scholarly journals Small Bowel Obstruction Caused by an Incarcerated Hernia after Iliac Crest Bone Harvest

ISRN Surgery ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Steven d'Hondt ◽  
Savas Soysal ◽  
Philipp Kirchhoff ◽  
Daniel Oertli ◽  
Oleg Heizmann
Keyword(s):  
Small Bowel ◽  
Bowel Obstruction ◽  
Iliac Crest ◽  
Abdominal Cavity ◽  
Easy Access ◽  
Autogenous Bone ◽  
Elective Resection ◽  
Left Femur ◽  
Onlay Mesh ◽  
The Right

The iliac crest has become an often used site for autogenous bone graft, because of the easy access it affords. One of the less common complications that can occur after removal is a graft-site hernia. It was first reported in 1945 (see the work by Oldfield, 1945). We report a case of iliac crest bone hernia in a 53-year-old male who was admitted for elective resection of a pseudarthrosis and reconstruction of the left femur with iliac crest bone from the right side. One and a half months after initial surgery, the patient presented with increasing abdominal pain and signs of bowel obstruction. A CT scan of the abdominal cavity showed an obstruction of the small bowel caused by the bone defect of the right iliac crest. A laparoscopy showed a herniation of the small bowel. Due to collateral vessels of the peritoneum caused by portal hypertension, an IPOM (intraperitoneal onlay-mesh) occlusion could not be performed. We performed a conventional ventral hernia repair with an onlay mesh. The recovery was uneventful.

scholarly journals Laparoscopy in Management of Children with Small Bowel Obstruction

2016 ◽  
Vol 23 (3) ◽  
Author(s):  
A O Dvorakevych ◽  
A A Pereyaslov ◽  
Yu I Tkachyshyn
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Rapid Development ◽  
Abdominal Cavity ◽  
Ileocecal Valve ◽  
Adhesive Small Bowel Obstruction ◽  
Adhesive Properties ◽  
Postoperative Complication Rate ◽  
Common Causes

Small bowel obstruction caused by adhesions is one of the most common causes of hospital admission among children. Until recently, the presence of symptoms of small bowel obstruction was the contraindication for laparoscopy; however, rapid development of minimally-invasive surgery determined the implementation of these methods in the management of patients with small bowel obstruction.The objective of the research was to summarize our own experience of laparoscopic treatment of children with small bowel obstruction.Materials and methods. The study is based on the results of laparoscopic management of 86 children being operated on during 2007-2015. Laparoscopy was used in 90.7% of patients and laparoscopically assisted procedures were performed in 9.3% of cases. Results. Adhesive small bowel obstruction occurred more often after laparotomy (70.9%), while after laparoscopy it was detected in 16.3% of patients only. During surgical revision of the abdominal cavity, single obstructive bands often in the area of the ileocecal valve were found in 55.8% patients; diffuse dense bands were observed in 31.4% of children; in 12.8% of children twisting of a loop of small bowel around the Meckel’s diverticulum was noted. Laparoscopically assisted procedures were applied in cases that required bowel resection. The postoperative complication rate was 9.3%.Conclusions. In the presence of appropriate skills, laparoscopic adhesiolysis can be a real alternative to conventional laparotomy in treating children with small bowel obstruction. The usage of remedies with anti-adhesive properties improves the results of treating children with bowel obstruction.

scholarly journals Resected bowel syndrome: clinical course and treatment options

2020 ◽  
Vol 92 (12) ◽  
pp. 36-42
Author(s):  
I. E. Hatkov ◽  
T. N. Kuzmina ◽  
E. A. Sabelnikova ◽  
A. I. Parfenov
Keyword(s):  
Small Bowel ◽  
Mixed Type ◽  
Bowel Resection ◽  
Clinical Course ◽  
Abdominal Cavity ◽  
Small Bowel Resection ◽  
Nutritional Risk ◽  
Protein Energy ◽  
The Right ◽  
Resected Bowel

The current concepts of the short bowel syndrome and malabsorption after intestinal surgery are generally accepted, but do not fully reflect the patients condition, making it difficult to diagnose and treat it. Aim.The purpose of the study is to analyze the clinical course of the patients after bowel resection, to create a classification based on the variants identified to allow for a differentiated treatment and to introduce the concept of the resected bowel syndrome. Materials and methods.We observed 239 patients (96 men and 143 women) aged 18 to 80 who underwent intestinal resection for 1 month to 16 years (from 2002 to 2018). The 1st group included 96 patients with small bowel resection (40 men and 56 women). The 2nd group included 39 men and 58 women with small bowel resection, including the resection of the ileocecal valve and the right-hand side of the colon (n=97). The 3rd group included 17 men and 29 women with the resection of the right-hand side of the colon or colectomy (n=46). The survey included the NRS-2002 (Nutritional Risk Screening 2002) screening test to identify nutritional risk, a clinical assessment of the symptoms that occurred after the surgery, instrumental methods (esophagogastroduodenoscopy, colonoscopy with biopsy, ultrasound of the abdominal cavity organs and the kidneys, a plain radiography of the abdominal cavity organs, an X-ray examination of the small intestine and the intestinal passage), serum citrulline and short-chain fatty acids in faeces. Results.Based on the analysis of the clinical symptoms and the nutritional status of the patients, a new concept is proposed the resected bowel syndrome with two variants of its progression: either with or without the development of nutritional insufficiency of three types: the dehydration type, the protein-energy insufficiency type and a mixed type. Type 1 requires the use of antimicrobials with the control of SCFA concentrations in faeces. Type 2 requires the introduction of an optimal amount of easily digestible protein to correct protein-energy deficit. The 3rd (most severe) mixed type requires prescription of a parenteral nutrition component with the control of citrulline concentration in the blood serum. Conclusion.The proposed concept the resected bowel syndrome makes it possible to improve its diagnosis, take into account the variants of its progression and allow for a differentiated treatment.

scholarly journals Delayed primary fascia closure of Björck grade 4 open abdomen with enteroatmospheric fistulas after repeated surgery for adhesive small bowel obstruction: a case report

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yoshimasa Akashi ◽  
Koichi Ogawa ◽  
Kaoru Sasaki ◽  
Jaejeong Kim ◽  
Tsuyoshi Enomoto ◽  
...  
Keyword(s):  
Small Bowel ◽  
Parenteral Nutrition ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Open Abdomen ◽  
Abdominal Cavity ◽  
Wound Management ◽  
Adhesive Small Bowel Obstruction ◽  
Proximal Site ◽  
Fascia Closure

Abstract Background An open abdomen with frozen adherent bowels is classified as grade 4 in Björck’s open abdomen classification, and skin grafting after wound granulation is a typical closure option. We achieved delayed primary fascia closure for a patient who developed open abdomen with enteroatmospheric fistulas due to severe adherent small bowel obstruction. We present here the details of his management. Case presentation A 52-year-old man suffered acute abdominal pain during a flight and received an emergency laparotomy due to adhesive small bowel obstruction. Repeated laparotomies were required, and later open abdomen and proximal site jejunostomy were selected. After negative pressure wound therapy, he was transferred to our institution. Two enteroatmospheric fistulas emerged on the exposed intestine, and we diagnosed the condition as a Björck grade 4 open abdomen. After 8 months of wound care and parenteral nutrition, we decided to attempt primary wound closure because the patient required permanent oral restriction and total parenteral nutrition due to short bowel syndrome. A circular incision along the circumference of the exposed bowel allowed us to take a safe approach into the abdominal cavity. We removed the intestinal adhesions completely and resected the bowels, including the fistulas and anastomosed parts. Finally, the abdominal wall defect was reconstructed using the component separation technique, and the patient was discharged without an ostomy. Conclusions Primary fascia closure for grade 4 open abdomen is hard, but leaving a long interval before radical surgery and applying pertinent wound management may help solve this adverse situation.

scholarly journals Internal hernia caused by a free intraperitoneal staple after laparoscopic appendectomy

2018 ◽  
Vol 4 (1) ◽  
pp. 14 ◽  
Author(s):  
Lisa M. Angotti ◽  
Christopher Decker ◽  
Brittany Pahwa ◽  
Carl Rosati ◽  
Todd Beyer
Keyword(s):  
Small Bowel ◽  
Bowel Obstruction ◽  
Laparoscopic Appendectomy ◽  
Internal Hernia ◽  
Closed Loop ◽  
Ease Of Use ◽  
Lower Quadrant ◽  
Transition Points ◽  
The Veil ◽  
The Right

Background: Laparoscopic appendectomy is the gold standard for treatment of appendicitis. Stapled closure of the appendiceal stump is commonly performed and has several advantages. Few prior cases have demonstrated complications from free staples left within the abdomen after the stapler has been fired.Case report: A 29-year-old female underwent laparoscopic appendectomy for acute uncomplicated appendicitis during which the appendix and mesoappendix were divided using laparoscopic gastrointestinal anastomosis (GIA) staplers. Her initial recovery was uncomplicated. She returned on postoperative day 17 with sharp mid-abdominal pain, obstipation, and emesis. Her abdomen was distended, and she had a mild leukocytosis. Computed tomography (CT) demonstrated twisted loops of dilated small bowel in the right lower quadrant with two transition points, suggestive of internal hernia with closed loop bowel obstruction. Diagnostic laparoscopy was performed through the three prior appendectomy incisions. An adhesion between the Veil of Treves and the mesentery of the ileum caused by a solitary free closed staple, remote from the staple lines, had caused an internal hernia. The hernia was reduced, and the small bowel was noted to have early ischemic discoloration. The adhesion was lysed by removing the staple from both structures. The compromised loops of bowel began to show peristaltic movement and color returned to normal, and the procedure was concluded without resection. She was discharged home the following day.Conclusions: Gastrointestinal staplers are commonly used due to ease of use and low complication rate. It is not uncommon to leave free staples in the abdomen as retrieval can be difficult and time consuming. Our case is only the second in the literature reporting an internal hernia with closed loop bowel obstruction as a complication of retained staples. Choosing the most appropriate size staple load to reduce the number of extra staples, removing free staples, or the use of an endoloop can prevent potentially devastating complications.

scholarly journals Closed loop small bowel obstruction due to paracaecal internal herniation: a lesson in rarity

2018 ◽  
Vol 11 (1) ◽  
pp. e227461 ◽  
Author(s):  
Richard Menezes ◽  
Ranjeet Kamble ◽  
Anagha Joshi ◽  
Kalpesh Chaudhari
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Closed Loop ◽  
Iliac Fossa ◽  
Tertiary Hospital ◽  
Postoperative Recovery ◽  
Abdominal Ct ◽  
Distended Bowel ◽  
The Right

A 40-year-old man presented to the emergency department of our tertiary hospital with acute abdominal pain since 1 day, which responded to conservative measures initially. On further investigation and abdominal CT, he was diagnosed with closed loop small bowel obstruction with an encapsulated lesion with small bowel loops within, in the right iliac fossa, which was initially missed. On exploration, the patient had a sac in the right iliac fossa (paracaecal incarcerated internal hernia) with distended bowel loops within, the sac was excised after reduction of the contents. Postoperative recovery was uneventful.

scholarly journals Diagnostic program and tactical approaches to treatment of patients with obturative colonic obstruction of tumor genesis

2012 ◽  
Vol 93 (3) ◽  
pp. 426-431
Author(s):  
I S Malkov ◽  
M M Toltoev
Keyword(s):  
Bowel Obstruction ◽  
Surgical Intervention ◽  
Primary Anastomosis ◽  
Colonic Obstruction ◽  
Abdominal Cavity ◽  
Digital Rectal Examination ◽  
Postoperative Mortality ◽  
Diagnostic Procedures ◽  
Results Of Treatment ◽  
The Right

Aim. To determine the value of ultrasound investigations, colonoscopy and laparoscopy in the complex diagnosis of acute obturative colonic obstruction of tumor genesis and in selecting the optimal treatment strategy. Methods. Conducted was an anlysis of results of treatment of 112 patients with obturative colonic obstruction of tumor genesis. A set of diagnostic procedures was carried out for every admitted patient: digital rectal examination, radiography of the abdomen, ultrasound examination, fiber colonoscopy, and laboratory studies. Results. Based on the clinical and radiographic the diagnosis of obturative colonic obstruction was established in 64.3%, ultrasound investigation revealed the presence of bowel obstruction without specifying its location in 92% of the cases. Emergency colonoscopy was informative only in 55.5% of cases due to inadequate prior preparation of the colon. Using the developed methodology of preparing the colon, it was possible to perform colonoscopy up to the level of the tumor in 26 patients (92.9%) out of 28 patients. In the 32 cases minimal surgical intervention were performed by way of formation of an ileotransverse anastomosis by-pass, double-barreled ileostomy or colostomy. 80 patients underwent resection of the bowel with the tumor, including operations with the formation of a primary anastomosis, which were performed in 20 patients when the tumor was located in the right segments of the colon. In 22 patients an intraoperative colonic lavage was performed. Postoperative complications were recorded in 30 (26.8%) patients. Postoperative mortality was 24.1% (27 patients). Conclusion. Based on the radiographic and ultrasound investigations of the abdominal cavity it is possible to establish the presence of bowel obstruction without specifying the localization of the obstruction zone; in order to determine the cause of the obturative colonic obstruction it is necessary to perform an emergency colonoscopy with rigorous preparation of the colon according to the developed technique, while the volume of surgical intervention should be determined in each case individually.

scholarly journals Intestinal Obstruction due to Acute Appendicitis

2020 ◽  
Vol 14 (2) ◽  
pp. 346-353 ◽  
Author(s):  
Pham Hong Duc ◽  
Ngo Minh Xuan ◽  
Nguyen Huu Thuyet ◽  
Huynh Quang Huy
Keyword(s):  
Computed Tomography ◽  
Small Bowel ◽  
Acute Appendicitis ◽  
Intestinal Obstruction ◽  
Small Bowel Obstruction ◽  
Male Patient ◽  
Bowel Obstruction ◽  
Clinical Manifestations ◽  
Specific Research ◽  
The Right

Acute appendicitis has been proven to be a usual cause of mechanical small bowel obstruction since 1901, but there has been very little specific research on this subject. It usually occurs as an effect of adhesion because of periappendicular inflammation. Although previous studies exist, this presentation of acute appendicitis is not widely identified, which might lead to delays in making the right diagnosis and initiating treatment. We herein report a 17-year-old male patient who presented with the clinical manifestations of intestinal obstruction and fever for 3 days. Preoperative ultrasound and subsequent computed tomography were performed. On laparotomy, an obstructed bowel was seen, and the appendix was recognized to be the cause. We herein report a case of intestinal obstruction due to acute appendicitis and present an overview of the literature.

Intestinal obstruction caused by encircling fallopian tube

2021 ◽  
Vol 14 (8) ◽  
pp. e242530
Author(s):  
Ravi Lohani ◽  
Poorvi Mathur
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Fallopian Tube ◽  
Bowel Obstruction ◽  
White Cell Count ◽  
Clinical Signs ◽  
Intravenous Contrast ◽  
History Of ◽  
The Right ◽  
Surgery Department

A 50-year-old woman was admitted to our emergency surgery department with 1-week history of abdominal pain, distension, vomiting and constipation. On examination, she has a distended abdomen with sluggish bowel sounds, but no clinical signs of peritonitis. Blood tests were normal except for the increased white cell count and erythrocyte sedimentation rate (ESR). CT scan with oral as well as intravenous contrast demonstrated the small bowel obstruction without any insight into the aetiology of the disease. Intraoperatively, the right fallopian tube was found to encircle the terminal ileum. A right salpingo-oophorectomy was performed to release the bowel. This case report describes a rare cause of the small bowel obstruction in female patients.

scholarly journals Right para duodenal hernia presenting as small bowel obstruction: a rare case report

2020 ◽  
Vol 7 (7) ◽  
pp. 2410
Author(s):  
Dipanshu Kakkar ◽  
Shubra Kochar ◽  
Sanjeev Prasad
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Abdominal Hernia ◽  
Midline Laparotomy ◽  
Internal Hernias ◽  
Hernia Formation ◽  
Rare Case Report ◽  
Operative Findings ◽  
The Right

Internal hernias are rare congenital anomalies. The most common internal hernias are para duodenal hernias (53%) followed by pericaecal hernias 13%. Para duodenal hernia, a rare congenital anomaly that arises from an error of rotation of the midgut, is the most common type of intra-abdominal hernia. There are two types, right and left para duodenal hernia, the right being less common.  Here we present a case of a 21 years old male presented in surgical emergency department non-passage of flatus and stools since, 5 days with associated nausea, vomiting and abdominal pain. Abdominal CT demonstrated signs of small bowel obstruction. A midline laparotomy was performed. Intra operative findings suggestive of right sided para duodenal hernia. Careful reduction of hernia and plication of sacs done with new D-J flexure formation. Para duodenal hernias are rare congenital entities. Left para duodenal hernia is more common than right. The right para duodenal hernia occurs when the pre arterial limb of the mid gut loop fails to rotate around the superior mesenteric artery. Symptoms may vary according to degree of obstruction or gut ischemia. Reduction of contents of the sac and plication of the sac to prevent further hernia formation and resection of small bowel in cases of gut gangrene remains the mainstay of the treatment.

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