Uncommon Cause Of Bowel Obstruction Research Articles

Transverse Colon Volvulus: A Case Report and Review of the Literature

Background: Transverse colon volvulus is an uncommon cause of bowel obstruction. The total number of cases reported in the literature is 100. It constitutes a surgical emergency since it can lead to bowel infarction, peritonitis, and death if not diagnosed at once. It seemed appropriate to report this case that was treated at the Department of Visceral Surgery A, Lucien Hussel Hospital in Vienne, France Case presentation: We report a rare case of transverse colon volvulus in a 42-year-old Arabic man, with no particular history, who presented to our emergency department with a 5-day history of constipation, progressive abdominal pain, nausea, and vomiting. His last bowel movement had been 3 days ago. Abdominal radiography showed a large bowel obstruction with a “U-shaped” loop in the left upper abdomen. Abdominal computed tomography was not performed because of impaired renal function. He was operated on urgently after conditioning and the diagnosis of a transverse colon volvulus was done intraoperatively. Rotated in a 360° clockwise direction on its mesentery, the bowel was intact without signs of ischemia. An extended right hemicolectomy was carried out with end-to-side ileocolic anastomosis. Through this case, we will try to discuss its physiopathology, etiologies, diagnosis, and management in emergencies. Conclusion: This case is unusual because no etiological factor has been found. Its diagnosis can be difficult and management effectiveness remains controversial. It is important to highlight this case and those of the literature, as many surgeons may have never seen a case of transverse colon volvulus. Volvulus of the transverse colon may therefore not be considered in the differential diagnosis of recurrent intermittent abdominal pain or acute intestinal obstruction. Prompt recognition with emergency intervention constitutes the key to a successful outcome.

Acute Midgut Volvulus in a Previously Healthy 9- Year Boy

Intestinal malrotation is an uncommon cause of bowel obstruction after the first month of life. Nevertheless, this abnormality can be diagnosed even at older ages. In this case, we present a 9-year-old, healthy, well-nourished boy who came in Emergency Department with intermittent cramping abdominal pain, associated with bilious vomiting. After clinical examination, plain AXR, and ultrasonography with no important findings, we performed doppler ultrasound screening of the abdominal vessels, in which abnormal orientation of superior mesenteric vessels was found. After that, contrast-enhanced CT scan was performed, which confirmed the diagnosis of intestinal malrotation, and revealed the Whirlpool Sign, confirming the diagnosis of midgut volvulus. He underwent laparotomy and Ladd´s procedure was done for him. We recommend investigation for the possibility of intestinal malrotation in all patients of non-specific abdominal pain regardless of age, even if there is no intestinal obstruction.

360 Degree Twisted Transverse Colon in a Neurological Impaired Girl with a History of Chronic Constipation - A Case Report

Introduction: Transverse colon volvulus is an uncommon cause of bowel obstruction. Predisposing factors are mental retardation, dysmotility disorders, chronic constipation, and congenital megacolon. Case report: We presented a transverse colon volvulus in a 14-year-old girl with mental retardation. Chronic constipation in neurologically impaired patients was a risk factor predisposing to volvulus. The girl was admitted to our Clinic because of problems that last 4-5 days and was followed by abdominal pain, vomiting and lack of stool. Vomiting was once a day. She was sub febrile up to 37.6°C. On examination, the abdomen was distended, tense, diffusely painful. During the surgery, a 360° clockwise volvulus of the transverse colon was found. After the reduction of volvulus, an enormous transverse colon was resected and protective ileostomy was formed. In the postoperative period, ileostoma functioned a good. The definitive surgical treatment was done on the 20th postoperative day when the occlusion of the ileostomy and transanal biopsy of the rectum was done, which showed the presence of ganglia cells. The patient was discharged from our institution after 1 month. Conclusion: Pediatric patients with neurological conditions and mental retardation present an increased risk of colon transversum volvulus due to chronic obstruction.

Transverse colon volvulus presenting as bowel obstruction: a case report

BackgroundTransverse colon volvulus is an uncommon cause of bowel obstruction. The total number of cases reported in the literature is 100. It constitutes a surgical emergency since it can lead to bowel infarction, peritonitis, and death if not diagnosed at once. It seemed appropriate to report this case that was treated at the Department of Visceral Surgery A, University Hospital Center Hassan II of Fez in Morocco.Case presentationWe report a rare case of transverse colon volvulus in a 42-year-old Arabic man, with no particular history, who presented to our emergency department with a 5-day history of constipation, progressive abdominal pain, nausea, and vomiting. His last bowel movement had been 3 days ago. Abdominal radiography showed a large bowel obstruction with a “U-shaped” loop in the left upper abdomen. Abdominal computed tomography was not performed because of impaired renal function.He was operated on urgently after conditioning and the diagnosis of a transverse colon volvulus was done intraoperatively. Rotated in a 360° clockwise direction on its mesentery, the bowel was intact without signs of ischemia. An extended right hemicolectomy was carried out with end-to-side ileocolic anastomosis.Through this case, we will try to discuss its physiopathology, etiologies, diagnosis, and management in emergencies.ConclusionThis case is unusual because no etiological factor has been found. Its diagnosis can be difficult and management effectiveness remains controversial.It is important to highlight this case and those of the literature, as many surgeons may have never seen a case of transverse colon volvulus. Volvulus of the transverse colon may therefore not be considered in the differential diagnosis of recurrent intermittent abdominal pain or acute intestinal obstruction.Prompt recognition with emergency intervention constitutes the key to a successful outcome.

Sigmoid volvulus at the University Hospital of Iceland 2000-2013

Backround Sigmoid volvulus is an uncommon cause of bowel obstruction in most western societies. Treatment options include colonoscopy in uncomplicated disease with elective surgery later on. The aim of this study was to assess what treatment sigmoid volvulus patients receive along with long-term outcomes at Landspitali University Hospital. Methods The study was retrospective. Patients diagnosed with sigmoid volvulus at Landspitali University Hospital from 2000-2013 were included. Information regarding age, sex, and duration of hospital stay, treatment, short and long-term outcomes were gathered. Results Forty-nine patients were included in the study, of which 29 men and 20 women. Mean age was 74 (25-93). One patient underwent acute surgery on first arrival due to signs of peritonitis. Others (n=48) were treated conservatively in the first attempt with colonoscopy (n=45), barium enema (n=2) and rectal tube (n=1). Three other patients underwent acute surgery due to failed colonoscopy, 8 patients had planned surgery during the index admission. Thirty-six patients were discharged after conservative treatment with colonoscopy (n=35), barium enema (n=1) or rectal tube (n=1). Two patients came in for elec-tive surgery later on. Twenty-two patients (61%) had recurrence. Median time to recurrence was 101 days (1-803). Disease-free probability in 3, 6 and 24 months was 66%, 55% and 22% respec-tively. Total disease related mortality was 10.2%. Mortality (30 days) after acute surgery was 25% (1/4) and 16,6% (3/18) after planned surgery. Conclusions Sigmoid volvulus has high recurrence rate if not treated operatively. Total mortality due to sigmoid volvulus at Landspitali is low but surgery related mortality high.

Contemporary Management of Sigmoid Volvulus

BackgroundSigmoid volvulus is an uncommon cause of bowel obstruction that is historically associated with high morbidity and mortality. The objective of this study was to evaluate contemporary management of sigmoid volvulus and the safety of primary anastomosis in patients with sigmoid volvulus. MethodsThe National Surgical Quality Improvement Project from 2012 to 2015 was queried for patients with colonic volvulus who underwent left-sided colonic resection. A propensity score-matched analysis was performed to compare patients with sigmoid volvulus undergoing colectomy with primary anastomosis without proximal diversion to colectomy with end colostomy. ResultsTwo thousand five hundred thirty-eight patients with sigmoid volvulus were included for analysis. Patients had a median age of 68 years (interquartile range, 55–80) and 79% were fully independent preoperatively. Fifty-one percent of operations were performed emergently. One thousand eight hundred thirteen (71%) patients underwent colectomy with anastomosis, 240 (10%) colectomy with anastomosis and proximal diversion, and 485 (19%) colectomy with end colostomy. Overall, 30-day mortality and morbidity were 5 and 40%, respectively. After propensity score matching, mortality, overall morbidity, and serious morbidity were similar between groups. ConclusionsSigmoid volvulus occurs in elderly and debilitated patients with significant morbidity, mortality, and lifestyle implications. In selected patients, anastomosis without proximal diversion in patients with sigmoid volvulus results in similar outcomes to colectomy with end colostomy.

Internal Hernia Masquerading As Necrotizing Enterocolitis

In extremely preterm infants, acute abdominal emergencies are fortunately less common with improving care. Spontaneous intestinal perforation and necrotizing enterocolitis are conditions where emergency surgery is most often needed. Conservative medical management and placement of temporary drain are often used in the initial management. Internal hernia (IH) is an uncommon cause of bowel obstruction in neonates, is difficult to diagnose and unfortunately are found only at autopsy. The presentation in preterm infants, distinction between these conditions, and the need for early diagnosis of IH are discussed.

Metastatic Cardiac Liposarcoma of the Small Intestine Causing Eneteroenteric Intussusception: A Case Report and a Review of the Literature

Introduction: Primary cardiac liposarcoma is exceedingly rare and its metastatic potential varies based on tumor subclass. Intestinal intussusception is an uncommon cause of bowel obstruction in adults. We report a case of a primary cardiac liposarcoma in a pregnant woman with small bowel seeding leading to bowel intussusception. Case report: 29-year-old female with history of cardiac liposarcoma presents to the hospital at 27 weeks of gestational age with abdominal pain associated with intractable nausea and vomiting. Three months earlier she was admitted with shortness of breath and dyspnea on exertion. A left intra-atrial mass was found on Cardiac MRI. The patient underwent resection of the mass and mitral valve replacement. Pathology specimen was consistent with dedifferentiated liposarcoma. She was discharged on postoperative day 14. An MRI of the abdomen and pelvis obtained on latest admission revealed an entero-enteric intestinal intussusception with signs of small bowel obstruction.Due to acute cardiopulmonary decline and fetal distress, emergency C-section and exploratory laparotomy were performed. A healthy female infant was delivered. A 10 cm long intussuscepted proximal small bowel segment was identified. Partial small bowel resection with end-to-end anastomosis was performed. Gross pathology showed two polypoid lesions of 5 and 1cm in size. Pathology revealed spindle cells, macronucleoli and lipoid cytoplasmic vacuoles. Immunohistochemistry was positive for MDM2 and CDK4 stains. These findings were identical to the original neoplasm resected from the heart 3 months earlier. The patient succumbed to respiratory failure 8 days postoperatively. Discussion. Primary cardiac neoplasms are very rare. Liposarcoma accounts for about 13% of primary malignant tumors of the heart. Dedifferentiated liposarcoma commonly rises from the retroperitoneum and extremities and carries a lower incidence of distal seeding compared to the pleomorphic variant. Small bowel metastasis are rare. Surgical management is the preferred approach for cardiac liposarcoma. Intestinal intussusception is a rare cause of intestinal obstruction in adults. Enteroenteric intussusceptions due to malignancy accounts for up to 30% of all cases. Metastatic disease, adenocarcinoma and small bowel lymphomas are some of the leading causes.CT Scan of the abdomen and pelvis is the preferred imaging modality for diagnosis.Abdominal Ultrasound and abdominal MRI are two alternatives that can be used in pregnancy to minimize radiation exposure to the fetus. Surgical resection of the intussuscepted area is the treatment of choice in adults. To the best of our knowledge, this is the first reported case of a primary cardiac dedifferentiated liposarcoma causing metastasis to the small bowel with associated intussuception.Figure 1Figure 2Figure 3

Acute renal allograft dysfunction due to cecal volvulus: a case report.

PurposeAmong kidney transplant recipients with acute kidney injury, the differential diagnosis must be broadened to include conditions such as rejection, immunocompromised host infections, anatomic pathologies, and recurrent or de novo glomerular diseases. In this case report, we describe an unusual cause of acute renal allograft injury due to external compression of the allograft ureter.MethodsRetrospective review; case report.ResultsThe patient developed acute kidney injury of the renal allograft due to external compression of the allograft ureter coincident with a cecal volvulus. The patient underwent lysis of adhesions, right hemicolectomy, and end ileostomy creation with resolution of acute kidney injury.ConclusionsCecal volvulus is an uncommon cause of bowel obstruction and is often associated with adhesions following abdominal surgery. To our knowledge, cecal volvulus has not previously been reported as a direct contributor to acute kidney injury. This case highlights the need for a systematic approach to the patient with acute kidney injury and the special considerations involved in the diagnosis of renal failure in the kidney transplant population.

Gallstone ileus, an uncommon cause of bowel obstruction

Gallstone ileus is a rare complication of cholelithiasis. It is characterized by bowel obstruction secondary to gallstone impaction at some point of the gastrointestinal tract due to the existence of a bilioenteric fistula. The aim of this analysis was to evaluate our experience through a retrospective study, covering a 12-year period. It included 14 cases (10 women and 4 men) with a median age of 81 years; 11 of the patients had comorbidities. The main analytic alteration was an increase in urea (median 79mg/dl). Diagnosis was confirmed through abdominal computed tomography in 10 cases and plain abdominal x-ray in 4. The stone was located in the jejunum in 6 cases, the ileum in 6, and the sigmoid colon in one; the mean stone size was 3cm. There were 11 cases of cholecystoduodenal fistula, one case of cholecystocolonic fistula, and one idiopathic fistula. Two patients died, including the patient that did not undergo surgery.

Gallstone ileus, an uncommon cause of bowel obstruction

Gallstone ileus is a rare complication of cholelithiasis. It is characterized by bowel obstruction secondary to gallstone impaction at some point of the gastrointestinal tract due to the existence of a bilioenteric fistula. The aim of this analysis was to evaluate our experience through a retrospective study, covering a 12-year period. It included 14 cases (10 women and 4 men) with a median age of 81 years; 11 of the patients had comorbidities. The main analytic alteration was an increase in urea (median 79mg/dl). Diagnosis was confirmed through abdominal computed tomography in 10 cases and plain abdominal x-ray in 4. The stone was located in the jejunum in 6 cases, the ileum in 6, and the sigmoid colon in one; the mean stone size was 3cm. There were 11 cases of cholecystoduodenal fistula, one case of cholecystocolonic fistula, and one idiopathic fistula. Two patients died, including the patient that did not undergo surgery.

Gallstone ileus- An uncommon cause of bowel obstruction: A case report and review of literature.

Gallstone ileus occurs when gallstone migrates from the gallbladder to the bowel through a cholecysto-enteric fistula, causing mechanical bowel obstruction. It is an uncommon cause of bowel obstruction. It occurs almost exclusively in the elderly, and accounts for 25% of mechanical small bowel obstruction in patients over the age of 65 years. Clinical diagnosis of gallstone ileus is difficult and usually depends on the radiographic findings. We present a case of 70 year old female with history of unstable angina,

Right Upper Quadrant Pain at 34 weeks Pregnancy: An Unusual Presentation of Acute Cecal Volvulus

Right Upper Quadrant Painat 34 weeks Pregnancy: An Unusual Presentation of Acute Cecal Volvulus Intestinal obstruction during pregnancy carries significant fetal and maternal mortality. Cecal volvulus is an uncommon cause of bowel obstruction during pregnancy occurring when a poorly fixed cecum axially rotates or folds resulting in strangulation and ischemia. Without surgical intervention, cecal volvulus can lead to peritonitis, septic shock and ultimately death. Vague clinical symptoms, apprehension toward the use of radiographic studies in pregnancy and poor recognition of this condition often delay the diagnosis of cecal volvulus in this patient population. We present a case of acute cecal volvulus in a 19-year-old, pregnant female with right upper quadrant pain successfully managed with caesarian section delivery and right hemicolectomy.

Stomach in the Pelvis - Itʼs Not A Joke!

Introduction: We report a rare case of massive gastric dilatation secondary to closed loop small bowel obstruction caused by internal hernia leading to obstruction of biliary intestinal limb of Whipple procedure. Case Report: A 59-year-old woman with multiple abdominal surgeries including sigmoid colectomy for sigmoid volvulus, pylorus preserving Whipple surgery for pancreatic hamartoma 3 years prior, presented with nausea, vomiting, constipation and periumbilical abdominal pain for 2 days. Examination was remarkable for tachycardia and soft but distended abdomen, diffuse tenderness and hypoactive bowel sounds. Lab evaluation showed WBC 14 K/μl and creatinine 2.62 mg/dl. Nasogastric tube placement yielded 4 l bilious fluid in the first hour. CT scan of abdomen demonstrated massively distended stomach, measuring 15 cm transversely, 14 cm antero-posteriorly and 35 cm craniocaudally extending into the pelvis with proximal small bowel dilatation. Patient responded to conservative management and small bowel follow through study performed 48 hours later showed marked decompression of the stomach. Six weeks later, patient was readmitted with similar clinical presentation. CT scan showed evidence of gastric distension and partial bowel obstruction in the mid anterior abdomen involving multiple segments of small bowel. She did not respond to conservative management for 10 days and laparotomy was performed later on. Laparotomy revealed small bowel closed loop obstruction due to internal hernia, obstructing the biliary limb of Whipple procedure adjacent to the gastrojejunostomy. Discussion: Closed loop obstruction is a rare type of bowel obstruction associated with high mortality of 35% at 36 hours of delayed diagnosis. Internal hernia is an uncommon cause of bowel obstruction reported in 0.2% to 0.9% of autopsies and in 0.5-4.1% of cases of intestinal obstruction. Internal hernia cause closed loop obstruction when the narrow defect causes occlusion of the loops of small bowel entering and exiting through mesenteric defect or congenital mesenteric opening. Postsurgical adhesions can cause more narrowing of the defect. We present a very unusual case of closed loop intestinal obstruction of the biliary limb of Whipple procedure that in addition lead to massive gastric distension of stomach.Figure: CT scan with oral contrast.

Left paraduodenal hernia causing small bowel obstruction in an adolescent patient

Internal hernias are an uncommon cause of bowel obstruction, accounting for less than 1% of cases. Paraduodenal hernias, the most common type of internal hernias, are believed to be congenital in origin. They can be asymptomatic, cause chronic abdominal pain, or present with acute intestinal obstruction with strangulation and ischemia. We describe a case of left paraduodenal hernia found in a patient who presented with acute intestinal obstruction.

Intestinal chondrolipoma: uncommon cause of bowel obstruction

A case of intestinal obstruction caused by jejunal chondrolipoma in an 11-year-old boy is presented. To the best of our knowledge, this seems to be the first report of chondrolipoma arising from the small bowel in English language literatures.

Surgical Treatment of a Sigmoid Volvulus Associated with Megacolon: Report of a Case

Sigmoid volvulus occurring concomitantly with megacolon is an uncommon cause of bowel obstruction, and various approaches to treatment have been proposed. We report herein a case of sigmoid volvulus with megacolon that was successfully treated by elective surgery following endoscopic reduction during the same hospital stay. A 70-year-old woman was admitted to our hospital with abdominal pain, distension, and severe constipation. Physical examination, plain abdominal X-ray, and barium enema confirmed a sigmoid volvulus and further examinations revealed concomitant megacolon. An elective sigmoid colectomy was performed following successful endoscopic decompression. The postoperative course was uneventful and there was no residual colonic dysmotility. Histologically, no aganglionic tissue was observed in the resected specimen.

STRANGULATED PARA-ILEOSTOMY HERNIA

Para-ileostomy hernia is an uncommon cause of bowel obstruction following ileostomy. Two cases are reported that demonstrate the difficulty in diagnosis and the high morbidity associated with this condition. Early recognition and repair of the uncomplicated and strangulated hernia are recommended.