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Bhatti UF, Shen AS, Melo N, Barmparas G, Wang AS, Margulies DR, Alban RF. Don't Let the Sun Rise on Small Bowel Obstruction Without Surgical Consultation-Redefining Nonoperative Management Pathways. Am Surg 2024:31348241248797. [PMID: 38644162 DOI: 10.1177/00031348241248797] [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] [Indexed: 04/23/2024]
Abstract
Introduction: Small bowel obstruction (SBO) is a common cause of hospital admission leading to resource utilization. The majority of these patients require non-operative management (NOM) which can lead to increased length of stay (LOS), readmissions, resource utilization, and throughput delays. Early surgical consultation (SC) for SBO may improve efficiency and outcomes. Methods: We implemented an institution-wide intervention (INT) to encourage early SC (<1 day of diagnosis) for SBO patients in July 2022. A retrospective analysis was performed on all patients with SBO requiring NOM from January 2021 to June 2023, categorized into pre- and post-INT groups. The primary outcome was the number of SC's and secondary outcomes were early SC (<1 day of diagnosis), utilization of SBFT, LOS, 30-day readmission, and costs of admission. Results: A total of 670 patients were included, 438 in the pre-INT and 232 in the post-INT group. Overall, SBFT utilization was significantly higher in cases with SC (17.2% vs 41.4%, P < .001). Post-INT patients were more likely to receive SC (94.0% vs 83.3%, P < .001) and increased SBFT utilization (47.0% vs 33.6%, P = .001). Additionally, early SC improved significantly in the post-INT group (74.3% vs 65.7%, P = .03). There was no difference in LOS between groups (4.0 vs 3.8 days, P = .48). There was a trend toward decreased readmission rates in the INT group at 30 days (7.3% vs 11.0%, P = .13) and reduced direct costs in the INT group (US$/admission = 8467 vs 8708, P = .1). Conclusion: Hospital-wide interventions to increase early surgical involvement proved effective by improving early SC, increased SBFT utilization, and showed a trend towards decreased readmission rates and direct costs.
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Affiliation(s)
- Umar F Bhatti
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Aricia S Shen
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Nicolas Melo
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Galinos Barmparas
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Andrew S Wang
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel R Margulies
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Rodrigo F Alban
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
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2
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Rashid A, Kumar M, Lee MJ. A systematic review of participant descriptors reported in studies of adhesive small bowel obstruction. Colorectal Dis 2024. [PMID: 38609340 DOI: 10.1111/codi.16986] [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: 11/30/2022] [Revised: 04/05/2023] [Accepted: 11/05/2023] [Indexed: 04/14/2024]
Abstract
AIM Reporting of participant descriptors in studies of adhesive small bowel obstruction (ASBO) can help identify characteristics associated with favourable outcomes and allow comparison with other studies and real-world clinical populations. The aim was to identify the pattern of participant descriptors reported in studies assessing interventions for ASBO. METHOD This systematic review was registered with PROSPERO (CRD42021281031) and reported in line with the PRISMA checklist. Systematic searches of Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) were undertaken to identify studies assessing operative and non-operative interventions for adults with ASBO. Studies were dual screened for inclusion. Descriptors were categorised into conceptual domains by the research team. RESULTS Searches identified 2648 studies, of which 73 were included. A total of 156 unique descriptors were identified. On average, studies reported 12 descriptors. The most frequently reported descriptors were sex, age, SBO aetiology, history of abdominal surgery, BMI and ASA classification. The highest number of descriptors in a single study was 34, compared to the lowest number of descriptors which was one. Pathway factors were the least frequently described domain. Overall, 37 descriptors were reported in just one study. CONCLUSION There is a lack of consistency in participant descriptors reported in studies of SBO. Furthermore, a significant proportion of the descriptors were used infrequently. This makes it challenging to assess whether study participants are representative of the wider population. Further work is required to develop a Core Descriptor Set to standardise the reporting of patient characteristics and reduce heterogeneity between studies.
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Affiliation(s)
- Adil Rashid
- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield, UK
- Academic Directorate of General Surgery, Sheffield Teaching Hospitals NHS FT, Sheffield, UK
| | - Mithun Kumar
- Department of General Surgery, University Hospital Coventry and Warwickshire, Coventry, UK
| | - Matthew J Lee
- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield, UK
- Academic Directorate of General Surgery, Sheffield Teaching Hospitals NHS FT, Sheffield, UK
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3
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Abe E, Ishida T, Osuga T, Kakuyama S, Ogawa H, Nabeshima K. Double balloon enteroscopy in the detection and removal of jejunal anisakiasis: Case report. DEN Open 2024; 4:e339. [PMID: 38352969 PMCID: PMC10863477 DOI: 10.1002/deo2.339] [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] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/11/2024] [Accepted: 01/28/2024] [Indexed: 02/16/2024]
Abstract
A 53-year-old Japanese man presented to the emergency department with epigastric pain and bloating. Computed tomography revealed a thickening of the jejunal wall and proximal dilation. Double-balloon enteroscopy was performed to investigate the jejunal thickening, which revealed an anisakis larva in the jejunum with an associated ulcer. The larva was removed using endoscopic forceps, after which there was immediate improvement of symptoms. Further patient interview determined that he had consumed marinated mackerel the day before the onset of symptoms. After diagnosis of small intestinal anisakiasis, he was successfully treated using double-balloon enteroscopy. Its use for small intestinal anisakiasis is rare, and this case may be the first instance in the jejunum. Removal of the anisakis larva led to a clear diagnosis and a quick resolution of symptoms. A history of raw fish consumption a few days before the onset of abdominal symptoms and abnormal findings on computed tomography scans are key to the diagnosis of small intestinal anisakiasis. Double-balloon enteroscopy was thought to be a safe means of making accurate diagnoses and appropriate treatment of our patients.
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Affiliation(s)
- Erika Abe
- Department of GastroenterologyAkashi Medical CenterHyogoJapan
| | - Tsukasa Ishida
- Department of GastroenterologyAkashi Medical CenterHyogoJapan
| | - Tatsuya Osuga
- Department of GastroenterologyTakatsuki General HospitalOsakaJapan
| | - Saori Kakuyama
- Department of GastroenterologyTakatsuki General HospitalOsakaJapan
| | - Hirofumi Ogawa
- Department of GastroenterologyTakatsuki General HospitalOsakaJapan
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4
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Van Horn AL, Soult AP, Sternick ME, Sturm EL, Britt RC. Type of Prior Operation Does Not Predict Surgical Intervention for Small Bowel Obstruction. Am Surg 2024:31348241241709. [PMID: 38532245 DOI: 10.1177/00031348241241709] [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] [Indexed: 03/28/2024]
Abstract
Background: Patients with prior abdominal surgeries are at higher risk for intra-abdominal adhesive tissue formation and subsequently higher risk for small bowel obstruction (SBO).Purpose: In this study, we investigated whether surgical intervention for SBO was more likely following specific types of abdominal surgeries.Research Design: With retrospective chart review, we pooled data from 799 patients, ages 18 to 89, admitted with SBO between 2012 and 2019. Patients were evaluated based on whether they underwent surgery or were managed conservatively. They were further compared with regard to past surgical history by way of type of abdominal surgery (or surgeries) undergone prior to admission.Results: Of the 799 patients admitted for SBO, 206 underwent surgical intervention while 593 were managed nonoperatively. There was no significant difference in number of prior surgeries (2.07 ± 1.56 vs 2.36 ± 2.11, P = .07) or in number of comorbidities (2.39 ± 1.97 vs 2.65 ± 1.93, P = .09) for surgical vs non-surgical intervention. Additionally, of the operations evaluated, no specific type of abdominal surgery predicted need for surgical intervention in the setting of SBO. However, for both surgical and non-surgical intervention following SBO, pelvic surgery was the most common type of prior abdominal surgery (45% vs 43%). There are significantly more female pelvic surgeries in both the operative (91.4% vs 8.6%, P < .0001) and nonoperative groups (89.9% vs 10.2%, P < .0001).Conclusion: Ultimately, no specific type of prior operation predicted the need for surgical intervention in the setting of SBO.
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Affiliation(s)
| | - Alexa P Soult
- Department of Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Molly E Sternick
- Department of Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Emily L Sturm
- Department of Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Rebecca C Britt
- Department of Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
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5
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Rabai NA, Khaldi N, Alrababah A, Marji WA, Mugdadi MM. A Pelvic Hernia Through Two Defects in the Pouch of Douglas in a Patient With Peritoneal Xanogranuloma: A Report of a Very Rare Case. Cureus 2024; 16:e56808. [PMID: 38654769 PMCID: PMC11036346 DOI: 10.7759/cureus.56808] [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] [Accepted: 03/23/2024] [Indexed: 04/26/2024] Open
Abstract
Pelvic internal hernias, including pouch of Douglas hernias, are a very rare cause of small bowel obstruction. They pose a challenge in diagnosis due to their rarity and lack of specific radiological features. The definitive diagnosis is usually reached intraoperatively. The treatment consists of reduction with or without resection of the herniated bowel and primary repair of the defect. Mesh placement has been reported but is still arguable, as no musculofacial defect is involved. Here, we present a case of a 28-year-old female patient, a nulliparous with multiple medical conditions including familial Mediterranean fever (FMF) and an extremely rare tumor, peritoneal xanthogranuloma. She had a history of laparoscopic left ovarian cystectomy, and complained of abdominal pain and distention for three days prior to admission. Her symptoms were associated with constipation and recurrent vomiting and she was admitted as a suspected case of small bowel obstruction. CT scan suggested the possible diagnosis of a pelvic hernia, yet the definitive diagnosis was reached intraoperatively after noticing the presence of two defects on the left side of the pouch of Douglas. A primary repair of the defects was performed after reduction of the viable herniated bowel. The patient was discharged on the third postoperative day with uneventful course of recovery.
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Affiliation(s)
- Nimah A Rabai
- Department of General Surgery, Princess Basma Teaching Hospital, Irbid, JOR
| | - Najih Khaldi
- Department of General Surgery, Princess Basma Teaching Hospital, Irbid, JOR
| | | | - Wissam A Marji
- Department of Radiology, Princess Basma Teaching Hospital, Irbid, JOR
| | - Mu'ayyad M Mugdadi
- Department of General Surgery, Jordanian Royal Medical Services, Irbid, JOR
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6
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Jamsari G, Kwik C, King J, Pathma-Nathan N. Rare case of strangulated primary acquired perineal hernia causing small bowel obstruction requiring emergency operative repair. J Surg Case Rep 2024; 2024:rjae164. [PMID: 38505337 PMCID: PMC10948740 DOI: 10.1093/jscr/rjae164] [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: 02/08/2024] [Accepted: 02/24/2024] [Indexed: 03/21/2024] Open
Abstract
Primary acquired perineal hernia is rare with only 100 reported cases in the literature. Emergency presentations of intestinal obstruction secondary to perineal hernia are very rare and to-date, there are only eight cases reported in the literature. We present a case of a 74-year-old lady who presented with a small bowel obstruction secondary to strangulated perineal hernia in the absence of pelvic exenteration or abdominoperineal resection requiring operative repair via combined open transabdominal and transperineal approach. To our knowledge, this case represents the first reported case of intestinal obstruction secondary to primary acquired perineal hernia in the absence of pelvic exenteration or abdominoperineal resection.
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Affiliation(s)
- Giuleta Jamsari
- Department of Surgery, Westmead Hospital, Corner of Hawkesbury and Darcy Roads, Westmead, NSW 2145, Australia
| | - Charlotte Kwik
- Department of Colorectal Surgery, Westmead Hospital, Corner of Hawkesbury Road and Darcy Roads, Westmead, NSW 2145, Australia
| | - Jenny King
- Department of Obstetrics and Gynaecology, Westmead Hospital, Corner of Hawkesbury and Darcy Roads, Westmead, NSW 2145, Australia
| | - Nimalan Pathma-Nathan
- Department of Colorectal Surgery, Westmead Hospital, Corner of Hawkesbury Road and Darcy Roads, Westmead, NSW 2145, Australia
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7
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Liang JT, Liao YT, Chen TC, Huang J, Hung JS. Changing patterns and surgical outcomes of small bowel obstruction in the era of minimally invasive surgery for colorectal cancer. Int J Surg 2024; 110:1577-1585. [PMID: 38051917 PMCID: PMC10942203 DOI: 10.1097/js9.0000000000000980] [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: 08/11/2023] [Accepted: 11/21/2023] [Indexed: 12/07/2023]
Abstract
INTRODUCTION This study aimed to investigate whether the incidence, patterns, and surgical outcomes of small bowel obstruction (SBO) have changed in the era of minimally invasive surgery (MIS) for primary colorectal cancer (CRC). METHODS Consecutive patients who underwent laparotomy for SBO were divided into MIS and traditional open surgery (TOS) groups based on the previous colorectal cancer operation technique used. The MIS group was selected from 1544 consecutive patients who underwent MIS as a treatment for primary CRCs between 2014 and 2022, while the TOS group was selected from 1604 consecutive patients who underwent TOS as a treatment for primary CRCs between 2004 and 2013. The demographics, clinicopathological features, and surgical outcomes were compared between the two groups. RESULTS The SBO incidence in patients who underwent MIS for primary CRC was significantly lower than that in patients who underwent TOS (4.4%, n =68/1544 vs. 9.7%, n =156/1604, P <0.0001). Compared with the TOS group, the MIS group had significantly different ( P <0.0001) SBO patterns: adhesion (48.5 vs. 91.7%), internal herniation (23.5 vs. 2.6%), external herniation (11.8 vs. 1.9%), twisted bowel limbs (4.4 vs. 0.6%), ileal volvulus with pelvic floor adhesion (5.9 vs. 1.9%), and nonspecific external compression (5.9 vs. 1.3%). A subset analysis of patients with adhesive SBO (ASBO) showed that the MIS group tended to ( P <0.0001) have bands or simple adhesions (75.8%), whereas the TOS group predominantly had matted-type adhesions (59.4%). Furthermore, SBO in the MIS group had an acute (<3 months) or early (3-12 months) onset (64.7%), while that in the TOS group ( P <0.0001) had an intermediate or a late onset. When the surgical outcomes of SBO were evaluated, the TOS group had significantly more ( P <0.0001) blood loss and longer operation time; however, no significant difference was observed in the surgical morbidity/mortality (Clavien-Dindo classification ≧3, 11.8 vs. 14.1%, P =0.6367), hospitalization, and readmission rates between the two groups. Postoperative follow-up showed that the estimated 3-year (11.37 vs. 18.8%) and 6-year (25.54 vs. 67.4%) recurrence rates of SBO were significantly lower ( P =0.016) in the MIS group than in the TOS group. CONCLUSIONS The wide adoption of MIS to treat primary CRC has led to a lower incidence, altered patterns, and reduced recurrence rates of SBO. Awareness of this new trend will help develop surgical techniques to prevent incomplete restoration of anatomical defects and bowel malalignments specifically associated with MIS for CRC, as well as facilitate timely and appropriate management of SBO complications whenever they occur.
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Affiliation(s)
- Jin-Tung Liang
- Department of Surgery, Division of Colorectal Surgery, National Taiwan University Hospital and College of Medicine, Taipei
| | - Yu-Tso Liao
- Department of Surgery, Division of Colorectal Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu
| | - Tzu-Chun Chen
- Department of Surgical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan, Republic of China
| | - John Huang
- Department of Surgery, Division of Colorectal Surgery, National Taiwan University Hospital and College of Medicine, Taipei
| | - Ji-Shiang Hung
- Department of Surgery, Division of Colorectal Surgery, National Taiwan University Hospital and College of Medicine, Taipei
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8
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Gismondi M, Ali OH, Ajao O, Dastur J. Jejunal Diverticulosis Presenting With Small Bowel Obstruction: A Diagnostic Challenge. Cureus 2024; 16:e56205. [PMID: 38618308 PMCID: PMC11016189 DOI: 10.7759/cureus.56205] [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] [Accepted: 03/14/2024] [Indexed: 04/16/2024] Open
Abstract
We report the case of a woman presenting with small bowel obstruction secondary to an enterolith that formed within a jejunal diverticulum. Prior to this acute presentation, the patient had experienced regular abdominal pain albeit not as severe as the current episode. The CT scan on admission required review by two consultant radiologists before the cause of the small bowel obstruction was diagnosed. Successful surgical management was performed involving a laparotomy, small bowel enterotomy, and removal of the enterolith. Although complications secondary to jejunal diverticula are documented, there is minimal literature on the complexities of making the diagnosis and the best management approach that should be adopted.
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Affiliation(s)
- Martha Gismondi
- Colorectal Surgery, Norfolk and Norwich University Hospital National Health Service (NHS) Foundation Trust, Norwich, GBR
| | - Omar H Ali
- Colorectal Surgery, Norfolk and Norwich University Hospital National Health Service (NHS) Foundation Trust, Norwich, GBR
| | - Omotayo Ajao
- Colorectal Surgery, Norfolk and Norwich University Hospital National Health Service (NHS) Foundation Trust, Norwich, GBR
| | - Jamasp Dastur
- Colorectal Surgery, Norfolk and Norwich University Hospital National Health Service (NHS) Foundation Trust, Norwich, GBR
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9
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Krol K, Chen YR, Morales Sierra MO, Nasir R, Mahabir N, Iyeke L, Jordan L, Shah T, Burke K, Friedman M, Dexeus D, Mihailos A, Richman M, Guttman J. Integrating Pre-test Probability and Point-of-Care Ultrasound (POCUS) in the Emergency Department (ED) Diagnosis of Small Bowel Obstruction (SBO). Cureus 2024; 16:e56397. [PMID: 38638773 PMCID: PMC11026035 DOI: 10.7759/cureus.56397] [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] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
Introduction A computed tomography (CT) scan and point-of-care ultrasound (POCUS) are commonly employed for diagnosing small bowel obstructions (SBOs). Prior studies demonstrated that POCUS has 90-95% sensitivity and specificity compared with CT scanning, which is the gold standard. Unlike other imaging modalities (in which the ordering and performing clinician are not the same), POCUS-performing/interpreting sonologists must recognize the risk of confirmation bias in the POCUS application. Per Bayesian analysis, the likelihood of a diagnosis being true following a diagnostic test is based on the ordering clinician's pre-test probability and the test characteristics (sensitivity and specificity, from which positive and negative likelihood ratios can be calculated). Consequently, establishing pre-test probability is important in informing downstream diagnostic or therapeutic interventions, as pre-test probability influences post-test odds. Little research has been done on the role of POCUS sonologist's pre-test probability and actual POCUS results regarding SBO. This study assessed the role of POCUS, integrating pre-test probability and POCUS results to determine post-test odds. Methods One hundred six patients were recruited on a convenience basis and underwent POCUS and CT between April 2017 and December 2022. All sonographers were credentialed in POCUS. POCUS sonologists' pre-test probabilities and POCUS and CT results were captured, which were compared. Sensitivity, specificity, LR+, and LR- were calculated, and correlations were made between pre-test probability and POCUS and CT results. Results POCUS exhibited a sensitivity of 92% and specificity of 90%, with a corresponding positive likelihood ratio (LR+) of 9.3 and a negative likelihood ratio (LR-) of 0.09 for diagnosing SBO. Among patients with a high pre-test probability of SBO, a negative ultrasound yielded post-test odds of 0.4%, whereas a positive POCUS yielded post-test odds of 39.6%. Among patients with a low pre-test probability, a negative POCUS resulted in post-test odds of 0%, while a positive POCUS led to post-test odds of 2.1%, yielding a number needed to scan (NNS) of ~50 to identify a patient with an SBO on CT. Conclusion This study confirmed POCUS's sensitivity and specificity of ~90-95% and a corresponding LR+ of 9.2 and LR- of 0.9. Pre-test probability substantially affected post-test odds. Patients with a high pre-test probability and a positive POCUS had post-test odds of 39.6 and should have a confirmatory CT, while those with a negative POCUS have very low post-test odds and very likely will not benefit from CT. Patients with low pre-test probability and a positive POCUS have post-test odds of 2.1%, similar to the Wells Score and HEART score; such patients may not benefit from a CT, though clinicians should use their judgment/discretion. Patients with a low pre-test probability and a negative POCUS have post-test odds of 0% and should not have a CT. Among low pre-test probability patients, the NNS was ~50 to identify patients with an SBO on CT.
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Affiliation(s)
- Katarzyna Krol
- Emergency Medicine, New York University Grossman School of Medicine, New York, USA
- Emergency Medicine, Northwell Health, New Hyde Park, USA
| | - Yi-Ru Chen
- Emergency Medicine, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, USA
| | - Melva O Morales Sierra
- Emergency Medicine, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, USA
| | - Rida Nasir
- Emergency Medicine, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, USA
| | - Naya Mahabir
- Emergency Medicine, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, USA
| | - Lisa Iyeke
- Emergency Medicine, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, USA
| | - Lindsay Jordan
- Emergency Medicine, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, USA
| | - Trupti Shah
- Emergency Medicine, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, USA
| | - Kevin Burke
- Emergency Medicine, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, USA
| | - Matthew Friedman
- Emergency Medicine, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, USA
| | - Daniel Dexeus
- Emergency Medicine, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, USA
| | - Athena Mihailos
- Emergency Medicine, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, USA
| | - Mark Richman
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
- Emergency Medicine, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, USA
| | - Joshua Guttman
- Emergency Medicine, Emory University School of Medicine, Atlanta, USA
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10
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Anderson ZD, Ashkin A, Raymond L. The Rapid Growth of Burkitt Lymphoma Causing Partial Small Bowel Obstruction. Cureus 2024; 16:e56227. [PMID: 38618387 PMCID: PMC11016283 DOI: 10.7759/cureus.56227] [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] [Accepted: 03/15/2024] [Indexed: 04/16/2024] Open
Abstract
Burkitt lymphoma (BL) is a neoplasm of the lymphoid tissue and one of the most prevalent malignancies worldwide. Classically, these patients present with unregulated B-cell differentiation causing fever, chills, night sweats, and weight loss. Although more common in children, in sporadic Burkitt lymphoma, symptoms often can be present in the abdomen. These patients also additionally report nausea, vomiting, and abdominal distention, which in rare instances can cause small bowel obstruction (SBO). Early detection and the initiation of chemotherapy remain highly effective in providing adequate care. This provides better outcomes and prevents surgical management.
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Affiliation(s)
- Zackary D Anderson
- Graduate Medical Education/Internal Medicine, Naples Community Hospital, Naples, USA
| | - Alex Ashkin
- Graduate Medical Education/Internal Medicine, Naples Community Hospital, Naples, USA
| | - Leslie Raymond
- Graduate Medical Education/Internal Medicine, Naples Community Hospital, Naples, USA
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11
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Feister K, Konstantinoff K, Hamade M, Mellnick V. Pearls and Pitfalls of Imaging Small Bowel Obstruction. Can Assoc Radiol J 2024:8465371241230276. [PMID: 38414182 DOI: 10.1177/08465371241230276] [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] [Indexed: 02/29/2024] Open
Abstract
Small bowel obstruction (SBO) is a common condition encountered by radiologists in the evaluation of patients with abdominal pain, and is an important diagnosis to be comfortable with given substantial associated morbidity and mortality. In this review, we summarize an imaging approach to evaluating patients with suspected SBO, discuss the role of certain imaging modalities such as radiography and small bowel follow through, CT, and MRI, as well as review some common and also less common causes of SBO such as internal hernia. We will also discuss tailoring the imaging approach to address specific clinical questions and special patient populations such as imaging the pregnant patient with suspected SBO, and the inflammatory bowel disease patient.
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Affiliation(s)
- Katharina Feister
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, Saint Louis, MO, USA
| | - Katerina Konstantinoff
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, Saint Louis, MO, USA
| | | | - Vincent Mellnick
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, Saint Louis, MO, USA
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12
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Santucci W, Choy A, Cheng Q, Ward S, Winter N, Hii MW. Small bowel obstruction secondary to barbed sutures in bariatric surgery: a cautionary tale. ANZ J Surg 2024. [PMID: 38407555 DOI: 10.1111/ans.18892] [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: 10/03/2023] [Revised: 01/09/2024] [Accepted: 01/22/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Laparoscopic bariatric surgery relies on technically challenging intracorporeal suturing for critical parts of the operation. Barbed sutures have been developed to provide an alternative to suturing for certain manoeuvres within a procedure. Barbed sutures theoretically negate the need for knot tying and allow for continuous application of tension; however the barbs can unintentionally adhere to surrounding tissues. We describe a case series of three patients who developed V-Loc™ (barbed) suture related small bowel obstruction (SBO) to promote awareness of this unusual but preventable complication. METHODS Medical records of patients diagnosed with V-Loc™ related SBO between 2018 and 2021 at a tertiary centre were reviewed. Data regarding presentation, diagnosis, management and outcomes were obtained. RESULTS Three patients were identified where V-Loc™ sutures were aetiologically related to early post-surgical small bowel obstruction secondary to small bowel adherence to barbed suture tail or adhesions between barbed suture tail and unintended viscera. In these cases, non-absorbable V-Loc™ sutures were used to close the small bowel mesenteric defect at Roux-en-Y gastric bypass surgery. All patients required adhesiolysis at re-look laparoscopy prior to resolution. All patients were discharged home well after relook laparoscopy. CONCLUSION Overly long or exposed V-Loc™ suture tails can result in SBO following laparoscopic bariatric surgery. Cutting the suture tail as close as practical to the final throw of the suture and/or covering exposed suture ends may prevent this complication.
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Affiliation(s)
- Walter Santucci
- Department of Hepatobiliary and Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Audrey Choy
- Department of Hepatobiliary and Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Qiuye Cheng
- Department of Hepatobiliary and Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Salena Ward
- Department of Hepatobiliary and Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Nicole Winter
- Department of Hepatobiliary and Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Michael W Hii
- Department of Hepatobiliary and Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- The Department of Surgery, The University of Melbourne, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
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13
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Giusto G, Cerullo A, Gandini M. Anastomotic techniques for small intestinal obstruction in horses. A scoping review. Equine Vet J 2024. [PMID: 38379364 DOI: 10.1111/evj.14076] [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: 10/26/2023] [Accepted: 02/05/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Small bowel obstruction (SBO) is a significant cause of surgery in adult horses presenting with colic pain. SBOs often require resection and anastomosis. While various techniques for intestinal anastomoses have been developed, it remains uncertain if any fully meet our clinical needs. OBJECTIVE To conduct a scoping review of publications on anastomosis techniques and outcomes for the treatment of SBO. STUDY DESIGN Scoping review. METHODS A literature review was conducted using the CAB, Web of Science, Scopus, and PubMed databases. Peer-reviewed scientific articles in English, published between 1992 and 2023, were included. A quality assessment was performed for potentially eligible articles. Experimental studies, case reports, and case series with less than five cases were excluded and relevant data on study methods and sample size were extracted and charted from remaining articles. Anastomosis type and outcome were reported for articles considered potentially eligible for meta-analysis. Articles in which only overall outcome was reported or details on type of anastomosis were not reported were excluded for the final charting. RESULTS Of 3024 articles, 210 underwent a quality assessment. The most common study designs were case reports and case series (64.3%), followed by experimental studies (17.1%). After further exclusions, 104 articles met the inclusion criteria. In only 42 articles detailed data on type of anastomosis and relative outcome were reported. A total of 23 anastomosis types were reported for the treatment of SBO, with 6 different outcomes evaluated. Both short- and long-term survival rates consistently exceed 70% for all types of anastomosis (jejuno-jejunal, jejuno-ileal, and jejunocaecal). MAIN LIMITATION Non-English language studies and conference proceedings were excluded. CONCLUSION The body of literature focused on surgical treatment for SBO exhibits low-quality evidence. Several techniques of anastomosis were described for different pathologies. However, there is a lack of homogeneity in reporting outcome for each surgical technique. Furthermore, outcomes considered varied significantly among studies and were sometimes poorly reported, although success rates are generally high. Overall, there is a need for better-structured studies on existing and commonly used techniques before comparing techniques and exploring other innovative approaches.
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Affiliation(s)
- Gessica Giusto
- Department of Veterinary Sciences, University of Turin, Turin, Italy
| | - Anna Cerullo
- Department of Veterinary Sciences, University of Turin, Turin, Italy
| | - Marco Gandini
- Department of Veterinary Sciences, University of Turin, Turin, Italy
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14
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Milosevic S, Kovac JD, Lazic L, Mitrovic M, Stosic K, Basaric D, Tadic B, Stojkovic S, Rasic S, Ivanovic N, Skrobic O. "Bezoar Egg"-A Rare Cause of Small Bowel Obstruction. Diagnostics (Basel) 2024; 14:360. [PMID: 38396399 PMCID: PMC10887705 DOI: 10.3390/diagnostics14040360] [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: 12/18/2023] [Revised: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Small bowel obstruction is a frequent medical condition with various causes, the most common being postoperative adhesions, volvulus, intussusception, hernias, and tumors. A bezoar-induced blockage of the small intestine is a rare condition that accounts for approximately 4% of all small bowel obstruction cases. Herein, we present the case report of a 71-year-old patient with diffuse abdominal pain caused by a small bowel obstruction due to a calcified bezoar (bezoar egg) resulting from a post-radiation intestinal stricture. The patient underwent a small bowel excision with the extraction of the bezoar, after which a full recovery was made.
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Affiliation(s)
- Stefan Milosevic
- Center for Radiology and Magnetic Resonance Imaging, University Clinical Centre of Serbia, Pasterova No. 2, 11000 Belgrade, Serbia; (S.M.); (J.D.K.); (L.L.); (K.S.)
| | - Jelena Djokic Kovac
- Center for Radiology and Magnetic Resonance Imaging, University Clinical Centre of Serbia, Pasterova No. 2, 11000 Belgrade, Serbia; (S.M.); (J.D.K.); (L.L.); (K.S.)
- Department for Radiology, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, 11000 Belgrade, Serbia
| | - Ljubica Lazic
- Center for Radiology and Magnetic Resonance Imaging, University Clinical Centre of Serbia, Pasterova No. 2, 11000 Belgrade, Serbia; (S.M.); (J.D.K.); (L.L.); (K.S.)
| | - Milica Mitrovic
- Center for Radiology and Magnetic Resonance Imaging, University Clinical Centre of Serbia, Pasterova No. 2, 11000 Belgrade, Serbia; (S.M.); (J.D.K.); (L.L.); (K.S.)
- Department for Radiology, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, 11000 Belgrade, Serbia
| | - Katarina Stosic
- Center for Radiology and Magnetic Resonance Imaging, University Clinical Centre of Serbia, Pasterova No. 2, 11000 Belgrade, Serbia; (S.M.); (J.D.K.); (L.L.); (K.S.)
| | - Dragan Basaric
- Department for HBP Surgery, Clinic for Digestive Surgery, University Clinical Centre of Serbia, Koste Todorovica Street, No. 6, 11000 Belgrade, Serbia; (D.B.); (B.T.)
- Department for Surgery, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, 11000 Belgrade, Serbia; (N.I.); (O.S.)
| | - Boris Tadic
- Department for HBP Surgery, Clinic for Digestive Surgery, University Clinical Centre of Serbia, Koste Todorovica Street, No. 6, 11000 Belgrade, Serbia; (D.B.); (B.T.)
- Department for Surgery, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, 11000 Belgrade, Serbia; (N.I.); (O.S.)
| | - Stefan Stojkovic
- Clinic for Gastroenterology and Hepatology, University Clinical Centre of Serbia, Koste Todorovica Street, No. 2, 11000 Belgrade, Serbia;
| | - Slobodan Rasic
- Department of Stomach and Esophageal Surgery, Clinic for Digestive Surgery, University Clinical Centre of Serbia, Koste Todorovica Street No. 6, 11000 Belgrade, Serbia;
| | - Nenad Ivanovic
- Department for Surgery, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, 11000 Belgrade, Serbia; (N.I.); (O.S.)
- Department of Stomach and Esophageal Surgery, Clinic for Digestive Surgery, University Clinical Centre of Serbia, Koste Todorovica Street No. 6, 11000 Belgrade, Serbia;
| | - Ognjan Skrobic
- Department for Surgery, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, 11000 Belgrade, Serbia; (N.I.); (O.S.)
- Department of Stomach and Esophageal Surgery, Clinic for Digestive Surgery, University Clinical Centre of Serbia, Koste Todorovica Street No. 6, 11000 Belgrade, Serbia;
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15
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Sakari T, Sköldberg F, Dietrich CE, Nordenvall C, Karlbom U. Incidence of adhesive small bowel obstruction after surgery for colorectal cancer in Sweden 2007-2016. Colorectal Dis 2024; 26:300-308. [PMID: 38158619 DOI: 10.1111/codi.16845] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/30/2023] [Accepted: 11/23/2023] [Indexed: 01/03/2024]
Abstract
AIM Population-based data on incidence and risk factors of adhesive small bowel obstruction (SBO) are limited. The aims of this study were to assess the risk of SBO and SBO surgery after bowel resection for colorectal cancer (CRC) and to assess whether this risk is modified by minimally invasive surgery (MIS) and radiotherapy in a retrospective national study. METHODS CRCBaSe, a nationwide register linkage originating from the Swedish Colorectal Cancer Register, was used to identify Stage I-III CRC patients who underwent resection in 2007-2016, with follow-up throughout 2017. Matched CRC-free comparators (1:6) were included as a reference of SBO and SBO surgery incidence. The association between MIS and preoperative radiotherapy and the incidence rate of SBO was evaluated in adjusted multivariable Cox regression models. RESULTS Among 33 632 CRC patients and 198 649 comparators, the 5-year cumulative incidence of SBO and SBO surgery was 7.6% and 2.2% among patients and 0.6% and 0.2% among comparators, with death as a competing risk. In all patients, MIS was associated with a reduced incidence of SBO (hazard ratio [HR] 0.7, 95% CI 0.6-0.8) and SBO surgery (HR 0.5, 95% CI 0.3-0.7). In rectal cancer patients, radiotherapy was associated with an increased incidence of SBO (HR 1.6, 95% CI 1.4-1.8) and SBO surgery (HR 1.7, 95% CI 1.3-2.3). DISCUSSION Colorectal cancer surgery is associated with a marked increase in risk of SBO, compared with the general population. The incidence is further increased if open surgery or radiotherapy is performed.
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Affiliation(s)
- Thorbjörn Sakari
- Department of Surgery, CFUG, Gävle Hospital, Gävle, Sweden
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Filip Sköldberg
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Caroline E Dietrich
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Caroline Nordenvall
- Department of Pelvic Cancer, GI Oncology and Colorectal Surgery Unit, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska institute, Stockholm, Sweden
| | - Urban Karlbom
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
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16
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Songadkar SV, Hansalia DS, Pathak HV, Desai JA. Congenital Transmesenteric Hernia With Closed-Loop Small Bowel Obstruction and Intestinal Gangrene in an Adult. Cureus 2024; 16:e53560. [PMID: 38445117 PMCID: PMC10913942 DOI: 10.7759/cureus.53560] [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] [Accepted: 02/04/2024] [Indexed: 03/07/2024] Open
Abstract
Internal hernias (IHs) are defined as the protrusion of the intestine through an aperture in the peritoneal ligament, mesentery, or the omentum, without traversing the fascial planes and leading to encapsulation of the protruded intestine within another compartment of an otherwise intact abdominal cavity. Internal hernias can be acquired or congenital. Congenital internal hernias resulting in small bowel obstruction are extremely rare, even more so in adults, occurring usually due to embryological or developmental defects, often undiagnosed, and requiring a high index of clinical suspicion. We report a rare case of a 22-year-old young adult with transmesenteric hernia of distal ileum through a congenital distal ileal mesenteric defect resulting in closed-loop small bowel obstruction and distal ileal gangrene, managed with resection and end-ileostomy, followed by stoma reversal one month later. It requires a high index of suspicion and remains a surgical emergency due to its predilection for intestinal gangrene and small bowel obstruction, with a high mortality rate due to delayed presentation and diagnosis.
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Affiliation(s)
- Siddharth V Songadkar
- General Surgery, Shree Krishna Hospital, Pramukhswami Medical College, Bhaikaka University, Karamsad, IND
| | - Dency S Hansalia
- General Surgery, Shree Krishna Hospital, Pramukhswami Medical College, Bhaikaka University, Karamsad, IND
| | - Haryax V Pathak
- General Surgery, Shree Krishna Hospital, Pramukhswami Medical College, Bhaikaka University, Karamsad, IND
| | - Jitesh A Desai
- General Surgery, Shree Krishna Hospital, Pramukhswami Medical College, Bhaikaka University, Karamsad, IND
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17
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Roesslhuemer P, Ruder TD, Cédric N, Schnueriger B, Heverhagen JT. Gallstone ileus - a well-known, but rarely encountered cause for small bowel obstruction. Radiol Case Rep 2024; 19:791-793. [PMID: 38111566 PMCID: PMC10726328 DOI: 10.1016/j.radcr.2023.11.042] [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: 09/29/2023] [Revised: 11/10/2023] [Accepted: 11/15/2023] [Indexed: 12/20/2023] Open
Abstract
Gallstone ileus is a well-known cause of small bowel obstruction in the radiological literature. In the experience of these authors, gallstone ileus occurs more often in quiz cases for registrars than in the everyday casework of a radiologist. The here presented case of a gallstone ileus provides a good opportunity to summarize cause, clinical presentation, radiological findings, and treatment options for both those studying for the specialist examinations and those whose specialist examinations are long past.
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Affiliation(s)
- Philipp Roesslhuemer
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Thomas D. Ruder
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Nesti Cédric
- Departement of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Beat Schnueriger
- Departement of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Johannes T. Heverhagen
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
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18
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Atuiri C, Zhang W, Cronin C. Eosinophilic Enteritis Causing Recurrent Small Bowel Obstruction: A Case Report. Cureus 2024; 16:e54355. [PMID: 38500945 PMCID: PMC10946293 DOI: 10.7759/cureus.54355] [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] [Accepted: 02/17/2024] [Indexed: 03/20/2024] Open
Abstract
Eosinophilic enteritis is an inflammatory condition characterized by eosinophilic infiltration of the gastrointestinal tract. This case report highlights a unique presentation of eosinophilic enteritis as a cause of recurrent small bowel obstruction. The diagnosis was elusive despite extensive abdominal imaging. A histopathologic examination of a full-thickness bowel segment showing extensive eosinophilic infiltration in the muscularis propria was vital in establishing the diagnosis. This report underscores the diagnostic complexities associated with eosinophilic enteritis and the need to consider this condition as a potential cause of recurrent abdominal pain and small bowel obstruction.
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Affiliation(s)
| | - Wei Zhang
- Internal Medicine, St. Luke's Hospital, St. Louis, USA
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19
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Biller J, Silvis J, Duke D. Recurrent Obturator Hernia: A Rare Entity. Cureus 2024; 16:e53732. [PMID: 38455806 PMCID: PMC10919941 DOI: 10.7759/cureus.53732] [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] [Accepted: 02/06/2024] [Indexed: 03/09/2024] Open
Abstract
Obturator hernias are rare with an incidence of less than 1% of all hernias and are most common in frail, elderly females. They are difficult to diagnose and even more difficult to repair. They often present with a small bowel obstruction from the incarcerated bowel. We report a case of a recurrent obturator hernia after a laparoscopic repair using a patch of omentum. The recurrence was repaired laparoscopically with a trans-abdominal preperitoneal repair (TAPP) with mesh. Given the rarity of the disease, there is scarce literature on the ideal method of repair, especially in patients with recurrence. However, with recent trends toward minimally invasive preperitoneal mesh hernia repairs for inguinal and ventral hernias, this type of repair should be strongly considered for patients with obturator hernias as well.
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Affiliation(s)
- Jessica Biller
- General Surgery, Conemaugh Memorial Medical Center, Johnstown, USA
| | - Jennifer Silvis
- Trauma and Acute Care Surgery, Conemaugh Memorial Medical Center, Johnstown, USA
| | - D'Arcy Duke
- Bariatric and Minimally Invasive Surgery, Conemaugh Memorial Medical Center, Johnstown, USA
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20
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Almarri NT, Elsaadawy RJ, Alhumaidan AM. Acute Gastric Ischemia in a Case of Small Bowel Obstruction. Cureus 2024; 16:e55113. [PMID: 38558711 PMCID: PMC10979248 DOI: 10.7759/cureus.55113] [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] [Accepted: 02/27/2024] [Indexed: 04/04/2024] Open
Abstract
Gastric ischemia is a relatively rare condition that can lead to severe or life-threatening outcomes. It can be caused by various etiological factors, including vascular occlusion, atherosclerosis, vasculitis, hypovolemic shock, cardiac failure, mesenteric ischemia, splanchnic vasoconstriction, and abdominal compartment syndrome. Furthermore, gastric dilation can be caused by volvulus and acute necrotizing gastritis. This condition may go unnoticed in the setting of intestinal obstruction. In this case report, we describe a 43-year-old female who presented with signs, symptoms, and radiological findings indicative of small bowel obstruction accompanied by a severely dilated stomach. Our aim is to highlight the importance of considering gastric ischemia in patients with small bowel obstruction and to demonstrate the outcomes of a surgical approach in such presentations.
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21
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Albostani A, Kfelati F, Alsaadi W, Faraman RA, Farman A. Small bowel obstruction due to a meat bolus bezoar: the second case report in literature. Ann Med Surg (Lond) 2024; 86:1139-1143. [PMID: 38333246 PMCID: PMC10849409 DOI: 10.1097/ms9.0000000000001633] [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: 09/29/2023] [Accepted: 12/07/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction Small bowel obstruction is a difficult emergency condition that may be caused due to many factors. However, bezoar-induced small bowel obstruction accounts for only 0.4-4.8% of all intestinal impaction patients. Bezoars are an entity of undigested materials classified into four types: phytobezoar, trichobezoar, pharmacobezoar, lactobezoar. Meat bolus bezoar is not named under any of these classifications. Case presentation A 75-year-old man presented with abdominal distention, vomiting, and constipation. On radiological imaging, a mass in the terminal ileum was detected. After 2 days of ineffective conservative therapy, the authors decided to perform an open surgery. Enterotomy approach was chosen after failing to milk the object into the colons. The foreign body impacting the bowels was identified as a meat bolus bezoar. The patient improved after the surgery. The authors recorded no recurrence or complications with our patient after 18 months of follow-up. Discussion Patients with small bowel obstruction usually present with acute abdominal pain and distension despite the blockage cause. Computed tomography is the most effective diagnostic tool in such cases. In bezoar-induced intestinal blockage, surgical management is mandatory if conservative therapy fails. Conclusion It is important to consider bezoar-induced small bowel obstruction as a potential cause of impaction in cases of acute abdominal pain accompanied with risk factors of bezoar formation, despite the bezoar type.
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Affiliation(s)
| | - Fadi Kfelati
- University of Aleppo, Faculty of Medicine, Aleppo
| | | | | | - Aasem Farman
- General Surgery Department, Al-Mouwassat University Hospital, Damascus University, Damascus, Syria
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22
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Eze AN, Eze AN, Chime CM, Chen F, Moris D, Schmitz R, Fitzgerald TN. Idiopathic Megaduodenum in a Teenager: A Case Report. Cureus 2024; 16:e51930. [PMID: 38333480 PMCID: PMC10851044 DOI: 10.7759/cureus.51930] [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] [Accepted: 01/08/2024] [Indexed: 02/10/2024] Open
Abstract
Megaduodenum is a rare clinical syndrome characterized by significant duodenal dilation, elongation, and hypertrophy. Given its rarity and nonspecific clinical manifestations, megaduodenum may be misdiagnosed, leading to delays in surgical care and increased morbidity. We describe a case of idiopathic megaduodenum in a teenage Caucasian female, who presented with a five-year history of halitosis, recurrent belching, bloating, nausea and vomiting, and postprandial epigastric abdominal pain. She was diagnosed with megaduodenum by dramatic findings on contrast radiography. She developed a duodenal volvulus necessitating emergency exploratory laparotomy, during which a duodenal plication and a side-to-side duodenojejunostomy were performed. Exploratory laparotomy and histopathological analysis were unrevealing of any definitive abnormalities to explain her megaduodenum. Postoperatively, she developed two early small bowel obstructions, both from subsequent adhesions requiring repeat laparotomy with adhesiolysis. She has subsequently recovered without incident. Diagnosis and accurate classification of megaduodenum requires surgical exploration with a full-thickness biopsy and subsequent histopathologic analysis to rule out obstructive or functional disorders of the duodenum. Treatment of megaduodenum depends on the underlying cause and degree of duodenal distention. It is crucial that clinicians are knowledgeable of the various surgical options, their indications, and the potential postoperative complications that may arise.
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Affiliation(s)
- Anthony N Eze
- Department of Surgery, Duke University Medical Center, Durham, USA
- Duke Global Health Institute, Duke University, Durham, USA
| | - Akachukwu N Eze
- Department of Medicine, Howard University College of Medicine, Washington, D.C., USA
| | - Chinecherem M Chime
- Department of Medicine, Howard University College of Medicine, Washington, D.C., USA
| | - Fengming Chen
- Department of Pathology, Duke University Medical Center, Durham, USA
| | - Dimitrios Moris
- Department of Surgery, Duke University Medical Center, Durham, USA
| | - Robin Schmitz
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Tamara N Fitzgerald
- Department of Surgery, Duke University Medical Center, Durham, USA
- Duke Global Health Institute, Duke University, Durham, USA
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23
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Apple A, Mulugeta-Gordon L, Zafman K, Leitner K. An unusual cause of small bowel obstruction: Case report of spontaneous uteroenteric fistula. Int J Gynaecol Obstet 2024; 164:349-351. [PMID: 37723887 DOI: 10.1002/ijgo.15122] [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: 07/07/2023] [Revised: 08/27/2023] [Accepted: 08/27/2023] [Indexed: 09/20/2023]
Abstract
SynopsisUteroenteric fistulae in the setting of degenerating leiomyomas may present with small bowel obstruction and require multidisciplinary surgical management to perform fertility‐sparing myomectomy.
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Affiliation(s)
- Annie Apple
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lakeisha Mulugeta-Gordon
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kelly Zafman
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kirstin Leitner
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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24
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Jackson HM, Saed K, Adams T, Maturasingh MB, Vedros FD, Masri MM. An interesting twist: 90 year-old female with acute small bowel obstruction due to midgut volvulus. J Surg Case Rep 2024; 2024:rjae001. [PMID: 38283414 PMCID: PMC10810726 DOI: 10.1093/jscr/rjae001] [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: 11/07/2023] [Accepted: 12/17/2023] [Indexed: 01/30/2024] Open
Abstract
We report an exceptionally rare presentation of midgut volvulus secondary to malrotation in a nonagenarian female. According to our extensive literature review, this 90-year-old female is the oldest reported case of midgut volvulus. This patient presented with acute recurrent emesis. Imaging showed midgut volvulus with associated small bowel obstruction. The patient underwent an exploratory laparotomy that revealed midgut volvulus because of congenital malrotation and Ladd's bands, necessitating a modified Ladd's procedure. The patient had an uneventful postoperative course. Congenital malrotation with Ladd's bands was likely asymptomatic throughout this patient's life. Our case adds to the scarce instances where midgut volvulus with malrotation is identified in elderly patients, underscoring the importance of considering this diagnosis irrespective of age. We recommend including midgut volvulus because of malrotation in a differential list of atypical small bowel obstruction in elderly patients.
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Affiliation(s)
- Hillary M Jackson
- Department of Graduate Medical Education, Larkin Community Hospital, South Miami, FL 33143, United States
| | - Khaled Saed
- Department of Graduate Medical Education, Larkin Community Hospital, South Miami, FL 33143, United States
| | - Turner Adams
- Ross University School of Medicine, 2300 SW 145th Ave #200, Miramar, FL 33027, United States
| | - Matthew B Maturasingh
- Faculty of Medical Sciences, University of the West Indies, St Augustine, Trinidad and Tobago
| | - Fallon D Vedros
- Medical University of the Americas, Charlestown, Nevis, West Indies
| | - Mohammad M Masri
- Department of Graduate Medical Education, Larkin Community Hospital, South Miami, FL 33143, United States
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25
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Barnard P, Mouline O. A Rare Case of Partial Small Bowel Obstruction Secondary to Intestinal Myeloid Sarcoma. Cureus 2024; 16:e52956. [PMID: 38283782 PMCID: PMC10810725 DOI: 10.7759/cureus.52956] [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] [Accepted: 01/24/2024] [Indexed: 01/30/2024] Open
Abstract
This case report details a rare case of small bowel myeloid sarcoma (MS) in an otherwise fit and well 49-year-old male presenting initially with vague obstructive symptoms and weight loss. The patient ultimately required an operation for a small bowel obstruction where a laparotomy and small bowel resection were performed due to three cicatrising completely obstructing lesions in the mid-jejunum. Fewer than 1% of patients with acute myeloid leukaemia (AML) present with MS as an initial diagnosis, and only 6.5% of these are intestinal in origin. This report adds to the current body of literature on this rare condition, emphasises the diagnostic challenges resulting in delays to diagnosis, and discusses the crucial role of early and accurate identification for optimal treatment and prognosis. Surgery may be warranted in patients with complications such as obstruction; however, systemic chemotherapy tailored to AML is the primary therapeutic approach for MS patients.
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Affiliation(s)
| | - Omar Mouline
- General Surgery, Cairns Hospital/James Cook University, Cairns, AUS
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26
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Deng Y(J, Baker E, Toshniwal S. Rare pelvic peritoneal defect causing small bowel obstruction in a young female with virgin abdomen. J Surg Case Rep 2024; 2024:rjad718. [PMID: 38213405 PMCID: PMC10781936 DOI: 10.1093/jscr/rjad718] [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: 12/04/2023] [Accepted: 12/17/2023] [Indexed: 01/13/2024] Open
Abstract
This case report discusses a 46-year-old female with no prior surgical history who presented with severe abdominal pain and generalized tenderness. She was found to have a small bowel obstruction secondary to internal hernia caused by a rare congenital pelvic peritoneal defect in the Pouch of Douglas. She required diagnostic laparoscopy and repair of the pelvic peritoneal defect. Congenital peritoneal defect is an extremely rare cause of small bowel obstruction but should remain a possible differential diagnosis in patients with virgin abdomen presenting with acute abdominal pain.
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Affiliation(s)
- Yunpeng (Jack) Deng
- General Surgical Department, Eastern Health, Box Hill, Victoria 3128, Australia
| | - Emily Baker
- General Surgical Department, Eastern Health, Box Hill, Victoria 3128, Australia
| | - Sumeet Toshniwal
- General Surgical Department, Eastern Health, Box Hill, Victoria 3128, Australia
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Martinez-Esteban A, Barron-Cervantes NM, Avila-Sanchez P, Chan-Nuñez C. Intussusception of Gastrojejunostomy After Pancreatoduodenectomy With Billroth II Reconstruction. Cureus 2024; 16:e51880. [PMID: 38327972 PMCID: PMC10849266 DOI: 10.7759/cureus.51880] [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] [Accepted: 01/08/2024] [Indexed: 02/09/2024] Open
Abstract
Gastrojejunal anastomosis or gastrojejunostomy (GJ) is a surgical procedure used for allowing gastric emptying, especially in cases where complex reconstructions are needed. One of the less common complications but one of the most relevant in morbidity is the intussusception of the GJ. It requires a high index of suspicion, preoperative optimization of the patient, diagnostic corroboration, and identification of associated complications with the use of contrasted imaging. It was described for the first time by Bozzi in 1914; currently, multiple cases have been described in the literature, being more frequent in bariatric surgeries and reconstructions after distal gastrectomy. In hepatopancreaticobiliary surgery, it is an even uncommon complication. We present the case of a 60-year-old man with intussusception of the efferent loop of the GJ after a pylorus-preserving pancreatoduodenectomy with a Billroth II reconstruction in the setting of malignancy of the extrahepatic bile duct along with our emergency surgical treatment.
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Affiliation(s)
| | | | - Pablo Avila-Sanchez
- Department of Hepato-Pancreato-Biliary Surgery, Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán, Mexico City, MEX
| | - Carlos Chan-Nuñez
- Department of Hepato-Pancreato-Biliary Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, MEX
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28
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Bockova M, Pazdírek F, Hoch J. Ileus conditions after rectal and Hartmann's resections. Rozhl Chir 2024; 102:395-401. [PMID: 38302426 DOI: 10.33699/pis.2023.102.10.395-401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
INTRODUCTION Bowel obstruction is one of the most common postoperative complications in pelvic surgery. In most cases, adhesive mechanical ileus of the small bowel is the cause. In procedures such as Hartmann's resection or abdominoperineal rectal resection, it seems that the large wound area on the pelvic walls and pelvic floor and the dead space after the removed rectum with mesorectum contribute to the ileus condition. The aim of this paper was to identify the risk factors for ileus after selected pelvic procedures and to map the possible ways of prevention and treatment of these complications. METHODS We performed retrospective simple analysis of a set of 98 patients who underwent elective abdominoperineal resection of the rectum, pelvic exenteration or Hartmann's resection for rectal cancer between 2017-2022. Postoperative complications were recorded, especially bowel obstruction, and perineal wound or rectal stump healing complications. In all 9 patients, who needed reoperation, we searched for risk factors for ileus known from the literature. We also described the management of ileus. RESULTS In the group of 9 patients subjected to detailed analysis, 8 risk factors were most common: male gender, obesity, history of radiotherapy, open surgery, requirement of adhesiolysis in primary surgery, large blood loss, difficult dissection, and impaired healing of the rectal stump/perineum. A total of 8 (88.9%) patients had a combination of 4 or more of the mentioned risk factors. CONCLUSION Our results confirm the impact of risk factors known from the literature; furthermore, they indicate a connection with the formation of a dead space in the pelvis and with complications of the rectal stump or perineal wound healing. Some of the risk factors cannot be changed, and current preventive measures cannot completely prevent the formation of adhesions. It is therefore advisable to look for other materials and methods that would ideally limit the formation of adhesions and at the same time fill the dead space and thus separate it from the perineal wound.
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Yee AC, Huang S, Singh R, Rizzi D, Shama N, Khoury N, Weisberg IS. Disseminated histoplasmosis in an HIV/AIDS transgender male-to-female with atypical and persistent GI manifestations. JGH Open 2024; 8:e13011. [PMID: 38268953 PMCID: PMC10805500 DOI: 10.1002/jgh3.13011] [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: 06/18/2023] [Revised: 11/09/2023] [Accepted: 11/12/2023] [Indexed: 01/26/2024]
Abstract
Disseminated histoplasmosis is a rare complication of infection due to Histoplasma capsulatum. Typically, histoplasmosis is self-limiting and asymptomatic in infected individuals with immunocompetence. Disseminated disease, however, can arise in high-risk populations with primary or acquired cellular immunodeficiency including HIV/AIDS, transplant recipients, and those undergoing immunosuppressive therapy. Here we describe a unique case of extrapulmonary gastrointestinal histoplasmosis by infiltrative Peyer's patch disease with bone marrow involvement in a transgender HIV-infected woman.
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Affiliation(s)
- Aaron C Yee
- Department of Internal MedicineNew York‐Presbyterian Brooklyn Methodist HospitalBrooklynNew YorkUSA
| | - Sarah Huang
- Department of Internal MedicineNew York‐Presbyterian Brooklyn Methodist HospitalBrooklynNew YorkUSA
| | - Ranbir Singh
- Department of Internal MedicineNew York‐Presbyterian Brooklyn Methodist HospitalBrooklynNew YorkUSA
| | - Dean Rizzi
- Department of Internal MedicineNew York‐Presbyterian Brooklyn Methodist HospitalBrooklynNew YorkUSA
| | | | - Neil Khoury
- University of Connecticut Health CenterFarmingtonConnecticutUSA
| | - Ilan S Weisberg
- Department of GastroenterologyNew York‐Presbyterian Brooklyn Methodist HospitalBrooklynNew YorkUSA
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30
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Bouhout T, Kharkhach A, Ramdani A, Harouachi A, Serji B. Early Small Bowel Obstruction Caused by Surgical Drain Following Rectal Cancer Surgery: A Case Report. Cureus 2024; 16:e52694. [PMID: 38384653 PMCID: PMC10879656 DOI: 10.7759/cureus.52694] [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] [Accepted: 01/21/2024] [Indexed: 02/23/2024] Open
Abstract
The abdominal drains are commonly used and could be a source of several complications, including infection and small bowel obstruction. We report the case of a 70-year-old male patient with intestinal obstruction related to abdominal drainage after rectal surgery. Acute bowel obstruction remains a rare complication of abdominal drains. Surgeons should be aware of this situation and use drains with caution. The treatment options include conservative treatment or surgery either a laparoscopic approach or laparotomy.
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Affiliation(s)
- Tariq Bouhout
- Department of Surgical Oncology, Oncology Hospital of Oujda, Faculty of Medicine and Pharmacy of Oujda, Université Mohammed Premier, Oujda, MAR
| | - Ayoub Kharkhach
- Department of Surgical Oncology, Oncology Hospital of Oujda, Faculty of Medicine and Pharmacy of Oujda, Université Mohammed Premier, Oujda, MAR
| | - Abdelbassir Ramdani
- Department of Surgical Oncology, Oncology Hospital of Oujda, Faculty of Medicine and Pharmacy of Oujda, Université Mohammed Premier, Oujda, MAR
| | - Abdelhakim Harouachi
- Department of Surgical Oncology, Oncology Hospital of Oujda, Faculty of Medicine and Pharmacy of Oujda, Université Mohammed Premier, Oujda, MAR
| | - Badr Serji
- Department of Surgical Oncology, Oncology Hospital of Oujda, Faculty of Medicine and Pharmacy of Oujda, Université Mohammed Premier, Oujda, MAR
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31
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Ghirardelli L, Beneduce AA, Gusmini S. A Rare Case of Small Bowel Obstruction due to Migration of a Percutaneous Biliary Stent. J Investig Med High Impact Case Rep 2024; 12:23247096241238527. [PMID: 38646799 PMCID: PMC11036911 DOI: 10.1177/23247096241238527] [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: 12/17/2023] [Revised: 02/20/2024] [Accepted: 02/25/2024] [Indexed: 04/23/2024] Open
Abstract
Biliary endoprostheses are widely used in the treatment of biliary lithiasis, malignant and benign strictures, and occasionally in long-lasting biliary fistulas. They can be placed endoscopically during endoscopic retrograde cholangiopancreatography and radiologically (percutaneous) when the endoscopic route is not feasible. Complications associated with the endoscopic placement of biliary endoprostheses are well described in the literature, with migration being the most common. Intestinal obstruction is a rare complication associated with the migration of these devices. There are no reports in the literature of this complication occurring after percutaneous placement. We present a case of a patient who arrived at the emergency department with ileal obstruction secondary to the migration and concurrent embedding of a covered stent placed radiologically to treat a biliary leak after surgery. The patient underwent diagnostic laparoscopic and ileal resection, revealing a lithiasic concretion at the tip of the stent, causing the small bowel obstruction.
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32
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Bhargava A, Gharde P, Tayade H, Inamdar A. A Miraculous Save: Gangrenous Bowel and Meckle's Diverticulum With Acute Superior Mesenteric Artery Thrombosis. Cureus 2024; 16:e52947. [PMID: 38406144 PMCID: PMC10893989 DOI: 10.7759/cureus.52947] [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: 08/29/2023] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
The superior mesenteric artery (SMA) is vital for parts of the small intestine and ascending colon. Thrombosis of this major artery is a severe and potentially fatal condition involving the occlusion of the arterial vascular supply, causing ischemia predisposing to gangrene. Meckel's diverticulum is a congenital outpouching in the lower part of the small intestine. The condition of gangrenous meckels diverticulum is, therefore, even more limited. This study presents a unique case of a 45-year-old male with coexisting features of SMA thrombus with acute small bowel intestinal obstruction. During the study, the patient was found to have sickle cell anemia with an AS pattern, which may have predisposed the formation of a thrombus. The patient underwent sequential management of active thrombus by thrombolysis first, followed by resection anastomosis for gangrenous bowel. With precise monitoring and therapeutic care, the patient made a remarkable recovery. The condition possesses a high mortality rate. Prompt recognition and timely intervention in this case are of utmost significance.
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Affiliation(s)
- Abhilasha Bhargava
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pankaj Gharde
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Harshal Tayade
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Akash Inamdar
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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33
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H S, Puttappa Shivagange S, Sajjan SS, G NS, T HM. When the Gut Took a Wrong Turn to the Right: A Case Report of a Rare Complication of Closed Loop Small Bowel Obstruction With Small Bowel Volvulus in a Right Paraduodenal Hernia With Midgut Malrotation. Cureus 2024; 16:e53342. [PMID: 38435937 PMCID: PMC10907547 DOI: 10.7759/cureus.53342] [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] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Internal hernias constitute 5.8% of all small bowel obstructions. The right paraduodenal hernia is a less common subtype of the paraduodenal hernia. Lack of specific signs and symptoms precludes its clinical diagnosis, which emphasizes the need for computed tomography in diagnosis. We present a case of a 24-year-old male patient with a right paraduodenal hernia and midgut malrotation causing closed loop small bowel obstruction and small bowel volvulus within the hernial sac who underwent laparoscopy-assisted reduction of hernia and adhesiolysis with closure of the peritoneal defect. Since the right paraduodenal hernia is associated with gut malrotation, risk of strangulation, closed-loop obstruction, and rarely volvulus, these patients need prompt radiological diagnosis and surgical intervention.
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Affiliation(s)
- Samanvitha H
- Department of Diagnostic Radiology, Bangalore Medical College and Research Institute, Bengaluru, IND
- Department of Diagnostic Radiology, People Tree Hospital, Bengaluru, IND
| | - Sushmitha Puttappa Shivagange
- Department of Diagnostic Radiology, Aster CMI Hospital, Bengaluru, IND
- Department of Diagnostic Radiology, Bangalore Medical College and Research Institute, Bangalore, IND
| | - Shantkumar S Sajjan
- Department of Diagnostic Radiology, Bangalore Medical College and Research Institute, Bengaluru, IND
| | - Naveen S G
- Department of General Surgery, Bangalore Medical College and Research Institute, Bengaluru, IND
| | - Harsha M T
- Department of Interventional Radiology, AIl India Institute of Medical Sciences Rishikesh, Rishikesh, IND
- Department of Radiology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
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Toriumi T, Terashima M, Mizusawa J, Uemura K, Kurokawa Y, Takiguchi S, Doki Y, Hihara J, Imamura H, Takagane A, Ito S, Yoshikawa T, Sano T, Sasako M. Association between the antiadhesion membrane and small bowel obstruction after open gastrectomy: A supplemental analysis of the randomized controlled JCOG1001 trial. Ann Gastroenterol Surg 2024; 8:30-39. [PMID: 38250686 PMCID: PMC10797834 DOI: 10.1002/ags3.12722] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 06/28/2023] [Accepted: 07/10/2023] [Indexed: 01/23/2024] Open
Abstract
Aim Postoperative small bowel obstruction (SBO) is one of the major complications that is mainly caused by postoperative adhesion. Recently, the antiadhesion membrane has become popular for postoperative SBO prevention. However, its efficacy is yet to be confirmed in the gastric cancer surgery field. Here, we conducted the supplemental analysis of the randomized controlled trial JCOG1001 to investigate the efficacy of the antiadhesion membrane on SBO prevention in patients with open gastrectomy for gastric cancer. Methods Of the 1204 patients enrolled in JCOG1001, 1200 patients were included. The development of SBO of Grade ≥ IIIa according to the Clavien-Dindo classification was recorded. Univariable and multivariable analyses were performed using the Fine and Gray model to determine the risk factors for SBO. Results Fifty-one patients developed SBO (median follow-up duration: 5.6 years). Total gastrectomy, combined resection, and blood loss significantly increased the risk for SBO development in the univariable analysis. Large amount of blood loss was independently associated with SBO development in the multivariable analysis (hazard ratio [HR], 3.089; 95% confidence interval [CI], 1.562-6.109, p = 0.0012). Antiadhesion membrane did not reduce the risk for SBO (HR, 1.299; 95% CI 0.683-2.470; p = 0.4246). In the patients belonging to subgroup analyses who received distal and total gastrectomy, the antiadhesion membrane was not associated with the incidence of SBO. Conclusions Antiadhesion membrane did not decrease SBO occurrence rate after open gastrectomy. Therefore, the use of antiadhesion membrane would not be effective for preventing SBO in gastric cancer surgery.
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Affiliation(s)
- Tetsuro Toriumi
- Division of Gastric SurgeryShizuoka Cancer CenterNagaizumi‐ChoJapan
| | | | - Junki Mizusawa
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Centre HospitalTokyoJapan
| | - Kohei Uemura
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Centre HospitalTokyoJapan
| | - Yukinori Kurokawa
- Department of Gastroenterological SurgeryOsaka University Graduate School of MedicineOsakaJapan
| | - Shuji Takiguchi
- Department of Gastroenterological Surgery, Graduate School of Medical SciencesNagoya City UniversityNagoyaJapan
| | - Yuichiro Doki
- Department of Gastroenterological SurgeryOsaka University Graduate School of MedicineOsakaJapan
| | - Jun Hihara
- Department of SurgeryHiroshima City Asa Citizens HospitalHiroshimaJapan
| | - Hiroshi Imamura
- Department of SurgeryToyonaka Municipal HospitalToyonakaJapan
| | | | - Seiji Ito
- Department of Gastroenterological SurgeryAichi Cancer Center HospitalNagoyaJapan
| | - Takaki Yoshikawa
- Gastric Surgery DivisionNational Cancer Center HospitalTokyoJapan
| | - Takeshi Sano
- Department of Gastroenterological SurgeryCancer Institute Ariake HospitalTokyoJapan
| | - Mitsuru Sasako
- Department of Gastroenterological SurgeryHyogo College of MedicineNishinomiyaJapan
- Department of SurgeryYodogawa Christian HospitalOsakaJapan
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Mishra S, Chaudhary K, Tyagi S, Mishra P, Misra V. Primary sclerosing encapsulating peritonitis. INDIAN J PATHOL MICR 2024; 67:182-184. [PMID: 38358217 DOI: 10.4103/ijpm.ijpm_1228_21] [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] [Indexed: 02/16/2024] Open
Abstract
Sclerosing encapsulating peritonitis also known as cocoon abdomen is a rare chronic inflammatory condition of the peritoneum in which the bowel loops are encircled by a membrane (cocoon formation) within the peritoneal cavity leading to intestinal obstruction. It can be primary (idiopathic) or secondary (chemotherapy, beta-blockers, peritoneal dialysis, shunts, tuberculosis, systemic lupus erythematosus, etc.). The symptomatology report includes recurrent episodes of abdominal pain and vomiting. We present here a case of a 32-year-old male who presented with complaints of being unable to pass stools, vomiting (3-4 times), and abdomen pain for 4 days. This case is considered worth mentioning due to its rarity, lack of identification of secondary causes, and diminutive mention of histopathological aspect.
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Affiliation(s)
- Swati Mishra
- Department of Pathology, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India
| | - Kuldeep Chaudhary
- Department of Pathology, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India
| | - Swati Tyagi
- Department of Pathology, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India
| | - Pratibha Mishra
- Department of Surgery, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India
| | - Vatsala Misra
- Department of Pathology, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India
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Al-Mulla AE, Elgazzar M, Shalaby O. Laparoscopic repair of internal hernia in one anastomosis gastric bypass (OAGB): a case report. J Surg Case Rep 2023; 2023:rjad670. [PMID: 38111490 PMCID: PMC10725789 DOI: 10.1093/jscr/rjad670] [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: 10/03/2023] [Accepted: 11/21/2023] [Indexed: 12/20/2023] Open
Abstract
One anastomosis gastric bypass (OAGB), considered an alternative to Roux-en-Y gastric bypass, is becoming an increasingly common procedure. It shows excellent results in terms of weight reduction and remission of metabolic disease. Among the advantages of OAGB is the lack of internal hernia due to the absence of jejuno-jejunal anastomosis. However, internal herniation in OAGB is not impossible, and multiple cases have been mentioned in the literature. We describe a laparoscopic revisional surgery of internal hernia in a patient with a 2-month history of OAGB.
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Affiliation(s)
- Ahmad Essam Al-Mulla
- Department of Surgery, Farwaniya Hospital, Ministry of Health Kuwait (MOH), Sabah Al-Nasser, Block 6, PO Box 13373, Farwaniya 81004, Kuwait
| | - Mohamed Elgazzar
- Department of Surgery, Farwaniya Hospital, Ministry of Health Kuwait (MOH), Sabah Al-Nasser, Block 6, PO Box 13373, Farwaniya 81004, Kuwait
| | - Omar Shalaby
- Department of Surgery, Farwaniya Hospital, Ministry of Health Kuwait (MOH), Sabah Al-Nasser, Block 6, PO Box 13373, Farwaniya 81004, Kuwait
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Yadav KK, Ghimire R, Subedi S, Kandel K, Yadav RK, Ghimire B, Shah JK. Radiolucent foreign body leading to complete small bowel obstruction: a diagnostic dilemma - a case report. Ann Med Surg (Lond) 2023; 85:6144-6147. [PMID: 38098606 PMCID: PMC10718328 DOI: 10.1097/ms9.0000000000001226] [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: 06/09/2023] [Accepted: 08/12/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction and importance Foreign body ingestion leading to luminal obstruction in both the small and large bowels is rare, especially in children. The authors present a case of a 7-year-old patient who presented with a small bowel obstruction caused by an ingested radiolucent foreign body. The previous herniotomy surgery 1 year back led to initial diagnostic confusion, highlighting the need for a broad differential diagnosis. Case presentation A 7-year-old child with a history of herniotomy presented with symptoms of small bowel obstruction. Radiological imaging revealed a soft tissue mass mimicking a polyp or cystic lesion. During exploratory laparotomy, a cystic structure was discovered in the terminal ileum. The foreign body, identified as a fluid-filled balloon, was inaccessible to endoscopy and was gently maneuvered into the ascending colon. It was punctured and removed during on-table colonoscopy. Clinical discussion This case underscores the challenges of diagnosing and managing luminal obstruction caused by radiolucent foreign bodies in children. The presence of previous surgery can mislead clinicians, necessitating a broad differential diagnosis. Radiological imaging played a crucial role in identifying the foreign body. Surgical intervention guided by an on-table colonoscopy allowed successful removal. Conclusion Foreign body ingestion leading to luminal obstruction should be considered, even in cases with previous abdominal surgery. Radiological imaging aids in identification, and timely surgical intervention, guided by on-table colonoscopy, facilitates foreign body removal. Awareness of such cases is essential for optimal care in pediatric patients with luminal obstruction caused by foreign body ingestion.
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Affiliation(s)
- Krishna K. Yadav
- Department of General Surgery, Tribhuvan University Teaching Hospital, Maharajgunj
| | - Ranjeet Ghimire
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University
| | - Sudan Subedi
- Department of General Surgery, Tribhuvan University Teaching Hospital, Maharajgunj
| | - Krishna Kandel
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University
| | | | - Bikal Ghimire
- Department of General Surgery, Tribhuvan University Teaching Hospital, Maharajgunj
| | - Jayant K. Shah
- Department of General Surgery, Tribhuvan University Teaching Hospital, Maharajgunj
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McCartt J, Cleveland E, Duet M, Paton L, Thompson K, Matthews B, Cunningham K, Ross SW, Reinke CE. Implementation of a Gastrografin Order Set for Small Bowel Obstruction Across a Health System: A Cohort Study. Am Surg 2023; 89:5850-5857. [PMID: 37191904 DOI: 10.1177/00031348231175135] [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] [Indexed: 05/17/2023]
Abstract
BACKGROUND The use of Gastrografin (GG) in the management of adhesive small bowel obstruction (SBO) has been shown to decrease the length of stay and operative intervention. METHODS This retrospective cohort study examined patients with an SBO diagnosis prior to implementation (PRE, January 2017-January 2019) and following implementation (POST, January 2019-May 2021) of a GG challenge order set made available across 9 hospitals within a health care system. Primary outcomes were utilization of the order set across facilities and over time. Secondary outcomes included time to surgery for operative patients, rate of surgery, nonoperative length of stay, and 30-day readmission. Standard descriptive, univariate, and multivariable regression analyses were performed. RESULTS PRE cohort had 1746 patients and POST had 1889. The utilization of GG increased from 14% to 49.5% following implementation. Significant variability existed within the hospital system with utilization at each individual hospital from 11.5% to 60%. There was an increase in surgical intervention (13.9% vs 16.4%, P = .04) and decrease in nonoperative LOS (65.6 vs 59.9 hours, P < .001) following implementation. For POST patients, multivariable linear regression showed significant reduction in nonoperative length of stay (-23.1 hours, P < .001) but no significant difference in time to surgery (-19.6 hours, P = .08). DISCUSSION The availability of a standardized order set for SBO can result in increased Gastrografin administration across hospital settings. The implementation of a Gastrografin order set was associated with decreased length of stay in nonoperative patients.
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Affiliation(s)
- Jason McCartt
- Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Elaine Cleveland
- Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Mary Duet
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Lauren Paton
- Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Kyle Thompson
- Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Brent Matthews
- Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Kyle Cunningham
- Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Samuel W Ross
- Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
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Gashoot K, Kashbour MO, Abuhlaiga M. Midgut Volvulus in Disguise: Acute Abdomen in Early Pregnancy. Cureus 2023; 15:e50955. [PMID: 38249175 PMCID: PMC10800149 DOI: 10.7759/cureus.50955] [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] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
Small bowel obstruction (SBO) in pregnancy is a challenging diagnosis. Case rarity, non-specific presentations, and the non-practicality of using X-ray/gamma-ray imaging modalities in pregnancy contribute to the increased difficulty in timely diagnosing midgut volvulus during pregnancy, thereby increasing maternal and fetal morbidity. We report a case of midgut volvulus in a 39-year-old lady, gravida 3, para 2, with two previous cesarean sections. Her only presenting complaint was abdominal pain for three days with no other associated symptoms. The case was successfully diagnosed using magnetic resonance imaging (MRI) and subsequently treated surgically by segmental resection with side-to-side ileocecal anastomosis, thereby saving the mother and fetus. Clinicians should have a low threshold of suspicion of the varied causes of SBO in pregnancy, particularly in patients with prior abdominopelvic surgeries. Imaging is central to preoperative diagnosis, and MRI has gained popularity with safety and accuracy comparable to computed tomography. Management aims at minimizing maternal and fetal morbidity and mortality.
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Affiliation(s)
- Khalid Gashoot
- Diagnostic Radiology, Tripoli Central Hospital, Tripoli, LBY
- Radiology, Tripoli University, Tripoli, LBY
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40
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Kubiszewski K, Chapman RW, Piazza Y, Patel D, Neychev V. Hypothyroidism Presenting as Adynamic Ileus Mimicking a Mechanical Small Bowel Obstruction: A Diagnostic and Management Dilemma. Cureus 2023; 15:e50799. [PMID: 38239558 PMCID: PMC10796157 DOI: 10.7759/cureus.50799] [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] [Accepted: 12/16/2023] [Indexed: 01/22/2024] Open
Abstract
Patients who present with nausea, vomiting, constipation, and abdominal pain typically undergo workups for small bowel obstruction (SBO). SBO is commonly caused by mechanical obstruction due to adhesions, inflammatory conditions, or malignancies. Hypothyroidism is primarily associated with decreased basal metabolic rate and rarely, in severe cases, gastrointestinal motility dysfunction. We report a case of a 44-year-old man who presented to the emergency department with abdominal pain, nausea, and vomiting. The workup, including computed tomography, showed a small bowel feces sign, highly suspicious for a mechanical SBO. His past medical history was significant for a poorly controlled hypothyroidism due to Hashimoto's thyroiditis with a markedly elevated thyroid stimulating hormone (TSH) level. He had no prior surgical history, and his family history was significant for a suspected inflammatory bowel disease (IBD) in his son. The patient failed initial resuscitative nonoperative management and underwent exploratory laparoscopy that revealed diffusely dilated small bowel loops with no obvious cause of mechanical obstruction. Inflammatory markers for IBD were found to be negative, and the patient's gastrointestinal motility gradually improved with daily intravenous levothyroxine.
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Affiliation(s)
- Kacper Kubiszewski
- Medical School, University of Central Florida College of Medicine, Orlando, USA
| | - Rachel W Chapman
- Medical School, University of Central Florida College of Medicine, Orlando, USA
| | - Yelena Piazza
- Pathology, University of Central Florida College of Medicine, Orlando, USA
- Pathology, UCF-Lake Nona Hospital, Orlando, USA
| | - Dhruv Patel
- Radiology, University of Central Florida College of Medicine, Orlando, USA
- Radiology, UCF-Lake Nona Hospital, Orlando, USA
| | - Vladimir Neychev
- Surgery, University of Central Florida College of Medicine, Orlando, USA
- Surgery, UCF-Lake Nona Hospital, Orlando, USA
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Terzian WTH, Appelbaum RD, Raposo-Hadley A, Tablazon ILD, Duy LAN, Chen MY, Dyer RB, Miller PR, Mowery NT. Successful Non-Operative Management of Adhesive Small Bowel Obstruction: Is it Really a Success? Am Surg 2023; 89:5304-5311. [PMID: 36537729 DOI: 10.1177/00031348221146973] [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] [Indexed: 12/22/2023]
Abstract
BACKGROUND In adhesive small bowel obstructions (ASBOs), literature has shown that passage of a water-soluble contrast challenge at either 8 hours or 24 hours is predictive of successful non-operative management (NOM) for an ASBO, but the long-term outcomes between these two groups are unknown. We hypothesized that patients who require longer transit times to the colon have a higher one-year recidivism of ASBO. METHODS This was a 4-year review of patients with presumed ASBO undergoing successful NOM. Those requiring operation or those with an SBO due to something other than adhesions were excluded. Patients were divided into two groups (8 hour and 24 hour) based on when contrast reached their right colon. Patients were followed for one year to determine ASBO recurrence. RESULTS 137 patients underwent NOM; 112 in the 8-hour group and 25 in the 24-hour group. One-year recurrence rate was 21.4% in the 8-hour group and 40% in the 24-hour group (P = 0.05). The median time to recurrence was 113 days in the 8-hour group and 13 days in the 24-hour group (P = 0.02). Of those who recurred in the 24-hour group, 60% recurred within 30 days (P = 0.01). On univariable analysis, first-time ASBO and 24-hour transit time were risk factors for recurrence. CONCLUSIONS Adhesive small bowel obstruction patients undergoing NOM in the 24-hour group had a recurrence rate nearly twice that of patients in the 8-hour group and may benefit from an operative exploration during the index hospitalization at the 8-hour mark of a water-soluble contrast challenge, especially if experiencing a first-time ASBO.
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Affiliation(s)
- W T Hillman Terzian
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Rachel D Appelbaum
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | - Lindsay A N Duy
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael Y Chen
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Raymond B Dyer
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Preston R Miller
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Nathan T Mowery
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Oh S, Ryu J, Shin HJ, Song JH, Son SY, Hur H, Han SU. Deep learning using computed tomography to identify high-risk patients for acute small bowel obstruction: development and validation of a prediction model : a retrospective cohort study. Int J Surg 2023; 109:4091-4100. [PMID: 37720936 PMCID: PMC10720875 DOI: 10.1097/js9.0000000000000721] [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: 04/03/2023] [Accepted: 08/19/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE To build a novel classifier using an optimized 3D-convolutional neural network for predicting high-grade small bowel obstruction (HGSBO). SUMMARY BACKGROUND DATA Acute SBO is one of the most common acute abdominal diseases requiring urgent surgery. While artificial intelligence and abdominal computed tomography (CT) have been used to determine surgical treatment, differentiating normal cases, HGSBO requiring emergency surgery, and low-grade SBO (LGSBO) or paralytic ileus is difficult. METHODS A deep learning classifier was used to predict high-risk acute SBO patients using CT images at a tertiary hospital. Images from three groups of subjects (normal, nonsurgical, and surgical) were extracted; the dataset used in the study included 578 cases from 250 normal subjects, with 209 HGSBO and 119 LGSBO patients; over 38 000 CT images were used. Data were analyzed from 1 June 2022 to 5 February 2023. The classification performance was assessed based on accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve. RESULTS After fivefold cross-validation, the WideResNet classifier using dual-branch architecture with depth retention pooling achieved an accuracy of 72.6%, an area under receiver operating characteristic of 0.90, a sensitivity of 72.6%, a specificity of 86.3%, a positive predictive value of 74.1%, and a negative predictive value of 86.6% on all the test sets. CONCLUSIONS These results show the satisfactory performance of the deep learning classifier in predicting HGSBO compared to the previous machine learning model. The novel 3D classifier with dual-branch architecture and depth retention pooling based on artificial intelligence algorithms could be a reliable screening and decision-support tool for high-risk patients with SBO.
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Affiliation(s)
- Seungmin Oh
- Department of Artificial Intelligence, Ajou University, Suwon, South Korea
| | - Jongbin Ryu
- Department of Artificial Intelligence, Ajou University, Suwon, South Korea
- Department of Software and Computer Engineering, Ajou University, Suwon, South Korea
| | - Ho-Jung Shin
- Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Jeong Ho Song
- Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Sang-Yong Son
- Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Hoon Hur
- Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Sang-Uk Han
- Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
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Nguyen MT, Pham AV. Early small bowel obstruction as a complication of abdominal drain in colon cancer surgery: a case report and literature review. Ann Med Surg (Lond) 2023; 85:5804-5808. [PMID: 37915704 PMCID: PMC10617939 DOI: 10.1097/ms9.0000000000001369] [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: 08/07/2023] [Accepted: 09/21/2023] [Indexed: 11/03/2023] Open
Abstract
Introduction Early postoperative small bowel obstruction (EPSBO) is an obstruction that occurs within 4 weeks after the initial surgery. Routine prophylactic abdominal drainage does not provide any benefit in colon cancer surgery. The cause of EPSBO due to the abdominal drainage tube is infrequent. Case presentation A 72-year-old male patient was diagnosed with sigmoid carcinoma and underwent laparoscopic left colectomy. A surgical drain was placed in the pouch of Douglas through the incision of the right iliac fossa trocar site. On the fourth day, he began to flatus, and the abdominal pain decreased. However, on the ninth day after surgery, the patient had more abdominal pain, could not pass gas and defecate, and the abdomen was more distended. An abdominal computed tomography (CT) scan showed a dilated loop of the small intestine above the transition site with a drainage sonde and no dilation of the loop below the sonde. The patient was indicated to remove the sonde. He could pass gas and defecate the next day again and was relieved of the abdominal distention. Discussion Once an EPSBO is considered, it is essential to think of the bowel obstruction caused by the drainage tube in the case of abdominal drainage. It is necessary to have a contrast CT scan to examine. Conclusion EPSBO due to intra-abdominal drainage is a rare condition that presents a challenge in diagnosis and treatment. Diagnosis usually begins on the fourth postoperative day, mainly in operations in the lower transverse mesentery, including drainage placement after laparoscopic surgery.
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Affiliation(s)
- Minh Thao Nguyen
- Anatomy and Surgical Training Department, Hue University of Medicine and Pharmacy
- Department of Gastrointestinal Surgery, Hue University of Medicine and Pharmacy Hospital, Hue University of Medicine and Pharmacy
| | - Anh Vu Pham
- Department of Gastrointestinal Surgery, Hue University of Medicine and Pharmacy Hospital, Hue University of Medicine and Pharmacy
- Department of Surgery, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
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Sugimori H, Masaki S, Honjo H, Kudo M, Watanabe T. Visualization of Gastrointestinal Bezoar Movement Causing and Releasing Small Bowel Obstruction on Computed Tomography in a Patient With Diabetes Mellitus. Cureus 2023; 15:e49133. [PMID: 38130514 PMCID: PMC10733117 DOI: 10.7759/cureus.49133] [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] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Although delayed gastric emptying promotes gastrointestinal bezoar formation in patients with diabetes mellitus (DM), the association between movement of gastrointestinal bezoars and glycemic status remains unclear. We report a case of small bowel obstruction (SBO) caused by impaction of the migrated gastric bezoar into the small bowel in a patient with DM. Correction of hyperglycemia and lactic acidosis led to normalization of gastrointestinal motility, followed by expulsion of the impacted bezoar and resolution of SBO. This case suggests a link between hyperglycemia, metabolic acidosis, and gastrointestinal motility based on visualization of gastrointestinal bezoar movement in the gastrointestinal tract using computed tomography.
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Affiliation(s)
- Hironobu Sugimori
- Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, JPN
| | - Sho Masaki
- Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, JPN
| | - Hajime Honjo
- Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, JPN
| | - Masatoshi Kudo
- Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, JPN
| | - Tomohiro Watanabe
- Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, JPN
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45
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Hulf T, Ben-David M. Small bowel obstruction caused by a mango phytobezoar within a Meckel's diverticulum. J Surg Case Rep 2023; 2023:rjad613. [PMID: 37965537 PMCID: PMC10641289 DOI: 10.1093/jscr/rjad613] [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: 09/27/2023] [Accepted: 10/15/2023] [Indexed: 11/16/2023] Open
Abstract
A fit and well gentleman in his 40s presented with vomiting and obstipation. His only relevant history being recent ingestion of a large quantity of mangoes. A computer tomography demonstrated a small bowel obstruction with a transition point in the right iliac fossa, but no other pathological findings. After a short period of non-operative management he proceeded to surgery, where a phytobezoar was identified at a Meckel's diverticulum causing a pantaloon shaped intra-luminal obstruction. A small bowel resection and primary anastomosis was performed and the patient had an uncomplicated post-operative course. Meckel's diverticuli are a relatively common phenomenon and may pre-dispose to bowel obstructions through a number of different mechanisms. This unusual case highlights the importance of considering this as a differential, and one that will likely require timely operative intervention.
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Affiliation(s)
- Toby Hulf
- Department of Surgery, Western Health, 160 Gordon Street, Footscray, VIC 3011, Australia
| | - Matan Ben-David
- Department of Surgery, Townsville University Hospital, 100 Angus Smith Dr, Douglas, QLD 4814, Australia
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46
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Beyene A, Bayissa B, Atalele M, Umer H, Alemu A, Semahegn A. Pneumatosis cystoids intestinalis in a patient with small bowel obstruction: a case report. J Surg Case Rep 2023; 2023:rjad612. [PMID: 38026738 PMCID: PMC10653986 DOI: 10.1093/jscr/rjad612] [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: 09/29/2023] [Accepted: 10/15/2023] [Indexed: 12/01/2023] Open
Abstract
Pneumatosis cystoides intestinalis is a rare and usually benign condition in which multiple thin-walled cysts develop in the submucosa or subserosa of the gastrointestinal tract. While usually asymptomatic, severe cases can result in pneumoperitoneum, which can be managed surgically or medically depending on circumstances. A 35-year-old male patient presented with signs and symptoms of intestinal obstruction. Then the patient was diagnosed with pneumatosis cystoides intestinalis. The patient underwent surgery, and antibiotic treatment, and was discharged improved with no incident. Pneumatosis cystoides intestinalis is a surgical condition that resembles other life-threatening top surgical emergencies and affects clinicians' decisions on diagnosis and treatment plans substantially, mainly in low-income countries. So, surgeons have to consider such kind of conditions and avoid the costs and morbidities associated with unnecessary bowel resection or surgery.
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Affiliation(s)
- Andinet Beyene
- Department of Surgery, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
| | - Badhaasaa Bayissa
- Department of Surgery, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
| | - Mezgebu Atalele
- Department of Surgery, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
| | - Hamza Umer
- Department of Surgery, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
| | - Addisu Alemu
- Department of Pathology, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
| | - Agumasie Semahegn
- College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, P.O. Box LG 586, Accra, Ghana
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Tan S, Maniar Y, Pacheco TBS, Spentzouris G, Malhotra A, Kella V. Unique multidisciplinary approach in a patient with small bowel obstruction and chronic mesenteric ischemia. J Surg Case Rep 2023; 2023:rjad577. [PMID: 37873044 PMCID: PMC10590653 DOI: 10.1093/jscr/rjad577] [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: 08/14/2023] [Accepted: 10/05/2023] [Indexed: 10/25/2023] Open
Abstract
Management of small bowel obstruction (SBO) in patients with symptomatic chronic mesenteric ischemia is a phenomenon that has not been previously described in the literature. This is an index case report describing the utilization of a multidisciplinary approach in a patient that suffered from SBO from cecal perforation with history of chronic mesenteric ischemia attributed to superior mesenteric artery (SMA) and celiac trunk stenosis. The patient was a 70-year-old female with recent diagnosis of ischemic colitis and chronic mesenteric ischemia, found to have high-grade SBO with transition point in the right lower quadrant. Computerized tomography angiogram showed occluded SMA, and severe celiac artery stenosis. Interventional radiology revascularized the celiac trunk with stent placement prior to right hemicolectomy for management of her high-grade SBO. Prospective research should ascertain whether revascularization indeed leads to improved post-operative outcomes.
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Affiliation(s)
- Sally Tan
- Department of Surgery, NYU Grossman Long Island School of Medicine, Mineola 11501, United States
| | - Yesha Maniar
- Department of Surgery, NYU Grossman Long Island School of Medicine, Mineola 11501, United States
| | - Tulio B S Pacheco
- Department of Surgery, NYU Grossman Long Island School of Medicine, Mineola 11501, United States
| | - Georgios Spentzouris
- Department of Surgery, NYU Grossman Long Island School of Medicine, Mineola 11501, United States
| | - Anuj Malhotra
- Department of Interventional Radiology, NYU Grossman Long Island School of Medicine, Mineola 11501, United States
| | - Venkata Kella
- Department of Surgery, NYU Grossman Long Island School of Medicine, Mineola 11501, United States
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Elkomos BE, Fahmy K, Kamel KA. Laparoscopic adhesiolysis versus open adhesiolysis in acute adhesive small bowel obstruction. J Minim Access Surg 2023; 19:511-517. [PMID: 37357493 PMCID: PMC10695316 DOI: 10.4103/jmas.jmas_43_23] [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: 02/09/2023] [Revised: 03/11/2023] [Accepted: 04/07/2023] [Indexed: 06/27/2023] Open
Abstract
Introduction Exploratory laparotomy is still the standard therapy for patients who need surgical intervention for adhesive small bowel obstruction (SBO). However, the use of laparoscopy in the management of adhesive SBO is still controversial. We aimed to detect the short-term outcomes between open and laparoscopic adhesiolysis for SBO. Patients and Methods This is a retrospective study of patients with adhesive SBO who underwent either laparoscopic or open surgery from June 2019 to July 2022 at Ain Shams University Hospitals. Intraoperative and early post-operative outcomes were compared in the two groups. Results A total of 89 patients with adhesive SBO were included in our study. Fifty-one cases underwent open adhesiolysis and 38 cases underwent laparoscopic adhesiolysis. Laparoscopic adhesiolysis is associated with a remarkable decrease in the operative time (71 min vs. 107 min, P = 0.001) and blood loss (50 ml vs. 120 ml, P = 0.001) in comparison to open adhesiolysis. In addition to that, those who underwent adhesiolysis by laparoscopy had a short hospital stay (2.4 days vs. 3.8 days, P = 0.001), early recovery (time to pass flatus 1.3 days vs. 2.8 days) and less post-operative complications (surgical site infection [SSI] 2.6% vs. 19.6%, P = 0.001). Moreover, open adhesiolysis is associated with a higher rate of early post-operative mortality. In addition to that, the incidence of iatrogenic injury was higher in the open group. Conclusion Laparoscopic adhesiolysis is a safe and feasible approach for the management of SBO and has better short-term outcomes, especially if done by skilled surgeons in advanced laparoscopic techniques.
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Affiliation(s)
| | - Karim Fahmy
- Department of General Surgery, Ain Shams University Hospital, Cairo, Egypt
| | - Kareem Ahmed Kamel
- Department of General Surgery, Ain Shams University Hospital, Cairo, Egypt
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Lin X, Lu J, Fitzgerald J. Surgical Drain-Related Small Bowel Obstruction After Open Radical Cystoprostatectomy: A Case Report. Cureus 2023; 15:e46368. [PMID: 37920634 PMCID: PMC10619705 DOI: 10.7759/cureus.46368] [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] [Accepted: 10/02/2023] [Indexed: 11/04/2023] Open
Abstract
Surgical drains are commonly used to manage intraperitoneal fluid after major surgeries, but their prophylactic use has been controversial due to potential complications. One rarely reported complication is small bowel obstruction (SBO), primarily seen in post-colorectal surgeries. We present a case of SBO following open radical cystectomy due to surgical drain placement, a complication not previously reported in urologic surgeries. The case highlights the importance of considering the risks and benefits of prophylactic drain placement. It emphasizes the need for a higher index of suspicion for SBO in patients with surgical drains who develop post-operative nausea and distention. Timely radiological imaging and clinical examination are crucial for accurate diagnosis and proper treatment.
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Affiliation(s)
- Xin Lin
- Urology, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, USA
| | - Jennifer Lu
- Urology, School of Medicine, Stony Brook University, Stony Brook, USA
| | - John Fitzgerald
- Urology, School of Medicine, Stony Brook University, Stony Brook, USA
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Jin L, Naidu K. When you hear hoofbeats, think horses before zebras - a case of recurrent small bowel obstructions with a twist. J Surg Case Rep 2023; 2023:rjad555. [PMID: 37846413 PMCID: PMC10576990 DOI: 10.1093/jscr/rjad555] [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: 08/24/2023] [Accepted: 09/21/2023] [Indexed: 10/18/2023] Open
Abstract
Mechanical small bowel obstructions (SBOs) account for a considerable proportion of hospital admissions for acute abdominal pain. SBOs are most frequently caused by adhesions; and very few SBOs are associated with intraperitoneal devices. An 84-year-old man was admitted to our tertiary institution with recurrent SBOs that were initially believed to be caused by his implantable cardioverter defibrillator which had undergone intraperitoneal migration. However, this was later found to be a misguided 'zebra'; as the cause was revealed to be a common 'horse' - adhesions. This article shares our key learnings from this diagnostic dilemma.
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Affiliation(s)
- LongHai Jin
- Department of General Surgery, The Canberra Hospital, Garran, ACT 2605, Australia
| | - Krishanth Naidu
- Department of General Surgery, The Canberra Hospital, Garran, ACT 2605, Australia
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