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Al-Khafaji RA, Christensen JK. Mesenteric Cystic Lymphangioma, an acute presentation in a 9-year-old child. Radiol Case Rep 2024; 19:2371-2375. [PMID: 38572275 PMCID: PMC10987839 DOI: 10.1016/j.radcr.2024.02.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/11/2024] [Accepted: 02/15/2024] [Indexed: 04/05/2024] Open
Abstract
Mesenteric lymphangioma is a rare malformation of the lymphatic system. Misdiagnosis of mesenteric cystic lymphangioma can occur due to its rarity and resemblance to other cystic lesions and ascites. The authors report an acute presentation of a mesenteric lymphangioma in a 9-year-old child. Clinical, radiological, and surgical findings are illustrated accordingly. As authors, we aim to add to the limited data of acute presentations of mesenteric lymphangiomas.
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Affiliation(s)
- Rasha A. Al-Khafaji
- The Department of Radiology, The Regional Hospital of Lillebælt, The Region of Southern Denmark
- The Department of Radiology, Odense University Hospital, The Region of Southern Denmark
| | - Johnny Kent Christensen
- The Department of Radiology, The Regional Hospital of Lillebælt/Kolding Hospital, The Region of Southern Denmark
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Neo JWQ, Mathur S, Chia CS, Ong CAJ. Intestinal obstruction secondary to peritoneal metastases: More harm than good with water-soluble contrast study? Asian J Surg 2024:S1015-9584(24)00590-6. [PMID: 38604855 DOI: 10.1016/j.asjsur.2024.03.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/22/2024] [Indexed: 04/13/2024] Open
Affiliation(s)
- Joreen Wen Qi Neo
- Department of Sarcoma, Peritoneal and Rare Tumors (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Center Singapore, Singapore; Department of Sarcoma, Peritoneal and Rare Tumors (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore
| | - Sachin Mathur
- Department of General Surgery, Division of Surgery and Surgical Oncology, Singapore General Hospital, Outram Road, Singapore, 169608
| | - Claramae Shulyn Chia
- Department of Sarcoma, Peritoneal and Rare Tumors (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Center Singapore, Singapore; Department of Sarcoma, Peritoneal and Rare Tumors (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore; SingHealth Duke-NUS Oncology Academic Medical Program, Duke-NUS Medical School, Singapore; SingHealth Duke-NUS Surgery Academic Medical Program, Duke-NUS Medical School, Singapore
| | - Chin-Ann Johnny Ong
- Department of Sarcoma, Peritoneal and Rare Tumors (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Center Singapore, Singapore; Department of Sarcoma, Peritoneal and Rare Tumors (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore; SingHealth Duke-NUS Oncology Academic Medical Program, Duke-NUS Medical School, Singapore; SingHealth Duke-NUS Surgery Academic Medical Program, Duke-NUS Medical School, Singapore; Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Center Singapore, Singapore; Institute of Molecular and Cell Biology, A∗STAR Research Entities, Singapore.
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Martínez Díaz M, Costa Roig A, Carazo Palacios ME, Viguria Marco I, Marco Macián A, Crehuet Gramatyka D. Intestinal obstruction as a result of intra-abdominal hematoma: a complication of low molecular weight heparin in pediatric patients. Cir Pediatr 2024; 37:84-88. [PMID: 38623802 DOI: 10.54847/cp.2024.02.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
INTRODUCTION Hematomas are a rare cause of intestinal obstruction. Subcutaneous heparin can bring about direct punctures on small bowel loops, potentially leading to traumatic hematoma and intestinal obstruction. CASE REPORTS We present three cases of pediatric patients with clinical signs of intestinal obstruction treated with subcutaneous heparin. Two cases had increased acute-phase reactants and radiological signs of intestinal suffering, so surgical treatment was decided upon, with intramural hematoma emerging as an intraoperative finding. The third case was conservatively managed with anticoagulant discontinuation and gut rest, since the patient had an adequate general condition and no findings compatible with ischemia or necrosis were noted in the complementary tests. DISCUSSION The administration of subcutaneous heparin may cause intestinal wall hematomas due to its anticoagulating effect and to the risk of inadvertent punctures on small bowel loops.
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Affiliation(s)
- M Martínez Díaz
- Pediatric Surgery Department. Hospital Universitario y Politécnico La Fe. Valencia (Spain)
| | - A Costa Roig
- Pediatric Surgery Department. Hospital Universitario y Politécnico La Fe. Valencia (Spain)
| | - M E Carazo Palacios
- Pediatric Surgery Department. Hospital Universitario y Politécnico La Fe. Valencia (Spain)
| | - I Viguria Marco
- Pediatric Surgery Department. Hospital Universitario y Politécnico La Fe. Valencia (Spain)
| | - A Marco Macián
- Pediatric Surgery Department. Hospital Universitario y Politécnico La Fe. Valencia (Spain)
| | - D Crehuet Gramatyka
- Pediatric Surgery Department. Hospital Universitario Central de Asturias. Oviedo (Spain)
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Moses Wong YK, Teng WW, Sharon Chong ZC, Tan CS, Wong YY, Thangavelu D, Md Umar MD, Hayati F. Holes can be perilous: A rare presentation of intestinal obstruction - Herniation through the broad ligament. Radiol Case Rep 2024; 19:1309-1312. [PMID: 38292799 PMCID: PMC10825535 DOI: 10.1016/j.radcr.2023.12.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 12/28/2023] [Accepted: 12/30/2023] [Indexed: 02/01/2024] Open
Abstract
A 57-year-old lady presented with symptoms of intestinal obstruction preceded by a 2-day history of lower abdomen pain. Clinically, she had a distended abdomen with tenderness in her lower abdomen. Laboratory investigations were unremarkable. An abdominal radiograph showed a dilated small bowel with no extensive bowel gas. A computed tomography (CT) scan showed suspected intestinal obstruction secondary to herniation into the right broad ligament. The decision was made to proceed with surgery, and the intraoperative results confirmed the CT results. The literature review is outlined here, and this instance illustrates a surprising discovery.
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Affiliation(s)
- Yung Kuan Moses Wong
- Department of Surgery, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - Wei Woon Teng
- Department of Surgery, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - Zi Ching Sharon Chong
- Department of Surgery, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - Chia Shing Tan
- Department of Surgery, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - Yue Yuan Wong
- Department of Surgery, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - Danesh Thangavelu
- Department of Surgery, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - Muhammad Danial Md Umar
- Department of Radiology, Keningau Hospital, Ministry of Health Malaysia, Keningau, Sabah, Malaysia
| | - Firdaus Hayati
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
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Ge J, Li Y, Shi D, Wei J, Wang J, Liu J. Cytomegalovirus colitis as intestinal obstruction in an immunocompetent adolescent: a case report and literature review. BMC Infect Dis 2024; 24:365. [PMID: 38561696 PMCID: PMC10983691 DOI: 10.1186/s12879-024-09255-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 03/26/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Cytomegalovirus infection manifests varying clinical characteristics and severity in diverse populations with different immune statuses. The signs and symptoms of gastrointestinal involvement are nonspecific. Here, we present a case of cytomegalovirus colitis in an immunocompetent adolescent, which manifested as intestinal pseud-obstruction. CASE PRESENTATION A 15-year-old man who had contracted novel coronavirus infection one month earlier was admitted to our hospital with fever, abdominal pain, and hematochezia. His abdomen was distended, and laboratory evaluation revealed a decrease in the blood count, an increase in inflammatory indicators and hepatic impairment. Imaging shows bowel wall thickening and dilatation of the colon. A diagnosis of intestinal infection combined with acute intestinal pseud-obstruction was made. Diarrhea persisted despite conservative treatment with empirical antibiotics. A colonoscopy was performed. Pathology confirmed cytomegalovirus infection. Ganciclovir therapy was initiated, and subsequent review showed a good recovery. CONCLUSIONS The case was diagnosed as cytomegalovirus colitis. We reviewed the reports of 9 cases of bowel obstruction, including our own, and found that the majority of the adult patients were elderly with underlying disease. Clinical and endoscopic manifestations are typically nonspecific, and imaging shows typical signs of intestinal obstruction. The final diagnosis was confirmed by pathology. Most of them have a good prognosis. We suggest that cytomegalovirus colitis can also lead to intestinal obstruction and that viral reactivation in immunocompetent individuals may be associated with inflammatory conditions and viral coinfection, particularly with the novel coronavirus.
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Affiliation(s)
- Jiongshan Ge
- Emergency Department, The State Key Laboratory for Complex, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Yan Li
- Emergency Department, The State Key Laboratory for Complex, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Di Shi
- Emergency Department, The State Key Laboratory for Complex, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Jiaxin Wei
- Emergency Department, The State Key Laboratory for Complex, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Jing Wang
- Pathology Department, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng Districtg, Beijing, 100730, China
| | - Jihai Liu
- Emergency Department, The State Key Laboratory for Complex, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China.
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Gebretsion MT, Mergiyaw YA, Shumargaw AT. Spleno-Sigmoid Knotting - An Unfamiliar Cause of Intestinal Obstruction. Am J Emerg Med 2024; 78:241.e1-241.e3. [PMID: 38402100 DOI: 10.1016/j.ajem.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/18/2024] [Indexed: 02/26/2024] Open
Abstract
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. She also experienced obstipation and frequent episodes of vomiting of ingested matter. Upon initial evaluation, she exhibited tachycardia and tachypnea, and her abdomen was grossly distended with diffuse direct and rebound tenderness. Further investigation revealed significant leukocytosis with neutrophil predominance. Emergency laparotomy was performed with a possible diagnosis of generalized peritonitis secondary to gangrenous sigmoid volvulus, which revealed gangrenous spleno-sigmoid knotting. DISCUSSION Various types of intestinal knots have been reported, with ileo-sigmoid knots being the most common and ileo-ileal knots being the rarest. Wandering spleen is a rare congenital anomaly with a variable clinical presentation ranging from asymptomatic to mild abdominal pain or acute abdomen due to torsion or acute pancreatitis. It can also cause intestinal obstruction, which may be the initial presentation. CONCLUSION In patients presenting with acute abdominal pain and features of bowel obstruction, the possibility of spleno-sigmoid knotting should be considered, and early intervention should be instituted to prevent gangrenous progression and sepsis.
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Affiliation(s)
| | - Yimam Ali Mergiyaw
- Department of Surgery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Vipudhamorn W, Juthasilaparut T, Sutharat P, Sanmee S, Supatrakul E. Abdominal cocoon syndrome-a rare culprit behind small bowel ischemia and obstruction: Three case reports. World J Gastrointest Surg 2024; 16:955-965. [PMID: 38577091 PMCID: PMC10989339 DOI: 10.4240/wjgs.v16.i3.955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/16/2023] [Accepted: 02/06/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Abdominal cocoon syndrome (ACS) represents a category within sclerosing encapsulating peritonitis, characterized by the encapsulation of internal organs with a fibrous, cocoon-like membrane of unknown origin, resulting in bowel obstruction and ischemia. Diagnosing this condition before surgery poses a challenge, often requiring confirmation during laparotomy. In this context, we depict three instances of ACS: One linked to intestinal obstruction, the second exclusively manifesting as intestinal ischemia without any obstruction, and the final case involving a discrepancy between the radiologist and the surgeon. CASE SUMMARY Three male patients, aged 53, 58, and 61 originating from Northern Thailand, arrived at our medical facility complaining of abdominal pain without any prior surgeries. Their vital signs remained stable during the assessment. The diagnosis of abdominal cocoon was confirmed through abdominal computed tomography (CT) before surgery. In the first case, the CT scan revealed capsules around the small bowel loops, showing no enhancement, along with mesenteric congestion affecting both small and large bowel loops, without a clear obstruction. The second case showed intestinal obstruction due to an encapsulated capsule on the CT scan. In the final case, a patient presented with recurring abdominal pain. Initially, the radiologist suspected enteritis as the cause after the CT scan. However, a detailed review led the surgeon to suspect encapsulating peritoneal sclerosis (ACS) and subsequently perform surgery. The surgical procedure involved complete removal of the encapsulating structure, resection of a portion of the small bowel, and end-to-end anastomosis. No complications occurred during surgery, and the patients had a smooth recovery after surgery, eventually discharged in good health. The histopathological examination of the fibrous membrane (cocoon) across all cases consistently revealed the presence of fibro-collagenous tissue, without any indications of malignancy. CONCLUSION Individuals diagnosed with abdominal cocoons commonly manifest vague symptoms of abdominal discomfort. An elevated degree of clinical suspicion, combined with the application of appropriate radiological evaluations, markedly improves the probability of identifying the abdominal cocoon before surgical intervention. In cases of complete bowel obstruction or ischemia, the established norm is the comprehensive removal of the peritoneal sac as part of standard care. Resection with intestinal anastomosis is advised solely when ischemia and gangrene have been confirmed.
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Affiliation(s)
- Witcha Vipudhamorn
- Department of Colorectal Surgery, Chiang Mai University, Chiang Mai 50200, Thailand
| | | | - Pawit Sutharat
- Department of Colorectal Surgery, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Suwan Sanmee
- Department of Colorectal Surgery, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Ekkarin Supatrakul
- Department of Colorectal Surgery, Chiang Mai University, Chiang Mai 50200, Thailand
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Siviero I, de Almeida UVB, Penna CRR, Di Puglia EBM, Simões BCB. Abdominal complications of ascariasis in childhood. J Pediatr (Rio J) 2024:S0021-7557(24)00027-5. [PMID: 38522478 DOI: 10.1016/j.jped.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 03/26/2024] Open
Abstract
OBJECTIVE Complications of ascariasis are a significant cause of abdominal pain in pediatric emergencies, especially where it is endemic. A literature review was conducted with the aim of improving diagnostic and therapeutic approaches for these patients. DATA SOURCES A PubMed search was conducted using the key terms "ascariasis complications" and "hepatobiliary ascariasis". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, case reports, and reviews published up to December 2023. SUMMARY OF FINDINGS Obstruction of the small bowel is the most common complication. Others that are, rarer and more difficult to properly identify and treat, such as biliary, hepatic, and pancreatic complications, acute appendicitis, Meckel's diverticulitis, or peritoneal granulomas. Hepatic and pancreatic complications are rarer and more serious in children than in adults. While plain radiography is usually the only option in cases of intestinal obstruction, ultrasonography is the examination of choice in cases of hepatobiliary, pancreatic, and appendicular ascariasis complications in childhood. The treatment is clinical and conservative in most patients. Surgical treatment is indicated if conservative therapy fails, or if there are signs of complications. Laparoscopy has been used as an excellent technical alternative in adults with hepatobiliary complications of ascariasis, but further studies on its use in children are still needed. CONCLUSION The creation of protocols and greater debate on this subject should be encouraged for a better understanding of the disease and to establish an early diagnosis and adequate treatment for children with complications resulting from massive infestation by Ascaris lumbricoides.
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Affiliation(s)
- Ivonete Siviero
- Universidade Federal do Rio de Janeiro (UFRJ), Faculdade de Medicina, Departamento de Cirurgia, Rio de Janeiro, RJ, Brazil.
| | - Ugo V B de Almeida
- Universidade Federal do Rio de Janeiro (UFRJ), Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG), Rio de Janeiro, RJ, Brazil
| | - Claudia R R Penna
- Universidade Federal do Rio de Janeiro (UFRJ), Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG), Rio de Janeiro, RJ, Brazil
| | - Elazir B M Di Puglia
- Universidade Federal do Rio de Janeiro (UFRJ), Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG), Rio de Janeiro, RJ, Brazil
| | - Betina C Bertrand Simões
- Universidade Federal do Rio de Janeiro (UFRJ), Faculdade de Medicina, Departamento de Cirurgia, Rio de Janeiro, RJ, Brazil
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Kim DH, Lee HH. Colon stenting as a bridge to surgery in obstructive colorectal cancer management. Clin Endosc 2024:ce.2023.138. [PMID: 38454545 DOI: 10.5946/ce.2023.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/29/2023] [Indexed: 03/09/2024] Open
Abstract
Colonic stent placement is a commonly used bridging strategy for surgery in patients with obstructive colorectal cancer. The procedure involves the placement of a self-expandable metallic stent (SEMS) across the obstructive lesion to restore intestinal patency and alleviate the symptoms of obstruction. By allowing patients to receive surgery in a planned and staged manner with time for preoperative optimization and bowel preparation, stent placement may reduce the need for emergency surgery, which is associated with higher complication rates and poorer outcomes. This review focuses on the role of colon stenting as a bridge to surgery in the management of obstructive colorectal cancer. SEMS as a bridge to surgery for left-sided colon cancer has been demonstrated to be particularly useful; however, further research is needed for its application in cases of right-sided colon cancer. Colon stent placement also has limitations and potential complications including stent migration, re-obstruction, and perforation. However, the timing of curative surgery after SEMS placement remains inconclusive. Considering the literature to date, performing surgery at an interval of approximately 2 weeks is considered appropriate. Therefore, colonic stent placement may be an effective strategy as a bridge to surgery in patients with obstructive colorectal cancer.
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Affiliation(s)
- Dong Hyun Kim
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Han Hee Lee
- Division of Gastroenterology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Lin SW, Chen CY, Chen PC, Feng CL, Lin HY, Chen JH. Assessing risk of recurrent small bowel obstruction after non-operative management in patients with history of intra-abdominal surgery: a population-based comprehensive analysis in Taiwan. Surg Endosc 2024:10.1007/s00464-024-10746-6. [PMID: 38453749 DOI: 10.1007/s00464-024-10746-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 02/06/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Despite a significant 30% ten-year readmission rate for SBO patients, investigations into recurrent risk factors after non-operative management are scarce. The study aims to generate a risk factor scoring system, the 'Small Bowel Obstruction Recurrence Score' (SBORS), predicting 6-month recurrence of small bowel obstruction (SBO) after successful non-surgical management in patients who have history of intra-abdominal surgery. METHODS We analyzed data from patients aged ≥ 18 with a history of intra-abdominal surgery and diagnosed with SBO (ICD-9 code: 560, 568) and were successful treated non-surgically between 2004 and 2008. Participants were divided into model-derivation (80%) and validation (20%) group. RESULTS We analyzed 23,901 patients and developed the SBORS based on factors including the length of hospital stay > 4 days, previous operations > once, hemiplegia, extra-abdominal and intra-abdominal malignancy, esophagogastric surgery and intestino-colonic surgery. Scores > 2 indicated higher rates and risks of recurrence within 6 months (12.96% vs. 7.27%, OR 1.898, p < 0.001 in model-derivation group, 12.60% vs. 7.05%, OR 1.901, p < 0.001 in validation group) with a significantly increased risk of mortality and operative events for recurrent episodes. The SBORS model demonstrated good calibration and acceptable discrimination, with an area under curve values of 0.607 and 0.599 for the score generation and validation group, respectively. CONCLUSIONS We established the effective 'SBORS' to predict 6-month SBO recurrence risk in patients who have history of intra-abdominal surgery and have been successfully managed non-surgically for the initial obstruction event. Those with scores > 2 face higher recurrence rates and operative risks after successful non-surgical management.
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Affiliation(s)
- Shang-Wei Lin
- Division of Plastic Surgery, Department of Surgery, Cathay General Hospital, Taipei, 10630, Taiwan
- Department of Surgery, Cathay General Hospital, Taipei, 10630, Taiwan
| | - Chung-Yen Chen
- Division of General Surgery, Department of Surgery, E-Da Hospital, Kaohsiung, Taiwan
- Bariatric and Metabolism International Surgery Center, E-Da Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Pin-Chun Chen
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Division of Colon & Rectal Surgery, Department of Surgery, E-Da Hospital, Kaohsiung, Taiwan
| | - Che-Lun Feng
- Division of General Surgery, Department of Surgery, E-Da Hospital, Kaohsiung, Taiwan
| | - Hung-Yu Lin
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
- Division of Urology, Department of Surgery, E-Da Cancer & E-Da Hospital, Kaohsiung, Taiwan.
| | - Jian-Han Chen
- Division of General Surgery, Department of Surgery, E-Da Hospital, Kaohsiung, Taiwan.
- Bariatric and Metabolism International Surgery Center, E-Da Hospital, Kaohsiung, Taiwan.
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
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Abokrecha A, Sayed AG, Alnajjar K, Almatrafi OA, Aldamouni M. Sigmoid atresia: Case report and literature review. Int J Surg Case Rep 2024; 116:109434. [PMID: 38401322 PMCID: PMC10944126 DOI: 10.1016/j.ijscr.2024.109434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/18/2024] [Accepted: 02/20/2024] [Indexed: 02/26/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Intestinal atresia is a congenital anomaly commonly happening in the small bowel and rarely in the colon. Colonic atresia can manifest as intestinal obstruction with abdominal distention and bilious vomiting. CASE PRESENTATION A 3-day-old male new-born who was referred from a rural hospital, full term, product of normal vaginal delivery, with a weight of 2400 g. The patient had a complaint of bilious vomiting, inability to pass meconium, and abdominal distension for three days. On clinical examination the patient had visible bowel loops and yellowish aspiration from the orogastric tube. An erect abdominal radiograph showed distended bowel loops and sharp air-fluid levels. Administration of contrast enema revealed resistance to pass the rectal tube and stopping of contrast pas the rectosigmoid region with contrast spillage from the anus. CLINICAL DISCUSSION Sigmoid atresia is a rare congenital anomaly that occurs in approximately 1 in 20,000 live births. The most common presentation is bilious vomiting and abdominal distension in the first 24 h of life. Diagnosis is confirmed with abdominal X-ray and contrast enema. Treatment is surgical, with primary repair being the most common approach. He underwent two stages of repair with an end colostomy and mucous fistula, then closure of the colostomy after four months of the first stage. CONCLUSION This presentation requires clinical suspicion with prompt care, as this condition can mimic Hirschsprung's disease. In our case, the patient has a classical presentation of sigmoid atresia that had an early diagnosis, which resulted in a better outcome.
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Affiliation(s)
- Ahmed Abokrecha
- Department of Pediatric Surgery, Maternity and Children Hospital, Makkah, Saudi Arabia
| | | | - Khalid Alnajjar
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Maeen Aldamouni
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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Tahmasbi H, Kashani P, Haghbin Toutounchi A, Sadeghmousavi S, Hasanzade A, Aghaei M. Jejunal adenocarcinoma; a case report and literature review. Int J Surg Case Rep 2024; 116:109372. [PMID: 38387372 PMCID: PMC10943634 DOI: 10.1016/j.ijscr.2024.109372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Small bowel carcinoma (SBC) is a rare malignancy comprising mainly of adenocarcinoma and carcinoid tumors. Among SBCs, small bowel adenocarcinoma (SBA) accounts for 30-40 % and is predominantly found in the duodenum, while jejunal and ileal presence considered rare. CASE PRESENTATION We have presented a case of jejunal adenocarcinoma in a patient with obstruction symptoms. Prior to the obstruction, the patient mainly suffered from weakness and weight loss, in addition to iron deficiency anemia. During the investigation of underlying causes, we observed evidence of mass. However, before any additional evaluation could take place, the obstruction necessitated surgical intervention. CLINICAL DISCUSSION Small bowel adenocarcinomas, particularly in the jejunum and ileum, are exceedingly rare and often present with complications such as obstruction, gastrointestinal bleeding, or perforation. Due to the non-specific symptoms, SBAs are challenging to diagnose before complications occur. SBAs are frequently diagnosed at advanced stages, so early diagnosis is crucial, as it can significantly impact patient survival. Thus, efforts should be made to expedite the diagnosis process to avoid complications and improve survival rates. CONCLUSION SBAs are a rare condition, often diagnosed by related complications. Recognizing the importance of early diagnosis and its positive influence on patient survival, physicians and surgeons should consider SBA in patients presenting with relevant symptoms or cases of obstruction.
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Affiliation(s)
- Hamed Tahmasbi
- Department of General Surgery, Imam Hosein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Parvin Kashani
- Department of Emergency Medicine, Imam Hosein medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Alireza Haghbin Toutounchi
- Department of General Surgery, Imam Hosein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Shaghayegh Sadeghmousavi
- Department of General Surgery, Imam Hosein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Arman Hasanzade
- Department of General Surgery, Imam Hosein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mohammad Aghaei
- Department of General Surgery, Imam Hosein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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13
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Tahouri T, Hedayati Omami S, Hosseini M, Rahimi-Movaghar E. Concurrent rectal perforation and obstruction following neoadjuvant chemoradiation for locally advanced rectal cancer: A case report. Int J Surg Case Rep 2024; 116:109337. [PMID: 38310787 PMCID: PMC10847799 DOI: 10.1016/j.ijscr.2024.109337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/06/2024] Open
Abstract
INTRODUCTION Locally advanced rectal cancer (LARC) is commonly managed with neoadjuvant chemoradiation (neoCRT) followed by surgery, though not without complications. The anatomical exposure of the colon and rectum and pelvic radiotherapy poses risk, with rectal perforation and bowel obstruction, though rare, carrying life-threatening potential. PRESENTATION OF CASE This case highlights an exceptionally rare occurrence of concurrent rectal perforation and rectal obstruction in a 77-year-old male with LARC, just two months post neoCRT. Initial symptoms included rectal bleeding, and diagnostic procedures confirmed rectal T1N3adenocarcinoma with no metastasis. Emergency admission, prompted by complete bowel obstruction symptoms, led to discovery of rectal perforation during laparotomy, sealed by the bladder. Pathological analysis attributed the cause to radiation proctitis, reporting complete response to neoCRT with no residual tumor. DISCUSSION The rarity of both bowel obstruction and perforation as neoCRT complications, particularly in the acute phase of radiation proctitis, is noteworthy in this case. The absence of tumoral cells at the affected sites emphasizes the exceptional nature of this case. CONCLUSION This case underscores the importance of recognizing acute post neoCRT injuries as potentially life-threatening complications, emphasizing the need for heightened awareness and consideration in clinical management.
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Affiliation(s)
- Tahmineh Tahouri
- Pediatric Cardiology, Shahid Modarres Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | | | - Maryam Hosseini
- Anatomical & Clinical Pathologist, Shahid Chamran Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ehsanollah Rahimi-Movaghar
- Department of Surgery, Farhikhtegan Hospital, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.
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14
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Tahmasbi H, Haghbin Toutounchi A, Hasanzade A, Sadeghmousavi S, Aghaei M. The omphalomesenteric duct fibrous band as a rare cause of bowel obstruction: A case report and literature review. Int J Surg Case Rep 2024; 116:109354. [PMID: 38340631 PMCID: PMC10943667 DOI: 10.1016/j.ijscr.2024.109354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE The omphalomesenteric duct (OMD) is an embryonic structure that normally undergoes obliteration during embryonic development, typically not persisting after birth. Failure of complete or partial obliteration can result in a type of malformation known as OMD remnant. CASE PRESENTATION We report a case of a 24-year-old male patient diagnosed with bowel obstruction. Abdominal computed tomography (CT) scan revealed the presence of an adhesion band. During surgery, a fibrous band connecting from the umbilicus to the mesentery of terminal ileum was found and resected. Pathological investigation confirmed the presence of an OMD remnant fibrous band. CLINICAL DISCUSSION OMD remnant can manifest in different forms such as Meckel's diverticulum, umbilical polyp, OMD cyst, OMD fistula, and fibrous band, occurring in approximately 2 % of infants and often presenting symptoms in early childhood. These conditions rarely cause complications in adults. Complications may include obstruction, gastrointestinal bleeding, bowel perforation, and omphalitis which can present with symptoms such as abdominal pain, vomiting, melena, lack of defecation, umbilical discharge, and dermal manifestations. Diagnostic approaches vary depending on the type of OMD remnant and associated complications, but ultrasonography and CT scan can be useful. While asymptomatic OMD remnants generally do not require further intervention, surgical treatment is the main option for complicated and symptomatic cases. CONCLUSION OMD remnant is a rare condition in adults that can lead to complications. Given that obstruction is a common complication of OMD remnant, OMD remnant should be considered in the differential diagnosis of patients presenting with bowel obstruction.
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Affiliation(s)
- Hamed Tahmasbi
- Department of General Surgery, Imam Hossein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Haghbin Toutounchi
- Department of General Surgery, Imam Hossein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Arman Hasanzade
- Department of General Surgery, Imam Hossein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shaghayegh Sadeghmousavi
- Department of General Surgery, Imam Hossein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Aghaei
- Department of General Surgery, Imam Hossein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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15
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Mattit A, Marrawi I, Kheir S, Khamis T, Qatleesh S, Ousta MA. Small bowel melanoma causing obstruction: A case report and a literature review. Int J Surg Case Rep 2024; 116:109388. [PMID: 38359583 PMCID: PMC10943987 DOI: 10.1016/j.ijscr.2024.109388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION Primary small bowel melanoma (PSBM) is a rare form of melanoma that originates from the intestinal mucosa. It is typically asymptomatic; however, it can present with non-specific symptoms, which pose challenges in accurately diagnosing the condition. In rare cases, it may manifest as small bowel obstruction, further adding challenges with diagnosis and management. CASE PRESENTATION A 57-year-old male presented to the hospital with complaints of chronic constipation, abdominal pain, and abdominal enlargement. Computed tomography (CT) scan revealed thickening of the jejunum wall, while endoscopy and biopsy revealed nothing. During surgery, surgeons identified and excised a jejunal mass. Subsequent pathological analysis confirmed the diagnosis of melanoma, and post-surgical examination failed to identify primary cutaneous melanoma. DISCUSSION PSBM is a rare and aggressive tumor often misdiagnosed due to non-specific symptoms and challenging imaging interpretations. Obstruction and intussusception are uncommon presentations. Surgical resection offers symptom control and improved prognosis, but achieving negative margins can be challenging. Early recognition and diagnosis are crucial for optimal management. CONCLUSION The lack of data in the literature presents challenges in identifying and selecting the optimal approach for managing PSBM. Physicians should increase their awareness of this specific type of tumor to facilitate early-stage diagnosis and provide appropriate care for patients.
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Affiliation(s)
- Ammar Mattit
- Faculty of Medicine, Al-Sham Private University, Damascus, Syria.
| | - Ibrahim Marrawi
- Faculty of Medicine, Al-Sham Private University, Damascus, Syria
| | - Safouh Kheir
- Faculty of Medicine, Al-Sham Private University, Damascus, Syria
| | - Taha Khamis
- Faculty of Medicine, Al-Sham Private University, Damascus, Syria
| | - Safaa Qatleesh
- Pathology Department, Al-Assad University Hospital, Damascus, Syria
| | - Muhammad Ali Ousta
- General Surgery Department, Al-Assad University Hospital, Damascus, Syria
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16
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Molla YD, Mequanint MB, Bisrat SH, Workneh GA, Alemu HT. Ileo-ileal knot causing acute gangrenous small bowel obstruction: a case report. J Med Case Rep 2024; 18:72. [PMID: 38388472 PMCID: PMC10885608 DOI: 10.1186/s13256-024-04404-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Ileo-ileal knotting is a very rare cause of small bowel obstruction, and only a few reports have been published. Small bowel obstruction (SBO) is one of the most common emergency surgical conditions that require urgent evaluation and treatment and is one of the leading causes of emergency surgical admission. There are many causes of SBO that are known in general surgical practice, and these causes are different in the developing and developed worlds. CLINICAL PRESENTATION In this article, we present a case of acute gangrenous SBO secondary to ileo-ileal knotting in a 37-year-old Ethiopian female patient after she presented with severe abdominal cramp, vomiting, and abdominal distension of 4 hours duration. The patient was operated on intraoperatively; she had gangrenous small bowel obstruction caused by ileo-ileal knotting. Later, the patient was discharged and improved after 12 days of hospital stay. CONCLUSION Ileo-ileal knotting should always be considered in the differential diagnosis of acute small-bowel obstruction. The diagnostic difficulty and the need for urgent treatment of this condition to yield optimal results are discussed.
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17
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Wang L, Chen Y, Chen S, Gao Z, Qian Y, Chen Q. Gastrointestinal trichobezoars in the pediatric population: a retrospective study. BMC Pediatr 2024; 24:124. [PMID: 38365624 PMCID: PMC10870568 DOI: 10.1186/s12887-023-04489-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/16/2023] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Trichobezoar is an extremely rare condition characterized by a foreign body in the gastrointestinal tract (GIT) among children. The foreign body may exist in the digestive tract for several years, and it becomes evident if complications develop. The current study aimed to present 21 cases of GIT trichobezoars. METHODS Retrospective analysis of children who were diagnosed with trichobezoars between August 2012 and December 2022. Patient demographics, clinical presentation, diagnosis, and therapy were collected and analyzed.Twenty-one patients had GIT trichobezoars. Data were collected and analyzed retrospectively. RESULTS Twenty-one patients were identified. All patients were female. Their mean age at admission was 8.9 ± 1.9 years. Furthermore, 19 (90.5%) patients presented with abdominal pain, 16 (76.2%) with vomiting, and 13 (61.9%) with a palpable mass. Sixteen patients underwent gastroduodenoscopy. Among them, 15 had gastric trichobezoars. Moreover, 12 patients underwent computed tomography scan. Eight patients presented with gastric and small intestinal BZs, one presented with increased small intestinal contents with dilation, and one presented with abundant gastric contents. Then, 20 patients underwent surgery. Among them, five underwent laparoscopic-assisted minilaparotomy (LAML), and the rest underwent laparotomy. The results showed that 10 (50%) patients had gastric trichobezoars; 7 (35%), Rapunzel syndrome; and 3 (15%), small bowel trichobezoars. Two patients developed superficial wound infection postoperatively. One patient had a recurrent gastric trichobezoar. CONCLUSION Trichobezoar should be considered in young girls with a history of hair eating or those with hair in the vomit or feces. Timely diagnosis and aggressive treatment are the keys to reducing complications and improving prognosis. Laparoscopic-assisted minilaparotomy is a safe, feasible, and effective surgical method for treating trichobezoars.
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Affiliation(s)
- Linyan Wang
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, 310052, China
| | - Yi Chen
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, 310052, China
| | - Sai Chen
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, 310052, China
| | - Zhigang Gao
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, 310052, China
| | - Yunzhong Qian
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, 310052, China
| | - Qingjiang Chen
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, 310052, China.
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18
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Sun YM, Xin W, Liu YF, Guan ZM, Du HW, Sun NN, Liu YD. Appendicitis combined with Meckel's diverticulum obstruction, perforation, and inflammation in children: Three case reports. World J Clin Cases 2024; 12:865-871. [PMID: 38322683 PMCID: PMC10841135 DOI: 10.12998/wjcc.v12.i4.865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/06/2023] [Accepted: 01/08/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Meckel's diverticulum is a common congenital malformation of the small intestine, with the three most common complications being obstruction, perforation, and inflammation. To date, only a few cases have been reported worldwide. In children, the clinical symptoms are similar to appendicitis. As most of the imaging features are nonspecific, the preoperative diagnosis is not precise. In addition, the clinical characteristics are highly similar to pediatric acute appendicitis, thus special attention is necessary to distinguish Meckel's diverticulum from pediatric appendicitis. Patients with poor disease control should undergo laparoscopic exploration to avoid serious complications, including intestinal necrosis, intestinal perforation and gastrointestinal bleeding. CASE SUMMARY This report presents three cases of appendicitis in children combined with intestinal obstruction, which was caused by fibrous bands (ligaments) arising from the top part of Meckel's diverticulum, diverticular perforation, and diverticular inflammation. All three patients, aged 11-12 years, had acute appendicitis as their initial clinical presentation. All were treated by laparoscopic surgery with a favorable outcome. A complete dataset including clinical presentation, diagnostic imaging, surgical information, and histopathologic findings was also provided. CONCLUSION Preoperative diagnosis of Meckel's diverticulum and its complications is challenging because its clinical signs and complications are similar to those of appendicitis in children. Laparoscopy combined with laparotomy is useful for diagnosis and treatment.
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Affiliation(s)
- Yi-Meng Sun
- School of Clinical Medicine, Weifang Medical University, Weifang 261000, Shandong Province, China
| | - Wang Xin
- Department of Pediatric Surgery, Weifang People’s Hospital, Weifang 261000, Shandong Province, China
| | - Yu-Fang Liu
- Department of Burn Surgery, Weifang People’s Hospital, Weifang 261000, Shandong Province, China
| | - Zhe-Ming Guan
- Department of Pediatric Surgery, Weifang People’s Hospital, Weifang 261000, Shandong Province, China
| | - Hao-Wen Du
- Department of Pediatric Surgery, Weifang People’s Hospital, Weifang 261000, Shandong Province, China
| | - Ning-Ning Sun
- Department of Pediatric Surgery, Weifang People’s Hospital, Weifang 261000, Shandong Province, China
| | - Yong-Dong Liu
- Department of Pediatric Surgery, Weifang People’s Hospital, Weifang 261000, Shandong Province, China
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Naous A, Itani R, Itani MK, Naja Z, Rajab M. Congenital adhesion band: A rare case in a neonate. Radiol Case Rep 2024; 19:499-502. [PMID: 38044906 PMCID: PMC10686888 DOI: 10.1016/j.radcr.2023.10.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/26/2023] [Accepted: 10/29/2023] [Indexed: 12/05/2023] Open
Abstract
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.
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Affiliation(s)
- Amal Naous
- Faculty of Medicine and Surgery, Beirut Arab University, Beirut, Lebanon
- Department of Pediatrics, Makassed General Hospital, Beirut, Lebanon
| | - Rania Itani
- Faculty of Medicine and Surgery, Beirut Arab University, Beirut, Lebanon
| | | | - Zeina Naja
- Department of Pediatrics, Makassed General Hospital, Beirut, Lebanon
| | - Mariam Rajab
- Department of Pediatrics, Makassed General Hospital, Beirut, Lebanon
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20
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Ha GW, Lee MR. Short-term and long-term oncologic outcomes of self-expandable metallic stent compared with tube decompression for obstructive colorectal cancer: a systematic review and meta-analysis. Ann Surg Treat Res 2024; 106:93-105. [PMID: 38318094 PMCID: PMC10838655 DOI: 10.4174/astr.2024.106.2.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 12/12/2023] [Accepted: 12/19/2023] [Indexed: 02/07/2024] Open
Abstract
Purpose Patients with obstructive colorectal cancer managed by emergency surgery show high morbidity, mortality, and stoma formation rates. Decompression modalities, including the self-expandable metallic stent (SEMS) and tube drainage (TD), have been used to improve surgical outcomes. However, there have been limited studies comparing the 2 modalities. We performed a meta-analysis on short- and long-term outcomes between SEMS and TD. Methods PubMed, EMBASE, Cochrane Library, and Google Scholar were searched. Data were pooled, and the overall effect size was calculated using random effect models. Outcome measures were perioperative short-term and 3-year survival outcomes. Results We included 20 nonrandomized studies that examined 2,047 patients in the meta-analysis. The meta-analysis showed SEMS had better short-term outcomes in clinical success rate, decompression-related complications, laparoscopic surgery rate, stoma formation rate, and postoperative complication rate with a relative risk (RR) of 0.36 (95% confidence interval [CI], 0.24-0.54; I2 = 20%), 0.32 (95% CI, 0.20-0.50; I2 = 0%), 0.47 (95% CI, 0.34-0.66; I2 = 87%), 0.34 (95% CI, 0.24-0.49; I2 = 52%), and 0.70 (95% CI, 0.54-0.89, I2 = 28%), respectively. However, there was no significant difference between the 2 groups in 3-year overall survival (RR, 0.99; 95% CI, 0.77-1.27; I2 = 0%). Conclusion Although the long-term oncologic impact of SEMS is still unclear compared with TD, the results of this meta-analysis may suggest that SEMS insertion can be performed more successfully and safely and may have benefits for short-term perioperative outcomes compared with TD. Further studies are warranted to provide more definitive survival results.
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Affiliation(s)
- Gi Won Ha
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Min Ro Lee
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
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21
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Wang SJ, Xue YJ, She LL, Xia Y, Lin JL. Clinical application of super-low-positioned intestinal decompression tube in the treatment of intestinal obstruction: a pilot study. Surg Endosc 2024; 38:880-887. [PMID: 38082011 DOI: 10.1007/s00464-023-10639-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/29/2023] [Indexed: 02/02/2024]
Abstract
OBJECTIVE This study aimed to evaluate the clinical application and efficacy of a super-low-positioned intestinal decompression tube in the treatment of intestinal obstruction. METHODS A total of 130 patients with postoperative small bowel obstruction were included in this study. The patients were divided into a super-low-positioned intestinal decompression group and a conventional intestinal decompression group. The clinical data, treatment outcomes, and complications were compared between the two groups. RESULTS The technical success rate of placing the super-low-positioned intestinal decompression tube was 100%, with no intraoperative complications. The patients in the super-low-positioned intestinal decompression group had a significantly shorter hospital stay (8.3 ± 5.2 vs 17.7 ± 13.3, P < 0.001) and a higher non-operative treatment success rate (83.6% vs 57.9%, P = 0.001) compared to the conventional intestinal decompression group. Multivariate logistic regression analysis showed that the placement of a super-low-positioned intestinal decompression tube was an independent protective factor for treatment outcomes (P = 0.001). The hospital stay was significantly shorter in the super-low-positioned intestinal decompression group compared to the conventional group in both successful non-operative treatment patients (6.9 ± 3.0 vs 11.2 ± 7.5, P < 0.001) and failed non-operative treatment patients (16.2 ± 7.4 vs 26.6 ± 14.4, P < 0.001). The super-low-positioned intestinal decompression tube effectively relieved the "Self-strangulation" phenomenon in patients with intestinal obstruction. CONCLUSION The super-low-positioned intestinal decompression tube is a safe and effective method for the treatment of intestinal obstruction, with better treatment outcomes and shorter hospital stays compared to conventional intestinal decompression. Further prospective studies are needed to validate these findings.
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Affiliation(s)
- Sun-Jian Wang
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Yun-Jing Xue
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Li-Lan She
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Yu Xia
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Ju-Li Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xin Quan Road, Fuzhou, 350001, Fujian Province, China.
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Hassine HB, Chaouch MA, Touir W, Jabra SB, Zouari K, Noomen F. A case report of idiopathic sclerosing encapsulating peritonitis causing an acute bowel occlusion in adult. Int J Surg Case Rep 2024; 115:109249. [PMID: 38241791 PMCID: PMC10828793 DOI: 10.1016/j.ijscr.2024.109249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/04/2024] [Accepted: 01/06/2024] [Indexed: 01/21/2024] Open
Abstract
INTRODUCTION Sclerosing peritonitis (SP), also known as abdominal cocoon, is a and potentially serious condition characterised by the fibrous encapsulation of the small intestine within the peritoneal cavity. CASE PRESENTATION In this report, we detail the case of a 67-year-old male with SP who initially presented with symptoms of constipation, vomiting, and abdominal pain. Despite a previous computed tomography (CT) scan revealing ileal thickening, the accurate diagnosis remained elusive until exploratory laparotomy. The patient underwent successful excision of the thick fibro-collagenous membrane, and histopathological examination revealed fibro-collagenous tissue with mild chronic inflammation. DISCUSSION SP can be classified into primary (idiopathic) and secondary forms. Primary SP, also referred to as cocoon abdomen, is more common in young females from tropical regions, while secondary SP is associated with peritoneal dialysis and other causative factors. Diagnosing SP presents challenges, as clinical symptoms may mimic those of other conditions. Imaging studies, especially CT scans, play a crucial role in the diagnostic process, yet the rarity of SP often leads to misdiagnosis. Although there is no consensus on treatment options, surgical intervention is generally recommended for symptomatic cases, involving excision of the cocoon and adhesiolysis. Conservative management may be considered for asymptomatic cases. The mortality rate for SP is high, emphasizing the importance of early diagnosis and intervention. CONCLUSION Primary sclerosing encapsulating peritonitis is a and complex, primarily affecting young individuals. Maintaining a high index of suspicion is crucial for an accurate diagnosis, and surgical intervention remains the primary treatment for symptomatic cases. The prognosis is generally favourable with timely and appropriate management.
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Affiliation(s)
- Hiba Ben Hassine
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
| | - Mohamed Ali Chaouch
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia.
| | - Wassim Touir
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
| | - Sadek Ben Jabra
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
| | - Khadija Zouari
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
| | - Faouzi Noomen
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
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Chaouch MA, Taieb AH, Jallali M, Chedly E, Gafsi B, Noomen F. Rare case report of intestinal obstruction due to incarcerated small bowel in omental breach. Int J Surg Case Rep 2024; 115:109245. [PMID: 38217921 PMCID: PMC10826806 DOI: 10.1016/j.ijscr.2024.109245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/04/2024] [Accepted: 01/06/2024] [Indexed: 01/15/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Intestinal obstruction without a past surgical history of abdominal surgeries or trauma is a rare and challenging clinical situation. This case report describes the presentation, diagnosis, and management of intestinal obstruction in a patient with an uncommon aetiology of small bowel obstruction. CASE PRESENTATION A 62-year-old female with a past medical history of hypertension, diabetes, and atrial fibrillation presented to the Emergency Department with symptoms of vomiting and abdominal distension for two days. The absence of similar prior episodes and lack of surgical or trauma history were notable. Physical examination revealed a mildly distended, tympanic abdomen. Radiographic X-ray and CT imaging identified dilated small bowel loops due to a mechanical small bowel obstruction without any evident aetiology. Surgical intervention involved the release of the incarcerated bowel loops and repair of the omental breach causing the small bowel obstruction, leading to a smooth postoperative recovery. DISCUSSION This case of intestinal obstruction, caused by an incarcerated bowel through an omental breach in a patient with no history of abdominal surgery or trauma, underscores the diagnostic challenges in atypical presentations. The critical role of imaging, specifically abdominal X-ray and CT scan, was key in identifying the rare obstruction cause. The successful surgical release and repair of the incarcerated bowel highlight the need for tailored surgical approaches. This report emphasizes the importance of considering uncommon etiologies and demonstrates the complexities involved in the diagnosis and treatment of gastrointestinal conditions, advocating for a multidisciplinary approach. CONCLUSIONS The importance of considering rare etiologies in patients with abdominal pain, especially those lacking a typical history, is emphasized. The effective use of imaging and tailored surgical approach was key to the successful outcome. This report adds to the limited literature on omental breaches causing intestinal obstruction and underlines the necessity of a multidisciplinary approach in such cases.
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Affiliation(s)
- Mohamed Ali Chaouch
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia.
| | - Ahmed Hadj Taieb
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
| | - Maissa Jallali
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
| | - Eya Chedly
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
| | - Besma Gafsi
- Department of Anesthesia, Monastir University Hospital, Monastir, Tunisia
| | - Faouzi Noomen
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
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Barquín Yagüez J, Juez LD, Hernández PI, Ballestero A, Martín O, Del Campo R, Vaello V, García-Pérez JC. Intestinal Helminths Infections as Infrequent Cause of Emergency Abdominal Surgery: A Retrospective Study in a University Hospital over 20 Years. Acta Parasitol 2024:10.1007/s11686-023-00789-5. [PMID: 38261243 DOI: 10.1007/s11686-023-00789-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024]
Abstract
INTRODUCTION All organs of any organism can be affected by helminths. They can be seen in a broad spectrum, from simple infestations to extensive, life-threatening involvement. Symptomatology is usually of chronic latent course. However, sometimes the presentation is acute and requires urgent surgical intervention. MATERIAL AND METHODS We conducted a retrospective observational prospective recruitment study of patients undergoing emergency surgery for helminth infection from January 2000 to December 2019 at a university hospital. Sociodemographic and analytical variables, variables related to the clinical process, and the diagnostic test were analysed. Variables related to the surgical procedure and postoperative complications were also analysed. RESULTS A total of 36 patients required emergency surgery for their helminth infection, which represented 0.26% of emergency abdominal surgeries. The mean age was 34.91 ± 21.5 years, with a predominance of men (69.4%). Most patients presented with pain in the right iliac fossa (69.4%), followed by symptoms compatible with intestinal obstruction (19.4%). The most frequent surgical interventions were appendectomy (38.9%) followed bowel resection (33.3%) and ileocecal resection (11.1%). Enterobious vermicularis and Anisakis simplex both together accounted for 75% of the sample. Statistically significant differences were identified in age (p < 0.001), diagnostic test performed (p = 0.032), intraoperative clinical diagnosis (p = 0.005) and surgical treatment received (p < 0.001). CONCLUSION The frequency of emergency surgeries for intestinal helminth parasitism is decreasing. However, the majority of these are E. vermicularis and Anisakis simplex, which have distinctly different clinical presentations. Identification and recognition by physicians continue to be necessary for further postoperative management and possible complications.
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Affiliation(s)
- José Barquín Yagüez
- General and Digestive Surgery Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Luz Divina Juez
- General and Digestive Surgery Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.
- Insituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.
- Universidad de Alcalá de Henares, Alcalá de Henares, Madrid, Spain.
- Servicio de Cirugía General y Aparato digestivo, Hospital Universitario Ramón y Cajal, Ctra. Colmenar, Km 9,1, 28034, Madrid, Spain.
| | - Patricia I Hernández
- Microbiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Insituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Araceli Ballestero
- General and Digestive Surgery Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Servicio de Cirugía General y Aparato digestivo, Hospital Universitario Ramón y Cajal, Ctra. Colmenar, Km 9,1, 28034, Madrid, Spain
| | - Oihane Martín
- Microbiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Insituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Rosa Del Campo
- Microbiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Insituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Victor Vaello
- General and Digestive Surgery Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Juan Carlos García-Pérez
- General and Digestive Surgery Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Insituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- Universidad de Alcalá de Henares, Alcalá de Henares, Madrid, Spain
- Servicio de Cirugía General y Aparato digestivo, Hospital Universitario Ramón y Cajal, Ctra. Colmenar, Km 9,1, 28034, Madrid, Spain
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25
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Ontan MS, Isik AT. Ogilvie's syndrome: bidirectional effect of hypokalaemia. BMJ Support Palliat Care 2024; 13:e957-e959. [PMID: 36754591 DOI: 10.1136/spcare-2022-004138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/01/2023] [Indexed: 02/10/2023]
Affiliation(s)
- Mehmet Selman Ontan
- Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Ahmet Turan Isik
- Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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Peiró I, Milla J, Arribas L, Hurtós L, González-Tampán AR, Bellver M, Fort E, Molina-Mata K, Joudanin JR, Valcarcel J, González-Barboteo J. Venting percutaneous radiologic gastrostomy in malignant bowel obstruction: safety and effectiveness in a comprehensive cancer centre. BMJ Support Palliat Care 2024; 13:e851-e854. [PMID: 36104161 DOI: 10.1136/spcare-2022-003895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/31/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Approximately 20% of established malignant bowel obstruction (MBO) patients do not respond to pharmacological treatment. In these cases, venting percutaneous radiologic gastrostomy (VPRG) may be useful. Existing evidence is based on retrospective studies with methodological limitations. The purpose of this study is to describe safety and effectiveness for symptom control after VPRG placement in a prospective cohort of MBO patients. METHODS Complications of VPRG placement, symptom control, destination on discharge and survival were analysed. RESULTS Twenty-one patients were included, 13 (61.9%) of whom were women. Mean age was 62.7 years (36-85). Local pain (n=8, 38.1%) and peristomal leakage (n=4, 19%) were the most frequent minor complications. No major complications occurred. Nausea and vomiting were relieved in most patients (n=20, 95.2%) after VPRG, and small quantities of liquid diet were introduced to these patients. Median time to death after VPRG was 13 days (IQR 8.6-17.4). Thirteen patients (61.9%) were discharged, with seven of them (33.3%) returning home. CONCLUSIONS When pharmacological treatment fails, the use of VPRG in MBO patients may be feasible, safe and effective.
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Affiliation(s)
- Inmaculada Peiró
- Clinical Nutrition Unit, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain
- Bellvitge Institute for Biomedical Research, Barcelona, Spain
| | - Jennifer Milla
- Palliative Care Unit, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain
| | - Lorena Arribas
- Clinical Nutrition Unit, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain
- Bellvitge Institute for Biomedical Research, Barcelona, Spain
| | - Laura Hurtós
- Clinical Nutrition Unit, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain
| | | | - Marta Bellver
- Clinical Nutrition Unit, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain
| | - Eduard Fort
- Clinical Nutrition Unit, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain
| | - Kevin Molina-Mata
- Medical Oncology Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain
| | - Jonathan R Joudanin
- Department of Radiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Joana Valcarcel
- Department of Radiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Jesús González-Barboteo
- Bellvitge Institute for Biomedical Research, Barcelona, Spain
- Palliative Care Unit, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain
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27
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Patterson M, Greenley S, Ma Y, Bullock A, Curry J, Smithson J, Lind M, Johnson MJ. Inoperable malignant bowel obstruction: palliative interventions outcomes - mixed-methods systematic review. BMJ Support Palliat Care 2024; 13:e515-e527. [PMID: 38557409 PMCID: PMC10850628 DOI: 10.1136/bmjspcare-2021-003492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/27/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Parenteral nutrition (PN) and palliative venting gastrostomies (PVG) are two interventions used clinically to manage inoperable malignant bowel obstruction (MBO); however, little is known about their role in clinical and quality-of-life outcomes to inform clinical decision making. AIM To examine the impact of PN and PVG on clinical and quality-of-life outcomes in inoperable MBO. DESIGN A mixed-methods systematic review and narrative synthesis. DATA SOURCES The following databases were searched (from inception to 29 April 2021): MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL, Bielefeld Academic Search Engine, Health Technology Assessment and CareSearch for qualitative or quantitative studies of MBO, and PN or PVG. Titles, abstracts and papers were independently screened and quality appraised. RESULTS A total of 47 studies representing 3538 participants were included. Current evidence cannot tell us whether these interventions improve MBO survival, but this was a firm belief by patients and clinicians informing their decision. Both interventions appear to allow patients valuable time at home. PVG provides relief from nausea and vomiting. Both interventions improve quality of life but not without significant burdens. Nutritional and performance status may be maintained or improved with PN. CONCLUSION PN and PVG seem to allow valuable time at home. We found no conclusive evidence to show either intervention prolonged survival, due to the lack of randomised controlled trials that have to date not been performed due to concerns about equipoise. Well-designed studies regarding survival for both interventions are needed. PROSPERO REGISTRATION NUMBER CRD42020164170.
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Affiliation(s)
- Michael Patterson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Sarah Greenley
- Institute of Clinical and Applied Health Research, Hull York Medical School, Hull, UK
| | - Yangmyung Ma
- Department of Plastic Surgery, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Alex Bullock
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Jordan Curry
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Jacquelyn Smithson
- Gastrointestinal and Liver services, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Michael Lind
- Hull York Medical School, University of Hull, Hull, UK
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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Hasegawa T, Sawada S, Saito T, Kohama M, Kajiyama K, Ishiguro C, Nonaka T, Okamura T, Iwasaki Y, Ueda T, Iguchi T, Horiuchi N, Uyama Y. Lower Risks of Gastrointestinal Perforation and Intestinal Obstruction in Patients with Atypical Antipsychotics in Comparison with Typical Antipsychotics Based on Real-World Data from the MID-NET ® in Japan. Ther Innov Regul Sci 2024; 58:192-199. [PMID: 37899426 PMCID: PMC10764367 DOI: 10.1007/s43441-023-00586-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 09/25/2023] [Indexed: 10/31/2023]
Abstract
Intestinal perforation and obstruction are known to be one of the adverse events caused by antipsychotics; however, warning information on package inserts varies among antipsychotics. To investigate the risks of gastrointestinal perforation and intestinal obstruction in patients prescribed atypical antipsychotics compared with those in patients prescribed typical antipsychotics, a nested case-control study was conducted utilizing real-world data from the MID-NET® medical information database in Japan. The study period spanned from January 1, 2009, to December 31, 2018. We found that the risks of gastrointestinal perforation and intestinal obstruction in patients prescribed atypical antipsychotics were significantly lower than those in patients prescribed typical antipsychotics (adjusted odds ratio, 0.48; 95% confidence interval, 0.29-0.80). This finding was supported with prolonged periods for the exposure definition in the sensitivity analyses. In addition, no major differences in the risks of atypical antipsychotics, such as risperidone, quetiapine, olanzapine, and aripiprazole, were identified in this study. The safety profile regarding the lower risks of gastrointestinal perforation and intestinal obstruction in patients prescribed atypical antipsychotics should be considered when choosing antipsychotics in clinical practice in terms of the proper use of such drugs.
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Affiliation(s)
- Tomoaki Hasegawa
- Office of Medical Informatics and Epidemiology, Pharmaceuticals and Medical Devices Agency, Kasumigaseki 3-3-2, Chiyoda-ku, Tokyo, 100-0013, Japan
| | - Sono Sawada
- Office of Medical Informatics and Epidemiology, Pharmaceuticals and Medical Devices Agency, Kasumigaseki 3-3-2, Chiyoda-ku, Tokyo, 100-0013, Japan
- IQVIA Solutions Japan K.K., Tokyo, Japan
| | - Tomoyuki Saito
- Office of Medical Informatics and Epidemiology, Pharmaceuticals and Medical Devices Agency, Kasumigaseki 3-3-2, Chiyoda-ku, Tokyo, 100-0013, Japan
| | - Mei Kohama
- Office of Medical Informatics and Epidemiology, Pharmaceuticals and Medical Devices Agency, Kasumigaseki 3-3-2, Chiyoda-ku, Tokyo, 100-0013, Japan
| | - Kazuhiro Kajiyama
- Office of Medical Informatics and Epidemiology, Pharmaceuticals and Medical Devices Agency, Kasumigaseki 3-3-2, Chiyoda-ku, Tokyo, 100-0013, Japan
| | - Chieko Ishiguro
- Office of Medical Informatics and Epidemiology, Pharmaceuticals and Medical Devices Agency, Kasumigaseki 3-3-2, Chiyoda-ku, Tokyo, 100-0013, Japan
- Section of Clinical Epidemiology, Department of Data Science, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takahiro Nonaka
- Office of Medical Informatics and Epidemiology, Pharmaceuticals and Medical Devices Agency, Kasumigaseki 3-3-2, Chiyoda-ku, Tokyo, 100-0013, Japan
- Department of Health and Medical Innovation, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Toshiyuki Okamura
- Office of Pharmacovigilance I, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Yukari Iwasaki
- Office of Pharmacovigilance I, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Takahiro Ueda
- Office of Pharmacovigilance I, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Toyotaka Iguchi
- Office of Pharmacovigilance II, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Naoya Horiuchi
- Office of Pharmacovigilance I, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Yoshiaki Uyama
- Office of Medical Informatics and Epidemiology, Pharmaceuticals and Medical Devices Agency, Kasumigaseki 3-3-2, Chiyoda-ku, Tokyo, 100-0013, Japan.
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Canny JD, Johnston DB, McBrearty JA, McElvanna K, Caddy G, McKay D. The use of colonic stents as a bridge to surgery in malignant colonic obstruction - A dual trust experience over 10 years. Ulster Med J 2024; 92:134-138. [PMID: 38292498 PMCID: PMC10824134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Introduction Worldwide colonic cancer is the third most common cancer with up to 30% of cases presenting with large bowel obstruction. Self-expanding metal stents (SEMS) have been used as a bridge to surgery (BTS) in the treatment of this malignant obstruction. We review the outcomes of SEMS as a BTS across two high volume colorectal units. Methodology A retrospective analysis of patients undergoing colonic stenting as a bridge to surgery was performed; outcomes were compared to previously published figures on emergency colonic resections. Inclusion criteria were adults (>18 years of age) undergoing colonic stenting for colonic obstruction with a view to elective resection. Patients undergoing stenting for palliation of symptoms were excluded. Results 39 patients were identified across both trusts over a ten-year period. 90 day mortality following BTS was found to be 3.6% and there was an 82.1% (32/39) technical success rate. 46.4% proceeded to an elective resection which was started laparoscopically. Permanent stoma rate was observed at 14.3% for elective surgery. Conclusion Stenting for relief of acute malignant obstruction as a bridge to surgery is a viable option in select patients. Further research is required to determine oncological safety and rate of local recurrences.
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Affiliation(s)
- J D Canny
- Ulster Hospital, Dundonald, South Eastern HSC Trust
| | - D B Johnston
- Ulster Hospital, Dundonald, South Eastern HSC Trust
| | | | | | - G Caddy
- Ulster Hospital, Dundonald, South Eastern HSC Trust
| | - D McKay
- Craigavon Area Hospital, Southern HSC Trust
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30
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Eze VN, Parry T, Boone D, Mallett S, Halligan S. Prognostic factors to identify resolution of small bowel obstruction without need for operative management: systematic review. Eur Radiol 2023:10.1007/s00330-023-10421-9. [PMID: 37938387 DOI: 10.1007/s00330-023-10421-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/06/2023] [Accepted: 09/24/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVES To identify imaging, clinical, and laboratory variables potentially prognostic for surgical management of small bowel obstruction. METHODS Two researchers systematically reviewed indexed literature 2001-2021 inclusive for imaging, clinical, and laboratory variables potentially predictive of surgical management of small bowl obstruction and/or ischaemia at surgery, where performed. Risk of bias was assessed. Contingency tables for variables reported in at least 5 studies were extracted and meta-analysed to identify strong evidence of association with clinical outcomes, across studies. RESULTS Thirty-one studies were ultimately included, reporting 4638 patients (44 to 313 per study). 11 (35%) studies raised no risk of bias concerns. CT was the modality reported most (29 studies, 94%). Meta-analysis of 21 predictors identified 5 strongly associated with surgical intervention, 3 derived from CT (peritoneal free fluid, odds ratio [OR] 3.24, 95%CI 2.45 to 4.29; high grade obstruction, OR 3.58, 95%CI 2.46 to 5.20; mesenteric inflammation, OR 2.61, 95%CI 1.94 to 3.50; abdominal distension, OR 2.43, 95%CI 1.34 to 4.42; peritonism, OR 3.97, 95%CI 2.67 to 5.90) and one with conservative management (previous abdominopelvic surgery, OR 0.58, 95%CI 0.40 to 0.85). Meta-analysis of 10 predictors identified 3 strongly associated with ischaemia at surgery, 2 derived from CT (peritoneal free fluid, OR 3.49, 95%CI 2.28 to 5.35; bowel thickening, OR 3.26 95%CI 1.91 to 5.55; white cell count, OR 4.76, 95%CI 2.71 to 8.36). CONCLUSIONS Systematic review of patients with small bowel obstruction identified four imaging, three clinical, and one laboratory predictors associated strongly with surgical intervention and/or ischaemia at surgery. CLINICAL RELEVANCE STATEMENT Via systematic review and meta-analysis, we identified imaging, clinical, and laboratory predictors strongly associated with surgical management of small bowel obstruction and/or ischaemia. Multivariable model development to guide management should incorporate these since they display strong evidence of potential utility. KEY POINTS • While multivariable models incorporating clinical, laboratory, and imaging factors could predict surgical management of small bowel obstruction, none are used widely. • Via systematic review and meta-analysis we identified imaging, clinical, and laboratory variables strongly associated with surgical management and/or ischaemia at surgery. • Development of multivariable models to guide management should incorporate these predictors, notably CT scanning, since they display strong evidence of potential utility.
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Affiliation(s)
- Vivienne N Eze
- Centre for Medical Imaging, University College London UCL, Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK
| | - Tom Parry
- Centre for Medical Imaging, University College London UCL, Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK
| | - Darren Boone
- Centre for Medical Imaging, University College London UCL, Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK
| | - Sue Mallett
- Centre for Medical Imaging, University College London UCL, Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London UCL, Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK.
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Ahmed G, Shaker Shaeir S, Elayadi M, Elkinaai N, Refaat A, Nasr A, Elgendy A. Nephrectomy for Pediatric Renal Tumors: A Modified Surgical Approach to Minimize Post-operative Intestinal Obstruction. J Pediatr Surg 2023:S0022-3468(23)00679-6. [PMID: 37989644 DOI: 10.1016/j.jpedsurg.2023.10.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/25/2023] [Accepted: 10/30/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND The authors present a modified surgical technique during tumor nephrectomy in children with a conservative approach towards small bowel manipulation and cutting of the peritoneal reflections. We aimed to evaluate this modified surgical approach regarding the incidence of post-operative small bowel obstruction (SBO), and its technical utility. METHODS The study includes all children with unilateral renal tumors who underwent radical nephrectomy and lymph nodes sampling at our tertiary center from 2010 to 2022. The modified technique was performed via the usual transverse incision. We cut the peritoneal reflections short of the cecum or short of the sigmoid colon. The colon is reflected over SB packing it, proceeding to nephrectomy and lymph nodes sampling. Data included demographics, clinical characteristics, treatment strategy, operative details, post-operative SBO, and overall outcomes. RESULTS The study included 890 patients with a median age of 3.2 years. The median tumor largest diameter was 13 cm (range: 9-18 cm). The modified surgical technique was adopted in 287 patients (32.3 %). Forty-three patients (43/890, 4.8 %) had post-operative SBO. Out of them, only 4 cases were operated on using the modified surgical technique (p-value<0.001). There were no significant differences between both techniques regarding timing of surgery, tumor rupture, lymph nodes sampling, and tumor size (p-value = 0.775, 0.328, 0.216, and 0.563, respectively). CONCLUSIONS The modified surgical approach is significantly correlated with lower incidence of post-operative SBO with no increased risk of tumor rupture or incomplete lymph nodes sampling. The timing of surgery or tumor characteristics had no significant impact on the technical utility of the modified surgical approach. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Gehad Ahmed
- General Surgery Department, Faculty of Medicine, Helwan University, Cairo, Egypt; Surgical Oncology Department, Children's Cancer Hospital, 57357, Cairo, Egypt
| | - Sayed Shaker Shaeir
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Moatasem Elayadi
- Pediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt; Pediatric Oncology Department, Children's Cancer Hospital, 57357, Cairo, Egypt
| | - Naglaa Elkinaai
- Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt; Pathology Department, Children's Cancer Hospital, 57357, Cairo, Egypt
| | - Amal Refaat
- Radio-Diagnosis Department, National Cancer Institute, Cairo University, Cairo, Egypt; Radio-Diagnosis Department, Children's Cancer Hospital, 57357, Cairo, Egypt
| | - Azza Nasr
- Radiotherapy Department, National Cancer Institute, Cairo University, Cairo, Egypt; Radiotherapy Department, Children's Cancer Hospital, 57357, Cairo, Egypt
| | - Ahmed Elgendy
- Surgical Oncology Unit, Department of Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt.
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Hasnaoui A, Trigui R, Heni S, Ramdass PVAK. Iatrogenic incarcerated diaphragmatic hernia following laparoscopic resection of a diaphragmatic cystic lymphangioma: A case report. Int J Surg Case Rep 2023; 112:108947. [PMID: 37826978 PMCID: PMC10582341 DOI: 10.1016/j.ijscr.2023.108947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/05/2023] [Accepted: 10/07/2023] [Indexed: 10/14/2023] Open
Abstract
INTRODUCTION Incarcerated iatrogenic right diaphragm hernia stands as a rare occurrence. Swift diagnosis and timely management are imperative. This article presents a particularly uncommon case of a right diaphragmatic hernia resulting from a neglected defect following the resection of a diaphragmatic lymphangioma and sheds light on the pitfalls that may lead to such a post-operative event. PRESENTATION OF CASE Our surgical ward admitted a 36-year-old patient presenting symptoms indicative of bowel obstruction. Four months earlier, the patient had undergone laparoscopic resection of a lymphangioma located in the right dome of the diaphragm. Thoracic auscultation yielded hyperactive bowel sounds at the lower lung field and the right costophrenic angle. Abdominal distention was observed without any signs of peritoneal irritation. A thoracic and abdominal CT scan provided confirmation of a right diaphragmatic hernia. Subsequently, an immediate laparotomy was performed. The right colic hepatic flexure was released, and the diaphragmatic breach was sutured. The postoperative course was uneventful. DISCUSSION Iatrogenic diaphragmatic hernia remains a possible complication of this surgery. It could occur even on the right side where the liver has a cushioning effect. Incarcerated diaphragmatic hernia is a surgical emergency that should be operated on as quickly as possible. A systematic check of the diaphragm's integrity at the end of the surgical procedure could prevent such complications. CONCLUSION While surgical techniques and laparoscopic instrumentation have witnessed significant advancements in recent years, achieving proficiency and the precise execution of surgical techniques remain of utmost importance.
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Affiliation(s)
- Anis Hasnaoui
- Faculty of Medicine of Tunis, Tunis El Manar University, Department of General Surgery, Menzel Bourguiba Hospital, Rue Djebal Lakhdar, 1006 Tunis, Tunisia.
| | - Racem Trigui
- Faculty of Medicine of Tunis, Tunis El Manar University, Department of General Surgery, Menzel Bourguiba Hospital, Rue Djebal Lakhdar, 1006 Tunis, Tunisia
| | - Sihem Heni
- Faculty of Medicine of Tunis, Tunis El Manar University, Department of General Surgery, Menzel Bourguiba Hospital, Rue Djebal Lakhdar, 1006 Tunis, Tunisia
| | - Prakash V A K Ramdass
- St. George's University School of Medicine, Department of Public Health and Preventive Medicine, St. George, Grenada
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Ballal RR, Ahmed T, Ail DA, Colaco SM. A rare presentation of idiopathic small bowel diaphragm disease - A case report. Int J Surg Case Rep 2023; 112:108966. [PMID: 37883871 PMCID: PMC10667883 DOI: 10.1016/j.ijscr.2023.108966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/12/2023] [Accepted: 10/21/2023] [Indexed: 10/28/2023] Open
Abstract
INTRODUCTION Diaphragm disease, typically associated with long-term non-steroidal anti-inflammatory drug (NSAID) use, manifests as diaphragm-like small bowel strictures, often resulting in bowel obstruction. CASE DESCRIPTION A 75-year-old male presented with features of recurrent subacute intestinal obstruction, later diagnosed with multiple small bowel strictures via CT imaging. Surgical intervention, including resection and anastomosis, was performed to alleviate the obstruction. Histopathological examination of the resected specimen confirmed diaphragm disease, challenging its traditional association with NSAID use. DISCUSSION Diaphragm disease, characterized by mucosal and submucosal diaphragm-like strictures, is typically attributed to NSAID usage. However, this case underscores the possibility of diaphragm disease in the absence of NSAID exposure. Pathological findings supported the presence of diaphragm-like strictures, despite the patient's denial of NSAID use. CONCLUSION This case emphasizes the importance of considering diaphragm disease as a differential diagnosis in patients with intermittent bowel obstruction, even in the absence of NSAID history.
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Affiliation(s)
- Rajesh R Ballal
- Department of General Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Talha Ahmed
- Department of General Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India.
| | | | - Sumith Marian Colaco
- Department of General Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
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Liu J, Jin Z, Sui B, Duan G. Abdominal cocoon in children: A case report. Asian J Surg 2023; 46:4850-4852. [PMID: 37302890 DOI: 10.1016/j.asjsur.2023.05.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 05/25/2023] [Indexed: 06/13/2023] Open
Affiliation(s)
- Jie Liu
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Zhiyuan Jin
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Bangzhi Sui
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China.
| | - Guangqi Duan
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China.
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Hasnaoui A, Trigui R, Ben Hassine M, Haggari A, Bellamine H. Sigmoid-rectal intussusception in an elderly patient: A case report of an unusual presentation of intestinal obstruction. Int J Surg Case Rep 2023; 112:109018. [PMID: 37931504 PMCID: PMC10667941 DOI: 10.1016/j.ijscr.2023.109018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/26/2023] [Accepted: 11/03/2023] [Indexed: 11/08/2023] Open
Abstract
INTRODUCTION Sigmoid-rectal intussusception or invagination is an infrequently documented condition in the adult population, with only a handful of cases reported in the medical literature. The underlying pathological mechanism involves impaired peristalsis, often attributed to a malignant tumor. CASE PRESENTATION A 78-year-old patient, with a history of abdominal pain and lower gastrointestinal bleeding, sought care at our emergency department with evident symptoms indicative of large bowel obstruction. Abdominal examination revealed distension and rectal examination found a mass mimicking an internal rectal prolapse. Subsequently, imaging studies confirmed the diagnosis of sigmoid-rectal intussusception. The patient underwent an emergency open sigmoid resection with Hartman's procedure. The postoperative course was uneventful. Anatomopathological analysis revealed the presence of stage I adenocarcinoma. A restoration of digestive continuity was scheduled six months later. One-year follow-up assessments showed no indications of local recurrence or distant metastasis. DISCUSSION Sigmoid rectal intussusception stands as a unique and infrequently reported medical entity. The absence of distinct clinical symptoms often renders diagnosis a challenging task, with confirmation typically relying on radiological findings. In contrast to the non-surgical approaches employed in pediatric cases, intussusception in adults necessitates surgical intervention due to its predominantly malignant underpinnings. CONCLUSION While sigmoid-rectal intussusception is an exceedingly rare occurrence, its manifestation with a multitude of non-specific symptoms can complicate clinical recognition. Nevertheless, it should be duly considered as a potential etiological factor in cases of large bowel obstruction, particularly when suggestive signs are found on rectal examination.
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Affiliation(s)
- Anis Hasnaoui
- Faculty of Medicine of Tunis, Tunis El Manar University, Department of General Surgery, Menzel Bourguiba Hospital, Rue Djebal Lakhdar, 1006 Tunis, Tunisia.
| | - Racem Trigui
- Faculty of Medicine of Tunis, Tunis El Manar University, Department of General Surgery, Menzel Bourguiba Hospital, Rue Djebal Lakhdar, 1006 Tunis, Tunisia
| | - Mohamed Ben Hassine
- Faculty of Medicine of Tunis, Tunis El Manar University, Department of General Surgery, Menzel Bourguiba Hospital, Rue Djebal Lakhdar, 1006 Tunis, Tunisia
| | - Ahmed Haggari
- Faculty of Medicine of Tunis, Tunis El Manar University, Department of General Surgery, Menzel Bourguiba Hospital, Rue Djebal Lakhdar, 1006 Tunis, Tunisia
| | - Houda Bellamine
- Department of Pathology, Menzel Bourguiba hospital, 7050 Menzel Bourguiba, Bizerta, Tunisia
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Ahmad A, Najeeb E, Ul Haq MB, Altaf A, Moiz A, Bashir H, Uzair M, Inam A. Cecal volvulus with acute appendicitis in a 33-year-old male managed by manual detorsion, cecopexy, and appendectomy: A case report. Int J Surg Case Rep 2023; 112:108904. [PMID: 37844385 PMCID: PMC10697277 DOI: 10.1016/j.ijscr.2023.108904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/25/2023] [Accepted: 09/28/2023] [Indexed: 10/18/2023] Open
Abstract
INTRODUCTION A volvulus is a serious surgical emergency caused by torsion or hyper-flexion of the bowel loop and its mesentery on a fixed point. Cecal volvulus is an uncommon cause of intestinal obstruction, accounting for just 1-1.5 % of all cases of bowel obstruction. CASE PRESENTATION A 33-year-old intellectually disabled male presented to the emergency department with complaints of generalized abdominal pain, absolute constipation, and non-projectile vomiting. He had a grossly distended and rigid abdomen with generalized tenderness and guarding. The abdomen was hyper-resonant. Bowel sounds were hypoactive. Digital rectal examination revealed an empty and collapsed rectum with no stool staining of the finger. Laboratory reports showed leukocytosis and neutrophilia. Radiographic imaging was consistent with acute intestinal obstruction. Laparotomy was performed, and cecal volvulus with viable bowel and acute appendicitis was diagnosed intra-operatively. Manual detorsion, cecopexy, and appendectomy were performed. The patient had an uneventful postoperative course. The patient is still on follow-up since June 2023, and no complication has occurred. CLINICAL DISCUSSION Cecal volvulus is an uncommon cause of intestinal obstruction with multiple etiologies. The annual incidence of cecal volvulus is estimated to be between 2.8 and 7.1 cases per million. Cecal volvulus may lead to life-threatening complications such as bowel ischemia and perforation. CONCLUSION Diagnosis of cecal volvulus must be made promptly to prevent bowel gangrene and perforation. In this case, manual detorsion and cecopexy were performed as the bowel was viable per-operatively due to early surgical intervention.
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Affiliation(s)
- Afaq Ahmad
- Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan; Department of General Surgery, Pakistan.
| | - Erum Najeeb
- Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan; Department of General Surgery, Pakistan
| | - Muhammad Burhan Ul Haq
- Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan; Department of General Surgery, Pakistan
| | - Aatiqa Altaf
- Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan; Department of General Surgery, Pakistan
| | - Abdul Moiz
- Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan; Department of General Surgery, Pakistan
| | - Humaira Bashir
- FCPS Gynaecology and Obstetrics, Pakistan; College of Physicians and Surgeons, Pakistan
| | | | - Aatif Inam
- Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan; Department of General Surgery, Pakistan
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Alzarooni HA, Ribeiro Junior MAF, Iddris SA, Alhammadi HB, DeSoucy ES, Alsayari AA. Sclerosing encapsulating peritonitis: A rare cause of small bowel obstruction. Int J Surg Case Rep 2023; 112:108959. [PMID: 37879291 PMCID: PMC10667872 DOI: 10.1016/j.ijscr.2023.108959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/10/2023] [Accepted: 10/10/2023] [Indexed: 10/27/2023] Open
Abstract
INTRODUCTION Sclerosing encapsulating peritonitis (SEP), also known as abdominal cocoon syndrome, represents a rare cause of small bowel obstruction. CASE PRESENTATION Herein we report an uncommon case of small bowel obstruction caused by SEP in a 30-year-old male with no prior surgical history who presented to the emergency department. The patient was diagnosed with SEP on preoperative CT scan and underwent a therapeutic laparotomy with extensive adhesiolysis. His symptoms resolved postoperatively and he was discharged in a good condition. DISCUSSION Sclerosing encapsulating peritonitis is more prevalent in men, and has a higher incidence in tropical and subtropical countries. The exact pathophysiology of the disease in not well understood, but subclinical intra-abdominal inflammation is theorized to result in a thick fibrocollagenous membrane encapsulating intra-peritoneal organs which leads to intestinal obstruction. The disease is categorized into primary and secondary SEP depending on identification of a pathologic factor. It is further divided into 3 sub-types according to the extent of the peritoneal membrane encasement observed intra-operatively. Patients often present with recurrent history of small bowel obstruction in the absence of prior abdominal surgery. Computed tomography of the abdomen with experienced radiologist interpretation can aid in preoperative diagnosis. In patients with recurrent obstructions and failure of non-operative management, surgical adhesiolysis remains the gold standard. CONCLUSION Sclerosing encapsulating peritonitis, is a rare cause of small bowel obstruction. The exact pathogenesis is not well understood. The main line of treatment is surgical adhesiolysis and excision of the intra-abdominal fibrocollagenous membrane.
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Affiliation(s)
- Hamda A Alzarooni
- Sheikh Shakhbout Medical City, Mayo Clinic Abu Dhabi, United Arab Emirates.
| | - Marcelo A F Ribeiro Junior
- Trauma, Critical Care and Acute Care Surgery, Sheikh Shakhbout Medical City, Mayo Clinic Abu Dhabi, United Arab Emirates; Khalifa University and Gulf Medical University, United Arab Emirates; Catholic University of Sao Paulo, Campus Sorocaba, Brazil
| | - Samirah A Iddris
- Sheikh Shakhbout Medical City, Mayo Clinic Abu Dhabi, United Arab Emirates
| | - Hamad B Alhammadi
- Sheikh Shakhbout Medical City, Mayo Clinic Abu Dhabi, United Arab Emirates
| | - Erik S DeSoucy
- Trauma, Critical Care and Acute Care Surgery, Sheikh Shakhbout Medical City, Mayo Clinic Abu Dhabi, United Arab Emirates; Uniformed Services University, United States.
| | - Ahmed A Alsayari
- Trauma, Critical Care and Acute Care Surgery, Division Chair General Surgery, Sheikh Shakhbout Medical City, Mayo Clinic Abu Dhabi, United Arab Emirates
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Matsuishi K, Saito S, Ohuchi M, Kiyozumi Y, Nasu J, Hanada N, Baba H. A case of internal hernia in the pararectal fossa. Surg Case Rep 2023; 9:178. [PMID: 37843687 PMCID: PMC10579196 DOI: 10.1186/s40792-023-01746-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 09/02/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Internal hernias are relatively rare and difficult to diagnose. Diagnostic delays lead to the progression of strangulation. In particular, pararectal fossa hernias are extremely rare. We encountered a case in which internal hernia occurred in the pararectal fossa. CASE PRESENTATION An 87-year-old woman was referred to our hospital because of persistent lower abdominal pain and vomiting. Contrast-enhanced computed tomography revealed findings of intestinal ischemia, such as closed loop formation with reduced contrast effect on the left side of the rectum in the pelvis. Strangulation small bowel obstruction was diagnosed, and emergency laparotomy was performed. The small intestine was found to invade the peritoneal reflection on the left side of the rectum. The patient was finally diagnosed with pararectal fossa hernia. The incarcerated small intestine was released with no bowel resection. The 4-cm hernia phylum was observed and closed by simple suture. The patient had a good postoperative course without recurrence. CONCLUSIONS We encountered a very rare case of internal hernia in the left pararectal fossa. Preoperative diagnosis of this disease is difficult, but it should nevertheless be considered in cases in which the cause of the intestinal obstruction is unknown.
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Affiliation(s)
- Kozue Matsuishi
- Department of Surgery, Kumamoto Chuo Hospital, 1-5-1 Tainoshima, Minami-Ku, Kumamoto, 862-0965, Japan
| | - Seiya Saito
- Department of Surgery, Kumamoto Chuo Hospital, 1-5-1 Tainoshima, Minami-Ku, Kumamoto, 862-0965, Japan
| | - Mayuko Ohuchi
- Department of Surgery, Kumamoto Chuo Hospital, 1-5-1 Tainoshima, Minami-Ku, Kumamoto, 862-0965, Japan
| | - Yuki Kiyozumi
- Department of Surgery, Kumamoto Chuo Hospital, 1-5-1 Tainoshima, Minami-Ku, Kumamoto, 862-0965, Japan
| | - Jiro Nasu
- Department of Surgery, Kumamoto Chuo Hospital, 1-5-1 Tainoshima, Minami-Ku, Kumamoto, 862-0965, Japan
| | - Norihisa Hanada
- Department of Surgery, Izumi General Medical Center, 520 Myozincho, Izumi City, Kagoshima, 899-0131, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan.
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Kim SM, Lee SH, Park GY, Kim SS, Lee CG, Jin SJ. Cecal duplication cyst in an infant presenting as shock: A case report. World J Clin Cases 2023; 11:6931-6937. [PMID: 37901014 PMCID: PMC10600866 DOI: 10.12998/wjcc.v11.i28.6931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/04/2023] [Accepted: 09/14/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Although intestinal obstruction is one of the most common surgical emergencies in an infant, it is difficult to diagnose neonatal enteric duplication cysts (EDC) preoperatively owing to their rarity as a cause of intestinal obstruction. We describe a case report of a neonatal EDC presenting intestinal obstruction and shock. CASE SUMMARY A 32-d-old male infant with a prenatal sonographic finding of bladder distension was admitted to our hospital for a severely distended abdomen, fever, and oliguria. The first diagnostic hypothesis was septic shock and intestinal obstruction. The patient's symptoms worsened; following an emergency surgical exploratory laparotomy and histopathological findings, the final diagnosis of cecal duplication cyst was confirmed. The patient's postoperative course was uneventful, and on the fifth postoperative day, oral feeding restarted. Twenty days later, the patient was discharged from the hospital. CONCLUSION Although EDC located in the cecum is exceptional, it should be considered when evaluating suspected intestinal obstruction and shock.
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Affiliation(s)
- Seung Mo Kim
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soochunhyang University College of Medicine, Bucheon 14584, Gyeonggi-do, South Korea
| | - Sun Hyang Lee
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soochunhyang University College of Medicine, Bucheon 14584, Gyeonggi-do, South Korea
| | - Ga Young Park
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soochunhyang University College of Medicine, Bucheon 14584, Gyeonggi-do, South Korea
| | - Sung Shin Kim
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soochunhyang University College of Medicine, Bucheon 14584, Gyeonggi-do, South Korea
| | - Cheol Gu Lee
- Department of General Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon 14584, GyeongGi-Do, South Korea
| | - Soo Ji Jin
- Department of Pathology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon 14584, GyeongGi-Do, South Korea
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Ethiraj S, Sahoo AK, Das BM. Spectrum of abdominal tuberculosis presenting as acute surgical emergency: Relevance in 21st century, a case series. Indian J Tuberc 2023; 70:422-429. [PMID: 37968048 DOI: 10.1016/j.ijtb.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 09/14/2022] [Accepted: 01/11/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Abdominal tuberculosis presenting as acute surgical emergency continues to be a major issue in developing countries including India. Being an indolent disease with varied presentation, there is a need to describe the epidemiology, clinicopathological nature of the disease. Hence, this series was conducted with the aim of describing our institutional experience in the management of abdominal tuberculosis presenting as acute surgical emergency, outlining the epidemiology, management aspects and the analysis of risk factors for poor outcome in our population. METHODS This was a descriptive series of patients operated for abdominal tuberculosis presenting as acute surgical emergency at a tertiary care hospital in Eastern India from January 2021 to January 2022. All consecutive patients presenting with intestinal obstruction or peritonitis who underwent laparotomy with intra operative and histopathological finding suggestive of tuberculosis were taken for the study. RESULTS A total of 30 patients with acute abdominal tuberculosis were included in the study. 56.7% of patients were males; the mean age of presentation was 43 years with majority of patients in the younger to middle age groups. Most (80%) patients were from rural areas with limited access to healthcare. One patient had co-infection with HIV. Five patients had diabetes and six patients had hypertension as co-morbidities. 73.3% of patients had primary intestinal tuberculosis. Majority (76.7%) presented with acute intestinal obstruction. All patients had colicky abdominal pain as a consistent feature. 40% of patients were anaemic and 70% had low serum albumin levels. The most common site of affection was Ileo-cecal region (73.3%) with stricture as the pathology. Segmental resection with end to end anastomosis was the most common procedure performed (46.7%). 26.7% of patients had an adverse post operative complication, and 23.3% had surgical site infection (SSI). The mortality rate in our series was 6.7%. Although coexisting SSI, co-morbidities were associated with increased mortality, it was not found to be statistically significant (p = 0.08). 16 patients were lost to follow up. CONCLUSION Abdominal tuberculosis presenting as acute abdomen continues to challenge surgeons even in the 21st century. Majority in the developing countries present late with varied complications. A high index of clinical suspicion is required for timely diagnosis to reduce the mortality and morbidity of the disease.
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Affiliation(s)
- Suraj Ethiraj
- Department of Surgery, SCB Medical College and Hospital, Cuttack, India.
| | - Ashok Kumar Sahoo
- Department of Surgery, SCB Medical College and Hospital, Cuttack, India
| | - Bhuban Mohan Das
- Department of Surgery, SCB Medical College and Hospital, Cuttack, India
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Ibarra Rodríguez I, Gavilanes Salazar GM, Ruiz Jiménez I, Sáenz Dorado A, Chamorro Juárez MR, Bueno Recio FJ. A new technique in the treatment of intestinal malrotation. Cir Pediatr 2023; 36:191-194. [PMID: 37818902 DOI: 10.54847/cp.2023.04.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Intestinal malrotation is a congenital pathology with potentially catastrophic complications, such as volvulus, whose treatment has barely not changed in nearly 100 years (Ladd's procedure). Dr. Abu-Elmagd recently described a new technique that was applied in one of our patients. CLINICAL CASE 12-year-old boy who had undergone Ladd's procedure as a result of intestinal volvulus secondary to malrotation when he was 2 days old. He had subocclusion and eventually obstruction, with intestinal volvulus compatible imaging. Intraoperative findings: duodenal subocclusion, volvulus and lymphangiectasias. Kareem's procedure: bowel positioning in normal rotation, duodenopexy (duodenal C posterior to the mesenteric vessels), formation of neo-Treitz, and fixation of the cecum, the ascending colon, and the mesenteric root. The patient was discharged on postoperative day 6 and remains asymptomatic after 1 year of follow-up. DISCUSSION Kareem's procedure is a safe and effective malrotation repair technique. It can replace Ladd's procedure as it reduces the risk of re-volvulation and improves digestive symptoms.
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Affiliation(s)
- I Ibarra Rodríguez
- Pediatric Surgery Department. Hospital Universitario Materno Infantil de Badajoz. Badajoz (Spain)
| | - G M Gavilanes Salazar
- Pediatric Surgery Department. Hospital Universitario Materno Infantil de Badajoz. Badajoz (Spain)
| | - I Ruiz Jiménez
- Pediatric Surgery Department. Hospital Universitario Materno Infantil de Badajoz. Badajoz (Spain)
| | - A Sáenz Dorado
- Pediatric Surgery Department. Hospital Universitario Materno Infantil de Badajoz. Badajoz (Spain)
| | - M R Chamorro Juárez
- Pediatric Surgery Department. Hospital Universitario Materno Infantil de Badajoz. Badajoz (Spain)
| | - F J Bueno Recio
- Pediatric Surgery Department. Hospital Universitario Materno Infantil de Badajoz. Badajoz (Spain)
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Hasnaoui A, Trigui R, Heni S, Ramdass PVAK. Abdominal cocoon: A rare case report of a small bowel obstruction. Int J Surg Case Rep 2023; 111:108897. [PMID: 37793231 PMCID: PMC10551648 DOI: 10.1016/j.ijscr.2023.108897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 10/06/2023] Open
Abstract
INTRODUCTION Sclerosing encapsulating peritonitis (SEP), or abdominal cocoon, is a remarkably rare entity. It consists of a fibrous layer or cocoon-like sac encasing, in most cases, the small bowel. The lack of specific symptoms makes preoperative diagnosis challenging. CASE PRESENTATION A 50-year-old patient, with no history of abdominal surgery or medical diseases, was admitted for symptoms of small bowel obstruction. On examination, the patient was underweight with a BMI of 18 kg/m2. Vital signs were stable. His abdomen was mildly distended and soft. Abdominal CT scan showed signs in favor of a left paraduodenal hernia with incarcerated small bowel loops. Intraoperatively, the small bowels were encapsulated in a cocoon-like structure formed by thick fibrous tissue associated with multiple adhesions. Careful adhesiolysis with complete resection of the membrane was performed. The postoperative course was uneventful. One year later, the patient was symptom-free. DISCUSSION SEP is thought to be a persistent inflammatory disorder due to a cause that remains unidentified. It is divided into two categories based on its etiology: primary and secondary. The most common mode of SEP revelation is bowel obstruction. Because there is no clear consensus on SEP management, the therapeutic approach typically follows the management strategy of bowel obstruction. CONCLUSION SEP is an uncommon cause of bowel obstruction. Preoperative detection can be challenging in the absence of pathognomonic signs. Treatment is based on surgery, specifically entailing complete excision of the cocoon and adhesiolysis.
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Affiliation(s)
- Anis Hasnaoui
- Faculty of Medicine of Tunis, Tunis El Manar University, Department of General Surgery, Menzel Bourguiba Hospital, Rue Djebal Lakhdar, 1006 Tunis, Tunisia.
| | - Racem Trigui
- Faculty of Medicine of Tunis, Tunis El Manar University, Department of General Surgery, Menzel Bourguiba Hospital, Rue Djebal Lakhdar, 1006 Tunis, Tunisia
| | - Sihem Heni
- Faculty of Medicine of Tunis, Tunis El Manar University, Department of General Surgery, Menzel Bourguiba Hospital, Rue Djebal Lakhdar, 1006 Tunis, Tunisia
| | - Prakash V A K Ramdass
- St. George's University School of Medicine, Department of Public Health and Preventive Medicine, St. George, Grenada
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Landolsi S, Trabelsi M, Dziri W, Firas J, Ridene I, Chebbi F. Reversed midgut rotation revealed by cecal volvulus in the elderly: A case report. Int J Surg Case Rep 2023; 111:108881. [PMID: 37793228 PMCID: PMC10551644 DOI: 10.1016/j.ijscr.2023.108881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 09/23/2023] [Accepted: 09/24/2023] [Indexed: 10/06/2023] Open
Abstract
INTRODUCTION Reverse midgut rotation constituted an extremely rare intestinal malrotation. Its recognition in the elderly was challenging as in our case revealed by cecal volvulus. CASE PRESENTATION A 78-years old man consulted for diffuse abdominal, vomiting, bowel movement and passing gas inability. Computed tomography concluded to cecal and last ileum loop volvulus with small intestine dilation upstream. Emergent laparotomy confirmed the existence of a cecal volvulus associated to a reversed midgut rotation non diagnosed at computed tomography before surgery. A Ladd' procedure was carried out. An isoperistaltic side-by-side ileocolic manual anastomosis was performed. DISCUSSION Our case illustrated an extremely rare reversed midgut rotation in the elderly accounting for 2 to 7 % of all embryologic midgut malrotation anomalies. It could be revealed by mobile right colon volvulus as in our case, whole midgut volvulus, retro-arterial tunnel pressure transverse colon stenosis, or Ladd' bands duodenojejunal obstruction. Its recognition at the elderly was challenging and needed careful computed tomography combined signs determination. Surgical treatment accounted for the treatment of choice for reversed midgut rotation especially in emergency settings as in our case. Ladd' procedure is still the most performed procedure. CONCLUSIONS Reverse midgut rotation constituted an extremely rare congenital intestinal malrotation. Its diagnosis in the elderly was challenging implicating careful interpretation of computed tomography.
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Affiliation(s)
- Sana Landolsi
- University of Tunis El Manar, Faculty of Medicine of Tunis, Department of Surgery, Mahmoud El Matri Hospital, Ariana, Tunisia.
| | - Mehdi Trabelsi
- University of Tunis El Manar, Faculty of Medicine of Tunis, Department of Surgery, Mahmoud El Matri Hospital, Ariana, Tunisia
| | - Wassim Dziri
- University of Tunis El Manar, Faculty of Medicine of Tunis, Department of Surgery, Mahmoud El Matri Hospital, Ariana, Tunisia
| | - Jaoued Firas
- University of Tunis El Manar, Faculty of Medicine of Tunis, Department of Surgery, Mahmoud El Matri Hospital, Ariana, Tunisia
| | - Imen Ridene
- University of Tunis El Manar, Faculty of Medicine of Tunis, Department of Radiology, Mahmoud El Matri Hospital, Ariana, Tunisia
| | - Faouzi Chebbi
- University of Tunis El Manar, Faculty of Medicine of Tunis, Department of Surgery, Mahmoud El Matri Hospital, Ariana, Tunisia
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Küçük A, Mohamed SS, Abdi AM, Ali AY. Intestinal obstruction due to giant liver cyst: A case report. World J Clin Cases 2023; 11:6246-6251. [PMID: 37731578 PMCID: PMC10507561 DOI: 10.12998/wjcc.v11.i26.6246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/17/2023] [Accepted: 08/21/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Congenital hepatic cysts are relatively rare but are now diagnosed earlier and more frequently with a routine prenatal ultrasound. Solitary liver cysts are divided into simple and solitary intrahepatic biliary cysts, depending on the biliary connection. While some solitary liver cysts are symptomatic in childhood, even in newborns, they are often found incidentally in adults. CASE SUMMARY A 3-mo-old female infant was admitted to Mogadishu Somali Training and Research Hospital with recurrent vomiting, respiratory problems, and abdominal bloating complaints. On examination, the abdomen was greatly distended and extremely tight. She had repeated vomiting for 3 d, no stool output, and decreased urine. The abdominal ultrasonography detected a solitary cystic lesion measuring 10 cm × 10 cm × 14 cm, extending from the liver or right kidney to the pelvis. In the magnetic resonance imaging examination of the patient, a solitary cystic structure of 10 cm × 10 cm × 14 cm in the right abdomen was observed, extending to the pelvis and possibly originating from the liver. The patient was operated via fenestration after her fluid and electrolytes improved. Oral nutrition was initiated on the 2nd postoperative day, and the drain was removed on the 5th postoperative day. The patient visited the outpatient clinic control 1 mo later with no clinical complaints. CONCLUSION Congenital liver cysts are usually followed without complications. They rarely reach gigantic dimensions and may cause respiratory distress, intestinal obstruction and recurrent vomiting. Surgery can provide quite successful outcomes in the treatment of giant sized simple liver cysts.
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Affiliation(s)
- Adem Küçük
- Düzce University Faculty of Medicine, Pediatric Surgery Clinic, Düzce 81110, Merkez, Turkey
| | - Shukri Said Mohamed
- Department of Pediatric Surgery, Somali Mogadishu Training and Research Hospital, Mogadishu 0000000, Somalia
| | - Abdishakur Mohamed Abdi
- Department of Pediatric Surgery, Somali Mogadishu Training and Research Hospital, Mogadishu 0000000, Somalia
| | - Abdullahi Yusuf Ali
- Department of Pediatric Surgery, Somali Mogadishu Training and Research Hospital, Mogadishu 0000000, Somalia
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Gautam P, Mainali P, Shah D, Shrestha S, Tiwari A, Karki A. Obturator hernia: An uncommon cause of intestinal obstruction: A case report. Int J Surg Case Rep 2023; 110:108670. [PMID: 37625229 PMCID: PMC10469917 DOI: 10.1016/j.ijscr.2023.108670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE An obturator hernia is a rare cause of bowel obstruction. Due to its narrow passage in the obturator canal, these are more susceptible to becoming incarcerated and subsequently strangulated. Due to its challenging detection, obturator hernia is often diagnosed late. CASE PRESENTATION A 75-year-old thin-built female with COPD presented to the emergency room with symptoms of abdominal obstruction. Abdominal examination revealed distension, firmness, rigidity, and tenderness with no bowel sounds. An erect abdominal X-ray showed multiple air-fluid levels, indicating an acute abdomen due to intestinal obstruction. Emergency exploratory laparotomy revealed an obturator hernia with strangulated ileum and perforation, necessitating resection and double barrel ileostomy. Unfortunately, despite all medical interventions, the patient succumbed to hospital-acquired pneumonia following the surgery. DISCUSSION Obturator hernia, known as 'the skinny old woman hernia,' is rarely externally visible or palpable, leading to frequent undiagnosed cases. It presents with bowel obstruction or perforation and carries the highest morbidity among abdominal hernias. Timely intervention is crucial to prevent complications like bowel strangulation. CONCLUSION This case report highlights the challenges of diagnosing and managing obturator hernia, a rare condition with significant morbidity. Early detection through imaging or operative findings is crucial to prevent complications like bowel strangulation, especially in older women at higher risk.
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Affiliation(s)
- Pratima Gautam
- Department of Surgery, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Prakash Mainali
- Department of Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Dharmesh Shah
- Department of Surgery, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Suraj Shrestha
- Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal.
| | - Ashish Tiwari
- Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | - Anurag Karki
- Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
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Sriselvakumar S. Spontaneous small bowel volvulus in young adult male. Radiol Case Rep 2023; 18:3080-3083. [PMID: 37434622 PMCID: PMC10331013 DOI: 10.1016/j.radcr.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 07/13/2023] Open
Abstract
Small bowel volvulus is a rare surgical pathology in western countries with a rather misunderstood pathophysiology. This condition refers to the abnormal torsion of the small bowel loops on its mesenteric axis and blockage of the mesenteric vessels, thus leading to bowel obstruction. Typical symptoms include abdominal pain and distention, vomiting and bloody stools. Volvulus can also cause ischemia due to a compromised blood supply. Small bowel volvulus can be life-threatening and require immediate surgery. In this case report, we present a 28-year-old male patient who was admitted to the emergency department with significant, unrelenting abdominal pain and vomiting with no blood. CT scan identified small bowel volvulus and torsion of the mesentery. The biopsy report confirmed no malignancy in this patient. The patient underwent surgery and was discharged 2 days later.
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Foula MS, Amer NM, Zakaria H, Ismail MH, Alshomimi SJ, Al Bisher HM, Alsaleem H, Almulhim K, Aldabaeab AE, Alratrout H, Alsadery HA, Alarfaj MA, Aljehani YM, El Damati AM. Surgical Management of Intra-gastric Balloon Complications, Single-Center Experience, and Literature Review. Obes Surg 2023; 33:2718-2724. [PMID: 37452985 DOI: 10.1007/s11695-023-06716-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 06/24/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION In Saudi Arabia, the prevalence of obesity has multiplied in the last decades leading to a surge in bariatric surgery and other endoscopic modalities. The intra-gastric balloon (IGB) is the most used endoscopic modality. Surgical management for IGB complications is required for gastrointestinal perforation and/or obstruction. However, the literature seems to underestimate these complications. MATERIALS AND METHODS A retrospective descriptive study was conducted in King Fahd University Hospital, Saudi Arabia, from Jan 2017 to Dec 2021, including all patients with complicated IGB who necessitated any surgical procedure. Exclusion criteria were patients with complicated IGBs that were only managed conservatively or endoscopically. RESULTS A total of 326 patients were admitted with different complications after bariatric procedures. Of them, six patients were referred due to IGB complications that necessitated operative intervention. All patients were young females. Three patients had gastric wall perforation, and were managed by endoscopic removal of the IGBs followed by exploratory laparotomy. One patient had an intestinal obstruction on top of a migrated IGB that was surgically removed. One patient had failed endoscopic retrieval of IGB and required a laparoscopic gastrostomy. Another patient had an esophageal rupture that required left thoracotomy, pleural flap, and insertion of an esophageal stent. All cases were discharged and followed up with no related complications. CONCLUSION IGB is an endoscopic alternative, within specific indications, for the management of obesity. However, surgical management may be necessary to manage its complications, including gastrointestinal perforation, IGB migration, and failure of endoscopic removal.
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Affiliation(s)
- Mohammed S Foula
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia.
| | - Nasser M Amer
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Hazem Zakaria
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Mona H Ismail
- Division of Gastroenterology, Department of Internal Medicine, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Saeed J Alshomimi
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Hassan M Al Bisher
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Hassan Alsaleem
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Khalifa Almulhim
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Abdulaziz E Aldabaeab
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Hefzi Alratrout
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Humood A Alsadery
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Mosab A Alarfaj
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Yasser M Aljehani
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Ahmed M El Damati
- Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Ali AK, Abdelhamid IM, Mohamed AH, Sabra TA. Chylolymphatic cyst as a rare cause of acute intestinal obstruction in infants. Int J Surg Case Rep 2023; 110:108789. [PMID: 37683513 PMCID: PMC10510053 DOI: 10.1016/j.ijscr.2023.108789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/01/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Chylolymphatic cysts are benign pathology in lymphatic vessels due to obstruction in the lymphatic system. Their incidence is still unknown. However, they account for approximately 3 % to 9 % of all pediatric lymphangiomas. Most of these lesions are asymptomatic and are discovered accidentally. They can present with non-specific abdominal pain, vomiting and changes in bowel habits. Rarely, Chylolymphatic cysts can cause fatal complications such as intestinal obstruction, volvulus or even torsion. CASE PRESENTATION A 3-month-old male presented to our unit with manifestations of acute intestinal obstruction. Abdominal examination revealed signs of generalized peritonitis and intestinal obstruction. Abdominal ultrasound revealed minimal turbid intraperitoneal collections and no motility of bowel loops. Plain erect abdominal radiograph revealed multiple small bowel air fluid levels. Abdominal exploration revealed a large Chylolymphatic cyst causing acute intestinal obstruction. Excision of the cysts was done with preservation of adjacent bowel loop. The patient was discharged in good health on the 6th day postoperative. A chylolymphatic cyst with a diameter of 5 cm was identified by histological investigation. CLINICAL DISCUSSION Mesenteric cyst is a rare intra-abdominal tumor with prevalence of about 1: 20,000 in pediatric age group. They are benign cystic pathology lined with a thin endothelium or mesothelium occur due to gross proliferation of isolated or ectopic lymphatics in mesentery that lack communication with the rest of the lymphatic system. Regarding pathology, mesenteric cysts are classified into four types including type 1 (Pedicled) and type 2 (Sessile), which are limited to the mesentery, hence can be excised completely with or without resection of the involved gut. Type 3 and type 4 are multicentric, so they require complex surgery and often sclerotherapy because of their extension into retroperitoneum. The majority of mesenteric cysts may present as asymptomatic abdominal mass or incidental finding on imaging or during laparotomy for other abdominal conditions. Preoperative diagnosis of mesenteric cyst in most cases is difficult as they have no definite characteristic features. Abdominal ultrasound which is the imaging modality of choice can reveal mesenteric cysts as cystic tumors. Surgical removal of the cyst is the standard treatment for chylolymphatic cysts. CONCLUSION Most Chylolymphatic cysts in infants are asymptomatic, but they can cause fatal complications such as intestinal obstruction, volvulus or even torsion.
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Affiliation(s)
- Ahmed Kamel Ali
- Pediatric Surgery, Faculty of Medicine, Assiut University, Egypt.
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Nie X, Sha Y. Endoscopic decompression of sigmoid volvulus in an adolescent. Asian J Surg 2023; 46:4074-4076. [PMID: 37147257 DOI: 10.1016/j.asjsur.2023.04.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 04/14/2023] [Indexed: 05/07/2023] Open
Affiliation(s)
- Xin Nie
- Department of General Surgery, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 200437, China
| | - Yingying Sha
- Department of General Surgery, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 200437, China.
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Uwumiro F, Olaomi O, Okpujie V, Nwevo C, Abel Umoudoh U, Ogunkoya G, Abesin O, Bojeranu M, Aderehinwo B, Oriloye O. Hospital teaching status and patient outcomes in intestinal obstruction surgery: A comparative analysis. Turk J Surg 2023; 39:204-212. [PMID: 38058369 PMCID: PMC10696440 DOI: 10.47717/turkjsurg.2023.6091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 06/12/2023] [Indexed: 12/08/2023]
Abstract
Objectives Surgery at large teaching hospitals is reportedly associated with more favourable outcomes. However, these results are not uniformly consistent across all surgical patients. This study aimed to assess potential disparities in clinical outcomes by hospital type for patients with intestinal obstruction. Material and Methods 2018 NIS was queried for all adult non-elective admissions for intestinal obstruction. Hospitals were classified as either smallmedium non-teaching hospitals or large teaching hospitals. Multivariate regression analyses were used to assess the association between hospital type and inpatient mortality, access to surgery, admission duration, non-home discharges, hospital costs, and postoperative complications. Results After adjustments, admission to large teaching hospitals was not associated with a reduction in inpatient mortality (AOR= 0.73; 95% CI= 0.41- 1.31; p= 0.29), lower likelihood of surgery (AOR= 0.93; 95% CI= 0.58-1.48; p= 0.76) or increased chance of early surgery (p= 0.97). Patients admitted to large teaching hospitals had shorter hospital stays (p= 0.002) and were less likely to be discharged to other acute care hospitals (AOR= 0.94; 95% CI= 0.80-0.94; p= 0.04). Admission to large teaching hospitals was not associated with a reduction in perioperative complications (AOR= 1.04; 95% CI= 0.80- 1.28; p= 0.91) or significantly higher hospital costs (mean increase= 1518; 95% CI= 1891-4927; p= 0.38). Conclusion Admission to large teaching hospitals does not necessarily result in better patient outcomes. Merely considering the teaching status of the hospital in isolation cannot explain the diverse outcomes observed for this condition.
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Affiliation(s)
- Fidelis Uwumiro
- Department of General Surgery, University of Benin Teaching Hospital, Benin City, Nigeria
| | - Oluwatobi Olaomi
- Department of General Surgery, University of Ibadan College of Medicine, Ibadan, Nigeria
| | - Victory Okpujie
- Department of General Surgery, University of Benin Teaching Hospital, Benin City, Nigeria
| | - Chimaobi Nwevo
- Department of General Surgery, University of Calabar Teaching Hospital, Calabar, Nigeria
| | | | - Grace Ogunkoya
- Department of General Surgery, Lagos State University Faculty of Medicine, Lagos, Nigeria
| | - Olawale Abesin
- Department of Surgery, Royal Cornwall Hospital (Treliske), Truro, Cornwall, United Kingdom
| | - Michael Bojeranu
- Department of Surgery, St. Barnabas Hospital SBH Health System, Bronx, New York, United States
| | - Bolanle Aderehinwo
- Department of General Surgery, Lagos State University Faculty of Medicine, Lagos, Nigeria
| | - Olasunkanmi Oriloye
- Deparment of Surgery, Petre Shotadze Tbilisi Medical Academy, Tbilisi, Georgia
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