scholarly journals Diaphragm Disease: The Limitation of Laparoscopy and Assessment of the Small Bowel for Strictures Using a Ball Bearing

2006 ◽  
Vol 6 ◽  
pp. 1139-1143 ◽  
Author(s):  
C.E. Moffat ◽  
M.N. Khyan ◽  
C.G. Davies ◽  
A.S.K. Ghauri ◽  
C.J. Ranaboldo

Diaphragm disease is a rare cause of intestinal obstruction that will be seen with increasing frequency with the widespread use of nonsteroidal anti-inflammatory drugs (NSAIDs). We present a case study of a patient with diaphragm disease where the diagnosis was not apparent at laparoscopy, and passage of a steel ball through the small intestine was required to identify all strictures present. A high index of suspicion, recognition of the limitations of conventional diagnostic aids, and the need to assess the full length of the small bowel are all important in the surgical management of this condition.

2020 ◽  
Vol 81 (3) ◽  
pp. 1-6
Author(s):  
Diwakar R Sarma ◽  
Pratik Bhattacharya

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.


2016 ◽  
Vol 98 (5) ◽  
pp. e79-e81 ◽  
Author(s):  
A-WN Meshikhes

Introduction Diaphragm disease is a rare consequence of small-bowel enteropathy, and usually occurs as a result of longstanding ingestion of non-steroidal anti-inflammatory drugs. DD is characterized by multiple strictures and saccular dilatations leading to symptoms of subacute intestinal obstruction. Often, the diagnosis is made on histological examination after laparotomy and resection of diseased small bowel. Case History Here, we report a case of an elderly female who suffered for many years from chronic, colicky abdominal pain and anaemia due to undiagnosed diaphragm disease. Eventually, she was referred to our surgical team because of a retained enteroscopy capsule. The diagnosis was made after laparotomy and bowel resection. This surgical intervention alleviated chronic symptoms, and the patient remained well at 1-year follow-up. Conclusions This case highlights the difficulty of diagnosing diaphragm disease without laparotomy and bowel resection. A high index of suspicion must be exercised in any patient with chronic, colicky abdominal pain and anaemia together with multiple strictures and saccular dilatations on computed tomography even in the absence of longstanding NSAID ingestion. Moreover, capsule enteroscopy should be avoided as a diagnostic modality of small-bowel disease if computed tomography raises the suspicion of strictures.


2012 ◽  
Vol 2 (1) ◽  
pp. 24
Author(s):  
Sunil V. Jagtap ◽  
Dhiraj B. Nikumbh ◽  
Ashok Y. Kshirsagar ◽  
Neha Ahuja

Eosinophilic enteritis is a rare disease of unknown etiology. It is characterized by eosinophilic infiltration of the bowel wall to a variable depth and symptoms associated with gastrointestinal tract depending upon the predominant layer involved. Diagnosis of eosinophilic enteritis requires a high index of suspicion and exclusion of various disorders that are associated with peripheral eosinophilia. We report a case of unusual presentation of eosinophilic enteritis clinically presenting as intestinal obstruction due to multiple strictures of the small bowel in an adult male.


2021 ◽  
pp. 1-3
Author(s):  
Abhishek Chaudhary ◽  
Kanchan Sone Lal Baitha ◽  
Yasir Tajdar

Background:The small intestine is the longest and convoluted portion in the digestive tract. It starts from pylorus and ends at ileocaecal valve. The small bowel consists of three parts measuring about 5 to 6 meters. The rst 25cm is the duodenum. Out of the rest part of small gut, jejunum th th. constitute the proximal 2/5 and ileum distal 3/5 The jejunum and ileum extend from the peritoneal fold that supports the duodeno-jejunal junction (Ligament of Treitz) down to ileocaecal valve. Material and Methods:All the patients admitted to PMCH, Patna and KMC, Katihar as intestinal obstruction was included for the study. The time period of study was from October 2014 to November 2016 in PMCH and December 2016 to January 2019 in KMC, Katihar. Out of all Intestinal obstruction 59 cases only of adult small gut obstruction were recorded for comparison and conclusive study.Conclusion: Small bowel obstruction remains a frequently encountered problem in abdominal surgery. Although modern day surgical management continues to focus appropriately on avoiding delayed operation, whatever surgery is indicated, not every patient is always best served by immediate operation


2009 ◽  
Vol 70 (5) ◽  
pp. 1402-1405 ◽  
Author(s):  
Hiroshi ASANO ◽  
Kazuto KOZIMA ◽  
Masaharu WADA ◽  
Hidekazu KAYANO ◽  
Nobuji OGAWA ◽  
...  

2020 ◽  
Vol 8 (C) ◽  
pp. 4-6
Author(s):  
Thomas Olagboyega Olajide ◽  
Olanrewaju Balogun

BACKGROUND: Internal hernias are uncommon causes of acute abdomen and intestinal obstruction. Internal herniation due to appendices epiploicae is very rare with only six cases reported in the literature.CASE REPORT: We, herein, present the report of a 64-year-old female who presented with features of intestinal obstruction due to internal herniation of a loop of small intestine through an orifice formed by the fusion of two appendices epiploicae. The band was divided into release the entrapped loop of bowel.CONCLUSION: A high index of suspicion with prompt surgical intervention will improve outcome.


1988 ◽  
Vol 41 (5) ◽  
pp. 516-526 ◽  
Author(s):  
J Lang ◽  
A B Price ◽  
A J Levi ◽  
M Burke ◽  
J M Gumpel ◽  
...  

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Shamita Chatterjee ◽  
Souvik Chatterjee ◽  
Sanjeev Kumar ◽  
Shahana Gupta

Internal herniation of small intestine is a very rare entity, and it poses a real diagnostic challenge clinically. Recurrent entrapment of the bowel may lead to partial to complete intestinal obstruction and eventually strangulation of the small bowel. Of this rare clinical entity, left paraduodenal hernia is more common. High index of suspicion with prompt management may prevent bowel strangulation and gangrene. We present a case of acute intestinal obstruction due to left paraduodenal hernia with malrotation of midgut in a 55-year-old male patient.


Author(s):  
K. D. Rybakov ◽  
G. S. Sednev ◽  
E. M. Askerov ◽  
A. M. Morozov ◽  
A. N. Pichugova ◽  
...  

Topicality. Adhesive intestinal obstruction is a common disease in abdominal surgery with a significant increase from year to year. During the last 20 years, the frequency of cases of adhesive intestinal obstruction (SCN) has increased by 2 times and has no tendency to decrease. In the UK, small bowel obstruction was an indication for 51% of all emergency laparotomies. Scott et al. reported seven emergency surgeries, accounting for 80% of all hospital admissions, morbidity, mortality, and health care costs in relation to general surgery in the United States. These seven operations included partial colectomy, small bowel resection, cholecystectomy, peptic ulcer surgery, adgeolysis, appendectomy, and laparotomy. Adhesive intestinal obstruction of the small intestine was the most frequent diagnosis in the behavior of four out of seven surgical interventions (partial colectomy, resection of the small intestine, adgeolysis and laparotomy). Postoperative adhesive processes are the main cause of small intestine obstruction, accounting for 60% of cases. Among all cases of intestinal obstruction, acute small intestine is 64.3–80%, while having a severe course and a worse prognosis. This causes a high mortality rate in this pathology. It ranges from 5.1% to 8.4%, occupying a leading place among all urgent diseases.The purpose of the study was to evaluate various modern methods of diagnosing adhesive intestinal obstruction.Material and methods. In this study, the method of classical analysis of domestic and foreign literature was applied, based on current data on the diagnosis of adhesive intestinal obstruction.Results. Historically, there has been a certain algorithm for examining patients arriving with suspected adhesive intestinal obstruction, which includes: complaints, anamnesis of the disease and life, objective status, as well as additional diagnostic methods. Patients with OCD usually present a wide range of complaints, such as nausea, vomiting and periodic abdominal pain. Nausea and vomiting follow the appearance of pain and are an early sign of proximal adhesive OCN. However, clinical symptoms are only partially able to diagnose adhesive intestinal obstruction. Laboratory data are of little significance in the diagnosis of intestinal obstruction, but they help to determine the presence and severity of metabolic disorders, homeostasis disorders, as well as to indicate possible starngulation. For the diagnosis of OCN, OBP survey radiography is routinely used. Computed tomography (CT) has a higher sensitivity and specificity compared to abdominal X-ray examination and is recommended by the Bologna Guidelines. Ultrasound examination (ultrasound) is increasingly used in the diagnosis of OCD. Ultrasound is a relatively simple inexpensive non-invasive imaging method that is devoid of radiation exposure, but depends on the operator's experience. To minimize the effects of ionizing radiation in children and pregnant women, magnetic resonance imaging is an effective alternative to computed tomography for intestinal obstruction.Conclusion. The problem of adhesive intestinal obstruction remains highly relevant, given the prevalence of the disease and high mortality rates. Currently, new promising methods for diagnosing this disease, including biomarkers and high-tech methods for visualizing the pathological process, such as computed tomography and magnetic resonance imaging, are acquiring high importance. At the same time, one should not forget about the routine research methods – X-ray of the abdominal cavity and classical methods of examining the patient – collecting complaints, anamnesis and determining the objective status. 


2017 ◽  
Vol 4 (8) ◽  
pp. 2727 ◽  
Author(s):  
Srinivas S. ◽  
Reddy K. R. ◽  
Balraj T. A. ◽  
Gangadhar A.

Background:This study was done at Niloufer hospital and institute of child health, Hyderabad with an aim of evaluating the clinical presentation, diagnostic evaluation, management and outcome of malrotation of intestines in the neonates.Methods: Cases of neonatal small intestinal obstruction due to malrotation presenting to the Department of Pediatric Surgery, Niloufer hospital over a period of two years were evaluated.Results: A total of 38 newborns presented to our department with intestinal obstruction due to malrotation. 3/38 patients presented with extensive gangrene of midgut. 4/38 patients died during the course of treatment.Conclusions: Malrotation is a relatively common cause of neonatal small bowel obstruction. A high index of suspicion is needed in neonates presenting with bilious vomiting. Early laparotomy prevents fatal complication of extensive gangrene due to midgut volvulus. 


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