased risk.

Dünndarmobstruktion während enzymatischen Therapieversuchs eines Magen-Bezoars

BACKGROUND: Bezoars are concretions of foreign material that become fixed in the stomach and occasionally in the duodenum. They may be of vegetable origin (phytobezoar) or consist of ingested hair (trichobezoar). Treatment options may be endoscopic, enzymatic dissolution or surgical. We present a rare case of intestinal obstruction due to a phytobezoar during enzymatic dissolution treatment. METHODS: Case report. RESULTS: A 65-year-old male patient with a history of previous gastric surgery (Billroth I and vagotomy) has been admitted with early satiety, loss of weight, nausea and vomiting. Two bezoars (nearly 8 and 5 cm in diameter) were seen in upper endoscopy. Endoscopic fragmentation and removal could not be undertaken. Enzymatic dissolution treatment with 15 ml N-acetylcysteine in 50 ml saline twice a day was started. On the third day of this treatment, patient was admitted with signs of intestinal obstruction. Computerized tomography confirmed the ileus due to fragmented bezoar in the intestine. The patient was operated on immediately and all the unfragmented bezoar and pieces of fragmented bezoars in the stomach were removed via gastrotomy. CONCLUSIONS: Treatment of bezoars depends on the size and composition of the bezoar and the clinical factors that led to its formation. Although each case must be individualized, large trichobezoars, foreign body bezoars, and concretions that are not amenable to dissolution or mechanical disruption are best removed surgically as in our case in order to avoid such rare complications.

Prenatal sonographic features of esophageal and ileal duplications at 18 weeks of gestation

We present a case of esophageal and ileal duplications at 18 weeks of gestation. Transabdominal ultrasonography of the fetus showed multiple cystic masses of 12 to 17 mm in diameter and continuity with each other in the abdomen and a unilocular cystic mass of 15 mm in diameter in the posterior mediastinum. The cystic mass filled the abdominal cavity with signs of intestinal obstruction. The thoracic cystic mass was tubular, sausage-shaped and behind the heart, which was displaced to the antero-lateral wall of the chest. Amniocentesis revealed a normal fetal karyotype 46,XY. Peristaltic movements in the abdominal cystic structure at 30 weeks of gestation suggested dilated intestinal loops. Follow-up ultrasound examinations showed polyhydramnios with amniotic fluid index of 30 cm and gradual enlargement of the cystic structures to 50 mm in the abdomen and 30 mm in the posterior mediastinum at 38 weeks of gestation. A male infant weighing 3900 g was delivered. Postnatal ultrasonographic examination and the findings of magnetic resonance imaging also suggested enteric duplication cysts. Prenatal diagnosis allowed prompt neonatal evaluation and surgical treatment of the esophageal and the ileal duplications, which was confirmed by pathological examination.