scholarly journals Early parastomal evisceration of small bowel following a loop ileostomy for malignant intestinal obstruction

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110158
Author(s):  
Oshan Basnayake ◽  
Y Prasanthan ◽  
Umesh Jayarajah ◽  
NMPG Ganga ◽  
Kanishka De Silva
Keyword(s):  
Small Bowel ◽  
Intestinal Obstruction ◽  
Bronchial Asthma ◽  
Rare Complication ◽  
Loop Ileostomy ◽  
Emergency Laparotomy ◽  
Aortic Lymph Node ◽  
Poor Nutritional Status ◽  
Life Threatening ◽  
Metastatic Colonic Cancer

Evisceration of bowel through the stoma is a rare complication and only few cases have been reported. Although most cases occur in the context of long-standing parastomal hernias, early evisceration may also occur causing significant morbidity to patients. The reported patient is a 53-year-old male with bronchial asthma who was diagnosed to have metastatic colonic cancer underwent a trephine loop ileostomy for intestinal obstruction. On post-operative Day 7, he developed small bowel evisceration through the ileostomy site. The patient underwent an emergency laparotomy and found to have non-viable prolapsed small bowel segment at the stoma site. Furthermore, there were extensive peritoneal deposits and large para aortic lymph node mass and ascites compromising the peritoneal space. Resection of non-viable small bowel and ileostomy refashioning was carried out. The patient was managed in the intensive care unit and he gained function of the ileostomy on post-operative Day 2. On Day 5, he died due to subsequent pneumonia and worsening acute respiratory distress syndrome. Early parastomal evisceration is an extremely infrequent life-threatening complication that requires urgent treatment. Disseminated cancer, bowel obstruction, poor nutritional status, ascites and exacerbation of bronchial asthma were additional risk factors in our patient.

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 Recurrent Intestinal Obstruction after Radiation Therapy: A Case Report and Review of the Literature

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
James Nguyen ◽  
Amani Jambhekar ◽  
Ziyad Nasrawi ◽  
Prasad Gudavalli
Keyword(s):  
Rectal Cancer ◽  
Case Report ◽  
Small Bowel ◽  
Intestinal Obstruction ◽  
Loop Ileostomy ◽  
Neoadjuvant Chemoradiation ◽  
Ileocolic Anastomosis ◽  
Neoadjuvant Radiotherapy ◽  
Diverting Loop Ileostomy ◽  
Radiation Induced

Introduction. In patients who have undergone resection for rectal cancer after neoadjuvant radiotherapy, loop ileostomy is commonly performed with few serious complications. In rare cases, if this irradiated small bowel is strictured, reversal of the affected ileostomy can have dire consequences. We present a case of a 62-year-old male with recurrent intestinal obstruction after closure of his loop ileostomy. Case Report. RC is a 62-year-old male who initially presented with rectal cancer and underwent neoadjuvant chemoradiation prior to a laparoscopic low anterior resection with diverting loop ileostomy. He underwent elective reversal of his ileostomy and developed persistent postoperative obstruction. He underwent resection of the prior reversal site with normal-appearing dilated proximal bowel loops and collapsed distal bowel loops. He again developed an obstructive picture and underwent resection of the prior anastomosis with creation of an ileocolic anastomosis, after which he recovered well postoperatively. Conclusion. In patients who receive radiation adjuvant therapy for colon cancer, radiation-induced stricture should be considered as a cause of small bowel obstruction postoperative. In the setting of a longstanding ileostomy, evaluation of a defunctionalized distal ileum may be necessary to evaluate potential obstruction from radiation changes.

scholarly journals Diaphragmatic hernia: a rare complication of hepatic ablation

2020 ◽  
Vol 65 (3) ◽  
pp. 103-106
Author(s):  
Mark T Macmillan ◽  
Shueh Hao Lim ◽  
Hamish M Ireland
Keyword(s):  
Microwave Ablation ◽  
Rare Complication ◽  
Diaphragmatic Injury ◽  
Diaphragmatic Defect ◽  
Emergency Laparotomy ◽  
Effective Technique ◽  
Case Presentation ◽  
Hepatocellular Carcinomas ◽  
Hepatic Ablation ◽  
Life Threatening

Introduction Ablation has become an effective treatment for small hepatocellular carcinomas (HCC). Whilst ablation is a safe and effective technique, diaphragmatic injury is a rarely associated but significant complication. Case presentation: We present a case of a 67 year old patient who developed a diaphragmatic defect following microwave ablation (MWA) for HCC. The diaphragmatic defect progressed to herniation which was complicated by perforation of intrahernial large bowel. The patient was treated by emergency laparotomy and an extended right hemi-colectomy was performed. Conclusion Our report adds to the current available knowledge on diaphragmatic injury following hepatic ablation and demonstrates the potential for life threatening consequences associated with this complication.

scholarly journals 798 A Rare Complication and Unexpected Pathology Following an Anterior Exenteration – A Case Report

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Robertson ◽  
G Lazaraviciute ◽  
L Kerr ◽  
D Hendry
Keyword(s):  
Case Report ◽  
Small Bowel ◽  
Abdominal Wall ◽  
Abdominal Wall Defect ◽  
Rare Complication ◽  
Endometrial Adenocarcinoma ◽  
Abdominal Wall Reconstruction ◽  
Emergency Laparotomy ◽  
Proximal Thigh ◽  
Urachal Adenocarcinoma

Abstract We present a case report of an unexpected pathology in addition to a rare complication in a 62-year-old female following an anterior exenteration and an abdominal wall reconstruction. Initial biopsies characterised the malignancy as a potential urachal adenocarcinoma, but the final pathology revealed a solitary endometrial adenocarcinoma metastasis from endometrial cancer 6 years previously. Due to the nature of the tumour, an abdominal wall resection was required, and reconstruction involved a pedicled thigh flap. Post-operatively the small bowel herniated under the flap and this resulted in true mechanical small bowel obstruction. The loop of herniated bowel is visible on CT imaging in the area of the proximal thigh. The patient returned to theatre for an emergency laparotomy and the abdominal wall defect was closed instead with a surgical implant derived from animal tissue. The patient made an excellent recovery, was discharged home, and continues to do well. This patient is an example of excelling in adversity.

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 796 Chronic Pneumoperitoneum: Cause or Consequence of Pneumatosis Cystoides Intestinalis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Baggaley ◽  
C Clements ◽  
I Gerogiannis ◽  
I Bloom
Keyword(s):  
Small Bowel ◽  
Unusual Case ◽  
Unknown Origin ◽  
Small Bowel Resection ◽  
Pneumatosis Cystoides Intestinalis ◽  
Emergency Laparotomy ◽  
Spontaneous Pneumoperitoneum ◽  
Life Threatening ◽  
General Surgeons ◽  
Perforated Viscus

Abstract Pneumatosis cystoides intestinalis (PCI), ‘gas cysts’ in the wall of the bowel, is a rare sign that can be found as a result of many different conditions, ranging from benign and asymptomatic, to life threatening. Its pathogenesis is not yet fully understood, and patients found to have PCI are treated in a heterogeneous manner. Pneumoperitoneum, however, is much more commonly seen by the General Surgeons, and most often occurs as a result of a perforated viscus; usually necessitating an emergent surgical intervention. Spontaneous pneumoperitoneum occurs very rarely, although it is seen more frequently with small bowel PCI, compared to large bowel PCI. We present here an unusual case of a patient with acute-on-chronic pneumoperitoneum and subsequently subacute small bowel obstruction associated with small bowel pneumatosis cystoides intestinalis. The patient also had extensive pan colonic and jejunal diverticulosis, although the area of perforation and PCI was discrete and located in the mid-ileum. It is unclear whether the patient had chronic pneumoperitoneum secondary to perforated PCI, or if the PCI developed secondary to an ileum perforation of unknown origin (fitting with the bacterial or mechanical theory of pathogenesis). The patient went onto to have an emergency laparotomy and small bowel resection 28 months after initial presentation and a trial of conservative management.

scholarly journals Small Bowel Obstruction due to Mesodiverticular Band of Meckel's Diverticulum: A Case Report

2010 ◽  
Vol 2010 ◽  
pp. 1-3 ◽  
Author(s):  
Aziz Sumer ◽  
Ozgur Kemik ◽  
Aydemir Olmez ◽  
A. Cumhur Dulger ◽  
Ismail Hasirci ◽  
...  
Keyword(s):  
Congenital Anomaly ◽  
Small Intestine ◽  
Case Report ◽  
Small Bowel ◽  
Intestinal Obstruction ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Rare Complication ◽  
Meckel’S Diverticulum ◽  
Meckel's Diverticulum

Meckel's diverticulum is the most common congenital anomaly of the small intestine. Common complications related to a Meckel's diverticulum include haemorrhage, intestinal obstruction, and inflammation. Small bowel obstruction due to mesodiverticular band of Meckel's diverticulum is a rare complication. Herein, we report the diagnosis and management of a small bowel obstruction occurring due to mesodiverticular band of a Meckel's diverticulum.

629 Small Bowel Entrapment Secondary to An Acetabular Fracture: A Case Report

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
J East ◽  
C Nzekwue ◽  
R Karthikeyan
Keyword(s):  
Small Bowel ◽  
Bowel Obstruction ◽  
Acetabular Fracture ◽  
Rare Complication ◽  
Primary Anastomosis ◽  
High Energy ◽  
Pelvic Fractures ◽  
Emergency Laparotomy ◽  
Diagnostic Challenge ◽  
Acetabular Fragment

Abstract Bowel entrapment within a pelvic fracture is a rare clinical occurrence. The first reported case was documented in 1907, with only 24 further cases reported in the literature since. Entrapment usually involves mobile segments of bowel and various fracture sites within the pelvis have been implicated. We report a case of a 31-year-old ‘trauma alert’, who sustained pelvic fractures following a pedestrian vs car ‘RTC’. The patient was initially taken to theatre for an examination under anaesthesia, where an immobile acetabular fragment was identified, but the hip joint was felt to be stable. A Denham pin was placed in the distal femur and traction applied. Two days post admission they developed abdominal pain and vomiting. A subsequent CT scan demonstrated small bowel entrapment within the acetabular fracture causing a mechanical obstruction. Emergency laparotomy confirmed an intra-acetabular hernia which was released via an extra-peritoneal route. A section of necrotic bowel was resected, and a primary anastomosis performed. Bowel entrapment poses a difficult diagnostic challenge and there is often a delay in diagnosis. Despite advances in imaging, initial radiographic features can be subtle, and it can be difficult to distinguish clinically between mechanical bowel obstruction and adynamic ileus. This case highlights that bowel entrapment is an important consideration in patients with pelvic fractures following high energy trauma. Awareness of this rare complication and a high index of suspicion are key to early diagnosis and timely surgical intervention, which has the potential to prevent significant complications including bowel obstruction, acute peritonitis and death.

scholarly journals A rare case of intestinal obstruction caused by internal hernia through post hysterectomy peritoneal defect

2021 ◽  
Vol 8 (4) ◽  
pp. 1347
Author(s):  
Ravi Kumar Sabu Murugesan ◽  
Kannan Ross ◽  
Joyce Prabakar
Keyword(s):  
Small Bowel ◽  
Intestinal Obstruction ◽  
Internal Hernia ◽  
Rare Case ◽  
Emergency Laparotomy ◽  
Female Status ◽  
Internal Hernias ◽  
Bowel Movements ◽  
Operative Findings ◽  
Increasing Trends

Internal hernia is a rare cause of intestinal obstruction. Nowadays acquired internal hernias are in increasing trends due to increased surgical procedures thus iatrogenic causes surpassing congenital internal hernias. Internal hernias after hysterectomy due to peritoneal defect is extremely rare. Here we present a case of 67 years old female status post hysterectomy ten years back, also a known type 2 diabetic presented to the emergency department with features suggestive of intestinal obstruction. Patient was taken up for emergency laparotomy and intra operative findings revealed small bowel loops herniating in a cavity that is formed by bladder anteriorly, caecum and sigmoid colon laterally and rectum posteriorly. Bowel loops were released. The bowel was found to be viable and the defect was closed. Bowel movements resumed on the third post-operative day. This case is presented here as it is an extremely rare case of internal hernia causing small bowel obstruction.

scholarly journals Spontaneous Evisceration of Incisional Hernia with Strangulation of Small Bowel: A Life Threatening Complication

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Nanduni Thalahitiyage ◽  
Sanjeevan Ravindrakumar ◽  
Janaka Nandasena ◽  
Arooran Krishnakumar ◽  
KirushanthanVeerasingam ◽  
...  
Keyword(s):  
Small Bowel ◽  
Incisional Hernia ◽  
Curative Resection ◽  
Rare Complication ◽  
Endometrial Adenocarcinoma ◽  
Life Threatening ◽  
History Of ◽  
Life Threatening Complication ◽  
Stage 1 ◽  
Threat To Life

Spontaneous evisceration of abdominal viscera is a rare complication of incisional hernia which could pose a serious threat to life if intervention is delayed. We report a case of a 62-year-old female with a history of curative resection for stage 1 endometrial adenocarcinoma 3 years ago, presenting with spontaneous evisceration of incisional hernia with strangulation of small bowel. Immediate resuscitation followed by emergency surgery was mandatory. During surgery, priority should be given to release the strangulation as soon as possible and the type of repair would depend on the viability of the bowel and the anatomy of the incisional hernia.

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