scholarly journals Ileosigmoid Knot—Unveiling the Diagnostic Dilemma with Radiologic Signs: A Case Report

2019 ◽  
Vol 02 (01) ◽  
pp. 053-057
Author(s):  
Poonam Hegde ◽  
Rupa Ananthasivan ◽  
Sudarshan Rawat ◽  
Pooja G. Patil ◽  
Bhavana Girishekar ◽  
...  
Keyword(s):  
Sigmoid Colon ◽  
Large Bowel ◽  
Closed Loop ◽  
Hypovolemic Shock ◽  
Bowel Loop ◽  
Emergency Laparotomy ◽  
Rapid Progression ◽  
Diagnostic Dilemma ◽  
Ileosigmoid Knot ◽  
The Right

AbstractIleosigmoid knot (ISK) is an unusual and serious condition that is known to pose a diagnostic dilemma due to overlapping features of acute closed-loop intestinal obstruction. Early diagnosis and intervention are of immense importance in this condition because they can prove life threatening with rapid progression to gangrene of both the ileum and sigmoid colon. We report a case of a 27-year-old man who presented 2 days post-appendicectomy procedure with acute abdominal pain, abdominal distention, and hypovolemic shock. Initial evaluation with ultrasonography (USG) and abdominal X-ray was performed, which revealed pleural effusion, ascites, and an ahaustral dilated large bowel loop in the right upper abdomen with convergence in the left lower abdomen. Further imaging with computed tomography revealed closed-loop obstruction of the sigmoid colon with beaked appearance of its afferent and efferent limbs in the pelvis. There was associated whirling or knotting of the ileum around the sigmoid pedicle along with features of mesenteric ischemia. Emergency laparotomy was performed, which revealed ISK with gangrene of the ileal and large bowel loops.

scholarly journals A rare case of a closed loop obstruction due to epiploic appendage of the sigmoid colon

2020 ◽  
Vol 2020 (3) ◽  
Author(s):  
Rathin Gosavi ◽  
Ee Ban
Keyword(s):  
Small Bowel ◽  
Sigmoid Colon ◽  
Rare Case ◽  
Closed Loop ◽  
Primary Anastomosis ◽  
Uterine Cancer ◽  
Small Bowel Resection ◽  
Uneventful Recovery ◽  
Ischemic Bowel ◽  
The Right

Abstract An internal hernia is a protrusion of viscera through a congenital or acquired defect in the mesentery of peritoneum. They account for <0.9% of all small bowel obstructions [1] and ~4% of obstructions due to hernias [2]. We present a rare case of closed loop obstruction secondary to a band adhesion traversing the lower abdomen from a sigmoid colon appendage epiploicae to the right pelvic wall. A 82-year-old woman presented to the emergency department with nausea, vomiting and worsening right sided abdominal pain for 24 h, on the background of previous pelvic radiation and hysterectomy for uterine cancer. She was subsequently found to have a closed loop obstruction with 30 cm of ischemic bowel strangulated by a band adhesion from a sigmoid colon appendage epiploicae to the right abdominal wall. The patient underwent a successful small bowel resection with primary anastomosis and made an uneventful recovery.

scholarly journals Ileosigmoid Knot at Week 13 of Pregnancy: Report of a Case

2014 ◽  
Vol 99 (3) ◽  
pp. 230-234 ◽  
Author(s):  
Riha Shimizu ◽  
Yoshinori Hoshino ◽  
Haruko Irie ◽  
Homare Ito ◽  
Toshiaki Terauchi ◽  
...  
Keyword(s):  
Sigmoid Colon ◽  
Preoperative Diagnosis ◽  
Primary Anastomosis ◽  
Rapid Progression ◽  
Optimal Management ◽  
Ileal Loop ◽  
Ileosigmoid Knot ◽  
Bowel Gangrene ◽  
Prompt Diagnosis ◽  
Gangrenous Bowel

Abstract The ileosigmoid knot (ISK) is a rare cause of intestinal obstruction. ISK is a condition in which the ileum wraps around the base of the sigmoid colon and forms a knot, leading to high mortality with rapid progression to bowel gangrene. We herein report a rare case of ISK at week 13 of pregnancy. The ISK was diagnosed by computed tomography, and the patient underwent emergency surgery for acute abdomen. Laparotomy showed segmental gangrenous change in the sigmoid colon, which was twisted around the distal ileal loop. The gangrenous bowel was resected, and primary anastomosis was performed. To our knowledge, the present case involves the first and earliest pregnancy in which a preoperative diagnosis of ISK was made and successful treatment was performed with surgery. A radiologic approach should be undertaken for prompt diagnosis and optimal management, even in early pregnancy.

Survival case of acute and severe respiratory distress due to spontaneous tension gastrothorax

2020 ◽  
Vol 13 (9) ◽  
pp. e235281
Author(s):  
Sanjan Asanaru Kunju ◽  
Prithvishree Ravindra ◽  
Ramya Kumar Madabushi Vijay ◽  
Priya Pattath Sankaran
Keyword(s):  
Tension Pneumothorax ◽  
Emergency Laparotomy ◽  
Severe Respiratory Distress ◽  
Mediastinal Shift ◽  
Breath Sounds ◽  
Chest X Ray ◽  
The Right ◽  
Tension Gastrothorax ◽  
Obstructive Shock ◽  
Survival Case

A 20-year-old woman presented with abdominal pain and shortness of breath. She was in obstructive shock with absent breath sounds on the left haemithorax. Chest X-ray showed a large radiolucent shadow with absent lung markings and mediastinal shift to the right side with concerns for tension pneumothorax. Though tube thoracostomy was done on the left side of the chest, column movement was absent. To confirm the diagnosis CT with contrast was done that revealed a huge left side diaphragmatic defect with abdominal contents in the thorax and mediastinal structures are shifted to left. She underwent emergency laparotomy and postoperative period was uneventful.

scholarly journals A very persistent chicken bone: two separate perforations from the same foreign object 2 months apart

2019 ◽  
Vol 12 (5) ◽  
pp. e228050
Author(s):  
Andrew James Brown ◽  
Thomas Whitehead-Clarke ◽  
Vera Tudyka
Keyword(s):  
Small Bowel ◽  
Bowel Perforation ◽  
Linear Structure ◽  
Small Bowel Resection ◽  
Emergency Laparotomy ◽  
Small Bowel Perforation ◽  
Chicken Bone ◽  
Abdomen Ct ◽  
Distal Migration ◽  
The Right

A 56-year-old man presented acutely with abdominal pain and raised inflammatory markers. Initial CT images demonstrated acute inflammation in the right upper quadrant surrounding a high-density linear structure. The appearance was of a chicken bone causing a contained small bowel perforation. This was managed conservatively with intravenous antibiotics and the patient was discharged 10 days later. The same patient returned to the hospital 2 months later, once again with an acute abdomen. CT imaging on this occasion showed distal migration of the chicken bone as well as free gas and fluid indicative of a new small bowel perforation. The patient underwent an emergency laparotomy, washout and small bowel resection. No foreign body was found at laparotomy or in the histopathology specimen. The postoperative course was complicated by an anastomotic leak. A further CT on that admission demonstrated that the chicken bone had migrated to the rectum!

scholarly journals Endoscopic Observation of the Growth Process of a Right-Side Sessile Serrated Adenoma/Polyp with Cytological Dysplasia to an Invasive Submucosal Adenocarcinoma

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Kaoru Omori ◽  
Kanako Yoshida ◽  
Sadafumi Tamiya ◽  
Tsutomu Daa ◽  
Masahiro Kan
Keyword(s):  
Narrow Band Imaging ◽  
Rapid Progression ◽  
Imaging Features ◽  
Sessile Serrated Adenoma ◽  
Serrated Adenoma ◽  
Small Nodule ◽  
Circular Pattern ◽  
Endoscopic Observation ◽  
Submucosal Adenocarcinoma ◽  
The Right

A sessile serrated adenoma/polyp (SSA/P) with cytological dysplasia in the right colon, which transformed to an invasive submucosal adenocarcinoma finally, was endoscopically observed in a 76-year-old woman. A whitish soft SSA/P (approximately 25 mm in diameter) was detected in the cecum. Biopsy samples were obtained from the small nodule, and the lesion was eventually diagnosed as an SSA/P with cytological dysplasia, considering endoscopic observations, among which the narrow-band imaging features suggested that the lesion was adenomatous, that is, a round-oval pattern, and hyperplastic, that is, comprising a circular pattern with dots and an invisible capillary vessel. After 11 months, an SSA/P had rapidly developed into a submucosal adenocarcinoma with lymphatic infiltrations, and the most aggressive deep invasion was observed in the central depression. This case suggests that right-side SSA/Ps with cytological dysplasia should be removed immediately, considering the potential for rapid progression to a larger size and eventually to deep and extensive cancer.

SP9.1.5 Compliance with the NELA pathway at a District General Hospital. Reducing time to theatre by limiting CT-associated delay - A prospective closed loop audit

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Shahrukh Ahmad ◽  
Nazhatul Hasbullah ◽  
Siddhartha Handa ◽  
Panna Patel
Keyword(s):  
Patient Outcomes ◽  
Closed Loop ◽  
Ct Scanning ◽  
District General Hospital ◽  
Electronic Records ◽  
Emergency Laparotomy ◽  
Out Of Hours ◽  
Included Patient ◽  
Ct Protocol ◽  
Reduced Time

Abstract Aim NELA recommends rapid request, conduct and reporting of CT to reduce the delay in time to theatre and thus ultimately improving patient outcomes. Our aim was to identify and reduce delays with regards to CT scanning and reporting. Methods Our Local Laparotomy Pathway standard recommends that CT scans be performed within one hour of being requested and reported within one hour of being performed. NELA data and electronic records were reviewed over a 3 month period (January 2020 to March 2020) - revealing that only 59% of pre-laparotomy CTs done (n = 17) complied with this standard. A dedicated “CT Emergency Laparotomy” protocol was introduced, which assigned the scan as top priority for both radiographers and radiologists. After making this change, data was prospectively collected to see if there was reduced time from CT request to report. Results Compliance with the pathway standard for the three month period from October 2020 to January 2021 increased to 81% (n = 21). Reasons for non-compliance included patient instability, awaiting renal profile; and COVID-related deep cleaning between patients. Out of hours, CT reporting was outsourced, which led to even quicker reporting – with multiple scans being both performed and reported within one hour of the request. Of the 16 patients that fit the criteria for urgent laparotomy, 87.5% (14 patients) were operated on within 6 hours of initial intention to operate. Conclusion Our re-audit showed that after the introduction of a dedicated laparotomy CT protocol, there was reduced time to CT report and ultimately reduced delay to Laparotomy.

A closed loop audit of the consenting process for elective large bowel resections against royal college of surgeons (RCS) guidance

2018 ◽  
Vol 55 ◽  
pp. S40
Author(s):  
S. Lawday ◽  
S. Scotcher ◽  
S. Murdock ◽  
A. Westwood ◽  
S. Narang
Keyword(s):  
Royal College ◽  
Large Bowel ◽  
Closed Loop

scholarly journals Complete sigmoid colon erosion by an intrauterine contraception device in an ectopic pregnancy: a case report

2021 ◽  
Vol 13 (3) ◽  
pp. 283
Author(s):  
Chuah Jun Sen ◽  
Nur Hayati Abd Samad ◽  
Tan Jih Huei ◽  
Lee Ee Peng
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Family Planning ◽  
Ectopic Pregnancy ◽  
Sigmoid Colon ◽  
Bowel Perforation ◽  
Abdominal Radiograph ◽  
Emergency Laparotomy ◽  
Contraceptive Device ◽  
Primary Health

ABSTRACT INTRODUCTIONAn intrauterine contraceptive device (IUCD) is a common contraception method used for family planning. IUCD erosion into adjacent organs is a rare but serious complication of IUCD use. CASE PRESENTATIONA 41-year-old female presented to us with a leaking left ectopic pregnancy. Emergency laparotomy and left salpingectomy were performed. A copper ICUD was found intraperitoneally and part of it had completely eroded into the sigmoid colon. Sigmoid colotomy was performed and the IUCD was removed successfully. Further history revealed that the patient had her IUCD inserted 12 years previously but was forgotten. The patient was discharged well after 4 days of admission. DISCUSSIONErosion of an IUCD into the colon is uncommon and may be asymptomatic or present with bowel perforation and obstruction. There should be a high index of suspicion for pregnancy occurring among women post-IUCD insertion. A misplaced IUCD can cause chronic inflammation of the fallopian tube, which may alter tubal functionality and increase the risk of ectopic pregnancy. Family planning is commonly done in primary health care. Primary care education and counselling are essential to improve awareness of fertile women to prevent similar complications. Periodic examination of IUCD string either by users or primary health-care practitioners is crucial. Ultrasound can be advocated if there are difficulties with the insertion. An abdominal radiograph is useful and should be performed in the case of missing IUCDs.

scholarly journals Acute presentation of ruptured ovarian cyst secondary to torsion with ipsislateral concomitant ectopic pregnancy: A case report

2014 ◽  
Vol 3 (2) ◽  
pp. 54-56
Author(s):  
Mahendra R Pandey ◽  
Neeva Ojha
Keyword(s):  
Acute Abdomen ◽  
Ovarian Cyst ◽  
Emergency Laparotomy ◽  
Hospital Emergency ◽  
Obstetrics And Gynaecology ◽  
History Of ◽  
Gestational Sac ◽  
One Year ◽  
The Right ◽  
Urine Pregnancy Test

Twenty-one year unmarried regularly menstruating lady without history of amenorrhea presented with acute abdomen in TU Teaching Hospital –Emergency Department. On evaluation urine pregnancy test was positive. Urgent ultrasound revealed multiloculated cystic lesion measuring 8.5 x 8 x 6.7 cms in the right adnexa anterolateral to the uterus with no intrauterine gestational sac. She underwent emergency laparotomy with right salpingo-oophorectomy. On laparotomy there was twisted and ruptured right ovarian cyst with unruptured ampullary pregnancy on the same side. There was coexistence of these two conditions which presented as acute abdomen. DOI: http://dx.doi.org/10.3126/njog.v3i2.10834 Nepal Journal of Obstetrics and Gynaecology Vol.3(2) 2008; 54-56

scholarly journals Huge Ovarian Cyst- A Case Report

2020 ◽  
Vol 2 (2) ◽  
pp. 87-90
Author(s):  
Sunita Maharjan ◽  
Ganesh Dangal ◽  
Aruna Karki ◽  
Hema Pradhan ◽  
Ranjana Shrestha ◽  
...  
Keyword(s):  
Ovarian Cyst ◽  
Ovarian Tissue ◽  
Delayed Diagnosis ◽  
Lower Abdominal Pain ◽  
Exploratory Laparotomy ◽  
Sudden Onset ◽  
Ultrasound Finding ◽  
Emergency Laparotomy ◽  
Diagnosis And Management ◽  
The Right

Ovarian cyst torsion (also termed as adnexal torsion) refers to partial or complete rotation of the ovary and a portion of fallopian tube along with its supply to vascular pedicle. It occurs commonly in females of all age group, more on the right side (60%) and often with acute lower abdominal pain lasting for few hours up to 24 hours. Ovarian cyst torsion is one of the devastating conditions hampering blood supply of ovary which may lead to total necrosis of ovarian tissue like in our case. Delayed diagnosis and management can lead to various complications. Here, we present a case of 46 years old perimenopausal female, para 2, living 2 who presented to our emergency department with complain of sudden onset severe pain abdomen since morning. Emergency exploratory laparotomy was done due to high clinical suspicion of torsion based on previous ultrasound finding of ovarian cyst done a day prior to the presentation. On intraoperative finding, the cyst was already necrosed. Due to timely diagnosis and management by emergency laparotomy, anticipated complications were reduced.    

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