scholarly journals Antiphospholipid Syndrome Presenting as Mesenteric Vein Thrombosis and Gangrenous Small Bowel

2020 ◽  
Vol 10 (2) ◽  
Author(s):  
Wan Ali WASR ◽  
Mohd Shahrir MS ◽  
Hussein H
Keyword(s):  
Small Bowel ◽  
Iliac Fossa ◽  
Exploratory Laparotomy ◽  
Anastomotic Site ◽  
Intermittent Fever ◽  
Mesenteric Lymph Nodes ◽  
Vein Thrombosis ◽  
Open Laparotomy ◽  
Right Iliac Fossa Pain ◽  
Bowel Lesion

A 35-year-old Jordanian gentleman presented with worsening right iliac fossa pain of three-day durations with vomiting, loose stool and intermittent fever. He later underwent laparoscopic surgery, which was subsequently converted to open laparotomy. Intraoperatively, there was thickened bowel with multiple mesenteric lymph nodes, and also thrombosis of the small bowel vein supplying the affected bowel lesion, the diagnosis which was later confirmed with the histopathological report. Resection with end-to-end anastomosis was done during the surgery. Within one-week post laparotomy, he developed another progressive abdominal pain and distension, vomiting and no bowel opening. He was sent for another exploratory laparotomy. Intraoperatively, there was a gangrenous small bowel segment measuring 130 cm, with an intact large bowel and previous anastomotic site. Resection of 150 cm of the small bowel was subsequently done.

Lockdown dilemma: ingestion of magnetic beads presenting as right iliac fossa pain and subacute small bowel obstruction

2020 ◽  
Vol 13 (11) ◽  
pp. e236429
Author(s):  
Bankole Oyewole ◽  
Anu Sandhya ◽  
Ian Maheswaran ◽  
Timothy Campbell-Smith
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Magnetic Beads ◽  
Iliac Fossa ◽  
Serous Fluid ◽  
Magnetic Resonance Scan ◽  
History Of ◽  
Right Iliac Fossa Pain ◽  
Multiple Episodes ◽  
Safety Netting

A 13-year-old girl presented with a 3-day history of migratory right iliac fossa pain. Observations and inflammatory markers were normal, and an ultrasound scan was inconclusive. A provisional diagnosis of non-specific abdominal pain or early appendicitis was made, and she was discharged with safety netting advice. She presented again 6 days later with ongoing abdominal pain now associated with multiple episodes of vomiting; hence, the decision was made to proceed to diagnostic laparoscopy rather than a magnetic resonance scan for further assessment. Intraoperative findings revealed 200 mL of serous fluid in the pelvis, normal-looking appendix, dilated stomach and a tangle of small bowel loops. Blunt and careful dissection revealed fistulous tracts that magnetised the laparoscopic instruments. A minilaparotomy was performed with the extraction of 14 magnetic beads and the repair of nine enterotomies. This case highlights the importance of careful history taking in children presenting with acute abdominal pain of doubtful aetiology.

Foreign body perforation of the distal ileum: an unusual cause of right iliac fossa pain managed via single incision laparoscopic surgery (SILS) approach

2021 ◽  
Vol 14 (2) ◽  
pp. e238563
Author(s):  
Matthew R Bonomaully ◽  
Zia Haque ◽  
Milind Rao
Keyword(s):  
Foreign Body ◽  
Single Incision ◽  
Iliac Fossa ◽  
Exploratory Laparotomy ◽  
Distal Ileum ◽  
Emergency Setting ◽  
Single Incision Laparoscopic Surgery ◽  
Single Incision Laparoscopy ◽  
History Of ◽  
Right Iliac Fossa Pain

A 61-year-old woman was seen by the emergency general surgical team with a 2-week history of right iliac fossa pain. Imaging revealed the possibility of a distal ileum perforating foreign body. Using a single incision laparoscopy surgery (SILS) approach, this diagnosis was confirmed at operation. This emerging technique meant a much smaller incision could be used than traditional exploratory laparotomy, with the benefit of less postoperative pain and a faster recovery. This case highlights an uncommon cause for abdominal pain and the importance of close liaison with radiologists and the low threshold for use of laparoscopy as a diagnostic tool. We advocate the use of SILS in the emergency setting for appropriate cases.

scholarly journals 637 Enterolith Ileus Secondary to Small Bowel Diverticulum: A Rare Cause of Small Bowel Obstruction

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
M Elmasry ◽  
A Dey ◽  
R Marshall
Keyword(s):  
Small Bowel ◽  
Iliac Fossa ◽  
Gallstone Ileus ◽  
Emergency Laparotomy ◽  
Duodenojejunal Flexure ◽  
Radiological Images ◽  
History Of ◽  
Right Iliac Fossa Pain ◽  
Small Intestinal ◽  
Abnormal Peristalsis

Abstract Small intestinal diverticula are rare and possibly acquired secondary to bowel dyskinesia, abnormal peristalsis, or high intraluminal pressures. Enterolith formation and obstruction are a less encountered complication of these diverticula. An elderly man, with no history of abdominal surgery, presented with 10 days of colicky right iliac fossa pain and recurrent episodes of bilious vomiting. He initially reported diarrhoea but complained of eventual absolute constipation for last 5 days. Physical examination revealed distended abdomen with right-sided tenderness and no mass or faeces on rectal examination. Abdominal CT revealed a 3.5 cm calculus in the distal ileum causing obstruction initially flagged as gallstone ileus. No gallstones or pneumobilia were identified although some intrahepatic duct dilatation was noted. An emergency laparotomy was conducted, where the radiological findings were reinforced, and the calculus was extracted via enterotomy. There were no abnormal communications between gallbladder and intestinal tract. The small bowel traced from duodenojejunal flexure to terminal ileum did not reveal any further calculi or diverticula. FTIR spectrum analysis of the extracted specimen indicated similarities to enterolith. Retrospective analysis of radiological images revealed a possible duodenal diverticulum. The case highlights the diagnostic conundrum and therapeutic challenges of small bowel diverticular enterolith.

scholarly journals 78 A Lockdown Dilemma; Ingestion of Magnetic Beads Presenting as Right Iliac Fossa Pain and Sub-Acute Small Bowel Obstruction

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
B Oyewole ◽  
A Sandhya ◽  
I Maheswaran ◽  
T Campbell-Smith
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Magnetic Beads ◽  
Iliac Fossa ◽  
Radiology Department ◽  
Magnetic Resonance Scan ◽  
History Of ◽  
Right Iliac Fossa Pain ◽  
Acute Small Bowel Obstruction ◽  
Operative Findings

Abstract A 13-year-old girl presented with a three-day history of migratory right iliac fossa pain. Observations and inflammatory markers were normal, and an ultrasound scan was inconclusive. A provisional diagnosis of non-specific abdominal pain or early appendicitis was made, and she was discharged with safety netting advice. She represented six days later with ongoing abdominal pain now associated with multiple episodes of vomiting; hence, the decision was made to proceed to diagnostic laparoscopy rather than a magnetic resonance scan for further assessment as recommended by the radiology department. Intra-operative findings revealed 200mls of serous fluid in the pelvis, normal-looking appendix, dilated stomach, and a tangle of small bowel loops. Blunt and careful dissection revealed fistulous tracts that magnetized the laparoscopic instruments. A mini-laparotomy was performed with the extraction of fourteen magnetic beads and the repair of nine enterotomies. Foreign body ingestion is a known cause of abdominal pain, which in some cases might mimic or even be the cause of acute appendicitis. This case highlights the importance of careful history taking in children presenting with acute abdominal pain of doubtful aetiology.

Complexities of an uncomplicated symptom: two cases of umbilical discharge

2020 ◽  
Vol 13 (9) ◽  
pp. e235604
Author(s):  
Nitin Agarwal ◽  
Nikhil Gupta ◽  
Manu Vats ◽  
Mradul Garg
Keyword(s):  
Small Bowel ◽  
Closed Loop ◽  
Exploratory Laparotomy ◽  
Abdominal Tuberculosis ◽  
Mesenteric Lymph Nodes ◽  
Mesenteric Lymph ◽  
Antituberculosis Therapy ◽  
Complex Fistula ◽  
History Of ◽  
Resection And Anastomosis

A 10-year-old boy presented with a low volume feculent umbilical discharge associated with fever and anorexia. Exploratory laparotomy revealed a complex fistula communicating with multiple small bowel loops and extensive peritoneal nodules with caseous mesenteric lymph nodes; suggestive of abdominal tuberculosis. Fistulectomy, adhesiolysis and a diversion jejunostomy were done and antituberculosis therapy was started. A 20-year-old man presented with serous umbilical discharge, having a history of similar complaints in his infancy. While he was being investigated, he developed peritonitis and had to be operated on emergency basis. An umbilical sinus connected with a fibrous band to Meckel diverticulum and a proximal closed loop small bowel obstruction perforation were found. Resection and anastomosis of the affected segment were done, and the patient recovered well.

scholarly journals Apixaban-induced haematoma causing small bowel intussusception

2019 ◽  
Vol 12 (10) ◽  
pp. e230952 ◽  
Author(s):  
Ariel P Santos ◽  
Jennifer M Rodriguez ◽  
Grace Berry
Keyword(s):  
Atrial Fibrillation ◽  
Small Bowel ◽  
Histopathological Examination ◽  
Exploratory Laparotomy ◽  
Adult Intussusception ◽  
Radiographic Findings ◽  
Vein Thrombosis ◽  
Small Bowel Intussusception ◽  
Direct Acting ◽  
Deep Vein

Apixaban (Eliquis) is a direct acting oral anticoagulant (DOAC) indicated for treatment of deep vein thrombosis, non-valvular atrial fibrillation, pulmonary embolism and postoperative venous thromboprophylaxis following hip or knee replacement. Complications are minimal and include, but are not limited to, bleeding and intracranial haemorrhage, and haematoma formation. Our patient is a 73-year-old woman who presented with clinical and radiographic findings of small bowel obstruction. She was found to be taking apixaban for atrial fibrillation. CT scan showed small bowel intussusception. She underwent an exploratory laparotomy and resection of the small bowel intussusception with primary side-to-side anastomosis. Histopathological examination showed that the intussusception was caused by an intramural haematoma. This case presents a rare instance of adult intussusception caused by a DOAC. To our knowledge, no case of intussusception caused by apixaban has yet been found in literature.

scholarly journals Kikuchi- Fujimoto Disease of Mesenteric Lymph Nodes Mimicking Acute Appendicitis

2013 ◽  
Vol 52 (192) ◽  
Author(s):  
Anne Shrestha ◽  
Katie Newton ◽  
Emyr Benbow ◽  
Rajeev Kushwaha
Keyword(s):  
Acute Appendicitis ◽  
Lymph Nodes ◽  
Iliac Fossa ◽  
Abdominal Mass ◽  
Low Grade ◽  
Mesenteric Lymph Nodes ◽  
Surgical Interventions ◽  
Mesenteric Lymph ◽  
Right Iliac Fossa Pain ◽  
High Index Of Suspicion

Kikuchi-Fujimoto disease, or histiocytic necrotising lymphadenopathy of unknown aetiology, is a rare, benign and self-limiting cause of lymphadenopathy often involving the cervical nodes, and rarely presenting with mesenteric lymphadenopathy. We present a 26-year-old Caucasian male, who presented with right iliac fossa pain and low grade pyrexia, mimicking acute appendicitis. He underwent a laparatomy and an extended right hemi-colectomy for a caecal mass. Histology of the specimen showed lymph nodes with extensive areas of necrosis, with abnormal architecture suggesting Kikuchi-Fujimoto lymphadenopathy. This was further confirmed by immunohistochemistry. In this context maintenance of a high index of suspicion of this condition can avoid major surgical interventions. We describe the management of our case of Kikuchi-Fujimoto’s disease involving the mesenteric nodes and provide an up to date review of the pertinent literature on this subject.  Keywords: abdominal mass; Kikuchi- Fujimoto disease; mesenteric lymphadenopathy; necrotising lymphadenitis.  

scholarly journals EP.TU.542Enterolith ileus secondary to small bowel diverticulum: a rare cause of small bowel obstruction

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Abhishek Dey ◽  
Mohamed Elmasry ◽  
Robert Marshall
Keyword(s):  
Small Bowel ◽  
Bowel Obstruction ◽  
Iliac Fossa ◽  
Gallstone Ileus ◽  
Kidney Injury ◽  
Emergency Laparotomy ◽  
Duodenojejunal Flexure ◽  
History Of ◽  
Right Iliac Fossa Pain ◽  
Abnormal Peristalsis

Abstract Small intestinal diverticula are rare and possibly acquired secondary to bowel dyskinesia, abnormal peristalsis or high intraluminal pressures. Enterolith formation within these diverticula and intra-luminal bowel obstruction from them are a less encountered complication. A seventy-five year old man, with no history of abdominal surgery, presented with 10 days of colicky right iliac fossa pain and recurrent episodes of bilious vomiting. He initially reported diarrhoea but complained of eventual absolute constipation for last 5 days. Physical examination revealed distended abdomen with right-sided tenderness and no mass or faeces were noted on rectal examination. Biochemistry indicated raised inflammatory markers and an acute kidney injury. Abdominal CT scan revealed a 3.5 cm calculus in the distal ileum causing obstruction initially flagged as gallstone ileus. No gallstones or pneumobilia were identified although some intrahepatic duct dilatation was noted. An emergency laparotomy was conducted, where the radiological findings were reinforced and the calculus was extracted via enterotomy. There were no abnormal communications between gallbladder and intestinal tract suggestive of passage of gallstone to ileum. The small bowel traced from duodenojejunal flexure to terminal ileum did not reveal any further calculi or diverticula. FTIR spectrum analysis of the extracted specimen indicated similarities to enterolith. Retrospective analysis of radiological images revealed a possible duodenal diverticulum. The case highlights the diagnostic conundrum and therapeutic challenges of small bowel diverticular enterolith.

Rare cause of right iliac fossa pain in a UK patient

2020 ◽  
Vol 13 (10) ◽  
pp. e234694
Author(s):  
Khurram Shahzad ◽  
Mohamed Elmedani ◽  
Smitha Mathew ◽  
Ioannis Peristerakis
Keyword(s):  
Small Bowel ◽  
Sedimentation Rate ◽  
Iliac Fossa ◽  
Blood Parameters ◽  
Right Hemicolectomy ◽  
Ascending Colon ◽  
Erythrocyte Sedimentation ◽  
History Of ◽  
Right Iliac Fossa Pain ◽  
Resected Bowel

A 62-year-old Asian man presented with a 3-month history of right iliac fossa pain which had progressively worsened over the last 3 weeks. All blood parameters were found to be unremarkable except for mildly elevated erythrocyte sedimentation rate. CT imaging demonstrated thickening of the ascending colon and caecum. Colonoscopic biopsies showed submucosal granulomas with features suggestive of schistosomiasis and parasite serology was positive for Schistosoma antibodies. He was treated with praziquantel and showed subsequent symptomatic and radiological improvement. However, he represented nearly 2 years later and underwent a right hemicolectomy for small bowel obstruction. The resected bowel showed an inflammatory caecal mass and a terminal ileal adenocarcinoma.

scholarly journals Small Bowel Obstruction Induced by Concurrent Postoperative Intra-Abdominal Adhesions and Small Bowel Fecal Materials in a Young Dog

2021 ◽  
Vol 8 (5) ◽  
pp. 83
Author(s):  
Jae-Eun Hyun ◽  
Hyun-Jung Han
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Surgical Intervention ◽  
Gastrointestinal Symptoms ◽  
Exploratory Laparotomy ◽  
Abdominal Adhesions ◽  
Abdominal Radiography ◽  
Foreign Body Removal ◽  
Small Intestinal

A 7-month-old neutered male poodle dog presented with general deterioration and gastrointestinal symptoms after two separate operations: a jejunotomy for small-intestinal foreign body removal and an exploratory laparotomy for diagnosis and treatment of the gastrointestinal symptoms that occurred 1 month after the first surgery. The dog was diagnosed as having small-bowel obstruction (SBO) due to intra-abdominal adhesions and small-bowel fecal material (SBFM) by using abdominal radiography, ultrasonography, computed tomography, and laparotomy. We removed the obstructive adhesive lesion and SBFM through enterotomies and applied an autologous peritoneal graft to the released jejunum to prevent re-adhesion. After the surgical intervention, the dog recovered quickly and was healthy at 1 year after the surgery without gastrointestinal signs. To our knowledge, this study is the first report of a successful treatment of SBO induced by postoperative intra-abdominal adhesions and SBFM after laparotomies in a dog.

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