scholarly journals Primary Segmental Small Bowel Volvulus in an Adolescent Female

2021 ◽  
Vol 09 (01) ◽  
pp. e76-e79
Author(s):  
Friederike Heidtmann ◽  
Felicitas Eckoldt ◽  
Hans-Joachim Mentzel ◽  
Ilmi Alhussami
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Bowel Obstruction ◽  
Clinical Presentation ◽  
Emergency Laparotomy ◽  
Small Bowel Volvulus ◽  
Delay In Diagnosis ◽  
Bowel Segment ◽  
Necrotic Bowel ◽  
Underlying Pathology

AbstractSmall bowel volvulus is a rare but important cause of abdominal pain and small bowel obstruction in children and adults. In the neonate, small bowel volvulus is a well-known complication of malrotation. Segmental small bowel volvulus is a lesser-known condition, which occurs in children and adults alike and can rapidly progress to bowel ischemia. Primary segmental small bowel volvulus occurs in the absence of rotational anomalies or other intraabdominal lesions and is rare in Europe and North America. Clinical presentation can be misleading, causing a delay in diagnosis and treatment, in which case the resection of necrotic bowel may become necessary.We report on a 14-year-old girl who presented with severe colicky abdominal pain but showed no other signs of peritoneal irritation or bowel obstruction. An emergency magnetic resonance imaging was highly suspicious for small bowel volvulus. Emergency laparotomy revealed a 115 cm segment of strangulated distal ileum with no underlying pathology. We performed a detorsion of the affected bowel segment. Despite the initial markedly ischemic appearance of the affected bowel segment, the patient achieved full recovery without resection of bowel becoming necessary.

Volvulus of the Small Bowel in Adults

2009 ◽  
Vol 75 (12) ◽  
pp. 1179-1182 ◽  
Author(s):  
Jaime Ruiz-Tovar ◽  
Vicente Morales ◽  
Alfonso Sanjuanbenito ◽  
Eduardo Lobo ◽  
Enrique Martinez-Molina
Keyword(s):  
Diabetes Mellitus ◽  
Abdominal Pain ◽  
Small Bowel ◽  
Ct Scan ◽  
Bowel Obstruction ◽  
Surgical Complications ◽  
Diagnostic Method ◽  
Small Bowel Volvulus ◽  
Previous Abdominal Surgery ◽  
Patients With Diabetes

The volvulus of the small bowel is a surgical emergency, causing small bowel obstruction. We performed a retrospective study of all the patients diagnosed and treated with small bowel volvulus between 1977 and 2007 at our institution. One hundred twenty-nine patients were analyzed. Thirty-nine patients presented primary volvulus and 90 secondary ones. The most frequent symptom was sudden abdominal pain. CT scan was the best diagnostic method with an accuracy of 83 per cent. Necrotic small bowel loops appeared in 46.5 per cent of the patients. Eighteen patients had postoperative complications (14%). Mortality rate was 9.3 per cent. A higher mortality is observed among patients with previous abdominal surgeries and cardiopathies. Necrotic loops are associated with higher mortality and incidence of surgical complications; patients with diabetes are associated with a higher incidence of necrotic loops. Cardiopathies are associated with more frequent medical and surgical complications. Recurrence rate was 3.9 per cent associated with simple devolvulation. Primary volvulus are more frequent among males and patients with diabetes. Jejunal location is associated with primary volvulus and these correlate with a higher incidence of necrotic loops. Primary volvulus presents a higher incidence of surgical complications. A bowel obstruction with sudden abdominal pain must be suspicious of small bowel volvulus. The main aim is to achieve an early diagnosis to prevent a necrotic small bowel. CT scan is the imaging test with the best diagnostic accuracy. Primary volvulus, the presence of necrotic loops, and patients with cardiopathies, diabetes mellitus, and with previous abdominal surgery are associated with a worse outcome.

scholarly journals Presentation of Small Bowel Volvulus in East Africa

2021 ◽  
pp. 251-256
Author(s):  
Richard Wismayer
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Surgical Intervention ◽  
Age Groups ◽  
Postoperative Recovery ◽  
Western World ◽  
Small Bowel Volvulus ◽  
Early Surgical Intervention

Introduction: A benign gastrointestinal surgical condition involving torsion of part or all of a segment of small bowel on its mesenteric axis is small bowel volvulus (SBV). The clinical presentation is similar to acute mesenteric ischaemia and hence a preoperative clinical diagnosis is difficult to obtain. In developing countries, as a presenting surgical cause of small bowel obstruction it has contributed to a significant burden. The aim of this case report was to discuss a typical case of small bowel volvulus in a developing country and highlight the importance of resuscitation and early surgical intervention. Presentation of case: A 35 year old lady admitted to hospital with a 3 day history of colicky central abdominal pain. She reported a long period of fasting and sudden ingestion of food. On physical examination her abdomen was moderately distended with minimal tenderness. Laboratory investigations were normal and a plain abdominal X-ray revealed features suggestive of small bowel obstruction. After resuscitation the patient was taken for a laparotomy where evidence of SBV was found. An omental band adhesion was divided, the volvulus untwisted and the small bowel was all viable. The patient made an uneventful postoperative recovery. Discussion: The incidence of SBV is higher in Africa, Asia and the Middle East compared to the Western world. Secondary SBV is more commonly found in older age groups however primary SBV is more common in children. The most common complaints of SBV includes abdominal pain, abdominal distention and vomiting. The mortality rate due to SBV has been found to be decreasing with early diagnosis due to abdominal CT scanning. This reduction in mortality is due to a reduction in the incidence of gangrene of the SBV. Conclusions: Due to the high mortality and variable presentation, surgeons must consider small bowel volvulus a probably diagnosis in a patient with abdominal pain and features of small bowel obstruction. Early surgical intervention is necessary to reduce the morbidity and mortality from SBV.

scholarly journals Small bowel obstruction and strangulation secondary to an adhesive internal hernia post ESWL for right ureteral calculi: a case report and review of literature

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Elaine N. Gitonga ◽  
Haitao Shen
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Internal Hernia ◽  
Ureteral Calculi ◽  
Emergency Laparotomy ◽  
Extracorporeal Shock Wave ◽  
Relative Safety

Abstract Background Extracorporeal shock wave lithotripsy (ESWL) is a relatively safe and convenient mode of treatment for ureteral and renal stones, despite its relative safety; ESWL is not without its complications. We present a case of a patient we managed for small bowel obstruction and strangulation due to an adhesive internal hernia after ESWL was done because of right ureteral calculi. Case presentation We report a case of a 59-year-old patient who presented with severe abdominal pain a few hours after ESWL because of a right upper ureteric calculus. The abdominal pain increased in severity in time and became more generalized. The patient had one episode of gross hematochezia as she was being prepped for emergency laparotomy. Intra-op, she had a strangulated internal hernia because of an omental-mesenteric adhesion. Conclusion This case report hopes to highlight the potential of complications like acquired IH due to adhesions in patients with a history of ureteral calculi, and also the complications that may come about post-ESWL. Patients who present with signs of persistent abdominal pain post-ESWL should be vigilantly observed. If symptoms persist, increase in intensity or there is a general deterioration of the patients’ hemodynamic status, even in light of negative MDCT findings, prompt surgical intervention is crucial for definitive diagnosis as well as management.

An Uncommon An Uncommon Cause of Acute Abdomen in Underprivileged Communities

2019 ◽  
Vol 8 (2) ◽  
Author(s):  
David Muchuweti ◽  
Hopewell Mungani ◽  
Hopewell Mungani ◽  
Farai Mahomva ◽  
Edwin Gamba Muguti ◽  
...  
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Acute Abdomen ◽  
Bowel Obstruction ◽  
Bowel Wall ◽  
Haemodynamic Instability ◽  
Small Bowel Volvulus ◽  
General Surgeons ◽  
Heavy Infestation ◽  
Emergency Abdominal Surgery

Oftentimes general surgeons working in poorly resourced communities carry out emergency abdominal surgery in patients with acute abdomen with no definitive preoperative diagnosis. The definitive diagnosis is made at laparotomy. Perforated small bowel obstruction secondary to heavy Infestation with Ascaris Lumbricoides brings a number of intraoperative challenges requiring correct intraoperative surgical management decisions. We present a case of a 17 year-old patient who was admitted with a diagnosis of small bowel obstruction who at laparotomy was found to have perforated gangrenous small bowel volvulus with heavy worm load visible through the bowel wall. Because of faecal peritoneal contamination and haemodynamic instability she underwent a two staged procedure with good outcome.

B-Lymphoblastic Lymphoma of the Small Bowel: An Extremely Rare Occurrence

2021 ◽  
pp. 000313482199867
Author(s):  
Nikolaos G Symeonidis ◽  
Kalliopi E Stavrati ◽  
Efstathios T Pavlidis ◽  
Kyriakos K Psarras ◽  
Eirini Martzivanou ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Soft Tissues ◽  
Lymphoblastic Lymphoma ◽  
Emergency Laparotomy ◽  
Rare Occurrence ◽  
Small Bowel Tumor ◽  
Gastrointestinal Lesions ◽  
Immature B Cells ◽  
B Lymphoblastic Lymphoma

B-lymphoblastic lymphoma is a neoplasm of immature B cells and is characterized by aggressive behavior and disease progression. Common sites of involvement are skin, lymph nodes, bone, soft tissues, breast, and the mediastinum. Gastrointestinal lesions are rarely encountered and therefore not fully described. We herein report the case of a 28-year-old male, who presented with abdominal pain and CT scan showed a tumor involving the small bowel and its mesentery. He underwent emergency laparotomy and enterectomy. Histopathology report revealed B-lymphoblastic lymphoma affecting the small bowel and the adjacent mesentery. This is the first documented case of a small bowel tumor diagnosed as B-lymphoblastic lymphoma in published literature.

scholarly journals Superior Mesenteric Venous Thrombosis after Laparoscopic Exploration for Small Bowel Obstruction

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Hideki Katagiri ◽  
Shozo Kunizaki ◽  
Mayu Shimaguchi ◽  
Yasuo Yoshinaga ◽  
Yukihiro Kanda ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Abdominal Surgery ◽  
Venous Thrombosis ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Anticoagulation Therapy ◽  
Mesenteric Venous Thrombosis ◽  
Laparoscopic Exploration ◽  
Abdominal Symptoms

Mesenteric venous thrombosis is a rare cause of intestinal ischemia which is potentially life-threatening because it can lead to intestinal infarction. Mesenteric venous thrombosis rarely develops after abdominal surgery and is usually associated with coagulation disorders. Associated symptoms are generally subtle or nonspecific, often resulting in delayed diagnosis. A 68-year-old woman underwent laparoscopic exploration for small bowel obstruction, secondary to adhesions. During the procedure, an intestinal perforation was identified and repaired. Postoperatively, the abdominal pain persisted and repeat exploration was undertaken. At repeat exploration, a perforation was identified in the small bowel with a surrounding abscess. After the second operation, the abdominal pain improved but anorexia persisted. Contrast enhanced abdominal computed tomography was performed which revealed superior mesenteric venous thrombosis. Anticoagulation therapy with heparin was started immediately and the thrombus resolved over the next 6 days. Although rare, this complication must be considered in patients after abdominal surgery with unexplained abdominal symptoms.

scholarly journals Small bowel volvulus versus adhesive small bowel obstruction: a diagnostic dilemma in a 19-year-old woman

2019 ◽  
Vol 12 (6) ◽  
pp. e229157
Author(s):  
Kay Tai Choy ◽  
Nathan Brunott
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Adhesive Small Bowel Obstruction ◽  
Diagnostic Study ◽  
Diagnostic Dilemma ◽  
Small Bowel Volvulus ◽  
Intraabdominal Adhesions ◽  
Preoperative Diagnostic ◽  
History Of

Small bowel volvulus (SBV) is often challenging to diagnose. Research suggests that the clinical presentation of this disease is often very similar to other more common causes of small bowel obstruction (SBO) such as intraabdominal adhesions and no single preoperative diagnostic study is sensitive or specific enough to identify this rare cause of mechanical SBO. This report describes a case of a 19-year-old woman who presented with irretractable vomiting and abdominal pain secondary to SBV. This case is unusual as her history of recurrent adhesive SBO presented a diagnostic dilemma that required a higher degree of clinical suspicion to tease these differential diagnoses apart. She underwent laparoscopy which facilitated successful detorsion and resection of the floppy tongue of jejunum. This report aims to increase the awareness among surgeons.

Diaphragm disease in emergency surgery

2020 ◽  
Vol 81 (3) ◽  
pp. 1-6
Author(s):  
Diwakar R Sarma ◽  
Pratik Bhattacharya
Keyword(s):  
Risk Factors ◽  
Small Intestine ◽  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Emergency Laparotomy ◽  
Diaphragm Disease ◽  
Inflammatory Drugs ◽  
Acute Small Bowel Obstruction ◽  
Anti Inflammatory

Background/Aims Diaphragm disease of the small bowel has been described in the literature over the last three decades. The pathognomonic characteristic of multiple circumferential stenosis is noted on gross examination of the bowel. It is a severe form of non-steroidal anti-inflammatory drug-induced enteropathy, often presenting as acute small bowel obstruction. A systematic review was performed to identify risk factors and patient outcomes in histologically-proven diaphragm disease of the small intestine in patients undergoing emergency operation for small bowel obstruction. Methods A comprehensive search was performed between January 1975 and March 2019 using relevant MeSH terms. Studies were chosen based on predefined inclusion criteria. Diaphragm disease of the small intestine was defined as macroscopically detected thin diaphragm-like mucosal folding inside the lumen of the bowel. The parameters assessed included patient characteristics, duration of use of non-steroidal anti-inflammatory drugs, type of emergency surgery performed, complications, recurrence, presentation and diagnosis of diaphragm disease. Results A total of 21 studies were analysed which included 17 case reports, one case series, and three retrospective comparative studies. Overall 29 patients with diaphragm disease of the small bowel were reported following emergency laparotomy for small bowel obstruction. Use of non-steroidal anti-inflammatory drugs was noted in all cases with an average duration of 3–5 years. All patients presented acutely with features of small bowel obstruction and had emergency laparotomy, except one who underwent laparoscopic resection. In the comparative studies patients were more likely to be female and to have been taking non-steroidal anti-inflammatory drugs for more than 7 years. Conclusions This is a rare disease, difficult to diagnose and often confirmed by the intra-operative macroscopic appearance of circumferential stenosis of the bowel. Risk factors for developing small bowel diaphragm disease include long-term use of non-steroidal anti-inflammatory drugs, and female gender. Patients with this disease are at increased risk of developing acute small bowel obstruction, so early identification is important.

scholarly journals Incarcerated Lumbar Hernia Complicated by Retroperitoneal Pseudoaneurysm 50 Years after Resection and Radiation Therapy of a Sarcoma

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Oluwatobi Onafowokan ◽  
Dabanjan Bandyopadhyay ◽  
Dale Johnson ◽  
Hugo J. R. Bonatti
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Ct Scan ◽  
Late Complication ◽  
Abdominal Hernia ◽  
Emergency Laparotomy ◽  
Incisional Hernias ◽  
History Of ◽  
The Right

Background. Lumbar hernias are rare abdominal hernias. Surgery is the only treatment option but remains challenging. Posterior incisional hernias are even rarer especially with incarceration of intra-abdominal contents.Case Presentation. A 68-year old female presented with a 3-day history of worsening acute abdominal pain and distension, with multiple episodes of emesis. A CT scan indicated a large incarcerated posterolateral abdominal hernia. The patient had a history of resection of a sarcoma on her back as a child and also received chemotherapy and radiation. During emergency laparoscopy, a hemorrhagic small bowel segment incarcerated in the hernia was reduced and resected, and the distended small bowel was decompressed. An elective hernia repair was scheduled. After temporary clinical improvement, the patient again developed abdominal pain, distention, and emesis. During emergency laparotomy, a large hematoma in the right flank was found and partially evacuated. The right colon was mobilized out of the hernia and the duodenum was kocherized. A20×20cm BIO-A mesh was placed on top of the Gerota fascia and cranially tucked under liver segment VI. Anteriorly, the mesh was fixated with absorbable tacks. The duodenum and colon were placed into the mesh pocket. A postoperative CT scan identified a 2 cm pseudoaneurysm of a side branch of a lumbar artery, and the bleeding source was embolized. The postoperative course was complicated byClostridium difficile-associated colitis, but ultimately, the patient recovered fully. At 6-month follow-up, there was no evidence for a recurrent hernia.Discussion. There is a paucity of literature concerning lumbar incisional hernias. Repair with bioabsorbable mesh seems feasible, but longer follow-up is necessary as the mesh was placed in an unusual fashion due to the retroperitoneal hematoma. The exact cause of the hemorrhage is unclear and may have been caused during the initial incarceration, during surgery, or may be a late complication of her previous radiation.

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