INTESTINAL MALROTATION - A COMMON YET DEADLY CAUSE OF NEONATAL SMALL BOWEL OBSTRUCTION

Background: This study was done at SMS Medical College, Jaipur with an aim of emphasizing the need of having a high index of suspicion in newborn presenting with bilious vomiting for the diagnosis of malrotation. Methods: Cases of neonatal small intestinal obstruction due to malrotation presenting to the Department of Paediatric Surgery, SMS Medical College, Jaipur over a period of two years were evaluated. Results: A total of 48 newborns presented to our department with intestinal obstruction due to malrotation. Majority (82%) of the patients presented in the 2nd and 3rd week of life. 6 out of 48 patients presented with extensive gangrene of midgut. 9/48 patients died during the course of treatment and during follow-up. Conclusion: Malrotation is a relatively common cause of neonatal small bowel obstruction. A high index of suspicion is required in neonates presenting with bilious vomiting. Prompt diagnostic tools and early laparotomy prevents fatal complication of extensive midgut gangrene due to volvulus.

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Neonatal small bowel obstruction due to malrotation: a clinical study

International Surgery Journal ◽

10.18203/2349-2902.isj20173107 ◽

2017 ◽

Vol 4 (8) ◽

pp. 2727 ◽

Cited By ~ 2

Author(s):

Srinivas S. ◽

Reddy K. R. ◽

Balraj T. A. ◽

Gangadhar A.

Keyword(s):

Small Bowel ◽

Intestinal Obstruction ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Pediatric Surgery ◽

Clinical Presentation ◽

Midgut Volvulus ◽

Fatal Complication ◽

Small Intestinal ◽

High Index Of Suspicion

Background:This study was done at Niloufer hospital and institute of child health, Hyderabad with an aim of evaluating the clinical presentation, diagnostic evaluation, management and outcome of malrotation of intestines in the neonates.Methods: Cases of neonatal small intestinal obstruction due to malrotation presenting to the Department of Pediatric Surgery, Niloufer hospital over a period of two years were evaluated.Results: A total of 38 newborns presented to our department with intestinal obstruction due to malrotation. 3/38 patients presented with extensive gangrene of midgut. 4/38 patients died during the course of treatment.Conclusions: Malrotation is a relatively common cause of neonatal small bowel obstruction. A high index of suspicion is needed in neonates presenting with bilious vomiting. Early laparotomy prevents fatal complication of extensive gangrene due to midgut volvulus.

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A Rare Case of Endometriosis of the Small Bowel

Case Reports in Pathology ◽

10.1155/2021/6676855 ◽

2021 ◽

Vol 2021 ◽

pp. 1-3

Author(s):

Moisés R. Zepeda ◽

Su K. Win

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Clinical Condition ◽

Rare Case ◽

High Index ◽

Clinical Event ◽

Clinical Encounters ◽

Abdominal Symptoms ◽

High Index Of Suspicion

Endometriosis of the small bowel is a rare clinical event. The clinical condition presents with vague abdominal symptoms and is usually not diagnosed acutely, unless clinicians have a high index of suspicion. Most patients are diagnosed after multiple clinical encounters. We present a case of endometriosis causing small bowel obstruction diagnosed postsurgically.

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META-ANALYSIS ON ETIOPATHOGENESIS OF SMALL BOWEL OBSTRUCTION IN THE DEPARTMENT OF GEN. SURGERY P.M.C.H. & K.M.C.H., BIHAR

10.36106/ijsr/6700138 ◽

2021 ◽

pp. 1-3

Author(s):

Abhishek Chaudhary ◽

Kanchan Sone Lal Baitha ◽

Yasir Tajdar

Keyword(s):

Small Intestine ◽

Small Bowel ◽

Abdominal Surgery ◽

Intestinal Obstruction ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Meta Analysis ◽

Ileocaecal Valve ◽

Time Period ◽

Ligament Of Treitz

Background:The small intestine is the longest and convoluted portion in the digestive tract. It starts from pylorus and ends at ileocaecal valve. The small bowel consists of three parts measuring about 5 to 6 meters. The rst 25cm is the duodenum. Out of the rest part of small gut, jejunum th th. constitute the proximal 2/5 and ileum distal 3/5 The jejunum and ileum extend from the peritoneal fold that supports the duodeno-jejunal junction (Ligament of Treitz) down to ileocaecal valve. Material and Methods:All the patients admitted to PMCH, Patna and KMC, Katihar as intestinal obstruction was included for the study. The time period of study was from October 2014 to November 2016 in PMCH and December 2016 to January 2019 in KMC, Katihar. Out of all Intestinal obstruction 59 cases only of adult small gut obstruction were recorded for comparison and conclusive study.Conclusion: Small bowel obstruction remains a frequently encountered problem in abdominal surgery. Although modern day surgical management continues to focus appropriately on avoiding delayed operation, whatever surgery is indicated, not every patient is always best served by immediate operation

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SMALL BOWEL OBSTRUCTION SECONDARY TO OBTURATOR HERNIA: A PRE-OPERATIVE DIAGNOSIS AT COMPUTED TOMOGRAPHY

Journal of Clinical and Health Sciences ◽

10.24191/jchs.v6i1.8868 ◽

2021 ◽

Vol 6 (1) ◽

pp. 46-49

Author(s):

Marlina Tanty Ramli ◽

Mohd Shukry Mohd Khalid ◽

Kartini Rahmat

Keyword(s):

Computed Tomography ◽

Small Bowel ◽

Elderly Patients ◽

Intestinal Obstruction ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Surgical Intervention ◽

Obturator Hernia ◽

Uneventful Recovery ◽

Presenting Symptoms

Obturator hernia is rare, but it must be considered in elderly patients who present with small bowel obstruction. The diagnosis is challenging unless there is a high index of suspicion as the presenting symptoms and signs are usually non-specific. Presence of positive Howship-Romberg sign is considered pathognomonic. Early diagnosis and rapid surgical intervention will reduce the high morbidity and mortality associated with undiagnosed obturator hernia. We report a case of a 93-year-old female patient who was admitted to our surgical department with symptoms of intestinal obstruction of 3-days duration. Howship-Romberg sign was negative. Computed tomography (CT) demonstrated the presence of left obturator hernia with proximal small bowel obstruction and no sign of strangulation. The patient had emergency laparotomy post-CT where the incarcerated bowel loop was released and the obstructed bowel was decompressed without any complication. The hernial defect was close with a mesh and the patient had an uneventful recovery post-surgery. In this case, we highlight that diagnosis of obturator hernia must always be considered in elderly patients who present with intestinal obstruction. Urgent CT could establish a rapid pre-operative diagnosis and aids inappropriate surgical intervention planning which is crucial in optimising the outcome.

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Acute Small-Bowel Obstruction From Intestinal Anisakiasis After the Ingestion of Raw Clams; Documenting a New Method of Marine-to-Human Parasitic Transmission

Open Forum Infectious Diseases ◽

10.1093/ofid/ofu087 ◽

2014 ◽

Vol 1 (2) ◽

Cited By ~ 6

Author(s):

Ehyal Shweiki ◽

David W. Rittenhouse ◽

Joana E. Ochoa ◽

Viren P. Punja ◽

Muhammad H. Zubair ◽

...

Keyword(s):

Small Bowel ◽

Intestinal Obstruction ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Parasitic Infection ◽

Human Infection ◽

New Method ◽

Acute Small Bowel Obstruction ◽

Intestinal Anisakiasis

Enteric anisakiasis is a known parasitic infection. To date, human infection has been reported as resulting from the inadvertent ingestion of the anisakis larvae when eating raw/undercooked fish, squid, or eel. We present a first reported case of intestinal obstruction caused by anisakiasis, after the ingestion of raw clams.

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Evaluation of the role of oral gastrografin in management of simple adhesive small bowel obstruction in children

International Surgery Journal ◽

10.18203/2349-2902.isj20190391 ◽

2019 ◽

Vol 6 (2) ◽

pp. 498

Author(s):

Almoutaz A. Eltayeb ◽

Nagla H. Abufaddan

Keyword(s):

Small Bowel ◽

Intestinal Obstruction ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Randomized Study ◽

Total Duration ◽

Oral Feeding ◽

Adhesive Small Bowel Obstruction ◽

Number Of Patients

Background: The risk of post-operative adhesive small intestinal obstruction is highest during the first post-operative year. Bowel injury during adhesiolysis increases the post-operative morbidity. Consequently, the conservative management of small bowel obstruction has considerable interest. The aim of this study was to evaluate the therapeutic role of gastrografin in the management of small bowel obstruction.Methods: All patients with simple adhesive small bowel obstruction will be included and treated conservatively for 48hours unless there was evidence of strangulation. After the first 48hours all the patients were given oral gastrografin unless improved or signs of strangulation arise. The evaluating parameters are the success rate, time to start full oral feeding and total duration of hospital stay.Results: Twenty-five cases were included in which two of them developed clinical evidence of strangulation during the first 48hours and were explored. Three cases improved on the conservative treatment. The remaining twenty cases were given oral gastrografin. Fourteen cases out of twenty showed the contrast dye in their large bowel by 24hours. Those 14 cases tolerated full oral feeding earlier and had shorter hospital stay than the remaining 6 cases that declared treatment failure and underwent surgical exploration.Conclusions: The use of gastrografin as a preliminary step of non-surgical treatment of simple adhesive intestinal obstruction may be helpful. However, further randomized study on a large number of patients was needed.

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Bile Salt Enterolith: An Unusual Etiology Mimicking Gallstone Ileus

Case Reports in Surgery ◽

10.1155/2018/8965930 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3

Author(s):

Dana Ferrari-Light ◽

Ariel Shuchleib ◽

Joel Ricci-Gorbea

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Surgical Intervention ◽

Gallstone Ileus ◽

Duodenal Diverticulum ◽

Multiple Risk Factors ◽

History Of ◽

High Index Of Suspicion ◽

Distal Jejunum

Primary enterolithiasis is a relatively uncommon but important cause of small bowel obstruction. We present a case of a 69-year-old male with a history of laparoscopic Roux-en-Y gastric bypass and asymptomatic duodenal diverticulum diagnosed with small bowel obstruction. CT imaging showed an obstruction distal to the jejunojejunostomy, and surgical intervention was warranted. A 4.5 cm enterolith removed from the distal jejunum was found to contain 100% bile salts, consistent with a primary enterolith. Clinicians should retain a high index of suspicion for enteroliths as a cause of small bowel obstruction, especially if multiple risk factors for enterolith formation are present.

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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 ◽

10.1093/bjsopen/zrab032.052 ◽

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.

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Study of clinical spectrum and management of acute intestinal obstruction

International Surgery Journal ◽

10.18203/2349-2902.isj20181060 ◽

2018 ◽

Vol 5 (4) ◽

pp. 1310

Author(s):

N. K. Jaiswal ◽

Sandeep Shekhar ◽

Pushkar Ranade

Keyword(s):

Abdominal Pain ◽

Small Bowel ◽

Intestinal Obstruction ◽

Bowel Obstruction ◽

Large Bowel ◽

Signs And Symptoms ◽

Large Bowel Obstruction ◽

Acute Intestinal Obstruction ◽

Medical College ◽

Tertiary Centre

Background: Acute intestinal obstruction is one of the major surgical emergencies. Intestinal obstruction is defined as partial or complete interference with forward flow of small or large intestinal contents. Intestinal obstruction of either small or large bowel continues to be a major cause of morbidity and mortality. Study aims to find the aetiology, diagnosis and management of acute intestinal obstruction.Methods: A total of 135 patients of acute intestinal obstruction was studied from November 2013 to October 2015 in government medical college, Nagpur. Study was done in patients in OPD of this tertiary centre. Inclusion criteria being patients coming to the hospital with features suggestive and further confirmed of acute intestinal obstruction. Patients included were in, age group of 18 years to 80 years giving written informed consent. Patient of pseudo obstruction were excluded from the study.Results: A total of 135 patients, presented with acute intestinal obstruction during the period of the study. Mean patient age was 45.87 years with peak incidence in those aged 21-30years. The foremost signs and symptoms were constipation (85.93%) and abdominal pain (91.11%). Adhesions and bands (61.9%) was the leading causes of intestinal obstruction.Conclusions: Present study concluded that small bowel obstruction is more common than large bowel obstruction. Abdominal pain, constipation and distension are the most common symptoms, while increased bowel sounds, tachycardia and tenderness is most common sign. Post-operative adhesion in small bowel and malignancy in large bowel is major cause of acute intestinal obstruction.

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A wandering tube

CJEM ◽

10.1017/cem.2016.393 ◽

2016 ◽

Vol 19 (5) ◽

pp. 398-399

Author(s):

Ina Dubin ◽

Moshe Gelber ◽

Ami Schattner

Keyword(s):

Small Bowel ◽

Intestinal Obstruction ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Geriatric Patients ◽

Gallstone Ileus ◽

Age Groups ◽

Gastrostomy Tube ◽

Emergency Physicians ◽

Adult Age

ABSTRACTThe predominant causes of acute mechanical small bowel obstruction in geriatric patients are adhesions and hernias, which is not much different than in other adult age groups. Unusual etiologies may be encountered, such as volvulus or gallstone ileus, but a displaced feeding gastrostomy tube is a distinctly rare cause of intestinal obstruction which needs to be considered by emergency physicians as it may be increasingly encountered.

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