scholarly journals Post-operative Intussusception, a rare case in pediatric, National Center for Paediatric Surgery, Gezira State, Sudan; 2021

2021 ◽  
Vol 8 (3) ◽  
pp. 001-004
Author(s):  
Omer Taha Ahmed Elmukashfi ◽  
Taha Ahmed Elmukashfi Elsheikh ◽  
Mustafa Abdulaziz Abdalla Ibrahim ◽  
Ahmed Mustafa Idris Mohamed ◽  
Diaaeldinn Yaseen Salman Mohammed

Intussusception is defined by Treves in 1899 as invagination of segment of bowel into adjacent segment usually proximal into distal. It’s a common cause of abdominal emergencies especially in children two years of age and younger. It accounts for 1 in 2000 infants and children and results in intestinal obstruction. Post-operative intussusception is one of the rare etiologies of intestinal obstruction that represents 0.01 to 0.25% after laparotomies and 5 -10% of all early postoperative intestinal obstructions. Our case is a ten years old female presented to the National Center for Pediatric Surgery; Gezira state; Sudan; February 2021 complaining of abdominal distention and constipation for 6 days. She had past history of acute appendicitis due to which she underwent emergency opened appendectomy. Her condition started one day after appendectomy. O/E : patient looks ill, febrile, not pale or jaundice; PR:140b/m; RR:25c/m; abdominal examination show: distended abdomen with full flanks, unhealed lanz incision with small amount of pus discharge; no dilated veins or visible peristalsis; hernia orifice were intact; lower abdomen was tense & tender; no palpable mass; DRE: rectum contains impacted hard stool. Emergency explorative laparotomy was done. Findings: Ileocecal intussusception, bowel was healthy and viable. Simple reduction was done. Conclusion and Recommendations: Post-operative intussusception usually associated with bowel ischemia and necrosis which is not consistent with our case. We highly recommended abdominal ultrasonography, CT scan; when there is a high index of suspicion.

2021 ◽  
Vol 49 ◽  
Author(s):  
Ana Clara Sarzedas Ribeiro ◽  
Rodolfo José Cavalcanti Souto ◽  
Tayrlla Polessa Rodrigues Silva ◽  
José Augusto Bastos Afonso ◽  
Carla Lopes Mendonça ◽  
...  

Background: Intussusception, characterized by invagination of an intestinal segment into the lumen of the adjacent segment, is one of the main causes of intestinal obstruction in cattle, and occurs more frequently in calves. The diagnosis of the disease is based on the history, clinical examination, and complementary exams, which are a challenge in this species, especially in calves, in which transrectal palpation is limited. As it is a non-invasive, effective, and low-cost test, ultrasonography could be an important tool in the diagnosis of intestinal obstructions, in which time is essential for the prognosis. Therefore, the objective was to report a case of intussusception in a calf diagnosed by ultrasound.Case: A 4-month-old calf, weaned at 3 months and raised intensively, was treated at the Clínica de Bovinos de Garanhuns, campus of the Universidade Federal Rural de Pernambuco (CBG/UFRPE), with a history of apathy, anorexia, and dyschezia for 3 days. On physical examination, fever, moderate dehydration, tachycardia, tachypnea with polypnea, bilaterally bulging abdomen, sound of fluid on ballottement, ruminal and intestinal hypomotility, and melena were observed. The hematological findings revealed leukocytosis due to neutrophilia (degenerate neutrophils), hypoproteinemia, and hyperfibrinogenemia. The analysis of the ruminal fluid showed compromised microbiota and increased chloride content. The transabdominal ultrasonography demonstrated, in the right ventral region, hypermotile and full small bowel loops and an increase in the volume of the peritoneal fluid. In addition, there was a segment of the small intestine which, in cross-section, showed multiple concentric rings (“onion rings”, “target pattern”, or “bull’s eye”) and adherence to adjacent loops, compatible with intestinal obstruction due to intussusception. Due to the seriousness of the clinical condition and the ultrasound findings, the animal was euthanized and the necropsy revealed focal fibrinous peritonitis and intestinal obstruction due to intussusception in ileum intestinal segments.Discussion: Intussusception has previously been reported in calves, however this is the first report of ultrasound diagnosis of the disease in Brazil. Although the etiology is rarely confirmed, the age group and recent changes in diet (weaning) were predisposing factors. The history, clinical signs, and laboratory tests were similar to those described in cattle with intussusception, however they may be present in other gastrointestinal illnesses. Other authors have also reported that the nonspecificity of the signs and the impossibility of performing transrectal palpation made it difficult to diagnose intestinal obstruction in calves without the use of other diagnostic tools. As it is a non-invasive and accurate technique, ultrasound has been used in ruminants for diagnostic purposes, including intestinal obstructions. In the present case, the main findings are described as the presence of a lesion with the appearance of multiple concentric rings, hypermotile, dilated, and full intestinal loops. The pathological findings were compatible with the ultrasound images and similar to those described by other authors, confirming the diagnosis. The use of ultrasonography as a diagnostic tool in cattle should be expanded, aiming at the early determination of diagnosis and prognosis, to reduce producer costs and animal discomfort. In cases of intussusception, late diagnosis makes treatment unfeasible.


2021 ◽  
Vol 9 (03) ◽  
pp. 472-475
Author(s):  
Saurav Sultania ◽  
◽  
Arvind Kumar Shukla ◽  
Pramila Sharma ◽  
Dinesh Kumar Barolia ◽  
...  

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.


BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kimutai R. Sylvester ◽  
Philip B. Ooko ◽  
Michael M. Mwachiro ◽  
Robert K. Parker

Abstract Background Cecal volvulus, which is a torsion involving the cecum, terminal ileum, and ascending colon around its own mesentery, results in a closed-loop obstruction. It is a rare reported cause of adult intestinal obstruction. This study aimed to review the clinical presentation, management, and outcomes at a rural, resource-limited referral center. Methods We performed a retrospective review of all patients with a diagnosis of cecal volvulus between January 1st, 2009 and December 31st, 2019 at Tenwek Hospital in Bomet, Kenya. The outcome of survival was compared by the time to presentation. Mortality was also compared with prior reports of intestinal obstruction at our institution. Results Thirteen patients were identified with a mean age of 52 years and a mean symptom duration of 5 days. All patients presented with abdominal pain and distension. Seven patients (54%) presented with perforation, gangrene, or gross peritoneal contamination. Identified risk factors were Ladds bands with malrotation, adhesions, and a sigmoid tumor. Procedures included primary resection and anastomosis (7), damage control (3) with anastomosis on second-look in 2 of these, simple surgical detorsion (1), and surgical detorsion and cecopexy (2). There were four mortalities (31%), of which all had delayed presentation with perforation and fecal contamination. Delays to presentation were associated with mortality (p = 0.03). Cecal volvulus resulted in increased perioperative mortality compared to all intestinal obstructions presenting to the institution (p < 0.0001). Conclusions Cecal volvulus carries a high risk of mortality. A high index of suspicion and early consideration in the differential diagnosis of intestinal obstruction should be considered to reduce the mortality associated with the delay in preoperative diagnosis.


2021 ◽  
Vol 8 (12) ◽  
pp. 3727
Author(s):  
Prawin Kumar Singh ◽  
Rakesh Kumar Sahu

Intussusception of the bowel is defined as the telescoping of a proximal segment of the bowel within the lumen of an adjacent segment. This condition is a common cause of intestinal obstruction in children below two years of age. It is considered a rare cause of intestinal obstruction in the adult. It accounts for 5% of all cases of intussusception and 1-2% of all cases of intestinal obstructions in the adult population. Almost up to 20% of cases are idiopathic and they are not having any lead point pathology. The rest of the cases are caused by organic lesions like Meckel’s diverticulum, benign and malignant lesions, metastatic neoplasm, intestinal polyp, etc. In adults’ preoperative diagnosis is difficult and a definitive diagnosis is made at laparotomy. Computerized tomography is the most sensitive diagnostic modality for this condition.


2018 ◽  
Vol 51 (5) ◽  
pp. 281-286 ◽  
Author(s):  
Ines Alves ◽  
José Carlos Marques

Abstract Objective: To characterize a population of patients with radiation-induced angiosarcoma (RIAS) of the breast treated at an oncology center, focusing mainly on the imaging features, although also on the clinical presentation, diagnosis, and management. Materials and Methods: We performed a retrospective review of patients with histologically proven angiosarcoma of the breast or chest wall, all of whom received radiotherapy, after conservative or radical breast surgery, between 2000 and 2015. Results: Eleven patients met the inclusion criteria. The median age at the time of diagnosis of RIAS of the breast was 71.5 years (range, 58-87 years), and the median latency period was 8.9 years (range, 4-27 years). The rate of local recurrence was 54.4%, RIAS recurring after a median period of 10 months (range, 3-18 months), and distant metastases occurred in three patients (27.3%). All of the tumors were accompanied by skin changes, and a palpable mass was seen in four. Most of the imaging findings were nonspecific. Six patients underwent magnetic resonance imaging, which revealed pronounced skin enhancement in all six. Ultrasound-guided core needle biopsies were negative in three of the eight patients. Conclusion: RIAS of the breast is a rare but recognized complication of radiotherapy for breast carcinoma, with a poor prognosis and high recurrence rate, which requires a high index of suspicion for a prompt diagnosis.


2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Lawal B. Abdullahi ◽  
Mohammad A. Mohammad ◽  
Lofty-John C. Anyanwu ◽  
Mohammad S. Aliyu ◽  
Bilya I. Liman

Intussusception is defined as the telescoping of a segment of the gastrointestinal tract within the lumen of the adjacent segment usually proximal to distal. It is a common cause of intestinal obstruction in children, rarely it can occur in adult. This condition is reported in both developed and developing countries, however there are few publications in Nigeria about the incidence, presentation and outcome of its management, most especially in children. This is a prospective study of pediatric patients managed in single center Kano over a period of 18months. The demographic data, clinical features, treatment and outcome of the management were evaluated and analyzed using SPSS version 23. Between June 2018 to December 2019, twenty-five children were managed with intussuception at Aminu Kano Teaching Hospital, there were 16 males and 9 females. The age of the patients ranges between 5 months to 6 years with most of patients in the ager range between 6 and 12 months. All of the 25 patients had exploratory laparotomy with manual reduction in 12 patients, while 13 patients had resection and anastomosis. Non-operative reduction using normal saline under ultrasound guidance was attempted for 2 patients, which was not successful. The length of hospital stay ranged between 4 days and 22 days. Few complications were observed which includes surgical site infection, wound dehiscence, postoperative ileus. One patient was re-operated for recurrent intussuception. Two patients died post operatively, while 23 patients were discharged home alive. Intussuception is still a common cause of intestinal obstruction in children in Kano. Late presentation was found to be associated with higher morbidity (complications).


2020 ◽  
Vol 2020 ◽  
pp. 1-4 ◽  
Author(s):  
Engelbert A. Nonterah ◽  
Solomon Atindama ◽  
Emmanuel Achumbowina ◽  
Michael B. Kaburise ◽  
Edwin Saanwie ◽  
...  

Introduction. Isolated jejunal perforation from blunt abdominal trauma is an extremely rare intra-abdominal injury that poses a huge diagnostic challenge. Delay in diagnosis and initiation of treatment often leads to significant morbidity and mortality. Diagnosis particularly in resource-poor settings may be extremely challenging and often relies on a high index of suspicion. This is due to lack of adequate diagnostic facilities and human resource to deal with the condition with resulting high occurrence of adverse outcomes. Case Presentation. We report a case of isolated jejunal perforation with associated mesentery injury in a young college student who sustained a kick to his abdomen while playing soccer. This is an unusual presentation since most reported cases often resulted from motor vehicular accidents, bicycle handlebar, and fall from a height. We emphasized the role of critical level of suspicion with a good history and physical examination as the major source of diagnosis since diagnostic procedures, such as abdominal ultrasonography and computed tomography, are largely unavailable in most resource-constraint settings. Early surgical intervention following diagnosis leads to good recovery and reduced mortality. Conclusion. Sufficient vigilance and suspicions of small bowel perforation should always be considered after blunt trauma even when symptoms and physical findings are minimal and when diagnostic capacity is limited.


2019 ◽  
Vol 12 (3) ◽  
pp. e228863 ◽  
Author(s):  
Hussain Adnan Abdulla ◽  
Eman Hamza ◽  
Ali Dhaif

Although colonic volvulus is a relatively rare cause of large bowel obstruction, accounting for up to 5% of all cases of intestinal obstruction, transverse colon volvulus is extremely uncommon compared with volvulus of the sigmoid colon or caecum and is responsible for only 3% of all reported cases. We report an unusual case of spontaneous volvulus of the transverse colon in a young man with sickle cell disease who underwent resection with primary anastamosis. Having a high index of suspicion and early operative intervention allowed for this patient to have an uneventful postoperative course.


2015 ◽  
Vol 32 (5) ◽  
pp. 389-396 ◽  
Author(s):  
Adam Gyedu ◽  
Francis Abantanga ◽  
Ishmael Kyei ◽  
Godfred Boakye ◽  
Barclay T. Stewart

Introduction: This study aimed to describe the epidemiology and outcomes of intestinal obstruction at a tertiary hospital in Ghana over time. Methods: Records of all patients admitted to a tertiary hospital from 2007 to 2011 with intestinal obstruction were identified using ICD-9 codes. Sociodemographic and clinical data were compared to a previously published series of intestinal obstructions from 1998 to 2003. Factors contributing to longer than expected hospital stays and death were further examined. Results: Of the 230 records reviewed, 108 patients (47%) had obstructions due to adhesions, 50 (21%) had volvulus, 22 (7%) had an ileus from perforation and 14 (6%) had intussusception. Hernia fell from the 1st to the 8th most common cause of obstruction. Patients with intestinal obstruction were older in 2007-2011 compared to those presenting between 1998 and 2003 (p < 0.001); conditions associated with older age (e.g. volvulus and neoplasia) were more frequently encountered (p < 0.001). Age over 50 years was strong factor of in-hospital death (adjusted OR 14.2, 95% CI 1.41-142.95). Conclusion: Efforts to reduce hernia backlog and expand the surgical workforce may have had an effect on intestinal obstruction epidemiology in Ghana. Increasing aging-related pathology and a higher risk of death in elderly patients suggest that improvement in geriatric surgical care is urgently needed.


2021 ◽  
Vol 55 (1) ◽  
pp. 84-87
Author(s):  
Offei K. Asare ◽  
Henry E. Obaka ◽  
Nelson K. Affram

Gallstone ileus is an uncommon cause of intestinal obstruction in Ghana. A patient with gallstone ileus that was diagnosed intra-operatively after being treated conservatively as adhesive small bowel obstruction for ten days is reported to highlight the importance of the clinical information in this condition. A 60-year-old Chinese male with recurrent intestinal obstruction who was initially being managed at a primary healthcare facility was subsequently referred to a tertiary hospital on account of computer tomography diagnosis of an intraluminal object obstructing the bowel. He had hypokalaemia that was corrected before surgery. Intra-operatively, a 4.5cm in diameter gallstone was removed from the terminal ileum. Gallstone ileus is rare in Ghana. A high index of suspicion is required to avoid a delay in diagnosis due to the low incidence of cholelithiasis in Ghana.


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