A case of volvulus of the small intestine during eight months of pregnancy

Intestinal obstruction is one of the chapters of modern surgery, where not all questions have yet been clarified and developed, which can be seen at least from the fact that this topic is the subject of discussion at the congresses and does not leave the pages of the surgical press. One thing is certain that the therapy of acute obstruction is exclusively surgical.

Quantitative evaluation of upper urinary tract pump function in pigs with acute unilateral lower ureteral obstruction by 640-slice dynamic volume CT

Background It is a challenging problem to differentiate obstructive hydronephrosis from noninvasive evaluation of renal pelvis and ureteral motility in patients. The purpose of this study was to explore the value of 640-slice dynamic volume CT (DVCT) in the quantitative measurement of upper urinary tract (UUT) pump function after acute unilateral lower ureteral obstruction in pigs. Methods In this study, a perfusion pig model was constructed by constant pressure perfusion testing of the renal pelvis and left nephrostomy. The perfusion and pressure measuring devices were connected to create a state of no obstruction and acute obstruction of the lower part of the left ureter. After successful modelling, continuous dynamic volume scanning of the bilateral renal excretion phase was performed with 640-slice DVCT, and pump functions of the renal pelvis and part of the upper ureter were calculated and analysed. No obstruction or acute obstruction of the lower part of the left ureter was observed. Pump functions of the renal pelvis and part of the upper ureter were determined. Results The results showed that after LUUT fistulostomy, the time difference between the average UUT volume and positive volume value increased gradually, and the calculated flow velocity decreased, which was significantly different from that of the RUUT. The volume difference of the LUUT increased significantly in mild obstruction. In the bilateral control, the volume change rate of the LUUT increased with mild obstruction and decreased with severe obstruction, and there was a significant difference between the left and right sides. Conclusion The continuous dynamic volume scan and measurement of 640-slice DVCT can obtain five pump function datasets of UUT in pigs with acute lower ureteral obstruction.

Case presentation on a rare cause of small bowel obstruction- trichobezoar: a case report

Trichobezoars are concretions of swallowed hairs retained within the digestive tract, most commonly stomach. Most common in young females and with psychiatric illness. Trichobezoar may be a cause of acute abdomen when it is complicated with acute obstruction or perforation. In this report we present a case of young girl who presented as an acute obstruction due to two large ileal trichobezoars.

Acute Budd Chiari syndrome in an ECMO patient

Introduction: Point-of-care ultrasound (POCUS) is widely utilized to make timely decisions regarding patient care. This approach allowed us to diagnose the cause of acutely rising transaminases in a patient in severe ARDS secondary to influenza pneumonia requiring veno-venous extracorporeal membrane oxygenation (VV-ECMO). Case report: A 36-year-old female presented with acute hypoxemic respiratory failure secondary to influenza A infection. Within 24 hours, she required intubation and met severe ARDS criteria with a PaO2/FiO2 ratio of 62. She was managed with high PEEP and low tidal volume ventilation strategy, however her clinical status continued to deteriorate and the decision was made to pursue VV-ECMO. Within hours of cannulation her aspartate aminotransferase (AST) dramatically increased from 736 to 4512 µ/L, with concurrent mild increases in alanine aminotransferase (ALT) and creatine phosphokinase (CPK). Point-of-care ultrasound was performed which revealed a complete absence of flow in the hepatic vein, secondary to acute obstruction by an 25-French drainage catheter for the ECMO circuit. The catheter was exchanged with a smaller French catheter and the patient’s transaminases and CPK levels quickly decreased and returned to normal within several days. Discussion: Budd-Chiari syndrome (BCS) is a rare but potentially life-threatening condition caused by acute obstruction of hepatic vein blood flow that can lead to fulminant liver failure if left untreated. BCS is usually caused by a hepatic vein thrombus, however any mechanical obstruction can lead to the same pathology. Point-of-care ultrasound lead to a prompt diagnosis and allowed for quick action to correct the obstruction. Although BCS is not a common problem with VV-ECMO, the syndrome should always be on the differential of any patient on VV-ECMO with acutely rising transaminases. Conclusion: Ultrasound played an integral role in providing a crucial diagnosis of BCS secondary to obstruction by an ECMO drainage catheter.

Spigelian hernia with bilateral undescended (impalpable) testis in a child: rare scenario

Spigelain hernia (SH) is rarely seen in children. Various mechanisms has been described for the co-existence with cryptorchidism. A 4 month old boy, a known case of bilateral impalpable testes and intermittent right lower abdominal swelling was brought to paediatric emergency with complaints of excessive cry, poor feeding and irreducible right lower abdominal swelling - the swelling was a little higher than the usual inguinal hernia. On exploration, SH was seen coming off the deep ring then turning around the conjoint tendon and dissecting between internal oblique and external oblique aponeurosis. The hernia contained oedematous but viable gut with compression over the testicular vessels. Gut was viable. The testes was mobilized and fixed into the scrotum. Left testis was impalpable for which nubbin excision was done at a later date. A SH in the lower abdomen may be confused with a high inguinal hernia. In acute obstruction, emergent exploration and reduction is the cornerstone of treatment.

Quantitative Evaluation of Upper Urinary Tract Pump Function in Pigs With Acute Unilateral Lower Ureteral Obstruction by 640-slice Dynamic Volume CT

Background: It is a challenging problem to differentiate obstructive hydronephrosis from non-invasive evaluation of renal pelvis and ureteral motility in patients. The purpose of this study was to explore the value of 640-slice dynamic volume CT (DVCT) in quantitative measurement of upper urinary tract (UUT) pump function after acute unilateral lower ureteral obstruction in pigs. Methods: In this study, perfusion pig model was made by constant pressure perfusion test of renal pelvis and left nephrostomy. The perfusion and pressure measuring devices were connected to create the state of no obstruction, acute obstruction of the lower part of the left ureter. After successful modeling, continuous dynamic volume scanning of bilateral renal excretion phase was performed with 640-slice DVCT, and pump functions of the renal pelvis and part of the upper ureter were calculated and analyzed. No obstruction, acute obstruction of the lower part of the left ureter. Pump functions of the renal pelvis and part of the upper ureter. Results: Results showed after LUUT fistulostomy, the time difference between the average UUTs volume and positive volume value increased gradually, and the calculated flow velocity decreased, which was significantly different from that of the RUUT. The volume difference of the LUUT increased significantly in mild obstruction. In the bilateral control, the volume change rate of the LUUT increased in mild obstruction and decreased in severe obstruction, and there was significant difference between the left and the right side. Conclusion: The continuous dynamic volume scan and measurement of 640-slice DVCT can obtain five pump function data of UUT in pigs with acute lower ureteral obstruction.

OPTIMAL DIAGNOSTIC ALGORITHM FOR COLORECTAL CANCER COMPLICATED BY ACUTE BOWEL OBSTRUCTION

AIM: to work out a diagnostic program that allows to individualize approach in preoperative care and surgery for patients with colorectal cancer complicated by acute obstruction.PATIENTS AND METHODS: the study included 442 patients with colorectal cancer complicated by acute obstruction, at whom were used special diagnostic methods for the purpose of precise diagnosis.RESULTS: the most informative and safe methods for the diagnosis of tumor obstruction were abdominal X-ray, CT scan, colonoscopy (CS), barium enema (BE) and abdominal ultrasound. These methods allow to prove bowel obstruction and its stage, to detect the tumor site, depth of invasion, distant metastases, to control the efficacy of decompression and to make prognosis of the outcome in 87.2-96.4% patients.CONCLUSION: the information obtained allows to plan individually the use of conservative, endoscopic and surgical methods of treatment for patients with colorectal cancer complicated by acute bowel obstruction.

Spontaneous rupture of the renal pelvis due to acute obstruction of the upper urinary tract

Cases of spontaneous rupture of the pyelocaliceal system of the kidney, not associated with the consequences of endourological surgery, are described extremely rarely in the literature. Most often, such a complication develops in patients with urolithiasis. The article analyzes the literature data on urinary tract apoplexy and presents its own clinical observations.