Ventriculoperitoneal shunt knotting causing bowel obstruction and necrosis in an adult patient

2021 ◽  
Vol 14 (1) ◽  
pp. e239265
Author(s):  
Orlando De Jesus ◽  
Christian Rios-Vicil
Keyword(s):  
Small Bowel ◽  
Adult Patient ◽  
Bowel Obstruction ◽  
Ventriculoperitoneal Shunt ◽  
Bowel Loop ◽  
Peritoneal Catheter ◽  
Bowel Segment ◽  
Life Threatening ◽  
Small Bowel Segment

Knotting or twisting of the peritoneal catheter around a bowel segment, causing bowel obstruction and necrosis, is extremely rare. Only six cases have been reported in the literature. This report described the second case of an adult patient with spontaneous knotting of the peritoneal catheter around a small-bowel segment, causing bowel obstruction and necrosis. The presentation of a knotted ventriculoperitoneal shunt around a bowel loop is stereotypical. Treatment and general recommendations have been made to help guide clinicians when encountering such cases. Evidence of small-bowel obstruction in a twisted, coiled or knotted peritoneal catheter may need surgical intervention. In the setting of progressive abdominal manifestations, knotting of the peritoneal catheter around bowel loops may cause bowel obstruction and may present with acute life-threatening manifestations. Efficient and expedite diagnosis should be made to coordinate multispecialty intervention and follow-up appropriately.

scholarly journals 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 ◽  
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.

scholarly journals Comparative short-term and long-term outcomes between internal and external intestinal plication in the management of small bowel obstruction

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Song Liu ◽  
Qiongyuan Hu ◽  
Lihua Shao ◽  
Xiaofeng Lu ◽  
Xiaofei Shen ◽  
...  
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Short Term ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Gut Dysfunction ◽  
Gut Function

Abstract Background Small bowel obstruction (SBO) is common and usually requires surgical intervention. Intestinal plication is a traditional but critical strategy for SBO in certain scenarios. This study is to compare the short-term and long-term outcome between internal and external plications in the management of SBO. Methods All patients receiving intestinal plication in our hospital were retrospectively collected. Short-term outcome including postoperative complications, reoperation, postoperative ICU stay, starting day of liquid diet and postoperative hospitalization, as well as long-term outcome including recurrence of obstruction, readmission, reoperation and death were compared between groups. Gut function at annual follow-up visits was evaluated as well. Results Nine internal and 11 external candidates were recruited into each group. The major causes of plication were adhesive obstruction, abdominal cocoon, volvulus and intussusception. Lower incidence of postoperative complication (p = 0.043) and shorter postoperative hospitalization (p = 0.049) was observed in internal group. One patient receiving external plication died from anastomosis leakage. During the 5-year follow-up period, the readmission rate was low in both groups (22.2 % vs. 9.1 %), and none of patients required reoperation or deceased. None of patients exhibited gut dysfunction, and all patients restored normal gut function after 4 years. Patients in external group demonstrated accelerated recovery of gut function after surgery. Conclusions This study compares short-term and long-term outcome of patients receiving internal or external intestinal plication. We suggest a conservative attitude toward external plication strategy. Surgical indication for intestinal plication is critical and awaits future investigations.

scholarly journals Anal Extrusion of Ventriculoperitoneal Shunt: A Case Report and Review of Literature

2021 ◽  
Vol 31 (4) ◽  
pp. 13
Author(s):  
Farhad Bal'afif ◽  
Donny Wisny Wardhana ◽  
Tommy Alfandy Nazwar ◽  
Novia Ayuning Nastiti
Keyword(s):  
Physical Examination ◽  
Ventriculoperitoneal Shunt ◽  
Surgical Procedure ◽  
Rare Complication ◽  
Female Child ◽  
Contributing Factors ◽  
Peritoneal Catheter ◽  
Factors Affecting ◽  
Vp Shunt ◽  
Life Threatening

<p>Ventriculoperitoneal (VP) Shunt is a commonly performed surgical procedure and offers a good result in the treatment of hydrocephalus. In general, 25% of the complication rate of this surgical procedure is abdominal complications. Anal extrusion of a peritoneal catheter is a rare complication ranging from 0.1 to 0.7% of all shunt surgeries. This study presents a rare case of anal extrusion of ventriculoperitoneal shunt in a 1-year-old female child who was asymptomatic. The physical examination revealed swelling and redness along the shunt tract on the retro auricular region, soft abdomen, and no catheter was observed in the anal. This study found several contributing factors affecting the complications in the anal extrusion of a peritoneal catheter, that are thin bowel wall in children and sharp tip and stiff end of VP shunt. The shunt should be disconnected from the abdominal wall, and the lower end should be removed through the rectum by colonoscopy or sigmoidoscopy/proctoscopy or by applying gentle traction on the protruding tube. This study concludes that due to potentially life-threatening consequences and case rarity, thorough anamnesis, physical examination, and objective investigation are needed to determine the appropriate management for anal extrusion of ventriculoperitoneal shunt. </p>

The Excluded Small-Bowel Segment

1976 ◽  
Vol 111 (9) ◽  
pp. 953 ◽  
Author(s):  
John W. Harmon
Keyword(s):  
Small Bowel ◽  
Bowel Segment ◽  
Small Bowel Segment

Small Bowel Obstruction by Wireless Enteroscopic Capsule and Unrecognized Intestinal Stricture

2006 ◽  
Vol 72 (12) ◽  
pp. 1216-1217
Author(s):  
Hadi Najafian ◽  
Camille Eyvazzadeh
Keyword(s):  
Small Bowel ◽  
Physical Examination ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Unusual Case ◽  
Bowel Resection ◽  
Anastomotic Stricture ◽  
History Of ◽  
Resection And Anastomosis

The wireless enteroscopy capsule (WEC) was approved for noninvasive visualization of small bowel. We report an unusual case of a previously healthy man with history of bowel resection and anastomosis who developed small bowel obstruction after ingestion of a WCE. At operation, an anastomotic stricture site was noted and the WEC was proximal to this stricture, causing obstruction. This case emphasizes the importance of a good history and physical examination, as well as vigilant follow-up and retrieval of WEC.

Analysis of mucosal regeneration and the expression profile of heat shock protein 70 in the isolated small bowel segment

2002 ◽  
Vol 10 (5) ◽  
pp. 320-327 ◽  
Author(s):  
Hatsuo Moriyama ◽  
Tsuyoshi Noguchi ◽  
Shinsuke Takeno ◽  
Katsuhisa Harada ◽  
Tetsuji Kudo ◽  
...  
Keyword(s):  
Heat Shock ◽  
Small Bowel ◽  
Heat Shock Protein ◽  
Expression Profile ◽  
Heat Shock Protein 70 ◽  
Mucosal Regeneration ◽  
Bowel Segment ◽  
Small Bowel Segment

scholarly journals Gastric remnant perforation due to trocar site herniation after laparoscopic Roux-en-Y gastric bypass

2019 ◽  
Vol 101 (3) ◽  
pp. e88-e90
Author(s):  
R Ebrahimi ◽  
M Kermansaravi ◽  
F Eghbali ◽  
A Pazouki
Keyword(s):  
Gastric Bypass ◽  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Diagnostic Laparoscopy ◽  
Gastric Remnant ◽  
Bowel Loop ◽  
Low Grade ◽  
Small Bowel Loop ◽  
Trocar Site

A 39-year-old woman was admitted with colicky left upper-quadrant pain, dyspnoea, low-grade fever, tachycardia and a subtle left upper-quadrant tenderness without leucocytosis. Computed tomography revealed a distended gastric remnant due to small-bowel loop herniation at the trocar site. The patient underwent a diagnostic laparoscopy as her general condition worsened. Perforation across the staple line was seen and repaired. The postoperative period was uneventful. As a rare complication of laparoscopic Roux-en-Y gastric bypass, small-bowel obstruction is of great importance because it can lead to gastric remnant perforation if not managed correctly. There have been rare reports of trocar site herniation as a cause of small-bowel obstruction following laparoscopic Roux-en-Y gastric bypass. Prompt diagnostic laparoscopy should be considered. This is the first case reported in which the excluded stomach was perforated due to trocar site herniation of the small-bowel loop. It should be noted that the tissue around the perforation is fragile and proper tension should be employed when it is repaired. Generally, an omental patch is not encouraged.

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