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Diagnosis of small bowel obstruction

S Shreshtha
A 70 year old lady presented to surgery emergency with small bowel obstruction without any obvious etiology. On exploration she was found to have an obstructed obturator hernia, which is a rare pelvic hernia with an incidence of 0.07-1.4% of all intra-abdominal hernias. Diagnosis is often delayed until laparotomy for bowel obstruction. Strangulation is frequent and mortality remains high (25%). Early diagnosis and surgical treatment contributes greatly to reduce the mortality and morbidity rates. A variety of techniques have been described, however surgical repair has not been standardized...
October 2016: Journal of Postgraduate Medicine
Nicola Guglielmo, Brice Malgras, Vinciane Place, Youcef Guerrache, Karine Pautrat, Marc Pocard, Philippe Soyer
Torsion of a uterine leiomyoma is a rare complication that can be life threatening because of ischemia or necrosis. This condition may also lead to gastrointestinal complications such as obstruction or, more rarely, small bowel volvulus. Its diagnosis is difficult and can be facilitated with the use of computed tomography or magnetic resonance imaging. Treatment is based on emergency surgical resection of the twisted uterine leiomyoma and detorsion of the small bowel volvulus.
September 28, 2016: Clinical Imaging
Gregory Nicolas, Tony Kfoury, Rasha Shimlati, Elliott Koury, Maroon Tohme, Elie Gharios, Raja Wakim
BACKGROUND Among the causes of constipation are bands and adhesions that lead to obstructions at different points in the intestinal tract. These can occur as a consequence of healing following surgery or trauma. However, an entity known as congenital band exists where a band is present from birth. Here we report three such cases of adults with symptoms of intestinal obstruction, in whom a congenital band was discovered through exploratory laparoscopy. CASE REPORT All three of these patients presented lacking a history of any abdominal trauma or previous abdominal surgeries, a fact that is often used to exclude an adhesion as a differential...
October 7, 2016: American Journal of Case Reports
Marc Dilauro, Matthew D F McInnes, Nicola Schieda, Ania Z Kielar, Raman Verma, Cynthia Walsh, Andrey Vizhul, William Petrcich, Joseph Mamazza
Purpose To evaluate the accuracy of computed tomography (CT) for diagnosis of internal hernia (IH) in patients who have undergone laparoscopic Roux-en-Y gastric bypass and to develop decision tree models to optimize diagnostic accuracy. Materials and Methods This was a retrospective, ethics-approved study of patients who had undergone laparoscopic Roux-en-Y gastric bypass with surgically confirmed IH (n = 76) and without IH (n = 78). Two radiologists independently reviewed each examination for the following previously established CT signs of IH: mesenteric swirl, small-bowel obstruction (SBO), mushroom sign, clustered loops, hurricane eye, small bowel behind the superior mesenteric artery, and right-sided anastomosis...
September 30, 2016: Radiology
E Ray-Offor, S N Elenwo, P O Igwe, C Ngeribara
BACKGROUND: The cystic dilatation of the biliary tract is an uncommon anomaly. Choledochocele, a cystic dilatation of the distal common bile duct, rarely presents clinically as massive gastrointestinal bleeding. AIM: This is to report a very rare disease condition and highlight minimal access options in surgical care. CASE SUMMARY: A 13 year-old boy was referred with a day history of sudden onset of passage of bright red blood per rectum with a fainting episode...
September 13, 2016: International Journal of Surgery Case Reports
Kirsten Risby, Steffen Husby, Niels Qvist, Marianne S Jakobsen
BACKGROUND: During the last decades neonatal outcomes for children born with gastroschisis have improved significantly. Survival rates >90% have been reported. Early prenatal diagnosis and increased survival enforce the need for valid data for long-term outcome in the pre- and postnatal counseling of parents with a child with gastroschisis. METHODS: Long-term follow-up on all newborns with gastroschisis at Odense University Hospital (OUH) from January 1 1997-December 31 2009...
September 2, 2016: Journal of Pediatric Surgery
Shariful Islam, Devin Hosein, Dilip Dan, Vijay Naraynsingh
Small bowel volvulus is a rare but life-threatening surgical emergency. Owing to its rarity, it is seldom entertained as a differential for small bowel obstruction. The aetiology may be either primary or secondary, with secondary being more common in the Western world. Prompt diagnosis and urgent surgical treatment is required if bowel necrosis is to be prevented, which is associated with increased mortality. We present a case of primary ileal volvulus with a gangrenous segment and a brief overview of the current literature...
2016: BMJ Case Reports
Mei Chin Lim, Niketa Chandrakant Chotai, Danilo Medina Giron
We present a case of a previously healthy 50-year-old gentleman who had recurrent vomiting and abdominal pain of two-month duration. The patient was subsequently diagnosed with abdominal cocoon on computed tomography. Idiopathic sclerosing encapsulating peritonitis, also known as abdominal cocoon, is a rare cause of small bowel obstruction. Visualization of variable encasement of the small bowel loops by a characteristic membranous sac, either preoperatively with cross-sectional imaging or intraoperatively, is the key to diagnosis...
2016: Case Reports in Medicine
Angel Torralba-Morón, Maria Urbanowicz, Carolina Ibarrola-De Andres, Guadalupe Lopez-Alonso, Francisco Colina-Ruizdelgado, Juan-Manuel Guerra-Vales
Endometriosis is a quite common pathology, however, intestinal endometriosis is a rare condition, which typically occurs with chronic symptoms. Its acute presentation is very infrequent. We herein report four cases of intestinal endometriosis, in which the clinical debut occurred acutely: two as an acute small bowel obstruction and two as a small bowel perforation. None of the cases had a preoperative diagnosis of endometriosis. The interest of these cases lies in this exceptional form of presentation, such as a surgical acute abdomen...
2016: Internal Medicine
Andrew Grock, Wendy Chan, Ian S deSouza
An otherwise healthy 36-year-old man presented with sudden-onset right upper quadrant abdominal pain and vomiting. A bedside ultrasound, performed to evaluate hepatobiliary pathology, revealed a normal gallbladder but free intraperitoneal fluid. After an expedited CT and emergent explorative laparotomy, the patient was diagnosed with a small bowel obstruction with ischemia secondary to midgut volvulus. Though midgut volvulus is rare in adults, delays in definitive diagnosis and management can result in bowel necrosis...
September 2016: Western Journal of Emergency Medicine
Stacy Loeb, Christian Meyer, Anna Krasnova, Caitlin Curnyn, Gally Reznor, Herbert Lepor, Adam S Kibel, Quoc-Dien Trinh
BACKGROUND AND PURPOSE: Whereas open radical prostatectomy is performed extraperitoneally, minimally invasive radical prostatectomy is typically performed within the peritoneal cavity. To determine whether minimally invasive radical prostatectomy is associated with an increased risk of small bowel obstruction compared to open radical prostatectomy. PATIENTS AND METHODS: In the U.S. Surveillance, Epidemiology and End Results (SEER)-Medicare database, we identified 14,147men diagnosed with prostate cancer from 2000 to 2008 treated by open (n=10,954) or minimally invasive (n=3,193) radical prostatectomy...
September 11, 2016: Journal of Endourology
Shigehiro Kojima, Tsuguo Sakamoto, Masayuki Honda, Dal Ho Kim
INTRODUCTION: A transmesosigmoid hernia is defined as small bowel herniation through a complete defect involving both layers of the sigmoid mesentery. Blunt trauma injury to the sigmoid mesocolon has been reported only rarely. We herein report a case of a strangulated transmesosigmoid hernia associated with a history of a fall from a height. PRESENTATION OF CASE: A 43-year-old woman presented to our hospital for evaluation of vomiting. She had no history of abdominal surgery but had sustained a complete spinal cord injury and pelvic fracture secondary to a fall from a height 25 years earlier...
2016: International Journal of Surgery Case Reports
Kazım Şenol, Mehmet Emrah Bayam, Uğur Duman, Evren Dilektaşlı, Muhammed Doğangün, Abdullah İnal, Deniz Necdet Tihan
Obturator hernia (OH) is a rare condition with high rates of morbidity and mortality. While diagnosis is difficult, surgery is the definitive treatment. Intestinal obstruction is the most common symptom upon admission. In addition, small-bowel obstruction is documented in more than half of OH patients. Advanced age, intestinal obstruction, bowel perforation, comorbid diseases, and clinical deterioration are risk factors for higher rates of mortality. The aim of the present report was to document clinical and surgical management of 3 female patients, each over 80 years of age, admitted to the emergency surgery department with intestinal obstruction and OH...
May 2016: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
Marco Moschetta, Arnaldo Scardapane, Michele Telegrafo, Nicola Maria Lucarelli, Valentina Lorusso, Giuseppe Angelelli, Amato Antonio Stabile Ianora
BACKGROUND: Multi-detector computed tomography (MDCT) represents the gold standard in patients with acute abdomen syndrome and suspected bowel ischemia. It provides a correct diagnosis and contributes to appropriate treatment planning. This study aims to evaluate the role of 3D Tissue Transition Projection (TTP) transparent wall CT reconstruction for detecting the degree of bowel dilatation and to correlate this finding with the aetiology and prognosis in patients affected by mesenteric infarction...
August 31, 2016: International Journal of Surgery
Akiko Fuyuki, Hidenori Ohkubo, Takuma Higurashi, Hiroshi Iida, Yumi Inoh, Masahiko Inamori, Atsushi Nakajima
BACKGROUND: Although chronic intestinal pseudo-obstruction (CIPO) is a rare and extremely severe functional digestive disorder, its clinical course and severity show various patterns. We assessed small bowel peristalsis in CIPO patients using cine-MRI (video-motion MRI) and their clinical characteristics to evaluate the clinical importance of performing cine-MRI in patients with this intractable disease. METHODS: The medical records of 131 patients referred to our institution with a suspected diagnosis of CIPO between 2010 and 2015 were retrospectively evaluated...
August 22, 2016: Journal of Gastroenterology
L Barbosa, A Ferreira, A A Póvoa, J P Maciel
Left paraduodenal hernia is a rarely found condition in which the small bowel herniates through a congenital peritoneal defect located behind the 4th portion of duodenum. It usually courses with non-specific symptoms and a widely variable clinical presentation which makes preoperative diagnosis very difficult. It has been associated with a high rate of complications, including bowel strangulation and even death. Prompt surgical intervention consisting of intraoperative surgeon's awareness and recognition of this condition are crucial in order to improve postoperative morbidity and mortality...
2016: BMJ Case Reports
Toru Kameda, Nobuyuki Taniguchi
Point-of-care abdominal ultrasound (US), which is performed by clinicians at bedside, is increasingly being used to evaluate clinical manifestations, to facilitate accurate diagnoses, and to assist procedures in emergency and critical care. Methods for the assessment of acute abdominal pain with point-of-care US must be developed according to accumulated evidence in each abdominal region. To detect hemoperitoneum, the methodology of a focused assessment with sonography for a trauma examination may also be an option in non-trauma patients...
2016: Journal of Intensive Care
Menelaos Zoulamoglou, Ioannis Flessas, Maria Zarokosta, Theodoros Piperos, Vasileios Kalles, Ioannis Tsiaousis, Ioannis Kaklamanos, Markos Sgantzos, Theodoros Mariolis-Sapsakos
INTRODUCTION: Peritoneal Encapsulation (PE) is a scarce congenital malformation, characterized by a supplementary peritoneal membrane that covers all or a part of the small intestine. PRESENTATION OF CASE: PE was unexpectantly discovered in a young woman during laparotomy for bowel obstruction. There were no specific pre-operative indications of this malformation. The operation was uneventful. DISCUSSION: PE is a very rare congenital anatomical anomaly that is difficultly identified pre-operatively...
2016: International Journal of Surgery Case Reports
Gabriele Bellio, Tommaso Cipolat Mis, Gladiola Kaso, Roberto Dattola, Biagio Casagranda, Marina Bortul
BACKGROUND: Renal cell carcinoma is the most frequent malignant neoplasia of the kidney accounting for 90 % of all renal solid tumors. Metastases from renal cell carcinoma are rarely located in the small bowel and generally their clinical presentation includes bleeding and obstruction. Intussusception in adults is an extremely rare pathological condition and only 30 to 35 % of small bowel intussusceptions are derived from malignant lesions. CASE PRESENTATION: We report here a clinical case of a 75-year-old white man hospitalized for anemia and subocclusion...
2016: Journal of Medical Case Reports
Scott McCusker, John Trangucci, William Frederick, A Aziz Richi, Salim Abunnaja
Primary myeloid sarcoma is a rare extramedullary manifestation of acute myeloid leukemia (AML). Typically, myeloid sarcoma presents after a diagnosis of AML or other myeloproliferative disorder. However, primary myeloid sarcoma may present without any preexisting condition, thereby making it extremely difficult to diagnose. We discuss a case of a 22-year-old female who was misdiagnosed initially with acute appendicitis and underwent an appendectomy. Postoperatively, she continued to be symptomatic and eventually developed small bowel obstruction...
June 2016: Connecticut Medicine
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