Diagnosis and Treatment of Small Bowel Strangulation Due To Congenital Band: Three Cases of Congenital Band in Adults Lacking a History of Trauma or Surgery

Small bowel obstruction in a 29-year-old male with congenital peritoneal bands: A rare case report from Syria

This case highlights the significance of maintaining clinical suspicion for CPBs in adults presenting with SBO. Early surgical intervention, offering both diagnosis and treatment, is essential for managing this rare cause of SBO. Increased clinical awareness of CPBs will help ensure they are considered in the differential diagnosis of adult patients with bowel obstruction.

The Assessment of CDX1, IHH, SHH, GATA4, FOXA2, FOXF1 in Congenital Intra-Abdominal Adhesions

Congenital abdominal adhesions are a rare condition that can result in a small bowel obstruction at any age, more frequently in pediatric populations. The cause remains unknown, and the importance of aberrant congenital bands is related to the difficulty of diagnosis, and cases of death with late detection have been documented. This research examines the expression of Caudal Type Homeobox 1 (CDX1), Indian Hedgehog (IHH), Sonic Hedgehog (SHH), GATA Binding Protein 4 (GATA4), Forkhead Box A2 (FOXA2) and Forkhead Box F1 (FOXF1) gene expression in human abdominal congenital adhesion fibroblast and endothelium cells by chromogenic in situ hybridization, with the aim of elucidating their potential association with the etiology of congenital intra-abdominal adhesion band development. The potential genes' signals were examined using a semi-quantitative approach. Significant correlations were observed between the expression of CDX1 (p <.001) and SHH (p=0.032) genes in fibroblasts from congenital intra-abdominal adhesions compared to fibroblasts from control peritoneal tissue. Statistically significant very strong correlations were found between the CDX1 and IHH comparing endothelium and fibroblast cells in congenital abdominal adhesion bands. There was no statistically significant difference found in the distribution of IHH, FOXA2, GATA4, and FOXF1 between the fibroblasts and endothelium of the patients compared to the control group. The presence of notable distinctions and diverse associations suggests the potential involvement of numerous morpho-pathogenetic processes in the development of intraabdominal adhesions.

Congenital adhesion band: A rare case in a neonate

Diseases of the gastrointestinal system may be congenital or acquired. Intestinal obstruction is common in children and neonates, and it has various causes. Obstructions due to congenital adhesion bands are rare. Few cases were reported in the literature. In this paper, we will discuss the case of an 8-day-old girl who was presented to the emergency department with signs of intestinal obstruction.

Small bowel obstruction due to a congenital adhesion: a rare case report

The exact incidence of small bowel obstruction (SBO) due to congenital adhesions remains unclear. Herein, we report a 59-year-old male who appeared in the emergency department with diffuse abdominal pain associated with vomiting. The patient reported no previous medical or surgical history. Clinical examination revealed a soft, distended abdomen and diffuse tenderness. Computed tomography indicated a close loop obstruction. A congenital band extending from mesentery to ileum and causing an internal hernia was identified via a midline incision. The band was ligated and divided. There is no difference in the clinical presentation, and the initial work-up of SBO on account of congenital adhesions was compared to other bowel obstruction causes. Surgical exploration is crucial for the diagnosis and treatment of congenital adhesions. Although laparotomy is considered the cornerstone of surgical management, laparoscopy has emerged as a feasible and safe alternative for the diagnosis and treatment of these congenital bands.

Adult small bowel obstruction due to congenital peritoneal belt: A case report

Introduction

Peritoneal bands on the virgin abdomen are an extremely rare etiology of occlusive syndrome. Congenital bridles can be in 0.7 to 2% a cause of small bowel obstruction.

Presentation of case

We report a case of a 21-year-old woman who was admitted with symptoms of bowel obstruction. The patient had no surgical or traumatic history. Laparotomy was done and the findings showed a congenital belt extending from the antimesenteric wall of the ileum to the vesical dome, causing bowel strangulation. Band's ligation proceeded smoothly after the operation.

Discussion

Congenital flanges present an uncommon situation. These bands are usually difficult to classify and define. They are usually observed in childhood. Therefore, this situation represents an unusual surgical problem in diagnosing clinically unexpected elderly patients.

Conclusion

Congenital or spontaneous flanges are an uncommon cause of occlusion, which presents a challenging diagnosis. Exploratory laparotomy or laparoscopy is mandatory.

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Peritoneal bands on the virgin abdomen are an extremely rare etiology of the occlusive syndrome, representing an unsual problem clinically unexpected in elderly patients.

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Their management is based on surgical treatment, and laproscopy is much more preferred.

Intraoperative decision making in bariatric surgery

BACKGROUND

Surgeons may encounter unexpected anatomical or pathological findings during various bariatric surgical procedures for which they must make prompt and critical decisions that had not been planned prior to the operation. In this practice review, we present our experiences with unexpected challenges and on-table decision making in bariatric surgery to share our knowledge with colleagues who may encounter the same challenges during bariatric surgery. This paper's content is of applied learning and practical value focusing on challenging intraoperative decision making; however, it does not discuss the details of the various techniques used during surgery.

METHODS

This work is a single-center retrospective review of operations carried out on patients who had unexpected intraoperative findings during bariatric surgery despite the implementation of detailed preoperative evaluations that would have otherwise suggested standard procedures. These findings resulted in abandoned surgery or laparoscopic sleeve gastrectomy instead of the intended Roux-en-Y gastric bypass.

RESULTS

A total of 449 patients had received various bariatric interventions in our unit between 2012 and 2016. Eleven patients, representing approximately 2.4% of the total number of patients surveyed had met the inclusion criteria and were added to the final list for analysis. The mean age of the included patients was 40.82 years (range: 30-51 years), and seven of the patients, representing approximately 63.6% of the included cases, were female. The mean body mass index of the 11 cases was 40.8 (range: 38-48). Only two cases (18.9%) had had their surgery abandoned; the rest (81.1%) had received laparoscopic sleeve gastrectomy instead of Roux-en-Y gastric bypass. None of the 11 patients had perioperative morbidity or mortality.

CONCLUSION

Intraoperative decision making for unexpected findings in bariatric surgery is challenging. In these circumstances, surgeons must make prompt and critical decisions, including abandoning the operation. The available literature on this subject is unsurprisingly limited because of the rarity of such findings.

A Case of Anomalous Congenital Band that Was Difficult to Differentiate from Omphalomesenteric Duct Anomaly

Anomalous congenital band (ACB) is rare and difficult to identify preoperatively. Here we report a pediatric ACB case that was preoperatively suspected using computed tomography and was difficult to differentiate from omphalomesenteric duct anomaly. ACB should be considered in the differential diagnosis of acute abdomen.