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

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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An Unusual Cause of Small Bowel Obstruction in a Child: Ingested Rhubarb

Case Reports in Surgery ◽

10.1155/2013/497214 ◽

2013 ◽

Vol 2013 ◽

pp. 1-2 ◽

Cited By ~ 2

Author(s):

Miguel Glatstein ◽

Dana Danino ◽

Ayelet Rimon ◽

Sergei Keidar ◽

Dennis Scolnik

Keyword(s):

Computed Tomography ◽

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Exploratory Laparotomy ◽

Acute Intestinal Obstruction ◽

Foreign Material ◽

Abdominal Radiography ◽

Plain Abdominal Radiography ◽

Fluid Levels

Small bowel obstruction is rarely caused by bezoars concretions formed from undigested foreign material in the gastrointestinal tract. An important cause of bezoars is phytobezoars, formed from vegetables or fruits. A four-year-old boy presented to our emergency department with symptoms of acute intestinal obstruction. Upright plain abdominal radiography revealed multiple air fluid levels. Ultrasound showed no abnormalities, and because of worsening symptoms computed tomography of abdomen was performed. It showed intraluminal obstruction of the terminal ileum. Exploratory laparotomy revealed a phytobezoar consisting of undigested rhubarb. The mass was milked through the large bowel and out the anus. Although rare in humans, bezoars are a well-documented cause of small bowel obstruction and should be considered when intraluminal bowel obstruction occurs. Bezoars causing small bowel obstruction may require surgical treatment.

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508 Conservative Management of Small Bowel Obstruction: A Local Experience

British Journal of Surgery ◽

10.1093/bjs/znab134.013 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

M Gonzalez ◽

M Aker ◽

P Manjunath ◽

A Mishra ◽

N Ward

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Positive Impact ◽

Statistical Significance ◽

Water Soluble ◽

Abdominal Adhesions ◽

Initial Management ◽

Local Experience ◽

Immediate Surgery

Abstract Introduction Post-operative intra-abdominal adhesions remain the leading cause of small bowel obstruction (SBO) representing one of the main diagnoses warranting emergency laparotomies. The National Audit in Small Bowel Obstruction advocates the use of water-soluble contrast agents (WSCA) as initial management of SBO. We aim to assess the role and outcomes of WSCA and its rate in successfully managing SBO non-operatively. Method We conducted a 2-year retrospective analysis including all patients admitted with adhesive SBO. Outcomes of patients who received WSCA were compared to those who hadn’t. Results 118 patients were included, 27(23%) of which required immediate surgery while 91(77%) were initially managed conservatively. From the latter group, 53(58.2%) received WSCA whilst 38(41.8%) didn’t. Of the group that received WSCA, 36(39.5%) were successfully managed non-operatively, compared to 26(28.5%) that didn’t, this however lacked statistical significance. LOS didn’t differ between these two groups (5 days vs. 5.5 days, p = 0.805). 32% of the patients required eventual surgical intervention needing longer LOS regardless of receiving WSCA (6.6 days vs. 13.6 days p < 0.001). Conclusions Adhesive SBO can be managed conservatively in up to two-thirds of patients. WSCA usage has a positive impact but needs further assessment in larger studies.

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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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Therapeutic Role of Gastrograffin in Adhesive Small Bowel Obstruction After Unsuccessful Conservative Treatment

Med Phoenix ◽

10.3126/medphoenix.v5i1.31395 ◽

2020 ◽

Vol 5 (1) ◽

pp. 26-31

Author(s):

MD Alam Shahid ◽

Pashupati Bhatta ◽

Akash Raya ◽

Binod Kumar Rai

Keyword(s):

Small Bowel ◽

Conservative Treatment ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Open Appendectomy ◽

Sampling Technique ◽

Exploratory Laparotomy ◽

Water Soluble ◽

Adhesive Small Bowel Obstruction ◽

Therapeutic Role

Background: The management of adhesive small bowel obstruction is quite debatable. Gastrograffin, a water-soluble hyperosmolar contrast is used as a diagnostic tool widely but it also has impressive therapeutic role. Hence this study was to determine its therapeutic role in management of adhesive bowel obstruction after failure of conservative treatment. Methods: This cross-section observational study of 42 patients was conducted in 1-year duration from 01 July 2018 to 30 June 2019 using non-probability purposive sampling technique. All the patients were first managed conservatively for 48 hrs, and then given 100ml of gastrograffin through NG tube and clamped. Appearance of dye in cecum on radiograph at different time frame (4, 8, 12 and 24 hours of administration) signifies the success and who failed to do so within 24 hrs. were planned for laparotomy. Results: A total of 42 patients with their age ranged 14-80 years (mean 44.6) were included. Among them 32 (76.19%) were male and 10 (23.80%) female. Most had open appendectomy followed by gynaecological surgery and exploratory laprotomy. Majority had midline incision followed by gridiron and pfanensteil incision. After 8 hrs of gastrograffin administration, it was positive in 12 patients while 19 had at 24 hrs. Total 31 patients showed complete resolution, while remaining 11 showed no improvement and undergone exploratory laparotomy. Conclusion: Thus, the administration of gastrograffin is an effective approach in the management of adhesive small bowel obstruction after failed conservative management and prevents surgeries.

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Diagnosis and Management of a Postpyloric Foreign Body Causing Small Bowel Obstruction in an Infant

Clinical Medicine Insights Case Reports ◽

10.1177/1179547617719249 ◽

2017 ◽

Vol 10 ◽

pp. 117954761771924

Author(s):

Victoria Bradford ◽

Marissa Vadi ◽

Harmony Carter

Keyword(s):

Foreign Body ◽

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Pediatric Population ◽

Exploratory Laparotomy ◽

Foreign Body Ingestion ◽

Common Occurrence ◽

Diagnosis And Management ◽

History Of

Foreign body ingestion is a common occurrence in the pediatric population and most ingestions resolve with little morbidity. Although radiopaque objects are easily identified on biplane radiographs, radiolucent objects may elude detection, delaying diagnosis. We report a case of a healthy 10-month-old infant who presented with a 5-day history of postprandial vomiting and imaging consistent with small bowel obstruction. On exploratory laparotomy, she was discovered to have a postpyloric foreign body requiring removal through an enterotomy.

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Small Bowel Obstruction by Broad Ligament Hernia: Three Case Reports, Management and Outcomes

Acta Médica Portuguesa ◽

10.20344/amp.10951 ◽

2019 ◽

Vol 32 (3) ◽

pp. 240

Author(s):

Manuela Graça Fernandes ◽

Ana Rita Mateus Loureiro ◽

Maria João Diogo Obrist ◽

César Prudente

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Case Reports ◽

Broad Ligament ◽

Exploratory Laparotomy ◽

Anatomical Location ◽

Internal Hernias ◽

Surgical History ◽

Broad Ligament Defect

Internal hernias are a rare cause of bowel obstruction (1%) and can be caused by broad ligament defects in 4% to 7% of the cases. These defects may be congenital or acquired and are classified according to its anatomical location. This paper reports three cases of small bowel obstruction by broad ligament hernia. The patients, three women aged from 35 to 51 years old, were admitted to the emergency department with small bowel obstruction. An exploratory laparotomy was performed during which an internal hernia through a broad ligament defect was identified. In all cases the hernia content was reduced and the defect closed. One of the patients required a segmental enterectomy. All patients had a favorable outcome. This paper aims to raise awareness about the broad ligament hernia as a cause of bowel obstruction, namely in middle-aged women with no surgical history.

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Association of Surgical Intervention for Adhesive Small-Bowel Obstruction With the Risk of Recurrence

JAMA Surgery ◽

10.1001/jamasurg.2018.5248 ◽

2019 ◽

Vol 154 (5) ◽

pp. 413 ◽

Cited By ~ 14

Author(s):

Ramy Behman ◽

Avery B. Nathens ◽

Stephanie Mason ◽

James P. Byrne ◽

Nicole Look Hong ◽

...

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Surgical Intervention ◽

Adhesive Small Bowel Obstruction ◽

Risk Of Recurrence

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Endometriosis of the appendix causing small bowel obstruction in a virgin abdomen

BMJ Case Reports ◽

10.1136/bcr-2019-230496 ◽

2019 ◽

Vol 12 (7) ◽

pp. e230496 ◽

Cited By ~ 1

Author(s):

Joseph Do Woong Choi ◽

Michael Yunaev

Keyword(s):

Emergency Department ◽

Abdominal Pain ◽

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Oestrogen Receptor ◽

Surgical Intervention ◽

Prior History ◽

Good Recovery ◽

History Of

A 29-year-old, otherwise well, nulligravid woman presented to the emergency department with 1-day history of generalised abdominal pain and vomiting. She had similar symptoms 6 months prior following recent menstruations, which resolved conservatively. She had no prior history of abdominal surgery or endometriosis. CT scan demonstrated distal small bowel obstruction. A congenital band adhesion was suspected, and she underwent prompt surgical intervention. During laparoscopy, a thickened appendix was adhered to a segment of distal ileum. There was blood in the pelvis. Laparoscopic adhesiolysis and appendicectomy were performed. Histopathology demonstrated multiple foci of endometriosis of the appendix with endometrial glands surrounded by endometrial stroma. Oestrogen receptor and CD10 immunostains highlighted the endometriotic foci. The patient made a good recovery and was referred to a gynaecologist for further management.

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