ACUTE SMALL-BOWEL OBSTRUCTION

Abstract Introduction Congenital diaphragmatic hernia (CDH) has been associated with other congenital malformations, such as intestinal rotation abnormalities. However, there is no standard evaluation and treatment of intestinal rotation during initial CDH repair. This study evaluates intestinal malrotation in CDH patients. Materials and Methods All patients with a CDH treated in a high-volume center between 2000 and 2015 were retrospectively evaluated. Demographics, gastrointestinal characteristics, surgical treatment, and abdominal outcomes (acute surgery, small bowel obstruction, and volvulus) were described. Results A total of 197 CDH patients were surgically repaired. In 76 (39%) patients, a malrotation was described at initial CDH repair, in 39 (20%) patients, a normal rotation, but 82 patients (42%) had no report on intestinal rotation. During follow-up (range: 2–16 years), 12 additional malrotations were diagnosed, leading to a prevalence of at least 45% (n = 88). These were mostly diagnosed due to acute small bowel obstruction, of which three had a volvulus. Of the 12 later diagnosed malrotations, 58% required acute surgery, compared to 3% of the 76 initially diagnosed patients (p < 0.001). Conclusion Malrotation is associated with CDH, with a prevalence of at least 45% and in 21% a normal intestinal rotation. “Missed” malrotations have a higher risk on need for acute surgery later in life.

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National prospective cohort study of the burden of acute small bowel obstruction

BJS Open ◽

10.1002/bjs5.50136 ◽

2019 ◽

Vol 3 (3) ◽

pp. 354-366 ◽

Cited By ~ 3

Author(s):

M. J. Lee ◽

A. E. Sayers ◽

T. M. Drake ◽

P. J. Marriott ◽

I. D. Anderson ◽

...

Keyword(s):

Cohort Study ◽

Small Bowel ◽

Small Bowel Obstruction ◽

Prospective Cohort Study ◽

Bowel Obstruction ◽

Prospective Cohort ◽

Acute Small Bowel Obstruction

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Diaphragm disease in emergency surgery

British Journal of Hospital Medicine ◽

10.12968/hmed.2019.0409 ◽

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.

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