obstructive acute abdomen

Ileosigmoidal knotting (ISK) is a rare, possibly fatal cause of intestinal obstruction. ISK is a compound volvulus that is more common in Africa and Asia. ISK is mostly seen in adults, pediatric cases reported in the literature are much rarer. In this report, we present the first reported case of ISK in a pediatric patient from Nepal. An 8-year-old male child presented with symptoms of abdominal pain, vomiting, and obstipation. The abdomen was distended with generalized tenderness. Erect abdominal X-ray showed multiple air-fluid levels...

INTRODUCTION AND IMPORTANCE: Cecal volvulus is a rare intestinal pathology that occurs due to abnormal cecum mobility associated with spectrum of complications. It is usually manifested in adults. However, on extremely rare occasions, it occurs in pediatrics. We presented a case of cecal volvulus demonstrating the significance of early diagnosis and treatment to reach successful outcomes. CASE PRESENTATION: A 12 year old boy who presented to the emergency department for clinical evaluation for acute abdomen...

BACKGROUND: Giant congenital biliary dilation (CBD) is a rare condition observed in clinical practice. Infants born with this condition often experience a poor overall health status, and the disease progresses rapidly, leading to severe biliary obstruction, infections, pressure exerted by the enlarged CBD on abdominal organs, disturbances in the internal environment, and multiple organ dysfunction. The treatment of giant CBD using laparoscopy is challenging due to the high degree of variation in the shape of the bile duct and other organs, making it difficult to separate the bile duct wall from adjacent tissues or to control bleeding...

INTRODUCTION: Acute aortic occlusion (AAO) is a rare but serious condition associated with significant morbidity and mortality. OBJECTIVE: This review provides an emergency medicine focused evaluation of AAO, including presentation, assessment, and emergency department (ED) management based on current evidence. DISCUSSION: AAO refers to obstruction of blood flow through the aorta due to either thrombosis or embolism. This condition primarily affects older adults ages 60-70 with cardiovascular comorbidities and most commonly presents with signs and symptoms of acute limb ischemia, though the gastrointestinal tract, kidneys, and spinal cord may be affected...

BACKGROUND: Radiographic imaging of abdomen and pelvis plays an important role in the diagnosis and management of ileal pouch disorders with modalities including computed tomography, magnetic resonance imaging, contrasted pouchography, and defecography. OBJECTIVES: A systematic review of the literature was performed and applications of cross-sectional imaging, pouchography, defecography, and ultrasonography are described. DATA SOURCES: PubMed, Google Scholar, and Cochrane database...

Uterine rupture in the setting of pyometra is a rare occasion, with an incidence of less than 0.5%. The clinical manifestation of a perforated pyometra is non-specific; therefore, it can mimic many other causes of acute abdomen, such as perforated viscus, acute appendicitis, or diverticulitis, which poses unique challenges to diagnosis solely based on clinical information. We reviewed a case of an elderly postmenopausal lady who presented with a sudden onset of generalized abdominal pain, preceded by fever and vomiting...

INTRODUCTION: Spleno-sigmoid knotting is the twisting of the spleen around the sigmoid colon, causing obstruction of the sigmoid colon. It is an uncommon cause of intestinal obstruction. To our knowledge, there has been no previous case report of spleno-sigmoid knotting before our case. CASE REPORT: Here, we present the case of an 18-year-old female patient who visited the surgical emergency outpatient department with diffuse and progressive abdominal pain lasting for one and a half days...

On ventilation since birth, a term neonate with an antenatally detected left-sided congenital diaphragmatic hernia (CDH) had a sudden worsening in respiratory parameters on day 5 of life. Tube displacement, obstruction, pneumothorax and equipment failure were all ruled out. The examination revealed decreased air entry on the left side and mild abdominal fullness. The chest and abdomen radiographs revealed the absence of bowel gas with a complete whiteout of the abdominal cavity. Since birth, the neonate had received parenteral nutrition via the umbilical venous line...

Adult intestinal malrotation is a rare anatomical anomaly that typically manifests during infancy but can also present in adulthood. Symptoms are mainly digestive, with a long history of intermittent abdominal pain and epigastralgia. It often presents a diagnostic challenge due to the varied and nonspecific nature of clinical symptoms. Radiological evaluations reveal diverse patterns of malrotation, including incomplete rotation, mesenteric base abnormalities, and associated malformations. Computed tomography (CT) scans consistently identify characteristic anatomical distortions, aiding in accurate diagnosis...

A 53-year-old Japanese man presented to the emergency department with epigastric pain and bloating. Computed tomography revealed a thickening of the jejunal wall and proximal dilation. Double-balloon enteroscopy was performed to investigate the jejunal thickening, which revealed an anisakis larva in the jejunum with an associated ulcer. The larva was removed using endoscopic forceps, after which there was immediate improvement of symptoms. Further patient interview determined that he had consumed marinated mackerel the day before the onset of symptoms...

Intussusception denotes the intricate phenomenon wherein one segment of the bowel undergoes invagination or telescoping into its contiguous distal segment. The ensuing invaginated segment may be propelled forward through peristaltic movements, potentially precipitating bowel obstruction or ischemia, culminating in necrosis of the affected bowel segment. Although the precise etiology of intussusception remains elusive, particularly in cases devoid of an identifiable lead point, dysrhythmic contractions and lymphoid hyperplasia have been implicated in the pathophysiology of this condition...

Waugh's syndrome is a rare disease that typically presents as acute-onset intussusception caused by gut malrotation. This disease, while generally reported during infancy or childhood, can also affect adults. This case report describes the rare case of Waugh's syndrome in an adult with cystic fibrosis. The patient, a 19-year-old male, was admitted one week after the onset of pain and distention in the abdomen, with vomiting alternating with constipation. He had visited emergency rooms in the past and was taking symptomatic treatment, but on arrival at our facility, he developed a tonic-colonic convulsion...

BACKGROUND: Low-grade appendiceal neoplasms (LAMN) are characterized by low incidence and atypical clinical presentations, often leading to misdiagnosis as acute or chronic appendicitis before surgery. The primary diagnostic tool for LAMN is abdominal computed tomography (CT) imaging. Surgical resection remains the cornerstone of LAMN management, necessitating en bloc tumor excision to minimize the risk of iatrogenic rupture. Laparoscopy, known for its minimal invasiveness, reduced postoperative discomfort, and expedited recovery, is a safe and reliable approach for LAMN treatment...

The vitellointestinal duct (VID) is an embryological remnant of the vitelline duct, a structure that connects the developing fetus to the yolk sac and is responsible for the nutritional support of the fetus during the early embryological days. The VID usually gets obliterated by the fifth to ninth week of gestational age after the establishment of placental nutrition. The patent VIDellointestinal duct is a relatively rare congenital condition that occurs in approximately 2% of the general population, with the most common presentation being Meckel's diverticulum...

An obturator hernia (OH) is a rare form of pelvic hernia in which the abdominal contents protrude through the obturator canal. Malnourished, frail, and multiparous elderly females are at risk of an OH. Preoperative diagnosis of obturator hernia is challenging because of non-specific symptoms. Most of the cases of OH reported in the literature are diagnosed during a laparotomy for acute intestinal obstruction. However, a contrast-enhanced computed tomography (CECT) scan of the abdomen is the best diagnostic investigation for OH...

Ileus is one of the most severe diagnoses of the group of acute abdomen events. Some patients with certain forms of bowel obstruction respond well to conservative therapy. However, the diagnosis of strangulation ileus can be delayed in some situations, resulting in high morbidity and mortality in such cases. Our paper presents the case of an 81-year-old female patient who developed an ileus shortly after ureteral stent placement due to obstructive hydroureteronephrosis. The strangulation of the small intestine was caused by an atypical position of the right ureter in the abdominal cavity...

The aim of the study was to compare and correlate levels of ferritin, transferrin, iron and APPs in healthy horses and those surgically treated for strangulating colic. On admission, measurements of inflammatory markers related to iron and total protein, fibrinogen, albumin, haptoglobin and ceruloplasmin were made. The study comprised 22 horses, divided into a control group (CG) of healthy horses (n = 10) and horses with surgically treated acute abdomen (n = 12), obstruction group (OG). The OG was subdivided according to the affected intestinal segment (small vs...

Acute cholangitis is a bile duct infection associated with bile duct obstruction. Bile culture is positive in most cases, and the most frequent etiological agent is Escherichia coli. Candida sp acute cholangitis is a rare finding, which is more common in patients with immunosuppression, use of corticosteroids, prolonged antibiotic treatment or surgical procedures of the bile duct. We present the case of a 67-year-old woman with none of the above-mentioned history who consulted for fever, abdominal pain and jaundice...

Video 1Gastrogastric intussusception and acute pancreatitis caused by a large pyloric gland adenoma treated with endoscopic submucosal dissection: A 75-year-old woman with a several-week history of intermittent postprandial nausea and vomiting presented to the emergency room after experiencing syncope, following several hours of persistent abdominal pain, nausea, and vomiting. A contrast-enhanced CT scan of the abdomen and pelvis was arranged. Axial images show gastrogastric intussusception with the intussusceptum, indicated by the dashed lines, telescoping into the intussuscipiens indicated by the arrowheads...

Small bowel obstruction (SBO) in pregnancy is a challenging diagnosis. Case rarity, non-specific presentations, and the non-practicality of using X-ray/gamma-ray imaging modalities in pregnancy contribute to the increased difficulty in timely diagnosing midgut volvulus during pregnancy, thereby increasing maternal and fetal morbidity. We report a case of midgut volvulus in a 39-year-old lady, gravida 3, para 2, with two previous cesarean sections. Her only presenting complaint was abdominal pain for three days with no other associated symptoms...