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Nakayama DK. Failure to Rescue a Virtuoso: The Death of Emanuel Feuermann. Am Surg 2024:31348241272339. [PMID: 39093054 DOI: 10.1177/00031348241272339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
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Yamani AS, Morris MC, Schrager JJ, Athota KP, Sams VG. A case of acute colonic pseudo-obstruction, sigmoid volvulus, and massive pneumoperitoneum in a young female patient. Int J Surg Case Rep 2024; 117:109558. [PMID: 38518469 PMCID: PMC10972842 DOI: 10.1016/j.ijscr.2024.109558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/13/2024] [Accepted: 03/16/2024] [Indexed: 03/24/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Acute colonic pseudo-obstruction (ACPO) is an uncommon phenomenon that is especially rare in young patients and can result in bowl ischemia and perforation if left untreated. Furthermore, pneumoperitoneum is almost always a concerning imaging finding and in the context of recent colonic resection may be a sign of anastomotic leakage. CASE PRESENTATION We describe a case of a young female patient with postpartum ACPO who subsequently underwent a hemicolectomy with colorectal anastomosis. The patient's hospital course was complicated by massive postoperative pneumoperitoneum that resulted in resection of the anastomosis and creation of an end colostomy. However, despite this measure, there was recurrent pneumoperitoneum on cross-sectional imaging 36 h later. This was treated non-operatively and the remainder of their hospital course was uneventful. CLINICAL DISCUSSION A potential etiology for ACPO during pregnancy may be due to compression of parasympathetic plexus nerves by the gravid uterus. Idiopathic pneumoperitoneum has been documented on a number of occasions, though this is generally in older patients. It can present with signs of peritonitis or can be asymptomatic. Simultaneous pneumothorax and pneumoperitoneum is rare and may be due to the transmission of air from the peritoneum to the mediastinum and thorax. The pneumoperitoneum itself may be due the air leakage through the significantly distended colon into the peritoneum. CONCLUSION The combination of ACPO following pregnancy and associated pneumothorax, pneumomediastinum, and recurrent pneumoperitoneum suggest a communicating defect between the thoracic, mediastinal, and peritoneal cavities. Furthermore, the possibility of underlying colonic dysmotility should be considered prior to the restoration of large bowel continuity.
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Affiliation(s)
- Ali S Yamani
- College of Medicine, University of Cincinnati, Cincinnati, OH, USA.
| | - Mackenzie C Morris
- College of Medicine, University of Cincinnati, Cincinnati, OH, USA; Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Jason J Schrager
- College of Medicine, University of Cincinnati, Cincinnati, OH, USA; Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Krishna P Athota
- College of Medicine, University of Cincinnati, Cincinnati, OH, USA; Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Valerie G Sams
- College of Medicine, University of Cincinnati, Cincinnati, OH, USA; Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
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Heck M, Kensing BC, Ismael HN. Cecal volvulus as a rare complication of internal hernia after Roux-en-Y gastric bypass: a case report and literature review. J Surg Case Rep 2024; 2024:rjae252. [PMID: 38666096 PMCID: PMC11045239 DOI: 10.1093/jscr/rjae252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
This case report describes a rare instance of cecal volvulus resulting from an internal hernia through Petersen's space, occurring 20 years after Roux-en-Y gastric bypass surgery, marking it as the second such case in English literature. An 81-year-old female presented with symptoms of bowel obstruction, and imaging findings concerning for cecal volvulus. Emergency surgery revealed necrotic bowel due to an internal hernia, necessitating a right hemicolectomy, with subsequent successful anastomosis and hernia defect closure. The incidence of internal hernias post-gastric bypass is notable, emphasizing the critical need for surgical vigilance. This case underscores the importance of considering internal hernias in differential diagnoses for bowel obstruction in post-bariatric surgery patients, highlighting the life-saving role of prompt surgical intervention in the management of cecal volvulus complications.
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Affiliation(s)
- Marvin Heck
- Department of Surgery, University of Texas Health Science Center at Tyler, Tyler, TX 75708, United States
| | - Benjamin C Kensing
- Department of Surgery, University of Texas Health Science Center at Tyler, Tyler, TX 75708, United States
| | - Hishaam N Ismael
- Department of Surgery, University of Texas Health Science Center at Tyler, Tyler, TX 75708, United States
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Khan Z, Challand CP, Lee MJ. Management of acute colonic pseudo-obstruction: opportunities to improve care? Ann R Coll Surg Engl 2024. [PMID: 38445579 DOI: 10.1308/rcsann.2024.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Acute colonic pseudo-obstruction (ACPO) is a functional bowel obstruction characterised by colonic dilatation in the absence of mechanical obstruction on imaging. Complications include bowel ischaemia, perforation and death. The aim of this study was to explore outcomes for patients treated for ACPO and to assess adherence to current ACPO treatment guidelines. METHODS This is a retrospective service evaluation and included patients with a diagnosis of ACPO between 1 March 2018 and 31 March 2023. Process measures were identified following discussion with the clinical team from published guidance. Patients were identified using clinical coding and radiological text reports. Cases were eligible for inclusion if they had radiologically confirmed ACPO. Data were collected following review of patient notes into Microsoft Excel. Descriptive analysis was performed with no formal statistical assessment. RESULTS A total of 45 patients were identified, of whom 13 were admitted under general surgery. All patients received admission bloods (n=45). Nearly all patients had computed tomography imaging (43/45, 96%). Only 3/45 (6.7%) of the patients received optimal conservative management (intravenous infusion, nil by mouth, flatus tube, treatment of reversible causes). In all, 11/45 (24%) required further treatment, of whom 7 received this within 72 h. The leading (11/45) complication following diagnosis of ACPO was hospital-acquired pneumonia. Mortality was seen in 9/45. CONCLUSIONS ACPO is often managed remotely by general surgeons. This may impact on the quality of conservative management, and timeliness of endoscopic or pharmacological intervention. Further work is needed to optimise management.
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Affiliation(s)
- Z Khan
- University of Sheffield, UK
- Sheffield Teaching Hospitals, UK
| | | | - M J Lee
- University of Sheffield, UK
- Sheffield Teaching Hospitals, UK
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Mari A, Emmanuel A. Dilated gut conditions: diagnosis and management. Clin Med (Lond) 2023; 23:558-560. [PMID: 38065609 PMCID: PMC11298501 DOI: 10.7861/clinmed.2023-ga2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Dilatation of the gut occurs in response to either mechanical obstruction or aperistalsis. The hallmark features are symptoms of bowel obstruction with vomiting, constipation, abdominal pain and distension. This review will primarily deal with the non-mechanical causes of gut dilatation, both intestinal and colonic, and differentiate between acute and chronic presentations.
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Affiliation(s)
- Amir Mari
- Israel Institute of Technology, Hadera, Israel and Nazareth Hospital EMMS, Nazareth, Israel
| | - Anton Emmanuel
- University College London, and consultant gastroenterologist, National Hospital for Neurology and Neurosurgery (Queen Square), London, UK
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Wilczyński B, Śnieżyński J. Ogilvie's Syndrome in a Patient at 23 Weeks of Pregnancy: Report of a Rare Case with Successful Surgical Intervention. AMERICAN JOURNAL OF CASE REPORTS 2023; 24:e941283. [PMID: 37864325 PMCID: PMC10599344 DOI: 10.12659/ajcr.941283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/01/2023] [Accepted: 08/16/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Ogilvie's syndrome (acute colonic pseudo-obstruction) is a syndrome characterized by symptoms suggestive of intestinal obstruction without an identifiable mechanical cause. It presents with excessive dilation of the loops of the large intestine. The treatment options include conservative management, endoscopic methods, and surgical intervention. If appropriate treatment is not implemented promptly, this syndrome can lead to life-threatening complications for the patient. Acute colonic pseudo-obstruction typically occurs in elderly individuals with numerous chronic diseases, extensive surgeries, or trauma. In younger individuals, risk factors include gynecological procedures, pregnancy, and childbirth. CASE REPORT This work presents a case of a 30-year-old woman at 23 weeks of pregnancy. She presented with persistent abdominal pain, nausea, and vomiting for several days. The patient was initially treated at the Obstetrics Clinic, where conservative management was implemented. Due to worsening symptoms after confirming pathological distension of the colon in the magnetic resonance imaging examination, she was transferred to the surgery clinic. Due to her unstable general condition and lack of improvement with conservative treatment, she was qualified for an appendectomy with the formation of a cecostomy. The performed surgical treatment led to an improvement in the patient's condition and did not have a negative impact on the further development of the child. CONCLUSIONS Ogilvie's syndrome in pregnancy is an extremely rare condition that can lead to significant complications. Its treatment requires the coordinated efforts of a multidisciplinary team of specialists. During the course of therapy, it is important to consider the limitations imposed by pregnancy on diagnostic and therapeutic methods.
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Numan L, Brotherton T, Baliss M, Ghosh S, Lamm V, Klos C, Sayuk G, Presti M, Elwing J. A Percutaneous Endoscopic Colostomy Tube to the Rescue. ACG Case Rep J 2023; 10:e01186. [PMID: 37868365 PMCID: PMC10586846 DOI: 10.14309/crj.0000000000001186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/25/2023] [Indexed: 10/24/2023] Open
Abstract
Percutaneous endoscopic colostomy (PEC) tube placement is a minimally invasive procedure used to treat recurrent colonic pseudo-obstruction, sigmoid volvulus, chronic intractable constipation, and neurogenic bowel. PEC is a viable treatment alternative for patients who have failed conservative therapies and are deemed high risk for surgical management. We present a case of acute colonic pseudo-obstruction after Clostridioides difficile infection that was unresponsive to medical treatment or endoscopic decompression. A PEC tube was placed into the transverse colon with successful resolution of the colonic distension.
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Affiliation(s)
- Laith Numan
- Department of Gastroenterology and Hepatology, St. Louis University, St. Louis, MO
| | - Tim Brotherton
- Department of Internal Medicine, St. Louis University, St. Louis, MO
| | - Michelle Baliss
- Department of Gastroenterology and Hepatology, St. Louis University, St. Louis, MO
| | - Soumojit Ghosh
- Department of Gastroenterology and Hepatology, St. Louis University, St. Louis, MO
| | - Vladimir Lamm
- Department of Gastroenterology, Washington University in St. Louis, St. Louis, MO
| | - Coen Klos
- Department of Surgery, St. Louis Veteran Affairs, St. Louis, MO
| | - Gregory Sayuk
- Department of Gastroenterology, Washington University in St. Louis, St. Louis, MO
- Department of Gastroenterology, St. Louis Veteran Affairs, St. Louis, MO
| | - Michael Presti
- Department of Gastroenterology and Hepatology, St. Louis University, St. Louis, MO
- Department of Gastroenterology, St. Louis Veteran Affairs, St. Louis, MO
| | - Jill Elwing
- Department of Gastroenterology, Washington University in St. Louis, St. Louis, MO
- Department of Gastroenterology, St. Louis Veteran Affairs, St. Louis, MO
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Sen A, Chokshi R. Update on the Diagnosis and Management of Acute Colonic Pseudo-obstruction (ACPO). Curr Gastroenterol Rep 2023; 25:191-197. [PMID: 37486594 DOI: 10.1007/s11894-023-00881-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE OF REVIEW Acute Colonic Pseudo-obstruction (ACPO) is a cause of large intestinal dilation and obstruction without any physical transition point. It remains difficult to diagnose and treat. We review the recent updates on diagnosis and management of ACPO. RECENT FINDINGS Recent guidelines have posited that conservative management can be tried in most cases of ACPO, but that early decompression and surgery should be considered. Use of neostigmine is still a viable option but there is also promising data on pyridostigmine as well as prucalopride. Resolution of ACPO should be followed by daily use of polyethylene glycol (PEG) to help prevent recurrence. ACPO warrants early and accurate diagnosis with exclusion of alternate causes of large bowel dilation. Conservative management can be attempted for 48-72 h in those with cecal diameters < 12 cm and without signs of peritonitis and perforation. Early escalation of management should be attempted with neostigmine followed by endoscopy and/or surgery as needed, given that longer periods of dilation are associated with worse outcomes. There is promising new evidence for use of pyridostigmine and prucalopride, but further trials are needed prior to incorporating them into regular use. Finally, studies are lacking regarding prevention of ACPO after initial resolution.
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Affiliation(s)
- Ahana Sen
- Department of Medicine, Section of Gastroenterology & Hepatology, Baylor College of Medicine, 7200 Cambridge Avenue, Suite 8B, Houston, TX, 77030, USA
| | - Reena Chokshi
- Department of Medicine, Section of Gastroenterology & Hepatology, Baylor College of Medicine, 7200 Cambridge Avenue, Suite 8B, Houston, TX, 77030, USA.
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Gislinge JIP, Scheuer CJ, Toustrup CH, Roenneberg ET. Caecal volvulus following a complicated caesarean section. BMJ Case Rep 2023; 16:e252757. [PMID: 37607760 PMCID: PMC10445342 DOI: 10.1136/bcr-2022-252757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Abstract
A caecal volvulus is a rare, but severe complication to a caesarean section, with serious risks of perforation, necrosis and peritonitis. We describe a case of a Middle Eastern woman admitted for an elective caesarean section due to a history of three cesareans in her home country. The operation was complicated by massive adhesions and a postpartum bleed of 1750 mL. She developed severe abdominal pain refractory to strong pain medication postoperatively. She was diagnosed with a caecal volvulus without perforation on CT, which was confirmed by laparotomy. The patient was treated with a hemicolectomy and made a full recovery.
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Affiliation(s)
| | | | | | - Elisabeth Thal Roenneberg
- Gynecology, Obstetrics and Fertility, Copenhagen University Hospital, Herlev Hospital, Herlev, Denmark
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Ogilvie Syndrome and Acute Kidney Injury: A Rare Complication of Cesarean Section and Preeclampsia. J Clin Med 2023; 12:jcm12062249. [PMID: 36983251 PMCID: PMC10052119 DOI: 10.3390/jcm12062249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/03/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Ogilvie syndrome, or acute colonic pseudo-obstruction (ACPS) is a rare occurrence, usually following surgery. It consists of a massive dilatation of the cecum, whose diameter becomes greater than 10 cm; its severity is variable, but, if not promptly recognized, it may be life-threatening. Acute kidney injury (AKI) is reported in this context due to both septic complications and to effective hypovolemia. ACPS most commonly affects males and individuals older than 60. In women, the median age at diagnosis is lower due to a strong association with Caesarean sections. The differential diagnosis after delivery may be challenging, due to a potential overlap of symptoms with preeclampsia or hemolysis low platelet elevated liver enzymes (HELLP) syndrome, both associated with AKI. The case herein discussed, regarding a 35-year-old woman, who developed AKI and Ogilvie syndrome after a Caesarean section for preeclampsia, may exemplify these diagnostic and therapeutic challenges, and is intended to raise awareness on this unusual complication of Caesarean delivery.
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Muacevic A, Adler JR. Acute Colonic Pseudo-Obstruction Secondary to Renal Calculus: A Case Report and Review of Pathophysiology. Cureus 2023; 15:e34756. [PMID: 36777972 PMCID: PMC9905947 DOI: 10.7759/cureus.34756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
Acute colonic pseudo-obstruction (ACPO) is obstruction of the large bowel without a mechanical cause. The exact mechanism remains incompletely understood but is thought to result from disruption to the autonomic regulation of the colon, typically in the context of hospitalized patients with medical illness, precipitating medications, or recent surgical intervention. This paper presents an unusual case of ACPO in an ambulatory patient with a recently passed renal calculus, explores the anatomy and physiology underlying the autonomic dysfunction theory of ACPO pathogenesis in the context of the case, and provides a 3D reconstruction of the patient's CT to illustrate the abrupt caliber change at the splenic flexure characteristic of ACPO.
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Westfall KM, Cleary RK. Acute Colonic Pseudo-Obstruction. Dis Colon Rectum 2022; 65:1431-1434. [PMID: 36194654 DOI: 10.1097/dcr.0000000000002642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
CASE SUMMARY A 33-year-old man with a history of chronic alcohol use, generalized anxiety disorder, and hypertension presented to the emergency department after a syncopal event. He was admitted to the medical intensive care unit for alcohol withdrawal, requiring intubation and sedation. On hospital day 7, abdominal x-ray image demonstrated a dilated cecum to 12 cm, transverse colon dilation to 7 cm, and decompressed distal colon ( Fig. 1 ). CT scan of the abdomen and pelvis confirmed dilation of the cecum and ascending and transverse colons ( Fig. 2 ). Colonoscopy showed no evidence of distal obstruction, but colonic distension persisted, and he subsequently underwent cecal decompression with an open "blow-hole" cecostomy fully matured at skin level via a small right lower quadrant incision. The nasogastric tube was removed on postoperative day 2, and his diet was slowly advanced. Abdominal x-ray image on postoperative day 5 demonstrated no colonic dilation. He was discharged home on postoperative day 7. The patient re-presented to the hospital 3 months later with cecostomy prolapse. He underwent cecostomy takedown with ileocecectomy via circumstomal incision. He was discharged home on postoperative day 2.
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Affiliation(s)
- Kristen M Westfall
- Department of Colon & Rectal Surgery, St. Joseph Mercy Ann Arbor, Ann Arbor, Michigan
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Parker DR, Kaczmarczyk J, Rana A, Sia TC. Total colonic volvulus with a 720° twist of freely mobile colon. BMJ Case Rep 2022; 15:e250163. [PMID: 36028240 PMCID: PMC9422812 DOI: 10.1136/bcr-2022-250163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2022] [Indexed: 11/04/2022] Open
Abstract
Segmental colonic volvulus involving the sigmoid or ileocaecal region is an important cause of large bowel obstruction and a well-established surgical emergency. Volvulus of the entire colon however is hazardously rare, in which case the diagnosis is likely to be made intraoperatively. The surgeon is then faced with the conundrum of the best surgical management, especially in the case of early intervention with viable bowel. To our knowledge this has never been reported.
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Affiliation(s)
- Dominic Robert Parker
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Division of Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Janina Kaczmarczyk
- Division of Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Abdullah Rana
- Division of Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Tiong Cheng Sia
- Division of Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
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