scholarly journals Surgery due to mechanical bowel obstruction in relapsed ovarian cancer: clinical and surgical results of a bicentric analysis of 87 patients

2021 ◽  
Author(s):  
R. Armbrust ◽  
R. Chekerov ◽  
S. Sander ◽  
M. Biebl ◽  
S. Chopra ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Bowel Obstruction ◽  
Salvage Surgery ◽  
Intestinal Resection ◽  
Careful Consideration ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
En Bloc ◽  
Small Bowel Length ◽  
Mechanical Bowel Obstruction

Abstract Introduction Mechanical bowel obstruction is a frequent acute and life-threatening event in relapsed ovarian cancer. Salvage surgery after failure of all conservative approaches, resulting in short bowel syndrome (SBS) constitutes a therapeutic dilemma. Our aim was to evaluate patients’ surgical and clinical outcome in these highly palliative situations. Previous, limited, data reported a high morbidity and mortality. However, recent surgical and therapeutical improvements in relapsed ovarian cancer (ROC) offer better identification of patients who might benefit from surgery in an effort to extend the window of opportunity to subsequently offer these patients novel systemic therapeutic approaches. Material and methods All subsequent ROC patients between 2012 and 2017 with acute mechanical bowel obstruction who underwent salvage extraperitoneal en bloc intestinal resection were retrospectively identified. Data were collected from two ESGO certified Ovarian Cancer Centers of Excellence (Charité Berlin and Imperial College London) and systematically evaluated regarding surgical and clinical outcomes. Results Overall, 87 ROC patients were included in the analysis (median age 56 years, range 24–88), 47% were platinum resistant. High grade serous was the most common histology (76%) while most of the patients (67%) had at least two previous lines of treatment. Mean observed OS was 7.8 months. After salvage surgery, 46% of the patients had a residual small bowel length < 180 cm and 18% > 180 cm resulting in 41% in need of total parental nutrition. In 80% of the patients a permanent stoma was necessary. 30d morbidity and mortality was 74% and 10%, respectively. More than half of the patients were able to receive further courses of chemotherapy after surgery. Discussion Salvage surgery for bowel obstruction in ROC patients needs careful consideration and identification of optimal surgical candidates to have the maximal therapeutic benefit. Despite the challenging morbidity profile, most patients managed to proceed to subsequent novel and conventional systemic treatment and so have their window of therapeutic opportunity extended.

scholarly journals Postoperative adhesions after abdominal surgery in children: a pilot study in the Philippines

2019 ◽  
Vol 2 (2) ◽  
pp. e000049
Author(s):  
Jan Miguel C Deogracias ◽  
Josefina R Almonte
Keyword(s):  
Risk Factors ◽  
Bowel Obstruction ◽  
Pediatric Population ◽  
Significant Risk ◽  
Intestinal Resection ◽  
The Philippines ◽  
Morbidity And Mortality ◽  
Postoperative Adhesions ◽  
Stoma Creation ◽  
Mechanical Bowel Obstruction

BackgroundPostoperative adhesions (POAs) causing mechanical bowel obstruction is a challenging problem for children who underwent prior abdominal surgeries. Unlike in adults, the role of conservative management remains controversial and children tend to require re-operation. However, despite the longer lifetime risk inherent to the pediatric population, studies are still lacking to come up with guidelines on diagnosis and management. This study aimed to review the profiles and outcomes of patients who underwent surgery for POA and to identify significant risk factors.MethodsThis was a retrospective review of 172 patients admitted at the Philippine General Hospital from 2010 to 2018 with the diagnosis of POA. Patients who did not undergo surgery and patients who had a different cause of bowel obstruction with the adhesions being only incidental were excluded from the study.ResultsNinety-one patients were included in the study. The mean age at surgery was 92.32 months and the male:female ratio was 2.8:1. The most common primary diagnoses were appendicitis, intussusception, and abdominal trauma. POA occurred within the first postoperative year in 63%. The 30-day morbidity and mortality rates were 9.89% and 7.69%, respectively. The most common complications were fascial and anastomotic dehiscences, and sepsis was the most common cause of death. Stoma creation during the index operation, and the presence of bowel gangrene, intestinal resection, and stoma creation during the surgery for POA were statistically significant risk factors for morbidity and mortality.ConclusionThe findings in this study support the experience in literature that timely operative intervention can prevent bowel strangulation in cases of mechanical bowel obstruction from POA. However, more data and studies are recommended to arrive at an evidence-based guideline in the management of these children.

scholarly journals Laparoscopic Treatment of Gallstone Ileus

2014 ◽  
Vol 7 ◽  
pp. CCRep.S16512 ◽  
Author(s):  
Huseyin Y. Bircan ◽  
Bora Koc ◽  
Umit Ozcelik ◽  
Ozgur Kemik ◽  
Alp Demirag
Keyword(s):  
Intestinal Obstruction ◽  
Bowel Obstruction ◽  
Intestinal Tract ◽  
Rare Complication ◽  
Gallstone Ileus ◽  
High Morbidity ◽  
Enteric Fistula ◽  
Laparoscopic Treatment ◽  
Mechanical Bowel Obstruction ◽  
Biliary Enteric Fistula

Gallstone ileus is a rare complication of cholelithiasis that has high morbidity and mortality. An intestinal obstruction can be caused by migration of a large gallstone through a biliary enteric fistula or by impaction within the intestinal tract. In this study, we present the case of an 81-year-old woman with a mechanical bowel obstruction by a gallstone that was treated by laparoscopy.

En bloc resection in giant bilobed splenic artery aneurysm

2021 ◽  
Vol 14 (9) ◽  
pp. e244319
Author(s):  
Venu Bhargava Mulpuri ◽  
Jayanta Samanta ◽  
Pankaj Gupta ◽  
Vikas Gupta
Keyword(s):  
Early Detection ◽  
Splenic Artery ◽  
Artery Aneurysm ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Morbidity And Mortality ◽  
Splenic Artery Aneurysm ◽  
High Morbidity ◽  
En Bloc ◽  
Distal Pancreas

Giant splenic artery aneurysms are rare and associated with high morbidity and mortality. Early detection is the key to decreasing morbidity and mortality. We present a giant splenic artery aneurysm which was managed by en bloc resection of the spleen, distal pancreas.

scholarly journals En Bloc Pancreaticoduodenectomy for Locally Advanced Right Colon Cancers

2017 ◽  
Vol 2017 ◽  
pp. 1-5
Author(s):  
Cihan Ağalar ◽  
Aras Emre Canda ◽  
Tarkan Unek ◽  
Selman Sokmen
Keyword(s):  
Survival Time ◽  
Locally Advanced ◽  
Multivisceral Resection ◽  
Right Colectomy ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Right Colon ◽  
En Bloc ◽  
Term Survival ◽  
Colon Cancers

Locally advanced right colon cancer may invade adjacent tissue and organs. Direct invasion of the duodenum and pancreas necessitates an en bloc resection. Previously, this challenging procedure was associated with high morbidity and mortality; however, today, this procedure can be done more safely in experienced centers. The aim of this study is to report our experience on en bloc right colectomy with pancreaticoduodenectomy for locally advanced right colon cancers. Between 2000 and 2012, 5 patients underwent en bloc multivisceral resection. No major morbidities or perioperative mortalities were observed. Median disease-free survival time was 24.5 months and median overall survival time was 42.1 (range: 4.5–70.4) months in our series. One patient lived 70 months after multivisceral resection and underwent cytoreductive surgery and total pelvic exenteration during the follow-up period. In locally advanced right colon tumors, all adhesions should be considered as malign invasion and separation should not be done. The reasonable option for this patient is to perform en bloc pancreaticoduodenectomy and right colectomy. This procedure may result in long-term survival with acceptable morbidity and mortality rates. Multidisciplinary teamwork and multimodality treatment alternatives may improve the results.

Factors Associated with Morbidity and Mortality in Patients with Mechanical Bowel Obstruction

2012 ◽  
Vol 11 (1) ◽  
pp. 1-5
Author(s):  
Nurkal Halis ◽  
Ozgur Sogut ◽  
Cahfer Guloglu ◽  
Abdullah Ozgonul ◽  
Mehmet Tahir Gokdemir ◽  
...  
Keyword(s):  
Bowel Obstruction ◽  
Morbidity And Mortality ◽  
Factors Associated ◽  
Mechanical Bowel Obstruction

Malignant Large Bowel Obstruction

2021 ◽  
Vol 34 (04) ◽  
pp. 251-261
Author(s):  
Roberta L. Muldoon
Keyword(s):  
Bowel Obstruction ◽  
Large Bowel ◽  
Treatment Plan ◽  
Treatment Options ◽  
Large Bowel Obstruction ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Comprehensive Knowledge ◽  
Clinical Scenarios ◽  
Diagnostic Modalities

AbstractLarge bowel obstruction is a serious and potentially life-threatening surgical emergency which is associated with high morbidity and mortality rate. The most common etiology is colorectal cancer which accounts for over 60% of all large bowel obstructions. Proper assessment, thoughtful decision-making and prompt treatment is necessary to decrease the high morbidity and mortality which is associated with this entity. Knowledge of the key elements regarding the presentation of a patient with a large bowel obstruction will help the surgeon in formulating an appropriate treatment plan for the patient. Comprehensive knowledge and understanding of the various treatment options available is necessary when caring for these patients. This chapter will review the presentation of patients with malignant large bowel obstruction, discuss the various diagnostic modalities available, as well as discuss treatment options and the various clinical scenarios in which they are most appropriately utilized.

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