Congenital Constriction Band Syndrome: Clinical Study of Three Cases in Togo

Introduction: Congenital constriction band syndrome (CCBS) or amniotic band syndrome is a complex set of congenital malformations, mainly affecting the limbs, but also the craniofacial and thoraco-abdominal region. The Patients: The purpose of this work is to describe the clinical and diagnostic aspects of CCBS in Togo in relation to 03 clinical cases. The Primary Diagnoses, Interventions, and Outcomes: The first case is characterized by an asymmetric bilateral superficial constriction groove of the lower limbs, pseudosyndactylias and synostosis of the tibia and fibula on X-ray. The second has a deep strangulation in the left arm with an amputation of the fingers associated with hypochromic skin lesions, poorly hemmed polylobal ear and skin growths. The latter characterized by persistent bridle, strangulation and ischemia downstream of that of the left wrist with postnatal amputation of the left hand. Conclusion: The strengthening of antenatal diagnosis, the introduction of genetic counselling and the establishment of a national malformations register should make it possible to improve the management of cases of amniotic flange disease.

EP.TU.193Omental band - A unusual cause of mechanical small bowel obstruction in a virgin abdomen

Introduction The small bowel obstruction in a non-operated abdomen is rare, and the most common causes are hernia and neoplasm. The complete mechanical small bowel obstruction due to an omental band in a patient with no previous abdominal surgery is rare, and less than five cases have been reported in the literature. Case presentation We report a 65 year old male patient presented to the emergency department with complaints of abdominal pain, distension, vomiting and obstipation for four days. On clinical examination, his abdomen was distended, diffusely tender, guarding. The blood investigations showed elevated White blood cells and neutrophils with normal CRP and the Serum lactate. The Abdominal X-ray was suggestive of SBO. The Computed tomography of the abdomen and pelvis showed marked dilatation of the jejunum, the ileum is entirely collapsed, the impression of a double beak sign in the mid-abdomen which would suggest closed-loop obstruction due to a possible internal hernia. We proceeded with emergency diagnostic laparoscopy converted to laparotomy, which showed omental band causing closed-loop proximal small bowel obstruction. The bowel loops appeared congested with the constriction band due to omental band. The omental band was divided, and the obstruction was relieved. Postoperatively patient recovered well and was discharged on day three post-op. Discussion The timely diagnosis and intervention could prevent complications like strangulation, ischemia and gangrene. Though the omental band is rare, it should still be suspected as an aetiology in patients without prior abdominal surgery.

554 An Unusual Case of a “Hernia Within a Hernia” Resulting in Small Bowel Obstruction and Strangulation

59-year-old female presented with symptoms of small bowel obstruction. She had a history of previous open right hemi-colectomy. She also had a previous complex strangulated ventral hernia which had required laparotomy and repair. Following this the patient had recurrence of the ventral hernia. Examination demonstrated a non-tender irreducible recurrent ventral hernia in a patient with a high BMI (> 40). CT reported a midline hernia containing dilated small bowel loops. Additionally, there was a separate narrower hernia arising from the original larger hernia containing a strangulated loop of small bowel. Emergency laparotomy was performed. At operation there was a large hernia containing a smaller secondary hernial defect. Within this secondary defect, there was a loop of jejunum with a constriction band. which was released. There was no vascular compromise to the bowel and no need for resection. The hernial sac was excised and the abdominal wall repaired. Post-operative recovery was uneventful. Discussion The patient had a known, recurrent wide necked ventral hernia. However, this was the first presentation of the new, smaller hernia. This case is unusual in that it demonstrates a multi-locular “hernia within a hernia”. Although multi-locular hernias have been previously described, there is a paucity of literature on these. Conclusions This “hernia within a hernia” is an uncommon surgical finding for which there is limited literature. Clearly without urgent surgical intervention there would be an increase in morbidity and mortality.

A Case Report of Osteomyelitis of Lower End of Tibia and Fibula as a Complication of Elastic Rubber Band Syndrome (Dhaga Syndrome)

Introduction: Rubber band syndrome is a rare acquired condition poorly discussed in literature, when neglected can lead to devastating complications of compartment syndrome and infection of soft tissue and bone as seen in the present case. Rubber band or Dhaga (sacred thread) when worn for prolonged duration can bury into the skin and soft tissue. Case Report: A 12-month-old girl developed osteomyelitis of tibia and fibula as sequelae of misdiagnosis and treatment for this syndrome. Assuming it to be a simple constriction band, incisions were given on medial and lateral aspect of the ankle, later she developed osteomyelitis of the tibia and fibula with in buried rubber band, which was removed and thorough curettage done and achieved good healing of the bones. Conclusion: Rubber band syndrome in not an uncommon condition, but when neglected or misdiagnosed can lead to complications such as compartment syndrome and osteomyelitis of the bones in involved limb as seen in this case. In suspected cases, imaging with sonography and X-ray of involved helps in diagnosis. Keywords: Osteomyelitis, rubber band syndrome, Dhaga syndrome, compartment syndrome.

Clubfeet and congenital constriction band syndrome

Background Clubfeet and constriction band syndrome is a very rare non-idiopathic condition. Treatment is often difficult and the recurrence deformity rate is high. The purpose of this study was to assess the effectiveness of Ponseti method in the treatment of congenital constriction band syndrome accompanied by clubfoot deformity and lymphedema. Case presentation We are presenting an interesting case of bilateral clubfeet and congenital circumferential constriction band syndrome in the lower limb. Ponseti method of correcting the congenital clubfoot deformity was applied. Constriction band release is accomplished by two stages completely excising the fibrous band and multiple two-stage Z-plasties on the right calf. Conclusion The results of this study indicate that the Ponseti method of gentle, systematic manipulation and weekly cast changes is an effective treatment of non-idiopathic clubfoot distal to congenital amniotic constriction band.

Clubfeet and congenital constriction band syndrome - Case report

Background: Clubfeet and constriction band syndrome is a very rare non-idiopathic condition. Treatment is often difficult and the recurrence deformity rate is high. The purpose of this study was to assess the effectiveness of Ponseti method in the treatment of congenital constriction band syndrome accompanied by clubfoot deformity and lymphedema. Case presentation: We are presenting an interesting case of bilateral clubfeet and congenital circumferential constriction band syndrome in the lower limb. Ponseti method of correcting the congenital clubfoot deformity was applied. Constriction band release is accomplished by two stages completely excising the fibrous band and multiple two-stage Z-plasties on the right calf. Conclusion: The results of this study indicate that the Ponseti method of gentle, systematic manipulation and weekly cast changes is an effective treatment of non idiopathic clubfoot distal to congenital amniotic constriction band.

Clubfeet and Constriction Band Syndrome - Case Report

Background: Clubfeet and constriction band syndrome is a very rare non-idiopathic condition. Treatment is often difficult and the recurrence deformity rate is high. The purpose of this study was to assess the effectiveness of Ponseti method in the treatment of congenital constriction band syndrome accompanied by clubfoot deformity and lymphedema. Case presentation: We are presenting an interesting case of bilateral clubfeet and congenital circumferential constriction band syndrome in the lower limb. Ponseti method of correcting the congenital clubfoot deformity was applied. Constriction band release is accomplished by two stages completely excising the fibrous band and multiple two-stage Z-plasties on the right calf. Conclusion: The results of this study indicate that the Ponseti method of gentle, systematic manipulation and weekly cast changes is an effective treatment of non idiopathic clubfoot distal to congenital amniotic constriction band.