Small Bowel Obstruction in Patients without a Previous History of Abdominal Operation

Internal hernia means a protrusion into pouches or openings in the peritoneum or mesentry in contrast to the hernias through defects in the retaining walls of the abdomen. Internal hernias are of many varieties with different classifications and can be congenital or acquired post-surgery. We present a case of a 55 year old female who presented with symptoms of acute small bowel obstruction with previous history of exploratory laparotomy 20 years back for reasons not known to her. Routine blood investigations, chest and abdomen skiagram and a CECT abdomen were performed (which gave no significant clue to diagnosis) and after a failed conservative trial patient was taken for exploration. Intra operatively a gangrenous loop of small bowel was found herniating through a band between the small bowel mesentry and the sigmoid mesocolon, forming a closed loop obstruction. Resection anastomosis of the gangrenous segment along with band transection was performed. The post-operative course was uneventful. Internal herniation as a cause of bowel obstruction should always be kept in mind as a differential.

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Small Bowel Obstruction: Clinical Presentation and Surgical Outcomes at Jimma University Medical Centre in Southwest Ethiopia

Gastrointestinal Nursing ◽

10.12968/gasn.2020.18.8.22 ◽

2020 ◽

Vol 18 (8) ◽

pp. 22-28

Author(s):

Adugna Olani ◽

Gemechu Lemi ◽

Yonas Biratu ◽

Ebissa Bayana

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Medical Center ◽

Previous History ◽

Cross Sectional Study ◽

Cross Sectional ◽

Surgical Ward ◽

History Of ◽

Prolonged Hospital

Background The mortality from small bowel obstruction (SBO) range between 2% and 8% globally, and the proper management of it is a clinical challenge for surgeons. In Africa, intestinal obstruction accounts for a great proportion of morbidity, and in Ethiopia it ranges from 20–56%. Aims The aim of this study was to assess the pattern of disease and management outcomes among patient admitted to the surgical ward at Jimma Medical Center in Jimma, Ethiopia. Methods A cross-sectional study was conducted over 5–25 November 2019. Data were entered in Epi-data 3.1 and exported to SPSS v23 for analysis. Logistic regression was undertaken to analyse the association between dependent and independent variables, and P-values below 0.05 at 95% CI were considered indicative of a statistically significant association. Results The study revealed that patient outcomes in SBO were significantly associated with people aged over 60 years, a prolonged hospital stay of more than 14 days, septic shock complications and previous history of congestive heart failure. Conclusions SBO was shown to be an issue of major concern, with major aetiologies related to volvulus, adhesions, intussusception and hernia.

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An Uncommon Cause of a Small-Bowel Obstruction

Case Reports in Gastrointestinal Medicine ◽

10.1155/2017/1628215 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4

Author(s):

Ali Zakaria ◽

Bayan Al Share ◽

Issam Turk ◽

Samira Ahsan ◽

Waseem Farra

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Previous History ◽

Granulomatous Inflammation ◽

Giant Cells ◽

Unknown Etiology ◽

Granulomatous Disease ◽

History Of ◽

Noncaseating Granulomas

Sarcoidosis is a systemic granulomatous disease of unknown etiology, characterized by the formation of noncaseating granulomas. Gastrointestinal (GI) system involvement that is clinically recognizable occurs in less than 0.9% of patients with sarcoidosis, with data revealing small intestine involvement in 0.03% of the cases. A high index of suspension is required in patients presenting with small-bowel obstruction and previous history of sarcoidosis. Establishing a definitive diagnosis of GI sarcoidosis depends on biopsy evidence of noncaseating granulomas, exclusion of other causes of granulomatous disease, and evidence of sarcoidosis in at least one other organ system. Treatment of GI sarcoidosis depends on symptomatology and disease activity. Herein, we are presenting a case of 67-year-old female patient who had acute small-bowel obstruction at the level of jejunum with postoperative histopathologic evidence of noncaseating granulomatous inflammation with multinucleated giant cells, consistent with sarcoidosis.

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563 A Rare Case of Small Bowel Obstruction Secondary to Peritoneal Encapsulation, Congenital Adhesional Band and Gallstone Ileus

British Journal of Surgery ◽

10.1093/bjs/znab259.300 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

P Gungadin ◽

A Taib ◽

M Ahmed ◽

A Sultana

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Unusual Case ◽

Gallstone Ileus ◽

Gall Stone ◽

Case Presentation ◽

Peritoneal Encapsulation ◽

History Of ◽

Gall Stone Ileus

Abstract Introduction Small bowel obstruction can be caused by multiple factors. We describe an unusual case of small bowel obstruction secondary to three rare factors: gallstone ileus, peritoneal encapsulation and congenital adhesional band. Case Presentation A seventy-nine-year-old male presented with a four-day history of obstipation and abdominal pain. CT abdomen pelvis revealed small bowel obstruction secondary to gallstone ileus. The patient was managed by laparotomy. The intraoperative findings revealed the presence of a congenital peritoneal encapsulation with an adhesional band and gallstone proximal to the ileo-caecal valve. Although there was some dusky small bowel, this recovered following the release of the band. Discussion Peritoneal Encapsulation is a rare congenital pathology resulting in the formation of an accessory peritoneal membrane around the small bowel. This condition is asymptomatic and rarely presents as small bowel obstruction. The diagnosis is often made at laparotomy. There are less than 60 cases reported in literature. Gallstone ileus is another rare entity caused by an inflamed gallbladder adhering to part of the bowel resulting in a fistula. Conclusions The rarity of these conditions mean that they are poorly understood. A combination of this triad of gall stone ileus in the presence of peritoneal encapsulation and congenital band has not been reported before. Knowledge of this would raise awareness, facilitate diagnosis and management of patients.

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An interesting case of left paraduodenal hernia.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.05.4648 ◽

2021 ◽

Vol 28 (05) ◽

pp. 755-758

Author(s):

Sahar Saeed ◽

Abeera Butt ◽

Syed Asghar Naqi ◽

Muhammad Mohsin Ali

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Interesting Case ◽

Paraduodenal Hernia ◽

Absorbable Suture ◽

Internal Hernias ◽

Plain Abdominal Radiography ◽

History Of ◽

Operative Recovery

Paraduodenal fossa hernias (PDFHs) represent 53% of all congenital internal hernias and 0.2-0.9% of all small bowel obstructions. Most of these hernias are diagnosed incidentally on laparotomy, and carry up to 50% lifetime risk of development of small bowel obstruction. We present our experience in diagnosing and treating a case of a massive left paraduodenal fossa hernia in a 17 year male, containing over 30% of the small bowel (jejunum and ileum), presenting with a history of recurrent incomplete small bowel obstruction. Plain abdominal radiography showed distended loops of jejunum and few air fluid levels. After laparotomy and identification of hernia, small gut was reduced and examined, which was found to be structurally and functionally intact with normal vascularity. The defect was closed with continuous absorbable suture (Vicryl 2-0) sparing the inferior mesenteric vessels. Patient’s post-operative recovery remained uneventful and he was discharged on 4th post-operative day.

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Predictors of Ischemic Bowel in Patients with Small Bowel Obstruction

The American Surgeon ◽

10.1177/000313481608201030 ◽

2016 ◽

Vol 82 (10) ◽

pp. 992-994 ◽

Cited By ~ 6

Author(s):

Michael P. O'Leary ◽

Angela L. Neville ◽

Jessica A. Keeley ◽

Dennis Y. Kim ◽

Christian De Virgilio ◽

...

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Bowel Ischemia ◽

Wall Thickening ◽

Ischemic Bowel ◽

Operative Exploration ◽

Common Etiology ◽

History Of ◽

Exploratory Laparoscopy

Preoperative diagnosis of ischemic bowel in patients with small bowel obstruction (SBO) is a clinical challenge. The aim of this study was to identify preoperative variables associated with ischemic bowel found at operative exploration. We performed a 5-year retrospective review of patients admitted to a university affiliated, county funded hospital who underwent exploratory laparoscopy or laparotomy for SBO. Patients were excluded if they had a known preoperative malignancy or hernia on physical examination. Multivariate logistic regression was used to determine factors independently associated with bowel ischemia or ischemic perforation. One hundred and sixteen patients underwent exploratory surgery for SBO. Mean age was 52 ± 14 years and most were male [64 (55.2%)]. Adhesions [92 (79.3%)] were the most common etiology of obstruction. Leukocytosis ( P = 0.304) and acidosis ( P = 0.151) were not significantly associated with ischemia or ischemic perforation. In addition, history of prior SBO ( P = 0.618), tachycardia ( P = 0.111), fever ( P = 0.859), and time from admission to operation ( P = 0.383) were not predictive of ischemic bowel. However, hyponatremia (≤134 mmol/L) and CT scan findings of wall thickening or a suspected closed loop were independently associated with bowel ischemia. Awareness of these predictors should heighten the concern for ischemic bowel in patients presenting with SBO.

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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 Wireless Enteroscopic Capsule and Unrecognized Intestinal Stricture

The American Surgeon ◽

10.1177/000313480607201213 ◽

2006 ◽

Vol 72 (12) ◽

pp. 1216-1217

Author(s):

Hadi Najafian ◽

Camille Eyvazzadeh

Keyword(s):

Small Bowel ◽

Physical Examination ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Unusual Case ◽

Bowel Resection ◽

Anastomotic Stricture ◽

History Of ◽

Resection And Anastomosis

The wireless enteroscopy capsule (WEC) was approved for noninvasive visualization of small bowel. We report an unusual case of a previously healthy man with history of bowel resection and anastomosis who developed small bowel obstruction after ingestion of a WCE. At operation, an anastomotic stricture site was noted and the WEC was proximal to this stricture, causing obstruction. This case emphasizes the importance of a good history and physical examination, as well as vigilant follow-up and retrieval of WEC.

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Small bowel volvulus versus adhesive small bowel obstruction: a diagnostic dilemma in a 19-year-old woman

BMJ Case Reports ◽

10.1136/bcr-2018-229157 ◽

2019 ◽

Vol 12 (6) ◽

pp. e229157

Author(s):

Kay Tai Choy ◽

Nathan Brunott

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Adhesive Small Bowel Obstruction ◽

Diagnostic Study ◽

Diagnostic Dilemma ◽

Small Bowel Volvulus ◽

Intraabdominal Adhesions ◽

Preoperative Diagnostic ◽

History Of

Small bowel volvulus (SBV) is often challenging to diagnose. Research suggests that the clinical presentation of this disease is often very similar to other more common causes of small bowel obstruction (SBO) such as intraabdominal adhesions and no single preoperative diagnostic study is sensitive or specific enough to identify this rare cause of mechanical SBO. This report describes a case of a 19-year-old woman who presented with irretractable vomiting and abdominal pain secondary to SBV. This case is unusual as her history of recurrent adhesive SBO presented a diagnostic dilemma that required a higher degree of clinical suspicion to tease these differential diagnoses apart. She underwent laparoscopy which facilitated successful detorsion and resection of the floppy tongue of jejunum. This report aims to increase the awareness among surgeons.

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