Volvulus with sigmoid necrosis in children: Two cases observed at Ignace Deen Hospital

Introduction: We report the clinical observation of 2 cases of volvulus with sigmoid necrosis in children. Observation: Two male patients, aged 12 and 15, were hospitalized with acute mechanical bowel obstruction. There was an asymmetric, motionless meteorism and rectal emptiness. X-rays of the abdomen revealed an arch. Laparotomy found volvulus with necrosis of the sigmoid colon. The Hartmann-type colostomy and the ideal colectomy were the surgical procedures. Conclusion: Sigmoid volvulus is a rare abdominal emergency in children and severe in the necrosis stage.

Surgery due to mechanical bowel obstruction in relapsed ovarian cancer: clinical and surgical results of a bicentric analysis of 87 patients

Introduction Mechanical bowel obstruction is a frequent acute and life-threatening event in relapsed ovarian cancer. Salvage surgery after failure of all conservative approaches, resulting in short bowel syndrome (SBS) constitutes a therapeutic dilemma. Our aim was to evaluate patients’ surgical and clinical outcome in these highly palliative situations. Previous, limited, data reported a high morbidity and mortality. However, recent surgical and therapeutical improvements in relapsed ovarian cancer (ROC) offer better identification of patients who might benefit from surgery in an effort to extend the window of opportunity to subsequently offer these patients novel systemic therapeutic approaches. Material and methods All subsequent ROC patients between 2012 and 2017 with acute mechanical bowel obstruction who underwent salvage extraperitoneal en bloc intestinal resection were retrospectively identified. Data were collected from two ESGO certified Ovarian Cancer Centers of Excellence (Charité Berlin and Imperial College London) and systematically evaluated regarding surgical and clinical outcomes. Results Overall, 87 ROC patients were included in the analysis (median age 56 years, range 24–88), 47% were platinum resistant. High grade serous was the most common histology (76%) while most of the patients (67%) had at least two previous lines of treatment. Mean observed OS was 7.8 months. After salvage surgery, 46% of the patients had a residual small bowel length < 180 cm and 18% > 180 cm resulting in 41% in need of total parental nutrition. In 80% of the patients a permanent stoma was necessary. 30d morbidity and mortality was 74% and 10%, respectively. More than half of the patients were able to receive further courses of chemotherapy after surgery. Discussion Salvage surgery for bowel obstruction in ROC patients needs careful consideration and identification of optimal surgical candidates to have the maximal therapeutic benefit. Despite the challenging morbidity profile, most patients managed to proceed to subsequent novel and conventional systemic treatment and so have their window of therapeutic opportunity extended.

A Descriptive Study of Clinical Presentation, Etiology and Management in Acute Mechanical Bowel Obstruction

Background: Acute mechanical bowel obstruction is a common surgical emergency and a frequently encountered problem in abdominal surgery. It constitutes a major cause of morbidity in hospitals around the world and a significant cause of admissions to emergency surgical departments. Intestinal obstruction belongs to highly severe conditions, requiring a quick and correct diagnosis as well as immediate, rational and effective therapy. Method: This is a prospective observational study which was carried on 130 patients of abdominal obstruction in the department of general surgery Sawai Man Singh Hospital Jaipur. Results: The majority of patients in our study were 31-40 years of age group. Mostly patients were male account about 86.15%. Pain abdomen was the most frequent presenting symptoms (95.38%) and absence of passage of flatus and feces was next complain (89.23%). Nausea and vomiting was present in 84.62% of patients. Abdominal tenderness was the most common physical finding on clinical examination (96.92%). Abdominal distension was present in 81.54% patients. Adhesions and bands were the most prevalent etiology of obstruction in the small bowel obstruction (58.45%) and tumour and volvulus were the most common etiology in the large bowel (12.31%). Conclusion: Intestinal obstruction is most commonly caused by intra-abdominal adhesions, Koch’s abdomen, malignancy and obstructed hernia. Conservative treatment with bowel rest and fluid resuscitation is successful in a variable proportion of patients. Patients with clinical degradation on assessment and radiological scans evoking ischemia or strangulated bowel obstruction need urgent surgery. Keywords: Bowel Obstruction, Pain, Adhesions, Tumour.

TOURNIQUET APPENDIX: RARE ETIOLOGY OF ORGANIC ACUTE INTESTINAL OBSTRUCTION

Acute appendicitis is the most common surgical emergency. A bowel obstruction due to the appendicitis is in most cases functional with a paralytic ileus mechanical bowel obstructions are rare or exceptional. We describe a rare case of a mechanical bowel obstruction due to a strangulation of the last ileal loop by the appendix.

ACUTE INTESTINAL OBSTRUCTION DUE TO MIGRATED INGUINAL HERNIOPLASTY MESH-A CASE REPORT

Mesh Hernioplasty is the gold standard for Inguinal hernia.However, it is not free of complications. Mesh migration causing intestinal obstruction, albeit rare, is a serious and complications. Timely surgical intervention is very important in the management of this condition. We report a rare case of an elderly male patient with mechanical bowel obstruction due to mesh migration 9 years after a right inguinal hernia meshplasty.

Mechanical Bowel Obstruction Caused by Incarcerated Left Amyand’s Hernia with Acute Appendicitis in Children

Amyand’s hernia is rare condition defined as the inclusion of the appendixin an ingunal hernia sac, It is an uncommon and rare condition estimatedto be found in approximately 1 % of hernia. However, in just 0.08 %, thecondition is complicated by an acute appendicitis. It may present as atender inguinal or inguinoscrotal swelling. In patients presenting amyand’shernia with mechanical bowel obstruction, signs of acute appendicitis maynot be initially recognized. This was the case while our patient was insurgery, as signs suggestive of acute appendicitis were discovered and thepatient received appendectomy and herniotomy. Presently, We report a caseof Amyand’s hernia in a 9-month-old male, who presented as a left-sidedcongenital hernia with distended abdominal and pain in the left groin. Heunderwent appendectomy and herniotomy, which revealed that the herniasac containing elongated inflamed appendix appeared with some adhesionsto sac, lying in the inguinal canal.

Gallstone Ileus: A Rare Cause of Intraluminal Small Bowel Obstruction

Background: Gallstone ileus is mechanical intestinal obstruction secondary to impaction of a gallstone within the gastrointestinal tract, and accounts for 1-4% of mechanical bowel obstruction, with a preponderance in the female population [1]. Case Presentation: 56 year-old female presented with right upper quadrant pain (RUQ) and multiple vomits, current smoker. Mechanical obstruction noted on computerised-tomography and underwent laparotomy revealing gallstone ileus. This is on a background of two prior episodes of RUQ pain, presenting to the hospital but lost of follow-up after discharging against medical advice two years ago