ACUTE INTESTINAL OBSTRUCTION - A RARE PRESENTATION OF MUCINOUS CYSTADENOMA OF APPENDIX

Background: Intestinal malrotation refers to the partial or complete failure of rotation of midgut around the superior mesenteric vessels in embryonic life. Arrested midgut rotation results due to narrow-based mesentery and increases the risk of twisting midgut and subsequent obstruction and necrosis. Midgut volvulus secondary to intestinal malrotation is a rare presentation in adults more so in the elderly. Its rarity portends a diagnostic dilemma for both the surgeon and radiologist, and CT scan showed dilated large and small intestine segments with air-fluid levels and twisted mesentery around superior mesenteric artery and vein indicating "whirlpool sign". In our patient Case presentation: 42 years old male who presented to the emergency department with acute onset of pain in the RUQ, vomiting, and absolute obstipation for the last 2 days. This patient had a history of similar two episodes of sub-acute intestinal obstruction in the last 6 months which has been managed conservatively. The patient underwent an elective exploratory laparotomy after 2 days of failed conservative management. Operative findings included the presence of adhesive bands in the RUQ (Ladd's Band), volvulus of the mid-portion of the small bowel in a clockwise fashion, and multiple intraabdominal adhesions and empty RIF and caecum pulled up in RUQ. We subsequently performed a Ladd's procedure, multiple adhesiolysis, and caecopexy and the patient had an uneventful recovery with eventual discharge on postoperative day 12. This case report reviews the incidence of malrotation in adults. It also high Conclusion: lights the difficulty in diagnosing midgut volvulus in the adult population given the nonspecific, insidious symptoms, therefore, prompting awareness of its existence and a high degree of clinical suspicion. Malrotation should be considered in the differential diagnosis in patients presented with acute abdomen and intestinal ischemia.

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Acute intestinal obstruction: A rare presentation of left sided adult congenital diaphragmatic hernia

Hellenic Journal of Surgery ◽

10.1007/s13126-015-0251-0 ◽

2015 ◽

Vol 87 (5) ◽

pp. 427-429 ◽

Cited By ~ 3

Author(s):

Shamita Chatterjee ◽

Arnab Mitra ◽

Suman Sarkar ◽

Sandeep Prasad

Keyword(s):

Intestinal Obstruction ◽

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Acute Intestinal Obstruction ◽

Rare Presentation ◽

Adult Congenital

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Rare Presentation of Acute Intestinal Obstruction: Cecal Volvulus with Malrotation

Journal of Case Reports ◽

10.17659/01.2019.0009 ◽

2019 ◽

pp. 33-35

Author(s):

S Pramod ◽

Ganesh Kumar

Keyword(s):

Intestinal Obstruction ◽

Acute Intestinal Obstruction ◽

Cecal Volvulus ◽

Rare Presentation

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Isolated segmental mega-diverticulosis of ileum: a rare presentation of acute intestinal obstruction

International Surgery Journal ◽

10.18203/2349-2902.isj20172419 ◽

2017 ◽

Vol 4 (6) ◽

pp. 2098

Author(s):

Veena A. ◽

Hanumanthaiah K. S. ◽

Manjunath K. ◽

Sandeep S. ◽

Sai Suraj Kotera

Keyword(s):

Intestinal Obstruction ◽

Terminal Ileum ◽

Interesting Case ◽

Acute Intestinal Obstruction ◽

Rare Entity ◽

Rare Presentation ◽

Pathological Evaluation ◽

Initial Imaging ◽

Operative Findings ◽

Low Prevalence

We present an interesting case of acute intestinal obstruction where a woman, aged 26, presented to emergency room with constipation for 2 days and vomiting for 1 day. The examination and initial imaging suggested sub-acute intestinal obstruction, since the condition progressed she was taken to operating room for laparotomy. The intra-operative findings revealed isolated segmental mega-diverticulosis of ileum. She underwent resection of terminal ileum and caecum with ileo-colic anastomosis. Pathological evaluation of specimen showed diverticular features. Ileal diverticulosis excluding Meckel’s is an extremely rare entity and complicating into acute intestinal obstruction is strange. With a low prevalence and absence of suspicion for it, diagnosis will be made intra operatively most of the time.

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Rare case of paracaecal hernia with intussusception presenting as small bowel obstruction: case report

International Surgery Journal ◽

10.18203/2349-2902.isj20201890 ◽

2020 ◽

Vol 7 (5) ◽

pp. 1662

Author(s):

M. S. Kalyan Kumar ◽

Shyamsundar R. ◽

Sabari Girieasan M. ◽

R. Kannan ◽

S. Nedunchezhiyan

Keyword(s):

Intestinal Obstruction ◽

Internal Hernia ◽

Exploratory Laparotomy ◽

Acute Intestinal Obstruction ◽

Emergency Laparotomy ◽

High Morbidity ◽

Rare Presentation ◽

Ileal Loop ◽

Rare Type ◽

Internal Hernias

Primary internal hernias are very rare in adults. They are an unusual cause of small intestinal obstruction and lead to high morbidity and mortality if left untreated. Clinical presentation of internal hernia is highly nonspecific. Imaging has limited role in diagnosing the cause of acute intestinal obstruction. Internal hernias are usually detected at laparotomy. We report a case of a 61-year-old male who presented with acute intestinal obstruction which was attributed later to a very rare type of internal hernia on exploratory laparotomy. A loop of ileum was found to enter the retroperitoneum through a hernia gate which was located lateral to the caecum and ileo ileal intussusception was noted proximal to the herniated loop. The segment of intestine was resected and anastamosed then hernial defect was closed. Paracaecal hernias are the rare type of hernias in internal hernia. In our case, intussusception was noted proximal to the herniated ileal loop which is a very rare presentation. Intussusception was reported previously with paraduodenal type. One should always keep in mind while conducting emergency laparotomy, internal hernias can be a cause for intestinal obstruction.

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