Colonic and type IV jejunal atresias with apple-peel bowel segment as the content of right inguinal hernia: A case report

Background: Colonic atresia is an uncommon entity. It may be associated with multiple anomalies. Case Presentation: We present a case, which was initially suspected to be jejunal atresia, but was found to have colonic atresia as well intra-operatively. The associated jejunal atresia with apple-peel configuration was present as the content of inguinal hernia. Conclusion: This case report highlights the rarity of the condition and the postoperative issues in the management of such patients.

Ventriculoperitoneal shunt knotting causing bowel obstruction and necrosis in an adult patient

Knotting or twisting of the peritoneal catheter around a bowel segment, causing bowel obstruction and necrosis, is extremely rare. Only six cases have been reported in the literature. This report described the second case of an adult patient with spontaneous knotting of the peritoneal catheter around a small-bowel segment, causing bowel obstruction and necrosis. The presentation of a knotted ventriculoperitoneal shunt around a bowel loop is stereotypical. Treatment and general recommendations have been made to help guide clinicians when encountering such cases. Evidence of small-bowel obstruction in a twisted, coiled or knotted peritoneal catheter may need surgical intervention. In the setting of progressive abdominal manifestations, knotting of the peritoneal catheter around bowel loops may cause bowel obstruction and may present with acute life-threatening manifestations. Efficient and expedite diagnosis should be made to coordinate multispecialty intervention and follow-up appropriately.

Primary Segmental Small Bowel Volvulus in an Adolescent Female

Small bowel volvulus is a rare but important cause of abdominal pain and small bowel obstruction in children and adults. In the neonate, small bowel volvulus is a well-known complication of malrotation. Segmental small bowel volvulus is a lesser-known condition, which occurs in children and adults alike and can rapidly progress to bowel ischemia. Primary segmental small bowel volvulus occurs in the absence of rotational anomalies or other intraabdominal lesions and is rare in Europe and North America. Clinical presentation can be misleading, causing a delay in diagnosis and treatment, in which case the resection of necrotic bowel may become necessary.We report on a 14-year-old girl who presented with severe colicky abdominal pain but showed no other signs of peritoneal irritation or bowel obstruction. An emergency magnetic resonance imaging was highly suspicious for small bowel volvulus. Emergency laparotomy revealed a 115 cm segment of strangulated distal ileum with no underlying pathology. We performed a detorsion of the affected bowel segment. Despite the initial markedly ischemic appearance of the affected bowel segment, the patient achieved full recovery without resection of bowel becoming necessary.

Stapler-assisted stoma prolapse repair with real-time fluorescent angiography using indocyanine green

Stoma prolapse is an increase in the size of the stoma secondary to intussusception of the proximal bowel segment. Transverse loop colostomy is most commonly involved. Although ostomy function is rarely impaired, large prolapses may cause patients distress and impair stoma dressing. Strangulation and ischemia of the prolapsed segment have been reported as complications. Herein, we report a stapler-associated repair of a prolapsed transverse loop colostomy with real-time perfusion studies using indocyanine green.

Comparative study of perioperative morbidities of the conventional and ultrasound-guided suprapubic catheterization in the patients of urinary retention during emergency

Background: Urinary retention is one of the common urological emergencies and conventional ‘blind’ SPC frequently used comfortable as well superior procedure for patients. During conventional SPC, the distended bladder is identified by palpation or percussion without proper attention to intervening bowel segment and other structures. However, the recently published data suggests that if, ultrasound is used during SPC, and it identifies not only bladder but also intervening bowel segment which complications. Therefore, the objective of this study was to assess and compare the perioperative complications of both methods.Methods: This prospective study was conducted between years November’2017 to June’2019. Sixty patients (n=60) of urinary retention were randomized to undergo ultrasound guided or conventional SPC procedures. Patients were divided into two equal groups of 30 patients in US-SPC (Group-A) and C-SPC (Group-B). After either SPC, the patients were closely observed for development of complications.Results: Overall, the patients had mean age of 53.87+21.418 and 53.87+21.418 years in C-SPC and US-SPC group, respectively. Mean operative time and subsequent initial urine drainage were almost equal in both groups. However, in C-SPC group, 5(16.7%) patients developed complications in the form of 03 misplaced catheters outside bladder, 01 into retro pubic space and another 01 into rectum. All patients in Group-A required ultrasound guided revision of SPC compared to none in Group-B.Conclusion: Overall, the ultrasound-guided SPC (US-SPC) is safer procedure compared to conventional ‘blind’ C-SPC in relieving urinary retention in emergency, thus it should be recommended procedure whenever need arise for SPC procedure.

Recurrent gastrointestinal bleeding in a patient with type 1 neurofibromatosis

Type 1 neurofibromatosis (NF1) is a hereditary disorder with an incidence of approximately 1:3000 at birth. Gastrointestinal (GI) lesions occur in approximately one-third of the patients, with most being asymptomatic and diagnosed incidentally. Symptomatic lesions leading to GI bleeding are uncommon. We share our experience of an elderly man with NF1, who presented with massive recurrent GI bleeding secondary to jejunal neurofibromas. The lesions were identified on CT scan of abdomen, and the patient was managed with resection of the involved bowel segment.

Ileo-ileo-colic intussusception in adults: a rare event causing acute intestinal obstruction

Intussusception is a common finding in children accounting for approximately 25% of all abdominal emergencies in patients below five years of age. This, however, is a rare observation in adults accounting for only 5% of all intussusceptions. Among them, those leading to acute intestinal obstruction are about 1-5%. Diagnosis is based on radiographic findings seen on ultrasonography or CT scan as the presentation in adults is often difficult to diagnose clinically due to the variable presentation. We present here a case of intussusception in a 24 year old male presenting as acute intestinal obstruction. Exploratory laparotomy with resection of the bowel segment was done followed by end to end anastomosis. Post-operative course was uneventful.