An Unusual Case of Small Bowel Volvulus Associated with Pneumatosis Intestinalis: A Case Report

INTRODUCTION: Pneumatosis cystoid intestinalis (PCI) is a rare disease reported in the literature affecting 0.03% of the population. It has a variety of causes and its manifestation may change widely. In the acute complicated form of pneumatosis intestinalis, management is challenging for physicians and surgeons. CASE PRESENTATION: We present a case of a 60-year-old patient who was admitted to our surgical department with a symptomatology suggestive of small bowel occlusion. Computed tomography demonstrated ileal volvulus associated with parietal signs suffering and pneumoperitoneum. An emergent exploratory laparoscopy followed by conversion was performed demonstrating segmental ileal pneumatosis intestinalis secondary to a small bowel volvulus due to an inflammatory appendix wrapping around the distal ileum. Detorsion, retrograde draining, and appendectomy were performed. DISCUSSION: PCI is an uncommon disease, affecting 0.03% of the population. It is usually presenting as a marginal finding resulting from various gastrointestinal pathologies. This case is exceedingly rare in the literature, featured by the ileal volvulus due to appendicitis.CONCLUSION: This work emphasizes the importance of surgical procedures in the management of symptomatic pneumatosis intestinalis.

Case Report: An unusual case of small bowel volvulus associated with pneumatosis intestinalis

Pneumatosis cystoid intestinalis is a rare disease reported in the literature affecting 0.03% of the population. It has a variety of causes and its manifestation may change widely. It usually presents as a marginal finding resulting from various gastrointestinal pathologies. In the acute complicated form of pneumatosis intestinalis, management is challenging for physicians and surgeons. We present a case of a 60-year-old patient who was admitted to our surgical department with a symptomatology suggestive of small bowel occlusion. Computed tomography demonstrated ileal volvulus associated with parietal signs suffering and pneumoperitoneum. An emergent exploratory laparoscopy followed by conversion was performed demonstrating segmental ileal pneumatosis intestinalis secondary to a small bowel volvulus due to an inflammatory appendix wrapping around the distal ileum. Further, detorsion, retrograde draining, and appendectomy were performed because there were no signs of necrosis and the appendix was pathological. The postoperative course was uneventful. This case is exceedingly rare in the literature, because it was featured by the ileal volvulus due to appendicitis.This case report emphasizes the importance of surgical procedures in the management of symptomatic pneumatosis intestinalis.

Case Report: Bowel Occlusion Following the Use of Barbed Sutures in Abdominal Surgery. A Single-Center Experience and Literature Review

Introduction: A high level of surgical ability is required to perform endoscopic knot tying. Barbed sutures help in avoiding this procedure, thus reducing intraoperative time and lowering blood loss and hospitalization time when compared to traditional sutures. Some cases of bowel occlusion following the use of barbed sutures have been described in literature. All of them are characterized by the entanglement of an intestinal loop in wire barbs with bowel occlusion symptoms.Case Presentation: We report two more cases which occurred in our Institute in 2020 and review those which have been reported in the literature by searching on Pubmed, Scopus, and Embase. We used the search terms: “Barbed,” ”Suture,” “Bowel,” and ”Obstruction.” We examined in the literature the surgical procedures, the type of complications, the time to onset of the complications, and the type of barbed suture.Discussion: Twenty-two cases in total were reported in the literature from 2011 to 2020, and bowel complications were largely subsequent to interventions such as hernia surgical repair and myomectomy. In order to take advantage of barbed sutures while minimizing the risk of adverse events, such as intestinal occlusion, some precautions may be considered, such as the shortening of thread tails and use of antiadhesive barriers. Moreover, performing a few stitches backwards when ending the suture might be a useful suggestion. Further studies in this field may be useful in order to assess whether it might be better avoiding barbed suture application on serosal tissues to prevent bowel damage.

Colonic Stent as “Bridge to Surgery” and Its Complications: A Case Report

Introduction: Endoluminal colonic stents can be used as a palliative solution in case of neoplastic subocclusions of the bowel and in some cases, they have been proposed as a temporary solution, in place of the derivative stoma, waiting for radical surgery. The "bridge to surgery" solution however can be complicated by perforations or dislocations that can make the patient's cancer treatment more complex. Case Presentation: A seventy-nine-year-old female patient presented a medium sigma adenocarcinoma that was treated initially with a stent to solve the bowel subocclusion. The procedure was complicated by a perforation that leaded to a modification of the TNM stage and consequently of the oncological therapeutic attitude. Conclusion: Self expandable stents could be used to solve the bowel occlusion to replace the derivative stoma performed in urgency. These procedures guarantee a better quality of life and generally less morbidity. However, an accurate assessment of the risks resulting from the positioning of the stents is necessary, avoiding the implant of the stent in tortuous or angled sections of the bowel with a high risk of decubitus and consequently of micro or macro perforations.

Prognostic CT findings of malignant bowel obstruction in patients with advanced ovarian cancer

Objective: To evaluate computed tomography (CT) findings able to predict outcome in patients with ovarian cancer (OC) and concomitant bowel occlusion. Methods: This institutional review board–approved retrospective study included 31 patients with OC and clinical evidence of bowel occlusion who underwent CT at presentation between February 2013 and June 2015. Two radiologists recorded various qualitative CT features. Correlations between CT and survival data were made with Mann-Whitney test, Wilcoxon test, and χ2 test, as appropriate. Receiver operating characteristic curves were generated for statistically significant CT findings using logistic regression model. Results: Two of 31 patients (6.5%) were alive at the end of this study; 29 patients (93.5%) died of disease. Median overall survival was 90 days. CT features associated with short life expectancy were bowel mural thinning ( p=0.03), mesenteric tumor deposits ( p=0.009), mesenteric infiltration ( p=0.02), and ascites ( p=0.04). Area under the curve was 0.728 ( p=0.03) for mesenteric tumor deposits in predicting malignant bowel obstruction. Conclusions: Accurate interpretation of CT features may guide decisions in care of women with OC and bowel obstruction.

Hiatal hernia as a late complication after gastrectomy

Introduction: Hiatal hernia is an extremely rare complication after total gastrectomy. Case presentation: An 80-year-old man presented with acute abdominal pain, vomiting, and orthopnoea. He had a history of total gastrectomy with a Roux-en-Y reconstruction five years before. An abdominal computed tomography scan revealed a right hemithorax herniation with small bowel occlusion. Exploratory laparotomy showed volvulus of the small intestine in the hiatal hernia. Conclusions: Hiatal hernia is a rare complication after gastrectomy but early detection and treatment are important to avoid dismal outcomes.