In the Era of Routine Use of CT Scan for Acute Abdominal Vain, Should All Adults with Small Bowel Intussusception Undergo Surgery?

2009 ◽  
Vol 75 (10) ◽  
pp. 958-961 ◽  
Author(s):  
Jaisa Olasky ◽  
Ashkan Moazzez ◽  
Kaylene Barrera ◽  
Tatyan Clarke ◽  
Jabi Shriki ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Ct Scan ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Acute Abdominal Pain ◽  
Operative Management ◽  
Lead Point ◽  
Small Bowel Intussusception

In contrast to adult colonic intussusception in which malignancy is the dominant cause, small bowel intussusceptions are mostly benign. Although surgery is the accepted standard treatment, its necessity in small bowel intussusceptions identified by CT scan is unknown. Twenty-three patients from 2005 to 2008 (16 males; median age, 44 years) with acute abdominal pain and CT-proven small bowel intussusception were studied. Factors associated with the necessity for surgery were determined. Among 11 patients who were managed operatively, surgery was deemed unnecessary in two patients based on negative explorations. Follow up in 10 of 12 patients managed nonoperatively was not associated with any recurrence of intussusception or malignancy (median follow up, 14 months). The only predictor of the need for surgery was CT evidence of small bowel obstruction and/or a radiologically identified lead point, which was present in 7 of 9 (78%) patients having a necessary operation and absent in 12 of 14 (86%) with no indication for surgery (P = 0.008). All small bowel intussusceptions found on CT scan in patients with acute abdominal pain do not require operative management. CT findings of small bowel obstruction and/or presence of a lead point are indications for surgery.

EP.FRI.614 An Atypical Case of Small Bowel Obstruction in the Virgin Abdomen: Case Presentation and Literature Review

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Tarak Chouari ◽  
Hamza Khan ◽  
Tanzeela Gala ◽  
Serena Ceraldi
Keyword(s):  
Small Bowel ◽  
Literature Review ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Treatment Algorithm ◽  
Operative Management ◽  
Case Presentation ◽  
Atypical Case ◽  
Low Threshold

Abstract Aims The management of post-operative adhesional small bowel obstruction (SBO) has shifted from the historical motto of “the sun should never rise and set on a complete SBO” to a non operative approach in selected patients. Despite this shift, the operative management of patients with SBO with a virgin abdomen is still encouraged.  Methods We present an atypical case of SBO managed conservatively with resolution, without surgical intervention. A literature review is conducted and our case compared with the current literature. A treatment algorithm is presented.  Results A 57 year old with a virgin abdomen presented with vomiting and abdominal pain. Computed tomography was consistent with mid to distal SBO proximal to the terminal ileum, in the context of a high riding caecum. He was managed conservatively. Symptoms resolved within 12 hours without gastrograffin. Gastrograffin was subsequently given to ensure contrast was present in the large bowel. At 6 month follow up he remains symptom free. Discussion Many advocate surgery is the cornerstone of the management of SBO in the virgin abdomen. There is little evidence to support this. Recent emerging evidence challenges this view. Ultimately the clinical evaluation of the patient is paramount in selecting which patients can be managed conservatively. A longer interval to operation may carry greater risk of ischaemia and bowel resection. Therefore careful patient selection and serial examination is vital and one should have a low threshold for early operative intervention in the patient which isn't settling. Follow up should be tailored to each patient.

scholarly journals Small bowel intussusception in marijuana users

2020 ◽  
Vol 2020 (9) ◽  
Author(s):  
Daniel Kakish ◽  
Marwan Alaoudi ◽  
Brian Welch ◽  
David Fan ◽  
Melissa Meghpara ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Acute Abdomen ◽  
Bowel Obstruction ◽  
Adult Intussusception ◽  
Lead Point ◽  
Review Of The Literature ◽  
Pathologic Process ◽  
Small Bowel Intussusception ◽  
Intestinal Obstructions

Abstract Intussusception occurs when one portion of bowel ‘telescopes’ into another due to a lead point created by a range of benign or pathologic process. Intussusception mostly occurs in children. Although adult intussusception (AI) is rare, accounting for <5% of intestinal obstructions, it is more concerning in adults as malignancy accounts for nearly 65% of lead points in AI. Patients present with severe abdominal pain concerning for an acute abdomen along with a degree of bowel obstruction. We have experienced a total of 11 patients within recent years presenting with symptoms of an acute abdomen due to AI. None of these patients were found to have a pathologic process creating a lead point. However, we found that all of them were marijuana users. In this report, we compare their management, hospital course and review of the literature discussing proposed mechanisms that suggest an association between cannabis and intussusception.

scholarly journals Point-of-care ultrasonography for the diagnosis of small bowel obstruction in the emergency department

CJEM ◽  
2015 ◽  
Vol 17 (2) ◽  
pp. 206-209 ◽  
Author(s):  
Joshua Guttman ◽  
Michael B. Stone ◽  
Heidi H. Kimberly ◽  
Joshua S. Rempell
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Acute Abdominal Pain ◽  
Point Of Care ◽  
Plain Radiography ◽  
Common Cause ◽  
Point Of Care Ultrasonography

AbstractSmall bowel obstruction (SBO) is a common cause of acute abdominal pain presenting to the emergency department (ED). Although the literature is limited, point-of-care ultrasonography (POCUS) has been found to have superior diagnostic accuracy for SBO compared to plain radiography; however, it is rarely used in North America for this. We present the case of a middle-aged man who presented with abdominal pain where POCUS by the emergency physician early in the hospital course expedited the diagnosis of SBO and led to earlier surgical consultation. The application of POCUS for SBO is easily learned and applied in the ED. POCUS for SBO may obviate the need for plain radiography and expedite patient care.

scholarly journals A Surprising Finding of Ileal Intussusception Caused by Pleural Mesothelioma Metastases

2020 ◽  
pp. 1-3
Author(s):  
Stefania Tamburrini ◽  
Antonella Pesce ◽  
Ester Marra ◽  
Giuseppe Mercogliano ◽  
Giuseppe Militerno ◽  
...  
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Malignant Pleural Mesothelioma ◽  
Bowel Obstruction ◽  
Clinical Condition ◽  
Acute Abdominal Pain ◽  
Pleural Mesothelioma ◽  
History Of

Background: Malignant pleural mesothelioma is an aggressive form of cancer originating in the pleural mesothelioma. It generally appears as a local disease in the affected hemithorax, and metastasis are rare. It is unusual for malignant pleural mesothelioma to manifest with gastrointestinal complications due to metastatic implants, but clinicians should be careful to take into consideration this hypothesis in patients with a history of malignant pleural mesothelioma referring to the Emergency Department with acute abdominal pain. Case Presentation: A 65-year-old man, with a medical history of pleural mesothelioma, presented to our emergency department for acute abdominal pain. The patient underwent abdominal ultrasound and abdominal Computed Tomography with intravenous contrast. At US examination a small bowel obstruction diagnosis was made, CT confirmed a mechanical small bowel obstruction due to an intussuscepted multiloculated mass in the terminal ileum, with CT’s signs of parietal damage; another peritoneal mass was reported adjacent to the posterior wall of the cecum and in contiguity with the iliopsoas muscle. Considering the acute medical presentation, the patient underwent surgery, with segmental bowel resection and a stapled side-by-side bowel anastomosis. Histopathology revealed metastasis of sarcomatoid pleural mesothelioma. The post-operative course was complicated by anastomotic leak treated with a conservative approach. The patient was discharged on the 24th post-operative day. Conclusion: Our case highlights the potential of pleural mesothelioma to metastasize within abdominal viscera, causing bowel obstruction. In presence of the patient’s critical clinical condition and advanced state of local disease, a surgical approach based on damage control procedure consisting in exploration, biopsies and ileostomy upstream the obstruction or, exploration and resection without anastomosis, carry on several advantages, solving the acute clinical condition, staging the disease and offering the possibility to proceed rapidly with supportive care (chemotherapy and/or surgery).

scholarly journals Laparoscopic management of a small bowel obstruction: paraduodenal hernia

2020 ◽  
Vol 7 (9) ◽  
pp. 3112
Author(s):  
Shrenik Govindaraj ◽  
Sridar Govindaraj ◽  
Mario Victor Newton ◽  
Clement Prakash
Keyword(s):  
Small Bowel ◽  
Ct Scan ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Internal Hernia ◽  
Paraduodenal Hernia ◽  
Small Bowel Mesentery ◽  
Foramen Of Winslow ◽  
One Year

Paraduodenal hernia are very rare but the commonest internal hernia. Left paraduodenal hernia is due to herniation of the small bowel into the fossa of Landzert. The fossa results from a combination of failure of fusion of the small bowel mesentery with the retro peritoneum and malrotation of the midgut. Here we present a 27 years lady who saw multiple consultants with varied presentations and underwent extensive investigations over a one-year period, with one consultant referring her to a psychiatrist for malingering. CT scan revealed a foramen of Winslow hernia. The radiologist has to be aware of the CT findings of this unusual hernia. At laparoscopy, it was a left paraduodenal containing small bowel. We reduced the contents and plicated the sac with closure of the mouth. Patient did well and was discharged on 3rd post-operative day. On follow up she is doing well.

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.

Jewish Holiday “Tu Bishvat” or Two Cases of Small Bowel Obstruction with Dried Apricot

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Kukeev I ◽  
◽  
Replyansky I ◽  
Czeiger D ◽  
Atias S ◽  
...  
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Gastric Bypass Surgery ◽  
Surgical Removal ◽  
Cellulose Content ◽  
Lead Point ◽  
First Case ◽  
Dried Fruit ◽  
High Level

Introduction: Small bowel obstruction caused by bezoars is rare. One of the causes of phytobezoars is dried fruits. We present two cases of small bowel obstruction caused by dried apricots during Jewish holiday “Tu BiShvat”. Case Presentation: Two men, 54 and 86 years old hospitalized with acute abdomen attributed to small bowel obstruction. In the first case - intoxicated patient, due to suspicion of mesenteric ischemia underwent laparotomy. A lead point caused obstruction was found and after enterotomy whole dried apricot was removed. The patient swallowed it whole three days before hospitalization. In the second case, edentulous patient with small bowel obstruction and peritonitis underwent laparotomy. The cause of obstruction was a dried apricot swallowed whole by the patient. Discussion: Presentation of bezoar with features of acute surgical abdomen is extremely rare, accounting for only 1% of the patients. The expansion of phytobezoar that is high in cellulose content can absorb a large amount of fluid causing an obstruction of the small bowel. The treatment of small bowel obstruction caused by bezoars varies from dissolving with cellulase, papain and even Coca-Cola, followed by endoscopic and surgical removal. Conclusion: A high level of suspicion needs to exist in the presence of a history of eating dried fruit, which can cause gastrointestinal obstruction. Especially on background gastric bypass surgery and inadequate mastication.

Sign in / Sign up

Export Citation Format

Share Document