Signs Of Intestinal Obstruction Research Articles

Cases with Recurrent Hospitalization due to Unexplained Ileus: Paraduodenal Hernia

Internal hernia is one of the rare causes of surgical pathologies in the abdomen.Paraduodenal hernia (PDH) is the most frequent subtype of internal hernia. There are no specific clinical and laboratory findings for diagnosis. This situation may cause delays in diagnosis and adverse clinical outcomes in patients. Computed Tomography (CT) is an imaging method that can help in the diagnosis of internal hernia. A case report of our two patients who were followed up in the clinic, who had been hospitalized with similar complaints in the past and operated for paraduodenal hernia (PDH) has been prepared. Internal herniation is one of the pre-diagnoses that should be kept in mind, especially in the history of unexplained and recurrent hospitalization in patients with abdominal pain and signs of intestinal obstruction. Observation of hernia sac on CT and observing small intestinal loops trapped in it are the only objective findings that can help us in the diagnosis of internal herniation.

Intestinal obstruction delaying the diagnosis of acute appendicitis: a case presentation

Acute appendicitis is the most common surgical emergency worldwide. Patients often present with symptoms such as abdominal pain, migrating pain, loss of appetite, nausea, and vomiting. Signs of intestinal obstruction are rarely detected in patients. A 55-year-old male patient presented to the emergency department with complaints of abdominal distension, nausea, and vomiting, leading to admission to the surgical clinic with a diagnosis of intestinal obstruction. Due to the predominance of obstruction symptoms in the patient and the inadequacy of radiological evaluations due to the dilatation of bowel loops, emergency surgery was not performed. Following monitoring in the ward, laparotomy was performed in the patient, revealing a complete obstruction at 90 cm from the ileocecal valve, and a diagnosis of acute appendicitis was established. Appendectomy was performed, and the patient was discharged in a healed condition. Acute appendicitis can rarely lead to intestinal obstruction and may present with unexpected clinical manifestations.

Intestinal anisakiasis: CT imaging findings-a 10-year descriptive study in a single center.

The aim of this study was to retrospectively review cases of intestinal anisakiasis diagnosed by CT over a 10-year period and to evaluate imaging findings associated with the disease. This retrospective study included 71 patients with clinical suspicion of intestinal anisakiasis in whom an abdominopelvic computed tomography (CT) was performed at a single institution between June 2011 and December 2021. To identify the cases, we used medical term search engines and the hospital's radiology case database. Clinical information was gathered from the medical records. A radiologist with five years of experience reviewed and analyzed the CT images to determine the characteristic findings of intestinal anisakiasis. The study included 47 confirmed cases of intestinal anisakiasis. The mean age of the patients was 52 years (range 18-87 years), being more frequent in men than women (26:21). All patients reported ingestion of raw fish, most commonly anchovies in vinegar (30/47, 63,8%). Abdominal pain was the predominant symptom, accompanied by nausea, vomiting, and occasionally fever. The most common clinical suspicions were intestinal obstruction (14/47, 29,8%) and appendicitis (10/47, 21,3%), whereas intestinal anisakiasis was suspected in only 2 cases prior to imaging. CT showed thickening of the bowel wall with submucosal edema in all patients, predominantly involving the ileum (43/47, 91,5%), usually in a relatively long segment (mean of 17,5 cm, range 10-30 cm). Simultaneous involvement of multiple bowel segments was observed in 16 cases (34%). Intestinal obstruction with dilatation of proximal loops (33/47, 70,2%), ascites (45/47, 95,7%), and mesenteric fat striation (32/47, 68,1%) were also common findings. This study demonstrates the value of computed tomography in suggesting the diagnosis of intestinal anisakiasis, which often presents with nonspecific clinical manifestations. The characteristic CT findings that provide diagnostic clues are bowel wall thickening with submucosal edema, typically involving a long segment of the ileum, with signs of intestinal obstruction, ascites, and mesenteric fat striation. Simultaneous involvement of several intestinal segments (typically the gastric antrum and right colon) is an additional finding to be considered and may provide a diagnostic clue.

Malrotation in the Adult, a Forgotten Etiology of Partial Gut Obstruction: A Report of Two Cases

Ninety percent of cases of malrotation have shown signs and symptoms of intestinal obstruction by the first year of life. It is thus an often-overlooked etiology in adult patients. Evidence-based recommendations are also limited because of the paucity of cases. This paper discusses the two cases of malrotation from diagnosis to surgical management at a tertiary academic hospital. Both are previously well adult male patients with virgin abdomen who presented with vomiting and signs of intestinal obstruction. During medical decompression, CT scan with triple contrast clinched the diagnosis of malrotation for which Ladd’s procedure was done, with no operative complications. The authors’ experience and previous literature support early decompression, imaging, and surgery for all cases of malrotation regardless of severity of symptoms. Key words: intestinal malrotation, bowel obstruction, Ladd’s procedure

Mesenteric lipoma in a child: A case report

Lipoma is a benign tumor of mature fat cells. It quite rarely occurs in the intestinal mesentery in children. Mesenteric lipomas usually do not cause gastrointestinal symptoms unless they affect the intestinal passage. However, as the mass grows, symptoms suggestive of partial intestinal obstruction, such as abdominal pain, vomiting, and abdominal distension, may be observed, or total intestinal obstruction may develop due to volvulus. In our study, a case with mesenteric lipoma with acute abdominal findings was presented. A four-year-old male patient presented with abdominal pain and vomiting. On physical examination, the patient was agitated and dehydrated, the abdomen was distended, and there was widespread tenderness; however, the mass was not palpable. Computed Tomography (CT) revealed a suspicious appearance for leiomyosarcoma with a size of 102x79x87 mm in fat density containing septa. In the exploration, a 120x120x70 mm encapsulated, lobular mass was detected 50 cm proximal to the ileocecal valve, covering the 10 cm ileal segment. The mass was excised totally together with a 10 cm small intestine segment, and ileal anastomosis was performed. The diagnosis of mesenteric lipoma was confirmed histopathologically. As a result, mesenteric lipoma, which is rare in children, is a benign pathology, and its treatment is total surgical excision. In children with signs of intestinal obstruction, mesenteric lipoma should be considered in the differential diagnosis, whether the mass is palpated or not.

Rare Presentation of Rectal Carcinoma in a Yamani Patient

Carcinoma of the rectum often presents as painless bleeding per rectum, abdominal discomfort and rarely as intestinal obstruction or bowel perforation. The studied case was presented with large perianal fistula and signs of intestinal obstruction.

Adult ileocolic intussusception due to primary diffuse large B-cell lymphoma.

Intestinal intussusception is an uncommon condition in adults. Unlike the idiopathic spontaneous occurrence in children, about half of the cases in this population are associated with malignant neoplasms. This report describes a 44-year-old male patient presenting with abdominal pain and signs of intestinal obstruction. Through a CT examination, the patient was diagnosed with ileocecal intussusception. A 3 cm lesion was found in the terminal ileum, and a segmental enterectomy was performed. An immunohistochemical analysis identified a large B-cell lymphoma. Due to the high association with tumors, the finding of intestinal intussusception in adults should be properly investigated, regardless of symptoms.

A rare cause of intestinal obstruction in children: signet-ring cell adenocarcinoma of the colon.

Signet-ring cell adenocarcinoma of the colon is well-recognized in adult patients who are extremely rare and not well-documented in children. Our study aims to raise awareness about this rare disease and its long-term outcomes. We retrospectively evaluated patients with signet-ring cell colon adenocarcinoma. Six patients, three boys and three girls, with a mean age of 14.83 (range, 13-17 years), presented with signs of intesti-nal obstruction and were diagnosed with signet-ring cell colon adenocarcinoma. All patients had air-fluid levels on abdominal X-ray. Abdominal ultrasonography of all patients revealed subileus. Abdominal computed tomography was performed in five patients, and pre-operative colonoscopy was conducted in two patients before the emergency intervention. All of the patients underwent emergent exploratory laparotomy with the preliminary diagnosis of acute abdomen. In two patients, debulking surgery followed by a stoma was performed. The remaining four patients were treated with anastomosis following intestinal resection. All girls had metastases on the ovary. One of the patients died due to the burden of multiple metastases in the early period, and three died in the sixth post-operative year. We have been following the remaining two patients since then. Although signet-ring cell carcinomas (SRCCs) are rare, they should be considered in the differential diagnosis of acute abdomen and intestinal obstruction in pediatric patients. Despite early diagnosis and treatment, SRCC has a poor prognosis in the pediatric population.

Abdominal Cocoon Syndrome, A Rare Case Report

A rare cause of intestinal obstruction is an abdominal cocoon. Preoperatively, most cases are difficult to diagnose. In most cases, surgical removal of the membrane resulted in complete recovery. The exact cause of abdominal cocoon is unknown. We described a male patient who presented with signs of intestinal obstruction and was diagnosed as having an abdominal cocoon intraoperatively.

ABCL-310 Triple Metachronous Malignancies in Primary Diagnosed Diffuse Large B-Cell Lymphoma Patient: A Case Report

Diffuse large B-cell lymphoma (DLBCL), the most common type of non-Hodgkin lymphoma (NHL), is known to be associated with increased risk of second primary malignancies (SPM). The occurrence of more than one type of cancer in a single patient is considered a rare finding, either appearing at the same time (synchronous) or subsequently (metachronous). This study is to present this interesting case of a male patient diagnosed with DLBCL, basal cell carcinoma (BCC), and adenocarcinoma of colon metachronously. A case report from May 2012 to January 2022. Oncology Unit/Oncology Center Mansoura University, Egypt. A 43-year-old male patient, HCV positive, diagnosed from splenectomy with DLBCL, Stage IV. In 2012, the patient received 8 cycles of CHOP protocol and achieved complete remission. In 2016, he presented with a face ulcer, which was excised with adequate safety margins, and histopathological examination revealed BCC. In 2017, he presented with acute abdomen. Computed tomography (CT) showed a well-defined soft tissue mass at the distal part of the ascending colon and hepatic flexure with signs of intestinal obstruction. The patient underwent right hemicolectomy and double barrel ileotransverse colostomy, and the histopathological examination revealed grade II adenocarcinoma, Stage IIa. Then, he received 6 cycles of adjuvant de Gramont regimen. After that, CT and colonoscopy were free. In 2019, he presented with B symptoms and right axillary lymphadenopathy; biopsy revealed NHL of large-cell type in favor of high-grade follicular lymphoma. After receiving 4 cycles of DHAP protocol, PET/CT was negative. Yet, he refused autologous stem cell transplantation. In 2021, he presented with cervical lymphadenopathy and tumor lysis syndrome. Biopsy showed DLBCL. The patient is 43 years old, male, HCV positive, underwent splenectomy, was diagnosed with DLBCL, and received chemotherapy. All of these are considered risk factors for SPM. The patient received supportive treatment, and 3 sessions of hemodialysis were done. He has been lost to follow-up since January 16th, 2022. DLBCL increases the risk of SPM mostly due to immune dysfunction, immunosuppression, and the mutagenic effects of chemotherapy. Hence, regular screening of DLBCL patients and survivors is recommended.

Major Congenital Malformations of Gastrointestinal Tract Among Neonates Presenting to Tertiary Care

Background: Major congenital malformations of gastrointestinal tract (CMGIT), are usually manifested in early neonatal period by signs of intestinal obstruction and may be life threatening. A broad spectrum of Gastrointestinal Tract (GIT) anomalies can be seen including both upper and lower GIT. As compared to other congenital anomalies, GIT anomalies are not well studied and till now very few studies have reported prevalence and pattern of GIT malformations. Objective: To determine different type of common gastrointestinal anomalies among neonates presenting at tertiary care hospital. Methods: This descriptive cross sectional study was done at National Institute of Child Health (NICH) Karachi over period of 6 months, from 1-8-17 to 31-1-18. All neonates presenting to emergency department and got hospitalized with CMGIT were enrolled. Results: There were 35 neonates enrolled with CMGIT. Out of these 16(45.7%) were male and 19(54.3%) were females. Mean age 9.4+3.82 (range 1-20) days. Mean weight was 2.5±0.98 (range 0.5-4.5) kg. Mean duration of symptoms was 5.8+1.72 (range 1-9) days. Among the CMGIT, 12 (34.3%) cases were of Anorectal malformation, persistent Vitelline duct was found in 6 (17.1%), Intestinal atresia in 4(11.4%), Intestinal stenosis in 5(14.3%), Hirshsprung disease in 4(11.4%) and Exomphalos in 4 (11.4%). Conclusion: Anorectal malformations were most common anomaly followed by persistent vitelline duct. Antenatal follow up and anomaly scan of all neonates should be done. Keywords: Gastrointestinal anomaly, Neonates, congenital anomaly.

Imaging Findings in Dogs and Cats With Presumptive Sclerosing Encapsulating Peritonitis.

This retrospective case series describes imaging findings in seven dogs and two cats with a presumptive diagnosis of sclerosing encapsulating peritonitis (SEP) between 2014 and 2021. Peritoneal effusion was present in all animal patients. Sonographically, echogenic fluid with or without echogenic intraperitoneal septations, gathered or corrugated bowel loops, and abdominal lymphadenomegaly were suggesting an inflammatory process and the presence of adhesions. Gathering of the bowel with abdominal distension and/or signs of intestinal obstruction were major findings on radiographs. Abdominal fat stranding was an additional finding in animals undergoing a CT examination. Previous surgery, pregnancy, and the presence of a perforating foreign body were potential predisposing causes in 4/9 animals. Peritonitis was septic in 4/9 animals. As SEP is a rare condition but life threatening, this detailed description of imaging findings in a short case series can be useful for a presumptive diagnosis and surgical planning.

Use of botulinum toxin type A in giant ventral postoperative hernia

Postoperative ventral hernia represents one of the causes of anterior abdominal wall hernias. Repair of this hernia can be very challenging for surgeons, as they are associated with cardiovascular and respiratory complications, development of compartment syndrome, and high recurrence rates. Our case is a 48-year-old woman was operated on twice. The first time was in 2015 due to perforation of colonic diverticulitis for which abdominal exploration and Hartmann’s procedure was performed. In 2016, the reverse of Hartmann’s procedure was done. Forty days after the second operation, she noticed a small hernia in the scar area that increased rapidly. After 1 year, it became irreducible with dimensions (30X17 cm) reached the para-umbilical region without any sign of intestinal obstruction. We decided to do hernioplasty using self-gripping mesh. Six weeks before surgery, botulinum toxin type A was injected intramuscularly to induce muscle weakness and restore the normal biomechanics of the anterior abdominal wall, facilitating closure and repair. Postoperative results and follow-up after 6 months were satisfactory.

Functional Intestinal Obstruction of Prematurity (FIOP): Short term management results: A case series

Background: Functional Intestinal Obstruction of Prematurity (FIOP) is the delay or failure of meconium evacuation in premature neonates. It is associated with hypomotility in the developing intestine. It mostly presents with signs of intestinal obstruction in very low (VLBW) or extremely low birth weight (ELBW) neonates. Case Series: We present short-term results regarding the management of 8 premature newborns with FIOP treated with Awolaran O. et al [1] algorithm in a pediatric hospital, two of them required a surgical procedure due to conservative management failure. Conclusion: Early conservative management is successful in most patients with FIOP, related to symptom resolution. Surgical management should be kept for those with conservative management failure.

Clinical and radiological features of incarcerated hernia

Many complications were reported secondary to herniation, including strangulation and incarceration, leading to intestinal obstruction and related clinical manifestations. Treating such cases is largely dependent on appropriately diagnosing and evaluating them to enhance the prognosis and prevent a recurrence. In the present literature review, we have discussed incarcerated hernias' clinical and radiological features. Physical examination is very important in establishing the diagnosis of these events and obtaining a thorough history from the patient. Most patients present with abdominal pain, tenderness, and erythematous changes. Signs of intestinal obstruction might also be reported when this complication develops. Signs include acute abdominal pain, nausea, and vomiting. Radiological findings might show the presence of air to fluid appearance. Clinicians should be aware of these clinical manifestations and perform an adequate physical examination to establish a proper diagnosis and manage these cases. The process of decision-making is important before deciding the most appropriate management approach. Therefore, it is important to assess patients before moving to the next steps.

Mesenteric Cystic Lymphangioma Induced Recurrent Abdominal Pain And Signs of Intestinal Obstruction: A Case Report

Mesenteric cystic lymphangioma is an uncommon benign abdominal mass. This is a case of a 40-year-old female who presented to the hospital with recurrent abdominal pain and distention. Computed Tomography and magnetic resonance imaging tests suggested a mesenteric cyst. The patient underwent laparotomy which confirmed the presence of a mesenteric cyst along with small bowel narrowing at the site of the cyst caused by multiple adhesive bands released during the procedure. The cyst was found and excised approximately 200 cm away from the ileocecal junction, and was pathologically confirmed to be a mesenteric cystic lymphangioma. These findings support that mesenteric cystic lymphangioma could cause chronic abdominal pain and intestinal obstruction.

SPONTANEOUS RUPTURE OF THE RIGHT CONGENITAL DIAPHRAGMATIC EVENTRATION ON THE RIGHT SUBJECTED TO SURGICAL CORRECTION IN A CHILD WITH MEGADOLICOCOLON

Спонтанний розрив гемідіафрагми у випадках вродженої діафрагмальної евентрації зустрічається вкрай рідко, у літературі повідомляють про унікальні випадки.In this context, the authors present the case of an 8-year-old child who was hospitalized in the coloproctology service for abdominal pain, lack of stool for more than 7 days, pronounced abdominal distension. The child suffers from Down's disease. In 2017, he was occasionally diagnosed with right diaphragmatic eventration and underwent surgical correction by thoracic approach. After a thorough evaluation, with signs suggestive of diaphragmatic hernia on the right, the child underwent surgery, intraoperatively the rupture of the right hemidiaphragm was found with intrathoracic ascension of the malrotated intestinal loops, transverse colon and omentum. The repair of the diaphragmatic eventration complicated by rupture was used using the “overcoat” folding procedure, on the suture line being carefully applied a collagen foil covered with components of the fibrin adhesive. The postoperative period passed without complications.Conclusion. Spontaneous rupture of the diaphragm is a rare complication in children with diaphragmatic eventration, especially on the right side, in this case obstruction of the malformative colon ascended intrathoracically with progressive dilation of the intestinal loops being responsible for distension with gradual thinning of the hemidiaphragm sac resulting malformation in diaphragmatic rupture with herniation and progressive obliteration of the pleural space. The case of rupture of the diaphragmatic eventration associated with megadolicocolon confirms that the respiratory symptoms characteristic of this clinical situation may be overshadowed by the predominance of signs of intestinal obstruction, without leading to sudden progressive clinical deterioration, which proved to be a misleading moment in diagnosis. certainty of this serious complication rarity.

A Rare Medullary Carcinoma of Jejunum

Abstract Introduction/Objective Medullary carcinoma of jejunum is an extremely rare condition. These tumors account for less than 0.04% of all colorectal cancers and less than 3 cases to date has been reported in the small intestine Methods/Case Report We present a case of 78-year-old woman with a celiac disease and collagenous colitis, chronic diarrhea, chronic anemia and 2.1 cm apple core lesion on mid to distal jejunum on CT leading to partial obstruction. Results (if a Case Study enter NA) Histologically tumor showed invasive carcinoma in a solid growth pattern with pushing border. The tumor cells were uniform, enlarged with prominent nucleoli and brisk mitotic activity. There was prominent inflammatory response within and around the tumor. Immunohistochemical stains were positive for CK7, CDX2 CK19, CKAE1-3 and negative for CD45, CK20, Chromogranin Synaptophysin, PAX-8. MLH1 &PMS2 showed loss of nuclear expression and MSH2 & MSH6 with Intact nuclear expression. Microsatellite instability was High (MSI- H) with instability in two or more microsatellite markers. Diagnosis of medullary carcinoma of jejunum was made. Conclusion Although the clinical manifestations can be consistent with signs of intestinal obstruction, often these rare tumors are discovered incidentally. Conditions such as celiac disease, Crohn’s disease, and other chronic inflammatory illnesses have been linked to contributing risk factors. Imaging and appropriate tumor markers have less role in diagnosis; however, biopsy is needed for definitive diagnosis. Even though the development of these tumors in the small bowel is rare, further enhancement of awareness can aid in the appropriate early detection and appropriate treatment modalities.

Evaluation and management of rectal bleeding in pregnancy.

Rectal bleeding occurs in about 40% of pregnant women, and is predominantly attributed to benign perianal pathology (haemorrhoids or anal fissures). More sinister causes of rectal bleeding may be heralded by key red flag clinical and biochemical features. These features should be evaluated in all women with rectal bleeding. Imaging investigations or flexible sigmoidoscopy may be warranted. The latter can be performed safely by experienced operators in pregnant women. Women with evidence of haemodynamic compromise, elevated inflammatory markers, significant anaemia, signs of intestinal obstruction or compromise to the fetus should be evaluated urgently. Providers must be mindful of the changes in normal ranges for common haematological and biochemical parameters in pregnancy compared with the non-pregnant state. Faecal calprotectin is an established tool for identification of intestinal inflammation and is valid in pregnancy. An elevated faecal calprotectin level (≥50µg/g) signifies a need for further diagnostic evaluation. Inflammatory bowel disease may present initially, or with worsening disease activity, in pregnancy. Expedient diagnosis with the use of faecal calprotectin, sigmoidoscopy with or without intestinal ultrasound, exclusion of alternative or compounding infective aetiologies, and institution of appropriate therapy are critical. Medical therapies for management of inflammatory bowel disease can be safely instituted in pregnancy. Colorectal cancer incidence is increasing in younger age groups, but fortunately remains rare. When diagnosed in pregnancy, colorectal cancer can be successfully and safely managed with a collaborative multidisciplinary team approach. Early diagnosis is key to optimising outcomes.

Sigmoid colon carcinoma-associated with an inguinal hernia.

Introduction: Inguinal hernias are common diseases in the population, and the prevalence of colorectal cancer has increased significantly in recent decades. However, the concomitant association of these two entities is rarely described in the literature. In most cases, due to the complex diagnosis, patients are treated in emergencies with obstruction or perforation. Nowadays, there is no established consensus on the best surgical approach when this association exists. Case Presentation: We report a case of an 84-year-old patient admitted to the emergency room with a chronic inguinoscrotal hernia, with signs of intestinal obstruction, being diagnosed in the preoperative period by computed tomography, a neoplasm of the sigmoid colon incarcerated in the hernial sac. The patient underwent radical oncologic surgical treatment and inguinal herniorrhaphy through two access routes, with good postoperative evolution and outpatient follow-up after sixteen months. Conclusions: The association between CRC and inguinal hernia is unusual, but the surgeons should keep this possibility in mind because the treatment must be aimed to accomplish a safe oncologic outcome and as optimal as possible hernia repair.