Supernumerary Remnant Vas Deferens Like Wolffian-Derivatives in a Young Child With Abdominal Cocoon Syndrome—A Clinicopathological Novelty

2021 ◽  
pp. 109352662110016
Author(s):  
Shilpi Agarwal ◽  
Kavita Gaur ◽  
Nikita Agrawal ◽  
Archana Puri
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Young Child ◽  
Intestinal Obstruction ◽  
Vas Deferens ◽  
Exploratory Laparotomy ◽  
Abdominal Cocoon ◽  
Ductus Deferens ◽  
Pediatric Subject ◽  
Documented Case

The abdominal cocoon syndrome is a rare cause of recurring intestinal obstruction in children. It refers to encasement of the small bowel by a fibrocollagenous membrane forming a cocoon. We report a nine year old male presenting with abdominal pain, distension, bilious vomiting and inability to pass stool and flatus for two days. In view of a persistently increasing bilious nasogastric output, an urgent exploratory laparotomy was performed. The small bowel loops were matted together forming a cocoon densely adherent to the parietal peritoneum with supra-colic fibrous bands. The bands histologically displayed multiple ductal remnants with epithelium resembling that of ductus deferens. These structures showed immunopositivity for pan-cytokeratin and basal CD10.Workup for tuberculosis and other etiological causes was unremarkable. This is the first documented case of abdominal cocoon in a pediatric subject associated with supernumerary wolffian remnants.

scholarly journals SMALL BOWEL DIVERTICULAR DISEASE;

2013 ◽  
Vol 20 (05) ◽  
pp. 776-782
Author(s):  
ANSAR LATIF ◽  
ANILA ANSAR ◽  
MUHAMMAD QASIM BUTT
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Intestinal Obstruction ◽  
Teaching Hospital ◽  
Abdominal Mass ◽  
Exploratory Laparotomy ◽  
Study Patient ◽  
Military Hospital ◽  
Study Results ◽  
Bleeding Per Rectum

Objectives: 1). To see the prevalence of small bowel diverticulosis in patients presenting with acute abdomen. 2). To knowpresentation and complications of diverticulosis in teaching hospital in Sialkot region of Pakistan. Introduction: Small bowel diverticulardisease may be complicated by small bowel obstruction. Multiple diverticulosis represents an uncommon pathology of the small bowel.Related complications such as diverticulitis, perforation, bleeding or intestinal obstruction, and acute pancreatitis appear in 10-30% ofthe patients, increasing the morbidity and mortality rates. This pathology which is uncommon is much higher in our study in patientsundergoing exploratory laparotomy in district level hospitals in Sialkot region of Pakistan. Study Design: Prospective and observational.Setting and duration: Combined Military Hospital, Sialkot (June 2005 to August 2010). Islam teaching hospital, Sialkot (September 2010to September 2012). Methods: 260 consecutive patients undergoing exploratory laparotomy for obstruction, peritonitis, pain and massabdomen were included in the study. Patient with established cause of obstruction were excluded. The data including demographicinformation, presentation, operative findings, complications and follow up were entered in structured proforma. Patients with less thanthree months of followup were also excluded from study. Results: Small bowel diverticuli were encountered in 24 (9%) out of 260 patientsincluding; 8 (3%) Meckel's, 9 (3.5%) jejunal, 3 (1.2%) duodenal and 4 (1.5%) Ileal diverticuli. These patients with diverticuli presented asintestinal obstruction, peritonitis, mass abdomen, vague abdominal pain and one patient with fresh bleeding per rectum. The indicationsof surgery were peritonitis 6 (25%), intestinal obstruction 13 (54.2%), abdominal mass 3(12.5%), nonspecific abdominal pain 1 (4.2%)and fresh bleeding per rectum of obscure origin 1 (4.2%). Complications encountered as Intestinal obstruction due to adhesion formationin 8; obstruction due to congenital bands attached to diverticuli in 3; diverticular perforation in 2; peritonitis due to diverticulitis in2,bleeding from arteriovenous malformation within the jejuna diverticuli in 1 and mass formation due to volvulus in 1. Three duodenaldiverticuli and 4 jejunal diverticuli were found as silent pathologies synchronous with other active pathologies.

Hernia interna estrangulada por plastrón en el tercio distal del apéndice cecal

2019 ◽  
Vol 62 (6) ◽  
pp. 24-27
Author(s):  
Leslie M. Leyva Sotelo ◽  
José E. Telich Tarriba ◽  
Daniel Ángeles Gaspar ◽  
Osvaldo I. Guevara Valmaña ◽  
André Víctor Baldín ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Early Diagnosis ◽  
Intestinal Obstruction ◽  
Acute Abdomen ◽  
Internal Hernia ◽  
Wide Spectrum ◽  
Internal Hernias ◽  
Mild Abdominal Pain ◽  
Made In

Internal hernias are an infrequent cause of intestinal obstruction with an incidence of 0.2-0.9%, therefore their early diagnosis represents a challenge. The most frequently herniated organ is the small bowel, which results in a wide spectrum of symptoms, varying from mild abdominal pain to acute abdomen. We present the case of an eight-year old patient with nonspecific digestive symptoms, a transoperative diagnosis was made in which an internal hernia was found strangulated by plastron in the distal third of the appendix. Appendectomy was performed and four days later the patient was discharged without complications.

scholarly journals Intestinal obstruction due to small bowel herniation through foramen of Winslow: a case report 

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
P. K. B. S. C. Bandara ◽  
A. M. Viraj Rohana ◽  
Aloka Pathirana
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Intestinal Obstruction ◽  
Reflux Disease ◽  
Bowel Loop ◽  
Internal Herniation ◽  
Small Bowel Loop ◽  
Foramen Of Winslow

Abstract Background Intestinal obstruction due to internal herniation of the bowel is a rare clinical entity which is often overlooked in the differential diagnosis of patients with abdominal pain who have no previous history of abdominal surgery. Several sites of bowel internal herniation have been described, amongst which internal herniation through the foramen of Winslow accounts for about 8% of cases. These patients present with nonspecific abdominal pain associated with symptoms of gastroesophageal reflux disease, and hence the diagnosis is often overlooked. The usual symptoms of intestinal obstruction can be delayed, which results in a delay in diagnosis and gangrene of the herniated bowel segment. Abdominal radiographs and computed tomography are helpful in the diagnosis. Open reduction is the management of choice; however, laparoscopic reduction has also been attempted, with good results. Case presentation We report a case of a middle-aged Sri Lankan man who presented with features of gastroesophageal reflux disease, developed features of intestinal obstruction and was found to have a gangrenous small bowel loop which had herniated through the foramen of Winslow. Following needle aspiration and reduction of the herniated small bowel loop, the gangrenous part of the small bowel was resected and an ileoileal anastomosis performed. The large foramen of Winslow was partially closed with interrupted stitches. The patient made an uneventful recovery. Conclusion Since delayed diagnosis of bowel obstruction is detrimental, it is of utmost importance to diagnose it early. Because internal herniation of the small bowel through the foramen of Winslow presents with nonspecific symptoms including features of gastroesophageal reflux disease, as documented in several cases worldwide and also presented by our patient, there should be a high degree of suspicion of internal herniation of the bowel causing bowel obstruction and low threshold for extensive investigation of patients presenting with symptoms of gastroesophageal reflux disease which does not resolve with usual medication.

scholarly journals T-shaped Meckel’s diverticulum: a rare anatomical variant complicating small bowel volvulus

2018 ◽  
Vol 5 (8) ◽  
pp. 2929
Author(s):  
Vergis Paul ◽  
Ramu R. ◽  
Kocheril Sheryl Mathews ◽  
Ashly Thomas ◽  
Reesha P. A. ◽  
...  
Keyword(s):  
Small Bowel ◽  
Intestinal Obstruction ◽  
Terminal Ileum ◽  
Meckel’S Diverticulum ◽  
Exploratory Laparotomy ◽  
Meckel's Diverticulum ◽  
Anatomical Variant ◽  
Small Bowel Volvulus ◽  
Common Presentation ◽  
Congenital Diverticulum

The Meckel's diverticulum is a congenital diverticulum arising from the terminal ileum and is the unobliterated proximal portion of the vitellointestinal duct. Intestinal obstruction due to Meckel’s diverticulum is the most common presentation in adults and is the second most common presentation in children. We present a case of a 58-year-old gentleman presented with acute abdomen who was later found to have Giant T- shaped Meckel’s Diverticulum complicating small bowel volvulus on exploratory laparotomy. A T-shaped Meckel's diverticulum has not yet been described.

scholarly journals Concurrent intestinal malrotation and Meckel's diverticulum presenting as acute intestinal obstruction in an adult

2021 ◽  
Vol 8 (6) ◽  
pp. 1904
Author(s):  
Aishwarya Emerald Manohar ◽  
M. S. Kalyan Kumar ◽  
V. Vijayalakshmi ◽  
R. Kannan
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Intestinal Obstruction ◽  
Meckel’S Diverticulum ◽  
Postoperative Recovery ◽  
Meckel's Diverticulum ◽  
Intestinal Malrotation ◽  
Emergency Laparotomy ◽  
Meckel’S Diverticulitis ◽  
Subacute Intestinal Obstruction

Intestinal malrotation is the partial or complete failure of rotation of midgut around the superior mesenteric artery, while Meckel’s diverticulum is the remnant of vitellointestinal duct and concurrence of these congenital abnormalities in an adult is considered a rarity. Till date only 3 cases of concurrent intestinal malrotation and Meckel's diverticulum have been reported. We report a 18 years male who presented with a 3 day history of abdominal pain, bilious vomiting, obstipation and chronic abdominal pain on and off since 3 years of age. During the last episode which occurred 1 year back, he was diagnosed with intestinal malrotation with subacute intestinal obstruction and was treated conservatively. Examination revealed the presence of signs of peritonitis. After resuscitation, CECT abdomen was taken which showed dilated small bowel loops in the subhepatic region associated with malrotation. Emergency laparotomy revealed a Ladd's band below which the gangrenous small bowel loops 150 cm from the duodenojejunal (flexure until 5 cm proximal to the ileocecal junction) were found herniating into the subhepatic region with a Meckel’s diverticulum and a right sided DJ flexure. We proceeded with the band release and resection of gangrenous bowel followed by proximal jejunostomy with distal ileostomy. HPE was consistent with Meckel’s diverticulitis without any ectopic gastric or pancreatic mucosa. Ostomy reversal was done after 8 weeks. Patient had an uneventful postoperative recovery during both the admissions and he is on regular follow-up now.

scholarly journals Difficult to Diagnose the Cause of Intestinal Obstruction due to Abdominal Cocoon Syndrome

2021 ◽  
Author(s):  
Cemal Ulusoy ◽  
Andrej Nikolovski ◽  
Nazım Öztürk
Keyword(s):  
Small Bowel ◽  
Intestinal Obstruction ◽  
Small Bowel Obstruction ◽  
Abdominal Mass ◽  
Clinical Signs ◽  
Rare Condition ◽  
Abdominal Cocoon ◽  
Sclerosing Encapsulating Peritonitis ◽  
Encapsulating Peritonitis ◽  
Palpable Abdominal Mass

Abdominal cocoon syndrome (sclerosing encapsulating peritonitis) is a rare condition associated with clinical signs of intestinal dysfunction, episodes of small bowel obstruction and sometimes a palpable abdominal mass. We present the case of a 46-year-old male patient with clinical signs of intestinal obstruction caused by primary sclerosing encapsulating peritonitis.

scholarly journals Small bowel knots

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.

SMALL INTESTINAL CARCINOID TUMOR-A CASE REPORT

2021 ◽  
pp. 36-37
Author(s):  
B. Santhi ◽  
S. Savitha ◽  
V. G. Vikraman
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Exploratory Laparotomy ◽  
Wall Thickening ◽  
Lower Quadrant ◽  
Polypoidal Lesion ◽  
Contrast Enhanced ◽  
Intraluminal Mass ◽  
Enhanced Computed Tomography ◽  
Contrast Enhanced Computed Tomography

Carcinoid tumors are neuroendocrine tumours, the most common tumour of the small bowel and its incidence is rising. Most carcinoid tumours grow slowly and mostly asymptomatic or may present with nonspecic abdominal pain or carcinoid syndrome. We had a 38 year old, female patient presented with generalized, intermittent, dull aching abdominal pain accompanied with distension and obstipation for 2 days with associated vomiting. She complained of weight loss and constipation during this period. On examination abdomen showed deep tenderness in periumbilical, right lower quadrant regions. No guarding, rigidity, mass or free uid. On per-rectal examination, there was no tenderness and the rectum was empty. Contrast enhanced computed tomography scan showed enhancing polypoidal lesion noted in distal ileum causing proximal dilatation of small bowel with air uid levels and circumferential wall thickening in dilated ileum proximal to polypoidal lesion, strongly enhancing nodal mass with specs of calcication, multiple mesentric lymph nodes and no liver metastasis. As the conservative management for 48 hours showed no improvement in symptoms, an emergency exploratory laparotomy was performed, and an intraluminal mass was identied from ileocecal junction causing obstruction with dilated loops of ileum and jejunum. Local resection of terminal ileum was performed and a side to side anastomoses was done using GI stapler. Histopathology showed diagnosis of neuroendocrine tumor

scholarly journals An Obstructing Small Bowel Phytobezoar in an Elderly Female Nigerian: A Case Report and Literature Review

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
O. S. Balogun ◽  
A. O. Osinowo ◽  
M. O. Afolayan ◽  
A. A. Adesanya
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Primary Closure ◽  
Abdominal Distension ◽  
Exploratory Laparotomy ◽  
Postoperative Recovery ◽  
Elderly Female ◽  
Insidious Onset

Small bowel obstruction secondary to phytobezoars is an unusual presentation in surgery. We present a case of an elderly female patient with an insidious onset of abdominal pain, abdominal distension, and bilious vomiting diagnosed radiologically to be small bowel obstruction. Exploratory laparotomy revealed a trapped mass of vegetable matter in the distal ileum. She had enterotomy with primary closure for removal of obstructing ileal phytobezoars. Her postoperative recovery was uneventful.

scholarly journals Perforated Meckel’s Diverticulum Lithiasis: An Unusual Cause of Peritonitis

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Umasankar Mathuram Thiyagarajan ◽  
Amirthavarshini Ponnuswamy ◽  
Atul Bagul ◽  
Prabakar Ponnuswamy
Keyword(s):  
Gastrointestinal Tract ◽  
Small Bowel ◽  
Intestinal Obstruction ◽  
Acute Abdomen ◽  
Congenital Malformation ◽  
Healthy Individual ◽  
Stone Formation ◽  
Meckel’S Diverticulum ◽  
Exploratory Laparotomy ◽  
Meckel's Diverticulum

Meckel’s diverticulum is the commonest congenital malformation of gastrointestinal tract and represents a persistent remnant of the omphalomesenteric duct. Although it mostly remains silent, it can present as bleeding, perforation, intestinal obstruction, intussusception, and tumours. These complications, especially bleeding, tend to be more common in the paediatric group and intestinal obstruction in adults. Stone formation (lithiasis) in Meckel’s diverticulum is rare. We report a case of Meckel’s diverticulum lithiasis which presented as an acute abdomen in an otherwise healthy individual. The patient underwent an exploratory laparotomy which revealed a perforated Meckel’s diverticulum with lithiasis; a segmental resection with end-to-end anastomosis of small bowel was performed. Patient recovery was delayed due to pneumonia, discharged on day 20 with no further complications at 6 months following surgery.

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