Closed loop obstruction and adhesive intestinal obstruction in perineal hernia

Perineal hernia with bowel gangrene is uncommon but known complication of laparoscopic extralevator abdominoperineal excision (ELAPE). We present a rare case of closed loop small bowel obstruction with bowel gangrene secondary to an incarcerated perineal hernia that developed 7 years after an ELAPE. Intraoperatively, we found a definitive transition point due to adhesions in pelvis and a closed loop obstruction of the distal small bowel at different site with gangrenous intestine. She was managed successfully surgically with adhesiolysis and fixation of defect with biological mesh. Prevalence of perineal hernias will rise in future because of the increasing cases of ELAPE, in which no repair of pelvic floor is performed. The need of follow-up of these operations and more reporting of such cases are important in increasing awareness of these complications. Patients should be made aware of such complications and should seek urgent medical care.

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Myxoid liposarcoma of small bowel presenting with intussusception and obstruction: A case report

Indian Journal of Case Reports ◽

10.32677/ijcr.v7i12.3171 ◽

2022 ◽

pp. 519-521

Author(s):

Mohd Monis ◽

Divyashree Koppal ◽

Aiman Ibbrahim ◽

Zeeshan Nahid

Keyword(s):

Small Bowel ◽

Intestinal Obstruction ◽

Leading Edge ◽

Surgical Excision ◽

Myxoid Liposarcoma ◽

Histopathological Analysis ◽

Contrast Enhanced ◽

Well Differentiated ◽

Enhanced Computed Tomography

Gastrointestinal liposarcomas are extremely rare with the most common reported morphological subtype being dedifferentiated liposarcoma and well-differentiated liposarcoma. These tumors are rarely diagnosed preoperatively and diagnosis is only confirmed on histopathological analysis. Treatment of gastrointestinal liposarcomas consists of surgical excision with widely negative margins followed by post-operative irradiation and close follow-up. We report an exceedingly rare case of myxoid liposarcoma of the small bowel (ileum) presenting with an unusual presentation with intussusception and intestinal obstruction. A 42-year-old male presented to the emergency department with features of intestinal obstruction. Contrast-enhanced computed tomography abdomen revealed ileo-ileal intussusception with an endoluminal soft-tissue lesion at the leading edge. The patient was taken for surgical intervention and the involved segment of the bowel along with the lesion was resected and re-anastomosis done. Histological sections of the mass along with immunohistochemistry suggested the pathological diagnosis of myxoid liposarcoma.

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A rare case of a closed loop obstruction due to epiploic appendage of the sigmoid colon

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa008 ◽

2020 ◽

Vol 2020 (3) ◽

Author(s):

Rathin Gosavi ◽

Ee Ban

Keyword(s):

Small Bowel ◽

Sigmoid Colon ◽

Rare Case ◽

Closed Loop ◽

Primary Anastomosis ◽

Uterine Cancer ◽

Small Bowel Resection ◽

Uneventful Recovery ◽

Ischemic Bowel ◽

The Right

Abstract An internal hernia is a protrusion of viscera through a congenital or acquired defect in the mesentery of peritoneum. They account for <0.9% of all small bowel obstructions [1] and ~4% of obstructions due to hernias [2]. We present a rare case of closed loop obstruction secondary to a band adhesion traversing the lower abdomen from a sigmoid colon appendage epiploicae to the right pelvic wall. A 82-year-old woman presented to the emergency department with nausea, vomiting and worsening right sided abdominal pain for 24 h, on the background of previous pelvic radiation and hysterectomy for uterine cancer. She was subsequently found to have a closed loop obstruction with 30 cm of ischemic bowel strangulated by a band adhesion from a sigmoid colon appendage epiploicae to the right abdominal wall. The patient underwent a successful small bowel resection with primary anastomosis and made an uneventful recovery.

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Closed loop bowel obstruction secondary to left paraduodenal hernia (of Landzert)

BMJ Case Reports ◽

10.1136/bcr-2019-232134 ◽

2019 ◽

Vol 12 (12) ◽

pp. e232134

Author(s):

Yeo Min Cho ◽

Gamze Aksakal ◽

Mohamed Ahmed Tawfik Ashour ◽

Suzanne Moore

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Rare Case ◽

Closed Loop ◽

Flank Pain ◽

Paraduodenal Hernia ◽

Good Recovery ◽

Left Colic Artery ◽

Unusual Phenomenon

A 34-year-old man presented with acute severe left-sided abdominal and flank pain with associated postprandial nausea and vomiting. CT imaging revealed findings suspicious for a closed loop small bowel obstruction. Intraoperative findings were that of a left paraduodenal hernia (of Landzert) secondary to a mesenteric defect immediately posterior to the ascending branch of the left colic artery. The defect was closed via minilaparotomy. Unfortunately, his postoperative course was complicated by small bowel obstruction which required further laparotomy and adhesiolysis. The patient eventually made a good recovery. Here, we present a rare case of intestinal obstruction and discuss the aetiologies and management of this unusual phenomenon.

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Ileosigmoid knotting: an unusual cause of acute intestinal obstruction with bowel gangrene

BMJ Case Reports ◽

10.1136/bcr-2018-226663 ◽

2019 ◽

Vol 12 (5) ◽

pp. e226663

Author(s):

Raj Kumar ◽

Pavan Kumar Shamanur Kenchappa ◽

Kusum Meena ◽

Brijesh Kumar Singh

Keyword(s):

Intestinal Obstruction ◽

Sigmoid Colon ◽

Bowel Obstruction ◽

Exploratory Laparotomy ◽

Large Bowel Obstruction ◽

Acute Intestinal Obstruction ◽

Haemodynamic Instability ◽

Ileocolic Anastomosis ◽

Bowel Gangrene

Ileosigmoid knotting (ISK) is a rare cause of intestinal obstruction rapidly progressing to bowel gangrene. It is characterised by the wrapping of loops of ileum and sigmoid colon around each other. The condition often remains undiagnosed preoperatively; however, it can be suspected by the triad of small bowel obstruction, radiographic features suggestive of predominately large bowel obstruction and inability to deflate the intestine by a sigmoidoscope. We are reporting a case of 56-year-old man who presented with features of acute intestinal obstruction and compensated shock within 24 hours of onset of symptoms. Exploratory laparotomy revealed ISK resulting in gangrene of ileum and sigmoid colon. In view of haemodynamic instability, end ileostomy was done after excising gangrenous segments. The patient improved and stoma closure and ileocolic anastomosis were done after 3 months in follow-up.

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Small bowel knots

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2020.0122 ◽

2020 ◽

Vol 102 (8) ◽

pp. 571-576

Author(s):

MY Beg ◽

L Bains ◽

P Lal ◽

H Maranna ◽

P Kumar N

Keyword(s):

Abdominal Pain ◽

Small Bowel ◽

Intestinal Obstruction ◽

Full Text ◽

Rare Case ◽

Case Reports ◽

Systematic Search ◽

Abdominal Distention ◽

The West ◽

Resection And Anastomosis

Introduction Intertwining of bowel loops to form a knot is very rare cause of intestinal obstruction. Among intestinal knots, ileoileal knotting is the most rare, with only a handful of cases reported in literature. We present a rare case of ileoileal knotting and review of small bowel knots. The aim of this review was to summarise the existing evidence on small bowel knots and to postulate the possible mechanisms for knotting. Methods A systematic search was conducted for literature published up to December 2019 using MEDLINE, PubMed and Google Scholar databases, together with the references of the full-text articles retrieved. Papers with case reports of small bowel knots were considered to be eligible for inclusion in the review. Findings A total of 14 case reports were evaluated. There was no clear predilection for age or sex. Mostly cases were from Asia and Africa with no cases from the West. The presenting complaints were abdominal pain (93%), vomiting (64%), abdominal distention (57 %) and obstipation (43%). The bowel was gangrenous in 78% of cases. All underwent exploration, with the majority requiring resection and anastomosis of the involved segment. Conclusion Ileoileal knotting is a very rare cause of intestinal obstruction. Possible mechanisms include loaded bowel with longer mesentery, vigorous peristalsis, single bulky meal, pregnancy and intussusception. The condition is extremely difficult to diagnose preoperatively and it is usually diagnosed intraoperatively. The standard of treatment is resection of gangrenous part and anastomosis.

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P53 First Reported Case of Successful Non-Surgical Management for Acute Small Intestinal Obstruction Caused by Enterolith as A Rare Complication of Jejunal Diverticulosis

BJS Open ◽

10.1093/bjsopen/zrab032.052 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

Fang Fang Quek ◽

Andrew Tanase ◽

Fang Fang Quek

Keyword(s):

Small Bowel ◽

Intestinal Obstruction ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Rare Complication ◽

Acute Intestinal Obstruction ◽

Jejunal Diverticulosis ◽

Jejunal Diverticulum ◽

Life Threatening

Abstract Introduction Enterolith ileus is a rare complication of jejunal diverticulosis, which in itself is a rare entity. Here we report a rare case of enterolith ileus as a complication of jejunal diverticulosis which is successfully managed conservatively. Case Report A 75-year-old female presented with a 7- day history of “gripey” abdominal pain with intermittent vomiting. She was able to pass flatus and had open bowel with small amount of loose stool. Patient was previously fit and well with no significant past medical history and had not undergone previous abdominal surgery. On admission, patient was in no acute distress and was afebrile. On examination, she had a very distended tympanic abdomen with left-sided tenderness but no palpable mass. Bowel sounds were present. Laboratory investigations revealed a white cell count of 22.6 x109/L, C-reactive protein of 26 mg/L and haemoglobin of 144 g/L. Abdominal X-rays revealed distended loops of small bowel indicating small bowel obstruction. CT images did not reveal pneumobilia which would be suggestive of gallstone ileus but showed intraluminal small bowel obstruction secondary to an enterolith in the terminal ileum. The scan also showed an inflamed jejunal diverticulum with fat stranding around but no perforation nor abscess was seen. The working diagnosis was acute intestinal obstruction caused by jejunal enterolith expulsed from jejunal diverticulum. Since no perforation nor abscess was noted, this patient was treated conservatively. Patient recovered uneventfully and was discharged with an MRI scheduled in 4-6 weeks for follow-up. The follow-up MRI was completely normal and patient has recovered uneventfully with conservative management. Discussion Acute intestinal obstruction caused by jejunal enterolith expulsed from jejunal diverticulum is rare. However, it is important to diagnose jejunoileal diverticulosis timely as they may lead to acute complications which can be life- threatening and may even cause death. Conclusion Many cases have reported jejunoileal diverticulosis being overlooked or misdiagnosed for other acute abdominal conditions. It is important to have a clinical awareness of this condition as although rare, it can lead to life-threatening complications.

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Modern methods for adhesive bowel obstruction diagnosis

Bulletin of the Medical Institute "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH) ◽

10.20340/vmi-rvz.2021.6.clin.3 ◽

2021 ◽

Author(s):

K. D. Rybakov ◽

G. S. Sednev ◽

E. M. Askerov ◽

A. M. Morozov ◽

A. N. Pichugova ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Computed Tomography ◽

Small Intestine ◽

Small Bowel ◽

Intestinal Obstruction ◽

Resonance Imaging ◽

X Ray ◽

Modern Methods ◽

Partial Colectomy ◽

Adhesive Intestinal Obstruction

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.

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Ectopia of the pancreas in the loop of the small intestine in an 8-y-o child

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care ◽

10.17816/psaic680 ◽

2020 ◽

Vol 10 (3) ◽

pp. 309-313

Author(s):

Aslamhon M. Sharipov ◽

Kholnazar A. Giesov ◽

Holmurod Z. Zaripov ◽

Imatihudo D. Sayfulloev ◽

...

Keyword(s):

Small Intestine ◽

Intestinal Obstruction ◽

Rare Case ◽

Clinical Observation ◽

Normal Growth ◽

Pancreatic Tissue ◽

Contrast Study ◽

Normal Pancreatic Tissue ◽

One Year

Ectopia of the pancreas in children is a rare congenital malformation in which normal pancreatic tissue develops in other organs, without communication with the main gland in the wall of the stomach, intestines, liver, gallbladder, Meckel's diverticulum, and the spleen. In this article, the authors cite a rare case of ectopia of the pancreas in the loop of the small intestine, which led to the development of intestinal obstruction. Girl B., eight years old, was admitted to the hospital on an emergency basis with paroxysmal abdominal pain. There was no nausea or vomiting. A contrast study of the gastrointestinal tract with barium sulfate was performed, which revealed a violation of the evacuation of the contrast medium. A laparoscopy was performed with the clinic for low intestinal obstruction. Revision of the intestine revealed a tumor-like formation measuring 6 4 cm at 60 cm from the ileocecal angle. A minilaporotomy was performed, a 10 cm section of the ileum was resected, bearing a tumor-like formation with an end-to-end anastomosis. The postoperative period is favorable. The girl was discharged from the hospital on the eighth postoperative day. On histological examination, pancreatic tissue was found in the wall of the small intestine, with duct ectasia. At the follow-up examination after one year. the patient had no complaints with normal growth and development. This clinical observation demonstrates the nonspecificity of the clinical picture and the difficulty of diagnosing pancreatic ectopia, and the advantages of minimally invasive interventions that allow diagnosing a rare pathology and its timely adequate correction.

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Acute intestinal obstruction due to appendicular tie syndrome: a rare case report

International Surgery Journal ◽

10.18203/2349-2902.isj20194099 ◽

2019 ◽

Vol 6 (9) ◽

pp. 3446

Author(s):

Akash Agrawal ◽

Palak Vora

Keyword(s):

Small Bowel ◽

Intestinal Obstruction ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Rare Case ◽

Acute Intestinal Obstruction ◽

Postoperative Adhesions ◽

Surgical Emergencies ◽

Common Causes ◽

Rare Case Report

Acute intestinal obstruction is one of the most common surgical emergencies encountered by surgeons on daily bases. Most common causes for small bowel obstruction includes postoperative adhesions and hernia. One of the rarest cause of intestinal obstruction is appendicular band syndrome. Here we report a case of small bowel obstruction due to appendicular tie syndrome in a 70 years old male patient at GMERS hospital, Dharpur, Patan, Gujarat, India.

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