Peach pit impaction presenting as gallstone ileus

Small bowel obstruction (SBO) secondary to fruit pit impaction is rare. The presence of an ovoid, stony body in the bowel lumen on radiologic imaging in a patient presenting with signs and symptoms of SBO is likely to raise concern for gallstone ileus. We report the case of a 56-year-old man who presented with a 1-day history of intermittent left-sided abdominal pain and nausea associated with a single episode of vomiting. CT scan of the abdomen and pelvis revealed a 3.3 cm impacted stony mass in the terminal ileum resulting in high-grade partial SBO. The mass had a hypodense centre encased within a hyperdense, ridged outer layer. The diagnostic impression was gallstone ileus. The object was removed via enterotomy and was found to be a peach pit.

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Lockdown dilemma: ingestion of magnetic beads presenting as right iliac fossa pain and subacute small bowel obstruction

BMJ Case Reports ◽

10.1136/bcr-2020-236429 ◽

2020 ◽

Vol 13 (11) ◽

pp. e236429

Author(s):

Bankole Oyewole ◽

Anu Sandhya ◽

Ian Maheswaran ◽

Timothy Campbell-Smith

Keyword(s):

Abdominal Pain ◽

Small Bowel ◽

Magnetic Beads ◽

Iliac Fossa ◽

Serous Fluid ◽

Magnetic Resonance Scan ◽

History Of ◽

Right Iliac Fossa Pain ◽

Multiple Episodes ◽

Safety Netting

A 13-year-old girl presented with a 3-day history of migratory right iliac fossa pain. Observations and inflammatory markers were normal, and an ultrasound scan was inconclusive. A provisional diagnosis of non-specific abdominal pain or early appendicitis was made, and she was discharged with safety netting advice. She presented again 6 days later with ongoing abdominal pain now associated with multiple episodes of vomiting; hence, the decision was made to proceed to diagnostic laparoscopy rather than a magnetic resonance scan for further assessment. Intraoperative findings revealed 200 mL of serous fluid in the pelvis, normal-looking appendix, dilated stomach and a tangle of small bowel loops. Blunt and careful dissection revealed fistulous tracts that magnetised the laparoscopic instruments. A minilaparotomy was performed with the extraction of 14 magnetic beads and the repair of nine enterotomies. This case highlights the importance of careful history taking in children presenting with acute abdominal pain of doubtful aetiology.

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563 A Rare Case of Small Bowel Obstruction Secondary to Peritoneal Encapsulation, Congenital Adhesional Band and Gallstone Ileus

British Journal of Surgery ◽

10.1093/bjs/znab259.300 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

P Gungadin ◽

A Taib ◽

M Ahmed ◽

A Sultana

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Unusual Case ◽

Gallstone Ileus ◽

Gall Stone ◽

Case Presentation ◽

Peritoneal Encapsulation ◽

History Of ◽

Gall Stone Ileus

Abstract Introduction Small bowel obstruction can be caused by multiple factors. We describe an unusual case of small bowel obstruction secondary to three rare factors: gallstone ileus, peritoneal encapsulation and congenital adhesional band. Case Presentation A seventy-nine-year-old male presented with a four-day history of obstipation and abdominal pain. CT abdomen pelvis revealed small bowel obstruction secondary to gallstone ileus. The patient was managed by laparotomy. The intraoperative findings revealed the presence of a congenital peritoneal encapsulation with an adhesional band and gallstone proximal to the ileo-caecal valve. Although there was some dusky small bowel, this recovered following the release of the band. Discussion Peritoneal Encapsulation is a rare congenital pathology resulting in the formation of an accessory peritoneal membrane around the small bowel. This condition is asymptomatic and rarely presents as small bowel obstruction. The diagnosis is often made at laparotomy. There are less than 60 cases reported in literature. Gallstone ileus is another rare entity caused by an inflamed gallbladder adhering to part of the bowel resulting in a fistula. Conclusions The rarity of these conditions mean that they are poorly understood. A combination of this triad of gall stone ileus in the presence of peritoneal encapsulation and congenital band has not been reported before. Knowledge of this would raise awareness, facilitate diagnosis and management of patients.

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1074 Gallstone Ileus: Two Decades After Cholecystectomy

British Journal of Surgery ◽

10.1093/bjs/znab259.358 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

K Matwala ◽

M R Iqbal ◽

T Shakir ◽

D W Chicken

Keyword(s):

Small Bowel ◽

Bowel Obstruction ◽

Rare Complication ◽

Open Cholecystectomy ◽

Gallstone Ileus ◽

Proximal Small Bowel ◽

Solid Diet ◽

History Of ◽

Ileocaecal Junction ◽

Tomography Scan

Abstract Introduction Gallstone ileus is a rare complication of gallstones that occurs in 1%-4% of all cases of bowel obstruction. We present a surprising case of gallstone ileus causing small bowel obstruction 19 years after open cholecystectomy. Case Report A 77-year-old male presented with a 3-day history of abdominal pain, 4 episodes of vomiting and absolute constipation. He had a surgical background of an open cholecystectomy and open appendicectomy 19 years and 45 years ago respectively. Medically, he had well-controlled hypertension and experienced a TIA 5 years prior. Computed Tomography Scan of the abdomen and pelvis revealed features consistent with an obstructing, heterogenous opacity in the distal small bowel without pneumobilia. The patient subsequently underwent diagnostic laparoscopy. Intraoperatively, an obstructing gallstone, measuring 4 cm, was found 50cm proximal to the ileocaecal junction, with dilatation of the proximal small bowel and distal collapse. Enterotomy and removal of the stone was done. Post-operatively, this gentleman recovered without complications and was discharged home two days later after being able to tolerate a solid diet. Conclusions This is the second reported case of gallstone ileus in a patient with previous cholecystectomy about two decades ago, according to our literature search. Although extremely rare, absence of the gallbladder does not exclude the possibility of gallstone ileus.

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Ceftriaxone-Induced Acute Pancreatitis

Annals of Pharmacotherapy ◽

10.1177/106002809302700108 ◽

1993 ◽

Vol 27 (1) ◽

pp. 36-37 ◽

Cited By ~ 18

Author(s):

Anthony E. Zimmermann ◽

Brian G. Katona ◽

Joginder S. Jodhka ◽

Richard B. Williams

Keyword(s):

Acute Pancreatitis ◽

Abdominal Pain ◽

Acute Abdominal Pain ◽

Signs And Symptoms ◽

Etiologic Agent ◽

Antibiotic Regimen ◽

Intravenous Injections ◽

Case Summary ◽

Catheter Sepsis ◽

History Of

OBJECTIVE: To report a case of probable ceftriaxone-induced acute pancreatitis. CASE SUMMARY: A patient with a history of short-bowel syndrome on home total parenteral nutrition developed fever, chills, and right flank pain. She was diagnosed with gram-negative catheter sepsis and prescribed antibiotic therapy to be administered for four weeks. After completion of the first week of therapy, the antibiotic regimen was changed to intravenous injections of ceftriaxone to be given daily at home. Prior to discharge the patient developed acute abdominal pain, leukocytosis, jaundice, and markedly elevated lipase and amylase concentrations consistent with acute pancreatitis. The patient's condition improved upon discontinuation of the ceftriaxone and the remainder of her stay was uneventful. DISCUSSION: There is only one other case report in the literature of probable ceftriaxone-induced pancreatitis. Multiple other medications have been implicated in causing acute pancreatitis. The exact mechanism of this uncommon adverse effect of ceftriaxone is unknown. CONCLUSIONS: There was a temporal relationship between the development of this patient's signs and symptoms and the administration of ceftriaxone. We could not identify any other factors that may have been responsible for the development of her acute pancreatitis. Ceftriaxone should be considered as a possible etiologic agent in patients who present with acute abdominal pain and elevated lipase and amylase concentrations.

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P154 DOES A PENO-SCROTAL APPROACH FOR PENILE PROSTHESIS IMPLANTATION INCREASE THE INCIDENCE OF INGUINAL HERNIAS POSTOPERATIVELY?

British Journal of Surgery ◽

10.1093/bjs/znab395.144 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Shadi Al-Bahri ◽

Hazem Taifour

Keyword(s):

Risk Factors ◽

Inguinal Hernia ◽

Case Series ◽

Penile Prosthesis ◽

Signs And Symptoms ◽

General Surgeon ◽

Direct Inguinal Hernia ◽

Prosthesis Implantation ◽

Radiologic Imaging ◽

History Of

Abstract Aim The incidence of direct inguinal hernia and reservoir migration post-penile prosthesis implantation is extremely rare. We present a case series of patients presenting with direct inguinal hernia following three-piece penile prosthesis implantation. Material and Methods Three patients presented with direct inguinal hernia shortly following penile prosthesis implantation for treatment of refractory erectile dysfunction due to venous leak that was confirmed on ultrasound imaging. All patients underwent standard open Lichtenstein tension free repair. Results All patients underwent penile prosthesis Implantation through a peno-scrotal approach in which the reservoir was placed in the space of Retzius. The first patient had reservoir displacement one day post-operatively presenting as an inguinal bulge and discomfort, and repaired the same day. The other two patients presented with symptoms of inguinal swelling and pain at 40 days and 8 months respectively. None of our patients had signs and symptoms of intestinal obstruction. Identifiable risk factors included high BMI and a history of smoking, however dissection and placement of the reservoir may play a role in weakening the floor of the inguinal canal. Conclusions Despite the rare incidence of inguinal hernia post-penile prosthesis implantation, identification of patients with risk factors for inguinal hernia development should be done preoperatively. This may be evaluated through preoperative radiologic imaging with an abdominal wall ultrasound or clinical examination by a general surgeon.

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A rare cause of small bowel diaphragm disease presenting with palpated abdominal mass

Journal of Surgical Case Reports ◽

10.1093/jscr/rjz230 ◽

2019 ◽

Vol 2019 (8) ◽

Cited By ~ 1

Author(s):

Aghyad K Danial ◽

Ahmad Al-Mouakeh ◽

Yaman K Danial ◽

Ahmad A Nawlo ◽

Ahmad Khalil ◽

...

Keyword(s):

Abdominal Pain ◽

Small Bowel ◽

Medical History ◽

Rare Complication ◽

Abdominal Mass ◽

Past Medical History ◽

Abdominal Symptoms ◽

Diaphragm Disease ◽

History Of ◽

Specific Symptoms

Abstract Small bowel diaphragm disease is a rare complication related to non-steroidal anti-inflammatory drug (NSAID) use. It presents with non-specific symptoms such as vomiting, abdominal pain, subacute bowel obstruction and occasionally as an acute abdominal condition. We report a case of diaphragm disease in a 33-year-old female who presented with vomiting, constipation and abdominal pain started 5 days earlier. Physical examination revealed palpated abdominal mass. The patient’s past medical history was remarkable for NSAID use. The patient was managed by surgical resection of involved intestine and diagnosis was confirmed by histological examination. Although there are few published cases of diaphragm disease in the medical literature, we recommend that this disease should be considered as one of the differential diagnoses when assessing patients presenting with non-specific abdominal symptoms with remarkable past medical history of NSAID use.

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

Case Reports in Surgery ◽

10.1155/2019/1072821 ◽

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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Endometriosis of the appendix causing small bowel obstruction in a virgin abdomen

BMJ Case Reports ◽

10.1136/bcr-2019-230496 ◽

2019 ◽

Vol 12 (7) ◽

pp. e230496 ◽

Cited By ~ 1

Author(s):

Joseph Do Woong Choi ◽

Michael Yunaev

Keyword(s):

Emergency Department ◽

Abdominal Pain ◽

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Oestrogen Receptor ◽

Surgical Intervention ◽

Prior History ◽

Good Recovery ◽

History Of

A 29-year-old, otherwise well, nulligravid woman presented to the emergency department with 1-day history of generalised abdominal pain and vomiting. She had similar symptoms 6 months prior following recent menstruations, which resolved conservatively. She had no prior history of abdominal surgery or endometriosis. CT scan demonstrated distal small bowel obstruction. A congenital band adhesion was suspected, and she underwent prompt surgical intervention. During laparoscopy, a thickened appendix was adhered to a segment of distal ileum. There was blood in the pelvis. Laparoscopic adhesiolysis and appendicectomy were performed. Histopathology demonstrated multiple foci of endometriosis of the appendix with endometrial glands surrounded by endometrial stroma. Oestrogen receptor and CD10 immunostains highlighted the endometriotic foci. The patient made a good recovery and was referred to a gynaecologist for further management.

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Anomalous Vascular Peritoneal Band Causing Small Bowel Obstruction in an Adult

Annals of African Surgery ◽

10.4314/aas.v17i2.10 ◽

2020 ◽

Vol 17 (2) ◽

pp. 85-87

Author(s):

Suzanne Nyakirugumi ◽

Mathenge Nduhiu

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Mesenteric Artery ◽

Signs And Symptoms ◽

Sub Saharan Africa ◽

Definitive Treatment ◽

Anomalous Artery ◽

History Of ◽

Sub Saharan

Peritoneal bands resulting in small bowel obstruction in adults are rare. We present a case study of a 39-year-old male who presented with a 10-day history of signs and symptoms of intestinal obstruction. The patient had no history of abdominal trauma or surgery. Intraoperatively, the small bowel obstruction was caused by a vascularized peritoneal band that had a membrane. The band formed a closed loop and caused the small bowel to herniate and lead to mechanical obstruction. In the band was an anomalous artery that connected the ileocolic artery to the descending branch of the left colic artery. The mainstay for diagnosis is an exploratory laparoscopy or laparotomy. The definitive treatment is transection of the band. This is the first reported case in Sub-Saharan Africa. Keywords: Small bowel obstruction, Congenital bands, Peritoneal bands, Vascular bands, Inferior mesenteric artery, Superior mesenteric artery

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A 12-year-old boy presented with fever and left-sided upper abdominal pain

Bangabandhu Sheikh Mujib Medical University Journal ◽

10.3329/bsmmuj.v11i4.38662 ◽

2018 ◽

Vol 11 (4) ◽

pp. 310-314

Author(s):

Mohuya Mondal ◽

Md. Rukunuzzaman ◽

A. K. M. Fazlul Bari ◽

Parisa Marjan ◽

Dipanwita Saha

Keyword(s):

Abdominal Pain ◽

Blood Transfusion ◽

Skin Infection ◽

Burning Sensation ◽

Bowel Habit ◽

High Grade ◽

Hypochondriac Region ◽

History Of ◽

Abdominal Examination ◽

Upper Abdominal

This article has no abstract. The first 100 words appear below: A 12-year-old boy of non-consanguineous parents presented with the history of fever and left sided upper abdominal pain for 1 month. His fever was high grade, intermittent, associated with chills and rigor. The abdominal pain was dull aching in nature without any radiation, aggravating or relieving factors. His bowel habit was normal. The child had no history of jaundice, cough, respiratory distress, burning sensation during micturition, earache, skin infection, contact with tubercular patient, blood transfusion or parenteral medica-tion. On examination, she was fretful, febrile, mode-rately pale, and anicteric. Tachycardia was present. Per abdominal examination revealed tenderness at the left hypochondriac region.

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