Small Bowel Obstruction in Patients with a Prior History of Cancer: Predictive Findings of Malignant Origins

A 29-year-old, otherwise well, nulligravid woman presented to the emergency department with 1-day history of generalised abdominal pain and vomiting. She had similar symptoms 6 months prior following recent menstruations, which resolved conservatively. She had no prior history of abdominal surgery or endometriosis. CT scan demonstrated distal small bowel obstruction. A congenital band adhesion was suspected, and she underwent prompt surgical intervention. During laparoscopy, a thickened appendix was adhered to a segment of distal ileum. There was blood in the pelvis. Laparoscopic adhesiolysis and appendicectomy were performed. Histopathology demonstrated multiple foci of endometriosis of the appendix with endometrial glands surrounded by endometrial stroma. Oestrogen receptor and CD10 immunostains highlighted the endometriotic foci. The patient made a good recovery and was referred to a gynaecologist for further management.

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A Bezoar Causing Bowel Obstruction After Roux-en-Y Gastric Bypass: A Case Report

ACTA MEDICA IRANICA ◽

10.18502/acta.v57i6.1886 ◽

2019 ◽

Author(s):

Alireza Tavassoli ◽

Mehrdad Fakhlaei ◽

Fatemeh Sadat Abtahi Mehrjardi ◽

Mehrdad Gazanchian

Keyword(s):

Bariatric Surgery ◽

Gastric Bypass ◽

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Eating Habits ◽

Gastric Surgery ◽

Prior History ◽

History Of ◽

High Level

Abstract- We aimed to present a patient with phytobezoar causing small bowel obstruction after Roux-en-Y gastric bypass. Thirty-year-old woman with a history of prior Roux-en-Y gastric bypass due to morbid obesity three years ago presented with colicky abdominal pain, distention, nausea, vomiting, and obstipation. Initial abdominal X-ray showed various distended small bowel loops with air-fluid levels. The patient was taken to operation room for laparoscopic exploration, and a phytobezoar was found in distal jejunum. The bezoar was fragmented and flushed through cecum. The patient tolerated the surgery and her symptoms relieved without complication. Moreover, she received dietary consultation in order to prevent future recurrences. Small bowel obstruction in a patient with prior abdominal surgery is mainly caused due to adhesions, stenosis of anastomosis and hernias. An uncommon cause for obstruction is bezoar formation. The majority of patients with bezoars have a history of gastric surgery. Diagnostic imaging is not always helpful, and surgical exploration is sometimes required for diagnosis. Treatment is mainly surgical, but conservative medical treatment is also reported to be helpful. Apart from removal of bezoar, a dietary consultation is required to avoid eating habits leading to bezoar formation. Bariatric surgery is becoming more common; thus its complications are becoming more common as well. Majority of patients with bezoars have a prior history of gastric surgery. Therefore it is important to maintain a high level of suspicion for timely diagnosis of bezoars in patients with prior history of bariatric surgery, especially Roux-en-Y gastric bypass.

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Jejunal Diverticular Disease with Unborn Enterolith Presenting as a Small Bowel Obstruction: A Case Report

The American Surgeon ◽

10.1177/000313480707300713 ◽

2007 ◽

Vol 73 (7) ◽

pp. 703-705 ◽

Cited By ~ 2

Author(s):

Phillip P. Crace ◽

Andre Grisham ◽

George Kerlakian

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Surgical Intervention ◽

Interesting Case ◽

Prior History ◽

Surgery Complications ◽

Blind Loop Syndrome ◽

Mobile Mass ◽

History Of

Jejunal diverticuli are rare and usually asymptomatic. More commonly, they are seen as incidental findings on CT images, enteroclysis, or during surgery. Complications such as bleeding, perforation, obstruction, malabsorption, diverticulitis, blind loop syndrome, volvulus, and intussusception may warrant surgical intervention. An interesting case of an unborn enterolith (enclosed calculus) from a jejunal diverticulum presenting as a small bowel obstruction is presented. The patient is a 66-year- old woman with no prior history of abdominal surgery who presented with a high-grade bowel obstruction. CT with intravenous barium contrast confirmed the presence of a transition point from dilated to decompressed small bowel in the mid jejunum. At laparotomy, a freely mobile mass was found in this area leading to the bowel obstruction. The mass was removed by making a small enterotomy in the jejunum. While running the small bowel proximally, a small segment of jejunum, approximately 8 cm, containing several diverticuli was found. This bowel obstruction was the result of an unborn enterolith from this segment of bowel. The patient's hospitalization was benign and she was discharged home on postoperative day 4.

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Peritoneal encapsulation: a rare cause of small bowel obstruction

BMJ Case Reports ◽

10.1136/bcr-2018-228594 ◽

2019 ◽

Vol 12 (4) ◽

pp. e228594

Author(s):

Abagayle E Renko ◽

Katelin A Mirkin ◽

Amanda B Cooper

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Case Reports ◽

Prior History ◽

Peritoneal Encapsulation ◽

Congenital Condition ◽

History Of ◽

Surgery First ◽

Imaging Signs

Peritoneal encapsulation syndrome (PES) is a rare cause of small bowel obstruction (SBO) in patients with no prior history of abdominal surgery. First described by Cleland in 1868, PES is a congenital condition characterised by small bowel encasement in an accessory, but otherwise normal peritoneal membrane.1 2A result of abnormal rotation of the midgut during early development, the condition causes fibrous encapsulation of the intestines, thus preventing bowel distention.3While preoperative diagnosis is difficult, several case reports have described clinical and imaging signs that can help clinicians with not only recognising the condition but also preparing appropriately for perioperative discovery of anatomical variants.3 4

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563 A Rare Case of Small Bowel Obstruction Secondary to Peritoneal Encapsulation, Congenital Adhesional Band and Gallstone Ileus

British Journal of Surgery ◽

10.1093/bjs/znab259.300 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

P Gungadin ◽

A Taib ◽

M Ahmed ◽

A Sultana

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Unusual Case ◽

Gallstone Ileus ◽

Gall Stone ◽

Case Presentation ◽

Peritoneal Encapsulation ◽

History Of ◽

Gall Stone Ileus

Abstract Introduction Small bowel obstruction can be caused by multiple factors. We describe an unusual case of small bowel obstruction secondary to three rare factors: gallstone ileus, peritoneal encapsulation and congenital adhesional band. Case Presentation A seventy-nine-year-old male presented with a four-day history of obstipation and abdominal pain. CT abdomen pelvis revealed small bowel obstruction secondary to gallstone ileus. The patient was managed by laparotomy. The intraoperative findings revealed the presence of a congenital peritoneal encapsulation with an adhesional band and gallstone proximal to the ileo-caecal valve. Although there was some dusky small bowel, this recovered following the release of the band. Discussion Peritoneal Encapsulation is a rare congenital pathology resulting in the formation of an accessory peritoneal membrane around the small bowel. This condition is asymptomatic and rarely presents as small bowel obstruction. The diagnosis is often made at laparotomy. There are less than 60 cases reported in literature. Gallstone ileus is another rare entity caused by an inflamed gallbladder adhering to part of the bowel resulting in a fistula. Conclusions The rarity of these conditions mean that they are poorly understood. A combination of this triad of gall stone ileus in the presence of peritoneal encapsulation and congenital band has not been reported before. Knowledge of this would raise awareness, facilitate diagnosis and management of patients.

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An interesting case of left paraduodenal hernia.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.05.4648 ◽

2021 ◽

Vol 28 (05) ◽

pp. 755-758

Author(s):

Sahar Saeed ◽

Abeera Butt ◽

Syed Asghar Naqi ◽

Muhammad Mohsin Ali

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Interesting Case ◽

Paraduodenal Hernia ◽

Absorbable Suture ◽

Internal Hernias ◽

Plain Abdominal Radiography ◽

History Of ◽

Operative Recovery

Paraduodenal fossa hernias (PDFHs) represent 53% of all congenital internal hernias and 0.2-0.9% of all small bowel obstructions. Most of these hernias are diagnosed incidentally on laparotomy, and carry up to 50% lifetime risk of development of small bowel obstruction. We present our experience in diagnosing and treating a case of a massive left paraduodenal fossa hernia in a 17 year male, containing over 30% of the small bowel (jejunum and ileum), presenting with a history of recurrent incomplete small bowel obstruction. Plain abdominal radiography showed distended loops of jejunum and few air fluid levels. After laparotomy and identification of hernia, small gut was reduced and examined, which was found to be structurally and functionally intact with normal vascularity. The defect was closed with continuous absorbable suture (Vicryl 2-0) sparing the inferior mesenteric vessels. Patient’s post-operative recovery remained uneventful and he was discharged on 4th post-operative day.

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Predictors of Ischemic Bowel in Patients with Small Bowel Obstruction

The American Surgeon ◽

10.1177/000313481608201030 ◽

2016 ◽

Vol 82 (10) ◽

pp. 992-994 ◽

Cited By ~ 6

Author(s):

Michael P. O'Leary ◽

Angela L. Neville ◽

Jessica A. Keeley ◽

Dennis Y. Kim ◽

Christian De Virgilio ◽

...

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Bowel Ischemia ◽

Wall Thickening ◽

Ischemic Bowel ◽

Operative Exploration ◽

Common Etiology ◽

History Of ◽

Exploratory Laparoscopy

Preoperative diagnosis of ischemic bowel in patients with small bowel obstruction (SBO) is a clinical challenge. The aim of this study was to identify preoperative variables associated with ischemic bowel found at operative exploration. We performed a 5-year retrospective review of patients admitted to a university affiliated, county funded hospital who underwent exploratory laparoscopy or laparotomy for SBO. Patients were excluded if they had a known preoperative malignancy or hernia on physical examination. Multivariate logistic regression was used to determine factors independently associated with bowel ischemia or ischemic perforation. One hundred and sixteen patients underwent exploratory surgery for SBO. Mean age was 52 ± 14 years and most were male [64 (55.2%)]. Adhesions [92 (79.3%)] were the most common etiology of obstruction. Leukocytosis ( P = 0.304) and acidosis ( P = 0.151) were not significantly associated with ischemia or ischemic perforation. In addition, history of prior SBO ( P = 0.618), tachycardia ( P = 0.111), fever ( P = 0.859), and time from admission to operation ( P = 0.383) were not predictive of ischemic bowel. However, hyponatremia (≤134 mmol/L) and CT scan findings of wall thickening or a suspected closed loop were independently associated with bowel ischemia. Awareness of these predictors should heighten the concern for ischemic bowel in patients presenting with SBO.

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Diagnosis and Management of a Postpyloric Foreign Body Causing Small Bowel Obstruction in an Infant

Clinical Medicine Insights Case Reports ◽

10.1177/1179547617719249 ◽

2017 ◽

Vol 10 ◽

pp. 117954761771924

Author(s):

Victoria Bradford ◽

Marissa Vadi ◽

Harmony Carter

Keyword(s):

Foreign Body ◽

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Pediatric Population ◽

Exploratory Laparotomy ◽

Foreign Body Ingestion ◽

Common Occurrence ◽

Diagnosis And Management ◽

History Of

Foreign body ingestion is a common occurrence in the pediatric population and most ingestions resolve with little morbidity. Although radiopaque objects are easily identified on biplane radiographs, radiolucent objects may elude detection, delaying diagnosis. We report a case of a healthy 10-month-old infant who presented with a 5-day history of postprandial vomiting and imaging consistent with small bowel obstruction. On exploratory laparotomy, she was discovered to have a postpyloric foreign body requiring removal through an enterotomy.

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