scholarly journals Small bowel obstruction secondary to obturator hernia in an elderly female

2020 ◽  
Vol 2020 (10) ◽  
Author(s):  
Aneela Devarakonda ◽  
Aarav Gupta-Kaistha ◽  
Nikhil Kulkarni
Keyword(s):  
Bowel Obstruction ◽  
Surgical Intervention ◽  
Delayed Diagnosis ◽  
Obturator Hernia ◽  
Computed Tomography Imaging ◽  
Rare Type ◽  
Midline Laparotomy ◽  
Mortality And Morbidity ◽  
Tomography Imaging ◽  
High Index Of Suspicion

Abstract Obturator hernia is an extremely rare type of pelvic hernia with relatively high mortality and morbidity due to delayed diagnosis. Most cases present with acute intestinal obstruction and typically affect elderly, emaciated females. A high index of suspicion is required for early diagnosis and timely surgical intervention. We present a rare case of an 81-year-old female who was initially discharged from the emergency department due to nonspecific symptoms. She represented with clinical features of bowel obstruction and was diagnosed preoperatively with computed tomography imaging identifying a left-sided obturator hernia with a loop of bowel extending through the obturator canal. She was taken to theater for lower midline laparotomy and repair of obturator hernia. Although many cases are identified intraoperatively, we will discuss preoperative means of diagnosis of obturator hernia from examination findings to imaging diagnosis.

scholarly journals Bowel obstruction in obturator hernia: a challenging diagnosis

2021 ◽  
Vol 8 (7) ◽  
pp. 2212
Author(s):  
Nimisha Ramachandran Chemmangattuvalappil ◽  
Babu John Pulluvelil ◽  
Ravindran Chirukandath ◽  
Santosh Vijayan Thekoot ◽  
Bobby Sebastian
Keyword(s):  
Bowel Obstruction ◽  
Clinical Case ◽  
Surgical Intervention ◽  
Exploratory Laparotomy ◽  
Obturator Hernia ◽  
Rare Type ◽  
Obturator Foramen ◽  
Surgical Interventions ◽  
Emergency Surgical Intervention ◽  
Specific Symptoms

The obturator hernia is a rare pelvic hernia that presents as bowel obstruction caused by the presence of an intestinal segment, more often ileum passing through obturator foramen. This type of hernia accounts for 0.5-1.4% of all hernias. We reported the clinical case of a 74 year old woman with no previous surgical interventions, presented to ER with abdominal pain and distension, features of intestinal obstruction, which she had experienced for previous three days. A CT scan revealed a right jejunal, obstructed obturator hernia. The patient underwent an emergency surgical intervention with emergency exploratory laparotomy and repair. This case was presented as obturator hernia was a rare type of hernia due to its diagnosis, which is often unclear with non-specific pain radiating to legs mimicking neurological symptoms. A prompt suspect based for the non-specific symptoms is crucial for the diagnosis. Surgical management depends on early diagnosis and it is the only possible treatment for this pathology.

scholarly journals SMALL BOWEL OBSTRUCTION SECONDARY TO OBTURATOR HERNIA: A PRE-OPERATIVE DIAGNOSIS AT COMPUTED TOMOGRAPHY

2021 ◽  
Vol 6 (1) ◽  
pp. 46-49
Author(s):  
Marlina Tanty Ramli ◽  
Mohd Shukry Mohd Khalid ◽  
Kartini Rahmat
Keyword(s):  
Computed Tomography ◽  
Small Bowel ◽  
Elderly Patients ◽  
Intestinal Obstruction ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Surgical Intervention ◽  
Obturator Hernia ◽  
Uneventful Recovery ◽  
Presenting Symptoms

Obturator hernia is rare, but it must be considered in elderly patients who present with small bowel obstruction. The diagnosis is challenging unless there is a high index of suspicion as the presenting symptoms and signs are usually non-specific. Presence of positive Howship-Romberg sign is considered pathognomonic. Early diagnosis and rapid surgical intervention will reduce the high morbidity and mortality associated with undiagnosed obturator hernia. We report a case of a 93-year-old female patient who was admitted to our surgical department with symptoms of intestinal obstruction of 3-days duration. Howship-Romberg sign was negative. Computed tomography (CT) demonstrated the presence of left obturator hernia with proximal small bowel obstruction and no sign of strangulation. The patient had emergency laparotomy post-CT where the incarcerated bowel loop was released and the obstructed bowel was decompressed without any complication. The hernial defect was close with a mesh and the patient had an uneventful recovery post-surgery. In this case, we highlight that diagnosis of obturator hernia must always be considered in elderly patients who present with intestinal obstruction. Urgent CT could establish a rapid pre-operative diagnosis and aids inappropriate surgical intervention planning which is crucial in optimising the outcome.

scholarly journals Bile Salt Enterolith: An Unusual Etiology Mimicking Gallstone Ileus

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Dana Ferrari-Light ◽  
Ariel Shuchleib ◽  
Joel Ricci-Gorbea
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Surgical Intervention ◽  
Gallstone Ileus ◽  
Duodenal Diverticulum ◽  
Multiple Risk Factors ◽  
History Of ◽  
High Index Of Suspicion ◽  
Distal Jejunum

Primary enterolithiasis is a relatively uncommon but important cause of small bowel obstruction. We present a case of a 69-year-old male with a history of laparoscopic Roux-en-Y gastric bypass and asymptomatic duodenal diverticulum diagnosed with small bowel obstruction. CT imaging showed an obstruction distal to the jejunojejunostomy, and surgical intervention was warranted. A 4.5 cm enterolith removed from the distal jejunum was found to contain 100% bile salts, consistent with a primary enterolith. Clinicians should retain a high index of suspicion for enteroliths as a cause of small bowel obstruction, especially if multiple risk factors for enterolith formation are present.

scholarly journals Sawing Through The Neck - A Case of Serrated Fish Bone Migrating to Prevertebral Space

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Ngui LX ◽  
Shashi G. ◽  
Muhammad Nasri AB.
Keyword(s):  
Computed Tomography ◽  
Fish Bone ◽  
Computed Tomography Scan ◽  
Computed Tomography Imaging ◽  
Tomography Imaging ◽  
Transcervical Approach ◽  
Rigid Esophagoscopy ◽  
History Of ◽  
High Index Of Suspicion ◽  
Tomography Scan

Fish bone is the commonest pharyngeal foreign body, however migrating fish bone is a rare occurrence. We report a case of a 54-year-old male who had history of fish bone ingestion over a week and presented with odynophagia and worsening neck pain. Rigid esophagoscopy revealed tip of a fish bone which was embedded in granulation tissue. The fish bone migrated further with manipulation. Aided with computed tomography scan findings, the serrated fish bone was finally removed via transcervical approach without any complication. In conclusion, high index of suspicion and prompt removal of migrating fish bone with the aid of computed tomography imaging is necessary to avoid fatal complications.

scholarly journals Transvaginal Management of Vaginal Cuff Dehiscence with Bowel Evisceration following Delayed Diagnosis

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Samantha Bleull ◽  
Hunter Smith ◽  
Robert Shapiro
Keyword(s):  
Ct Scan ◽  
Bowel Obstruction ◽  
Surgical Approach ◽  
Prolonged Exposure ◽  
Bowel Resection ◽  
Delayed Diagnosis ◽  
Vaginal Flora ◽  
Vaginal Cuff ◽  
Vaginal Cuff Dehiscence ◽  
High Index Of Suspicion

One of the most serious complications that can arise from hysterectomy is vaginal cuff dehiscence with subsequent bowel evisceration. Treatment via vaginal approach has been utilized in early cases of vaginal cuff dehiscence where the need for bowel resection is less likely. Our case examines the treatment of vaginal cuff dehiscence through a vaginal approach approximately 36 hours after apparent vaginal dehiscence with subsequent bowel evisceration. In this case, we chose a vaginal approach even in the setting of possible bowel obstruction and a significant leukocytosis. We utilized CT scan findings to help guide our surgical approach. Although the subjective appearance of the bowel protruding through the vaginal cuff was reassuring, this played little role in guiding our decision with regard to surgical approach. Vaginal cuff dehiscence with evisceration can be managed successfully via a vaginal approach even with prolonged exposure of the bowel to vaginal flora. CT scan should be utilized to evaluate bowel integrity when considering a vaginal dehiscence repair. A high index of suspicion is warranted as these cases can present up to many years after hysterectomy.

scholarly journals Severe Necrotising Soft Tissue Infections in Orthopaedic Surgery

2002 ◽  
Vol 10 (2) ◽  
pp. 108-113 ◽  
Author(s):  
JC Theis ◽  
J Rietveld ◽  
T Danesh-Clough
Keyword(s):  
Orthopaedic Surgery ◽  
Surgical Intervention ◽  
Treatment Strategies ◽  
Predisposing Factors ◽  
Mortality And Morbidity ◽  
Presenting Symptoms ◽  
Group A ◽  
Inflammatory Drugs ◽  
The Mean ◽  
High Index Of Suspicion

Purpose. To review all cases of necrotising infection managed in the Department of Orthopaedic Surgery of Dunedin Hospital in New Zealand between 1989 and 1998. Methods. Hospital records were analysed for predisposing factors, clinical features, diagnostic results, treatment strategies, and outcomes. Results. 13 cases (9 males and 4 females) of necrotising infection were identified. The mean age was 48 years (range, 8–76 years). Presenting symptoms included painful swelling, erythema, and necrosis. Most patients had predisposing factors and had received non-steroidal anti-inflammatory drugs before presentation. 12 patients underwent surgical debridement including a total of 4 amputations. Septic shock developed in 9 patients who required dialysis for renal failure. Four patients died. The most common organisms identified were group A beta-haemolytic streptococci. Conclusion. Severe necrotising infections require a high index of suspicion and rapid medical and surgical intervention to reduce the mortality and morbidity.

scholarly journals Primary aortoduodenal fistula – overlooked because of guidelines?

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Felix Wiesmueller ◽  
Clemens Neufert ◽  
Jürgen Siebler ◽  
Roland Croner ◽  
Werner Lang ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Palliative Care ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Delayed Diagnosis ◽  
Emergency Laparotomy ◽  
Aortoduodenal Fistula ◽  
Computed Tomography Imaging ◽  
Tomography Imaging ◽  
Upper Gastrointestinal

AbstractPrimary aortoduodenal fistula is an uncommon yet mostly lethal finding. We present a case of a 63 year-old male who exhibited significant upper gastrointestinal bleeding and hemorrhagic shock. Repeated endoscopies did not detect any source of bleeding. Emergency laparotomy disclosed an aortoduodenal fistula. Despite intense medical efforts for several months the patient did not fully recover and treatment was limited to palliative care. In light of the substantial mortality associated with this condition, computed tomography imaging should be performed in case of doubt to prevent delayed diagnosis.

scholarly journals Fasciitis Necroticans after Elective Hernia Inguinal Surgery

2014 ◽  
Vol 2014 ◽  
pp. 1-3
Author(s):  
T. A. Sigterman ◽  
Kim J. Gorissen ◽  
Dennis E. J. G. J. Dolmans
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Surgical Intervention ◽  
Elective Surgery ◽  
Necrotising Fasciitis ◽  
Time Interval ◽  
Mortality And Morbidity ◽  
Hernia Inguinal ◽  
High Index Of Suspicion ◽  
Inguinal Surgery

Necrotising fasciitis is a rare but disastrous complication after elective surgery. We present two patients (both male, 58 and 18 years old) who developed necrotising fasciitis following elective inguinal hernia repair according to Lichtenstein. The importance of both recognition and time interval between symptom occurrence and surgical intervention is illustrated, emphasising the need for immediate action when necrotising fasciitis is suspected. A high index of suspicion of necrotising fasciitis should be maintained when a wound infection is accompanied by disproportional pain, lethargy, or sepsis. Epidermolysis and subcutaneous emphysema are often very late symptoms. Recognition and immediate intervention decrease mortality and morbidity.

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