215: Mucus hyperconcentration initiates bowel obstruction in the distal ileum of CF mice

Primary small bowel bezoars are rare and cause acute abdomen due to small bowel obstruction (SBO). A 69-year-old Japanese man presented with epigastric pain associated with fullness. Physical examination of the abdomen showed no marked signs of peritoneal irritation. An erect X-ray film of the abdomen showed small bowel obstruction. Computed tomography (CT) showed a dilated small bowel loop proximal to the site of the obstruction. Retrograde double balloon enteroscopy (DBE) was performed and showed yellow, hard bezoars blocking the distal ileum. At surgery, a bezoar was found impacted in the distal ileum, and enterotomy with extraction was performed. After 9 days, the patient was discharged from our hospital in satisfactory condition. DBE also appears to be a safe and useful diagnostic tool in patients with SBO, and the findings of DBE influence the strategy of therapy in patients in whom the cause of SBO could not be determined by conventional radiography.

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Free Intraperitoneal Gallstone: An Unusual Case of Small Bowel Obstruction from Extrinsic Compression

Case Reports in Surgery ◽

10.1155/2018/1341572 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Kor Woi Tiang ◽

Hang Fai So ◽

Yang Hwang ◽

Manjunath Siddaiah-Subramanya

Keyword(s):

Laparoscopic Cholecystectomy ◽

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Unusual Case ◽

Late Complications ◽

Distal Ileum ◽

Extrinsic Compression ◽

Laparoscopic Drainage ◽

Gallstone Spillage

Laparoscopic cholecystectomy (LC) is preferred in the treatment of symptomatic cholecystolithiasis. Gallstone spillage is not uncommon, and there have been reports of associated complications. We report a case of a free intraperitoneal gallstone, left inadvertently during LC, which developed an inflammatory phlegmon with abscess containing gallstone, causing extraluminal compression on the distal ileum, resulting in small bowel obstruction. This complication in particular is almost unheard of. The patient underwent laparoscopic drainage of abscess and retrieval of gallstone, which relieved the obstruction. Clinicians, therefore, need to keep an open mind in the workup for bowel obstruction. During LC, gallstone spillage should be prevented and retrieved whenever possible to minimize early and late complications associated with it.

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Intractable small-bowel obstruction due to urothelial cell carcinoma metastasis to the distal ileum: A rare cause of malignant bowel obstruction

Journal of Medical Sciences ◽

10.4103/jmedsci.jmedsci_32_19 ◽

2020 ◽

Vol 40 (1) ◽

pp. 30

Author(s):

Hsuan-Hwai Lin ◽

Yu-Chen Tseng ◽

Shing-Hwa Huang ◽

Liang-Wei Wen

Keyword(s):

Small Bowel ◽

Cell Carcinoma ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Urothelial Cell ◽

Distal Ileum ◽

Malignant Bowel Obstruction ◽

Urothelial Cell Carcinoma ◽

Carcinoma Metastasis

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249 Laparoscopic Assisted Enterolithotomy: A Viable Option in The Management of Gallstone Ileus

British Journal of Surgery ◽

10.1093/bjs/znab259.605 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

N Angamuthu ◽

S Alagaratnam ◽

R D'Souza ◽

M Varcada

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Gallstone Ileus ◽

Laparoscopic Approach ◽

Invasive Procedure ◽

Distal Ileum ◽

General Surgeon ◽

Bowel Loop ◽

Laparoscopic Assisted

Abstract Introduction Gallstone ileus (GSI) is a rare cause of small bowel obstruction in patients over the age of 65 years. We report a case of GSI treated successfully with a laparoscopic assisted enterolithotomy. Case report A 75-year-old female presented with two days of abdominal distension and vomiting with a non-peritonitic abdomen on examination. A computerised tomography scan demonstrated small bowel obstruction due to an obstructing stone in the distal ileum. Three port laparoscopy and small bowel assessment confirmed a solitary enterolith (4cms) in the distal ileum with upstream dilated loops. An infra-umbilical 6 cm midline incision was made and the localised bowel loop was delivered. An enterotomy was made proximal to the point of obstruction, stone retrieved, and a single layer interrupted closure was performed. Ten weeks post-operatively, patient had a virtual follow-up consultation and is doing well. Conclusions GSI often presents in elderly patients with multiple co-morbidities. A laparotomy with enterolithotomy is the initial treatment of choice with biliary intervention as a second operation, if needed, at a later date. Clearly, a conventional exploratory laparotomy in this cohort of patients carries a high risk and therefore the use of less morbid and less invasive procedure like laparoscopy should be considered. Although a total laparoscopic approach would require advanced laparoscopic skills particularly due to dilated bowel loops limiting the intra-abdominal space for suturing, a laparoscopic assisted approach as described above should be considered as a reasonable option within the remits of an emergency general surgeon.

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