RECURRENT SUB -ACUTE INTESTINAL OBSTRUCTION PRESENTED AS MIDGUT MALROTATION WITH VOLVULUS MANAGED BY LAAD'S PROCEDURE AND SURGERY IN AN ADULT PATIENT: A CASE REPORT AND LITERATURE REVIEW

2021 ◽  
pp. 6-8
Author(s):  
Sukanta Sikdar ◽  
Mala Mistri ◽  
Tuhinsubhra Mandal
Keyword(s):  
Case Report ◽  
Intestinal Obstruction ◽  
Adult Population ◽  
Exploratory Laparotomy ◽  
Acute Intestinal Obstruction ◽  
Intestinal Malrotation ◽  
Uneventful Recovery ◽  
Midgut Volvulus ◽  
Rare Presentation ◽  
Diagnostic Dilemma

Background: Intestinal malrotation refers to the partial or complete failure of rotation of midgut around the superior mesenteric vessels in embryonic life. Arrested midgut rotation results due to narrow-based mesentery and increases the risk of twisting midgut and subsequent obstruction and necrosis. Midgut volvulus secondary to intestinal malrotation is a rare presentation in adults more so in the elderly. Its rarity portends a diagnostic dilemma for both the surgeon and radiologist, and CT scan showed dilated large and small intestine segments with air-fluid levels and twisted mesentery around superior mesenteric artery and vein indicating "whirlpool sign". In our patient Case presentation: 42 years old male who presented to the emergency department with acute onset of pain in the RUQ, vomiting, and absolute obstipation for the last 2 days. This patient had a history of similar two episodes of sub-acute intestinal obstruction in the last 6 months which has been managed conservatively. The patient underwent an elective exploratory laparotomy after 2 days of failed conservative management. Operative findings included the presence of adhesive bands in the RUQ (Ladd's Band), volvulus of the mid-portion of the small bowel in a clockwise fashion, and multiple intraabdominal adhesions and empty RIF and caecum pulled up in RUQ. We subsequently performed a Ladd's procedure, multiple adhesiolysis, and caecopexy and the patient had an uneventful recovery with eventual discharge on postoperative day 12. This case report reviews the incidence of malrotation in adults. It also high Conclusion: lights the difficulty in diagnosing midgut volvulus in the adult population given the nonspecific, insidious symptoms, therefore, prompting awareness of its existence and a high degree of clinical suspicion. Malrotation should be considered in the differential diagnosis in patients presented with acute abdomen and intestinal ischemia.

scholarly journals A rare acute presentation of intestinal malrotation in the elderly

2020 ◽  
Vol 7 (10) ◽  
pp. 3432
Author(s):  
Abidemi A. Adesuyi ◽  
Oladele O. Situ ◽  
Cephas S. Batta
Keyword(s):  
The Elderly ◽  
Intestinal Malrotation ◽  
Age Group ◽  
Midgut Volvulus ◽  
Diagnostic Challenge ◽  
Rare Presentation ◽  
Diagnostic Dilemma ◽  
Acute Presentation ◽  
History Of ◽  
High Index Of Suspicion

Intestinal malrotation, a congenital anomaly of the midgut, typically presents in pediatrics age group with the most feared complication of midgut volvulus and its catastrophic sequelae. Midgut volvulus secondary to intestinal malrotation is a rare presentation in adults more so in the elderly. Its rarity portends a diagnostic dilemma for both the surgeon and radiologist. We report a 65-year-old man admitted following a referral with a 12-hour history of acute abdomen with an initial diagnosis of acute pancreatitis but later had laparotomy with intraoperative findings of a midgut volvulus and gangrenous ileal segment secondary to intestinal malrotation. This case emphasizes the importance of early diagnosis to prevent the disastrous complication of this disease. The rarity of this condition portends a formidable diagnostic challenge in adults hence the awareness of its possibility and a high index of suspicion is crucial in diagnosis.

scholarly journals Rare case of paracaecal hernia with intussusception presenting as small bowel obstruction: case report

2020 ◽  
Vol 7 (5) ◽  
pp. 1662
Author(s):  
M. S. Kalyan Kumar ◽  
Shyamsundar R. ◽  
Sabari Girieasan M. ◽  
R. Kannan ◽  
S. Nedunchezhiyan
Keyword(s):  
Intestinal Obstruction ◽  
Internal Hernia ◽  
Exploratory Laparotomy ◽  
Acute Intestinal Obstruction ◽  
Emergency Laparotomy ◽  
High Morbidity ◽  
Rare Presentation ◽  
Ileal Loop ◽  
Rare Type ◽  
Internal Hernias

Primary internal hernias are very rare in adults. They are an unusual cause of small intestinal obstruction and lead to high morbidity and mortality if left untreated. Clinical presentation of internal hernia is highly nonspecific. Imaging has limited role in diagnosing the cause of acute intestinal obstruction. Internal hernias are usually detected at laparotomy. We report a case of a 61-year-old male who presented with acute intestinal obstruction which was attributed later to a very rare type of internal hernia on exploratory laparotomy. A loop of ileum was found to enter the retroperitoneum through a hernia gate which was located lateral to the caecum and ileo ileal intussusception was noted proximal to the herniated loop. The segment of intestine was resected and anastamosed then hernial defect was closed. Paracaecal hernias are the rare type of hernias in internal hernia. In our case, intussusception was noted proximal to the herniated ileal loop which is a very rare presentation. Intussusception was reported previously with paraduodenal type. One should always keep in mind while conducting emergency laparotomy, internal hernias can be a cause for intestinal obstruction.

scholarly journals PHYTOBEZOAR

2006 ◽  
Vol 13 (03) ◽  
pp. 478-480
Author(s):  
ALI ASIA BANU ◽  
REHAN MASOOD ◽  
ISHTIAQ AHMED CHAUDHARY
Keyword(s):  
Case Report ◽  
Intestinal Obstruction ◽  
Terminal Ileum ◽  
Exploratory Laparotomy ◽  
Acute Intestinal Obstruction ◽  
Small Intestinal Obstruction ◽  
Small Intestinal

Objectives: We are presenting a case report of an11 year old boy brought in emergency with acute intestinal obstruction. An exploratory Laparotomy revealed two stonyhard large phytobezoars to be the cause of the acute small intestinal obstruction at terminal ileum. Enterotomy wasdone to remove the bezoars and patient had smooth recovery.

scholarly journals Strangulated internal supravesical hernia associated with left inguinal hernia: A very rare case report of acute intestinal obstruction

2021 ◽  
pp. 102393
Author(s):  
El yamine othmane ◽  
Fatimazahra Bensardi ◽  
Abdessamad majd ◽  
El Bakouri Abdelilah ◽  
Bouali Mounir ◽  
...  
Keyword(s):  
Case Report ◽  
Inguinal Hernia ◽  
Intestinal Obstruction ◽  
Rare Case ◽  
Acute Intestinal Obstruction ◽  
Rare Case Report

scholarly journals Congenital Descending Colonic Stenosis with Perforation of Transverse Colon in a Neonate: A Case Report

2012 ◽  
Vol 32 (1) ◽  
pp. 73-75
Author(s):  
R Hamid ◽  
AH Shera ◽  
NA Bhat ◽  
A Baba ◽  
A Rashid
Keyword(s):  
Intestinal Obstruction ◽  
Sigmoid Colon ◽  
Transverse Colon ◽  
Late Onset ◽  
Abdominal Distension ◽  
Exploratory Laparotomy ◽  
Uneventful Recovery ◽  
Colonic Stenosis ◽  
Colonic Atresia ◽  
Mucous Fistula

Colonic atresia and stenosis are rare causes of intestinal obstruction in the infant. Only 10 cases have been reported in Literature since 1966 and only one late-onset case has been reported in Literature until now. We describe the case of a 3 day old baby presenting with abdominal distension, failure to pass meconium and vomiting. X-ray of the abdomen showed dilated gut loops. Exploratory laparotomy was performed. At the junction of descending and sigmoid colon a stenosis was found, laparotomy also revealed a perforation of transverse colon. Transverse colostomy and a mucous fistula of sigmoid colon was performed after resecting stenosing segment and colon distal to perforation site upto stenosing site. Diagnosis was confirmed on histopathology. Colostomy was close after six weaks with uneventful recovery. Considering both the Literature and our case, congenital colonic stenosis should be considered one of the rare differential diagnoses in a neonate presenting as complete or partial intestinal obstruction. Key words: Colonic Stenosis; Perforation; Obstruction DOI: http://dx.doi.org/10.3126/jnps.v32i1.5446   J. Nepal Paediatr. Soc. Vol.32(1) 2012 73-75  

scholarly journals Strangulated internal hernia through the lesser omentum with intestinal necrosis: a case report

2002 ◽  
Vol 120 (3) ◽  
pp. 84-86 ◽  
Author(s):  
Gustavo Gibin Duarte ◽  
Belchor Fontes ◽  
Renato Sérgio Poggetti ◽  
Marcos Roberto Loreto ◽  
Paulo Motta ◽  
...  
Keyword(s):  
Case Report ◽  
Intestinal Obstruction ◽  
Internal Hernia ◽  
Clinical Manifestations ◽  
Acute Intestinal Obstruction ◽  
Main Task ◽  
Intestinal Necrosis ◽  
Lesser Omentum ◽  
Lesser Sac ◽  
Internal Hernias

CONTEXT: Internal hernias account for only 0.2 to 0.9% of the cases of intestinal obstruction. They do not have specific clinical manifestations, and are usually diagnosed during laparotomy for acute intestinal obstruction. Internal hernias through the lesser omentum are extremely rare. CASE REPORT: We report here the case of a 36-year-old patient who underwent exploratory laparotomy for acute intestinal obstruction. An internal hernia through the lesser omentum was found, with a strangulated ileal segment passing through the perforation into an abscess within the lesser sac. The surgical procedures included ileal resection, primary anastomosis, abscess removal, and placement of a drain in the lesser sac. The patient was reoperated 6 days later for abdominal sepsis; a lesser sac abscess was removed and the abdominal incision was left open. The patient stayed in the Intensive Care Unit for 15 days, and eventually left the hospital on the 28th post-admission day, with complete recovery thereafter. CONCLUSION: The early diagnosis of acute intestinal obstruction and immediate indication for laparotomy is the main task of the surgeon when faced with a case of acute abdomen with a hypothesis of internal hernia, so as to minimize severe postoperative complications, as illustrated by the present case.

scholarly journals Emergency surgical management of sub-hepatic appendicular perforation with abscess; rare presentation of a common disease: a case report

2021 ◽  
Vol 9 (11) ◽  
pp. 3478
Author(s):  
S. K. Sekendar Ali ◽  
Narendra Nath Mukhopadhyay
Keyword(s):  
Case Report ◽  
Surgical Management ◽  
Perforated Appendicitis ◽  
Exploratory Laparotomy ◽  
Clinical Suspicion ◽  
Common Disease ◽  
Emergency Setting ◽  
Atypical Presentation ◽  
Rare Presentation ◽  
High Level

Subhepatic appendicitis is a very rare presentation that has been rarely reported, accounting for 0.01% of acute appendicitis case. It is difficult to diagnose and prime to be aware of variants, manage such challenging case in emergency setting. We present a case of 29 years male patient with subhepatic perforated appendicitis and its sequelae-abscess and peritonitis who underwent an exploratory laparotomy and appendectomy. The initial diagnosis and surgical management of such patients is challenging due to very rare and atypical presentation in emergency setting. A high level of clinical suspicion, promote decision to operate and skillful surgical approach is discussed with briefly.

Sign in / Sign up

Export Citation Format

Share Document