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Ali AM, Mohamed YG, Mohamed AN, Güler İ. Etiology, Clinical Manifestations, and Imaging Evaluation of Intestinal Obstruction in Adults at Tertiary Hospital in Mogadishu, Somalia: A Retrospective Study. Int J Gen Med 2024; 17:5563-5572. [PMID: 39628981 PMCID: PMC11611986 DOI: 10.2147/ijgm.s472935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Accepted: 11/22/2024] [Indexed: 12/06/2024] Open
Abstract
Background Intestinal obstruction (IO) is a surgical emergency with high morbidity and mortality. The leading causes in adults include adhesions, incarcerated hernias, and tumors. Methods This three-year retrospective study reviewed adult patients with IO treated at Mogadishu Somalia Turkey Training and Research Hospital from June 1, 2019, to June 1, 2022. Results Of the patients studied, 67% were male, with a male-to-female ratio of 2:1. The most common symptoms were nausea and vomiting (93.2%), abdominal distension (90.2%), and inability to pass stool or gas (70.8%). Surgical management was required for 95.1% of patients, with only 4.9% managed conservatively. The most frequent postoperative complication was surgical site infection. Hospital stays for 52% of patients ranged from 8 to 14 days. The overall mortality rate was 4.9%. Discussion IO remains a critical surgical emergency worldwide, requiring urgent intervention. Aggressive treatment of hernias and timely surgical intervention for mechanical obstruction are essential to reduce complications and mortality. Delayed presentations contribute to higher mortality rates. Conclusion Small bowel obstruction was more frequent than large bowel obstruction, with fibrous adhesions and incarcerated hernias as the leading causes. Adhesiolysis and bowel resection with anastomosis were the most common surgical procedures. Further research using prospective study designs is recommended to improve understanding and outcomes.
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Affiliation(s)
- Abdihamid Mohamed Ali
- Department of General Surgery, Mogadishu Somali Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia
| | - Yahye Garad Mohamed
- Department of Radiology, Mogadishu Somali Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia
| | - Abdulkadir Nor Mohamed
- Department of General Surgery, Mogadishu Somali Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia
| | - İlkay Güler
- Department of General Directorate of Public Hospitals, Republic of Turkey, Ministry of Health, Ankara, Turkey
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Alsaiari A. Metastatic Urothelial Cancer Presenting as Small Bowel Obstruction: A Case Report. Cureus 2024; 16:e61228. [PMID: 38939301 PMCID: PMC11210193 DOI: 10.7759/cureus.61228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2024] [Indexed: 06/29/2024] Open
Abstract
Neoplasms are among the common causes of small bowel obstruction (SBO). Metastatic disease is the most common cause of neoplastic SBO and is most commonly the result of colon, ovarian, pancreatic, and gastric neoplasms. Metastatic SBO secondary to metastatic urothelial carcinoma is exceedingly rare, with only a few cases described in the literature. It is important for physicians to be aware of urothelial carcinoma as a potential etiology of SBO.
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Affiliation(s)
- Ahmed Alsaiari
- Department of Internal Medicine, University of Jeddah, Jeddah, SAU
- Department of Gastroenterology, MedStar Georgetown University Hospital, Washington, USA
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Wang H, Zhang JR, Tu PS, Chen WX, Chen S, Chen QF, Weng ZQ, Shang-Guan XC, Lin BQ, Chen XQ. Comparison of the effect between traditional conservation and nasointestinal tube placement in adhesive small bowel obstruction: A matched case-control study. Asian J Surg 2024; 47:2168-2177. [PMID: 38461140 DOI: 10.1016/j.asjsur.2024.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/09/2023] [Accepted: 02/02/2024] [Indexed: 03/11/2024] Open
Abstract
Adhesive small bowel obstruction (ASBO) causes a major burden in emergency medicine. Owing to in situ decompression, nasointestinal tube (NIT) placement has been increasingly used in clinical practice compared with traditional conservation (TC); however, the indications remain controversial. This study was designed to explore the indications for each treatment in ASBOs and then suggest the optimal strategy. After propensity score matching, 128 pairs were included (the NIT and TC groups). The occurrence of severe adverse events (SAEs), peri-treatment clinical parameters, and radiological features were compared between the successful and failed treatment groups. According to different stages of the entire treatment, the independent risk factors for adverse effects for ASBO were analysed in phase I and phase II. In phase I, normal red blood cells (RBC) levels (p = 0.011) and a balanced sodium ion level (p = 0.016) positively affected the outcomes of TC treatment. In phase II, for the TC group, the successful treatment rate reached 79.5% for patients with ASBOs whose normal RBC levels (p = 0.006) or decreasing white blood cells (WBC) levels (p = 0.014) after treatment. For the NIT group, the treatment success rate was 68.1% for patients whose electrolyte imbalance could be reversed or whose neutrophil count/lymphocyte ratio (NLR) levels was lower than 4.3 (p = 0.018). TC treatment is highly recommended for patients with normal RBC counts and sodium levels pretreatment. After dynamic monitoring of the treatment process, for both the TC and NIT groups, once ASBOs had elevated inflammatory biomarkers or irreversible electrolyte disturbances, surgical interference was preferred.
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Affiliation(s)
- Hui Wang
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Jun-Rong Zhang
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Peng-Sheng Tu
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Wen-Xuan Chen
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Shuai Chen
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Qing-Feng Chen
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Zong-Qi Weng
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Xin-Chang Shang-Guan
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Bing-Qiang Lin
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Xian-Qiang Chen
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
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Lohani R, Mathur P. Intestinal obstruction caused by encircling fallopian tube. BMJ Case Rep 2021; 14:e242530. [PMID: 34433526 PMCID: PMC8388300 DOI: 10.1136/bcr-2021-242530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2021] [Indexed: 11/03/2022] Open
Abstract
A 50-year-old woman was admitted to our emergency surgery department with 1-week history of abdominal pain, distension, vomiting and constipation. On examination, she has a distended abdomen with sluggish bowel sounds, but no clinical signs of peritonitis. Blood tests were normal except for the increased white cell count and erythrocyte sedimentation rate (ESR). CT scan with oral as well as intravenous contrast demonstrated the small bowel obstruction without any insight into the aetiology of the disease. Intraoperatively, the right fallopian tube was found to encircle the terminal ileum. A right salpingo-oophorectomy was performed to release the bowel. This case report describes a rare cause of the small bowel obstruction in female patients.
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Affiliation(s)
- Ravi Lohani
- Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Poorvi Mathur
- Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
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5
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Kim J, Lee Y, Yoon JH, Lee HJ, Lim YJ, Yi J, Jung WB. Non-strangulated adhesive small bowel obstruction: CT findings predicting outcome of conservative treatment. Eur Radiol 2020; 31:1597-1607. [PMID: 33128599 DOI: 10.1007/s00330-020-07406-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/24/2020] [Accepted: 10/09/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To clarify CT findings that predict outcome of conservative treatment in patients with non-strangulated adhesive small bowel obstruction (SBO). METHODS Unenhanced and contrast-enhanced abdominopelvic CT studies in 189 patients with adhesive SBO who had initial conservative treatment were reviewed. The CT findings included transition zone, beak signs, maximum bowel diameter, bowel diameter ratio, decreased bowel wall enhancement, increased unenhanced bowel wall attenuation, anterior parietal adhesion, bowel wall thickening, closed-loop obstruction, small bowel feces sign, whirl sign, mesenteric haziness, mesenteric, peritoneal fluid, and submucosal edema. These findings were statistically compared according to the success or failure of treatment. RESULTS Conservative treatment succeeded in 144 patients (76.2%) and failed in 45 patients (23.8%). At multivariate analysis, the lack of small bowel feces sign, focal, diffuse mesenteric haziness, and moderate amount of mesenteric fluid were independent findings predicting failure of conservative treatment, with odds ratios of 5.23, 5.5, 13.55, and 4.89, respectively. The presence of all significant findings showed a high specificity of 97.2% with positive likelihood ratio of 8.8. If CT scans showed none of the three significant findings, the negative predictive value was 97.6% and negative likelihood ratio was 0.08. CONCLUSIONS The lack of small bowel feces sign, focal, diffuse mesenteric haziness, and moderate amount of mesenteric fluid are independent CT findings predicting the failure of conservative treatment in patients with non-strangulated adhesive SBO. The combination of all CT findings suggests the need for surgery; absence of two or all CT findings should suggest an attempt for conservative treatment. KEY POINTS • To minimize delayed operation, it is important to identify non-strangulated adhesive small bowel obstruction patients in whom initial conservative treatment is likely to fail. • The lack of small bowel feces sign, the presence of mesenteric haziness, and a moderate amount of mesenteric fluid are independent factors predicting the failure of conservative treatment in patients with non-strangulated adhesive small bowel obstruction. • The combination of all three CT findings suggests the need for surgery; absence of two or all three CT findings should suggest an attempt for conservative treatment.
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Affiliation(s)
- Jieun Kim
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, 48108, South Korea.,Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yedaun Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, 48108, South Korea.
| | - Jung-Hee Yoon
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, 48108, South Korea
| | - Ho-Joon Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, 48108, South Korea
| | - Yun-Jung Lim
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, 48108, South Korea
| | - Jisook Yi
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, 48108, South Korea
| | - Won Beom Jung
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
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Vassiliu P, Ntella V, Theodoroleas G, Mantanis Z, Pentara I, Papoutsi E, Mastoraki A, Arkadopoulos N. Successful management of adhesion related small bowel ischemia without intestinal resection: A case report and review of literature. World J Gastrointest Pathophysiol 2019; 10:29-35. [PMID: 31559107 PMCID: PMC6751506 DOI: 10.4291/wjgp.v10.i2.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/16/2019] [Accepted: 08/21/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Intraabdominal adhesions develop spontaneously or after an inflammatory process or surgical procedure in the abdomen. They are the most common cause of small bowel obstruction (SBO). SBO occasionally leads to intestinal ischemia (InIs) which can be a life-threatening condition that requires management as soon as possible. We herein report a case of SBO with InIs presented in our institution and treated without intestinal resection.
CASE SUMMARY A 34-year-old man presented at the emergency department after a 12-h-onset diffuse abdominal pain, bloating and nausea. He had a history of traumatic right hepatectomy 11 years ago as well as adhesiolysis and resection of a long part of small bowel 2 years ago. An abdominal computed tomography (CT) showed dilated loops that led to the diagnosis of SBO. Due to deteriorating lactic acidosis, the patient was operated. Torsion of the small bowel around an adhesion led to 2.30 m of ischemic ileum. After the application of N/S 40 °C for 20 min, the intestine showed signs of improvement and it was decided to avoid resection and instead temporary close the abdomen with vacuum-pack technique. At the second-look laparotomy 48 h later, the intestine appeared normal. The patient was discharged on the 8th post-op day in excellent condition.
CONCLUSION In case of SBO caused by adhesions, extreme caution is needed if InIs is present, as the clinical signs are mild and you should rely for diagnosis in CT findings and lactate levels. Conservative surgical approach could reverse the effects of InIs, if performed quickly, so that intestinal resection is avoided and should be used even when minimum signs of viability are present.
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Affiliation(s)
- Pantelis Vassiliu
- 4th Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens 12462, Greece
| | - Vasiliki Ntella
- 4th Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens 12462, Greece
| | - George Theodoroleas
- 4th Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens 12462, Greece
| | - Zisis Mantanis
- 4th Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens 12462, Greece
| | - Ioanna Pentara
- 4th Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens 12462, Greece
| | - Eleni Papoutsi
- 4th Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens 12462, Greece
| | - Aikaterini Mastoraki
- 4th Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens 12462, Greece
| | - Nikolaos Arkadopoulos
- 4th Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens 12462, Greece
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Jiang W, Li W, Hao Q, Yao Y, Li Y, Ge J, Zhai H. Etiologic Spectrum of Intestinal Obstruction in Ningxia District: A Retrospective Analysis of 4908 Cases in a 10-Year Period. Gastroenterol Res Pract 2019; 2019:4935947. [PMID: 31346331 PMCID: PMC6617931 DOI: 10.1155/2019/4935947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/05/2019] [Accepted: 06/07/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Economic disparity contributes to the variation of intestinal obstruction (IO) etiologic spectrum. Clarifying the etiology distribution in local regions can help to unravel IO and promote early diagnosis, henceforth making sure standardized therapeutic interventions. METHODS Medical data of 4908 inpatients diagnosed with IO admitted to the General Hospital of Ningxia Medical University between January 2004 and December 2013 were recruited and analyzed retrospectively. The associated profiles included demographic features, clinical manifestations, and previous therapeutic operations. RESULTS 4908 cases of intestinal obstruction were identified during the period of study. It denoted that the hospitalization rate of IO has maintained upward momentum; the top four causes of IO were adhesion, tumor, intussusception, and hernias. These covered up nearly 80% of the total constitution. Among them, adhesive intestinal obstruction accounted for 45.17%, malignant bowel obstruction for 21.09%, intussusception for 8.72%, and hernia for 4.73%; abdominal surgery constituted for the majority (78.62%) of adhesive obstruction. The followed up analysis also found that appendectomy accounted for the biggest percentage, 28% of operation cases. Malignant bowel obstruction can have a rate of 96.43% in 1035 cases led by tumor lesions. Of which, the primary intestinal malignant tumor accounted for 68.64% and metastatic tumors for 31.36%. Nearly 50% occurred in the large intestine. The overall mortality of all 4908 cases was 4.7%. CONCLUSION The hospitalizations of IO delineated an increasing trend. Adhesion was the main etiology in IO. The odds of malignant bowel obstruction was increasing in the proportion of IO. There were some differences towards the etiologic spectrum compared with western countries.
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Affiliation(s)
- Wei Jiang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
- Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing 100050, China
- National Clinical Research Center for Digestive Diseases, Beijing 100050, China
| | - Wenyan Li
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
- Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing 100050, China
- National Clinical Research Center for Digestive Diseases, Beijing 100050, China
| | - Qian Hao
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
- Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing 100050, China
- National Clinical Research Center for Digestive Diseases, Beijing 100050, China
| | - Yuping Yao
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
- Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing 100050, China
- National Clinical Research Center for Digestive Diseases, Beijing 100050, China
| | - Yajun Li
- Department of Digestive Diseases, General Hospital of Ningxia Medical University, Yinchuan 750004, China
| | - Jun Ge
- Ningxia Medical University, Yinchuan, 750004 Ningxia Hui Autonomous Region, China
| | - Huihong Zhai
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
- Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing 100050, China
- National Clinical Research Center for Digestive Diseases, Beijing 100050, China
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Farkas NG, Welman TJP, Ross T, Brown S, Smith JJ, Pawa N. Unusual causes of large bowel obstruction. Curr Probl Surg 2018; 56:49-90. [PMID: 30777150 DOI: 10.1067/j.cpsurg.2018.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 12/10/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Nicholas G Farkas
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
| | - Ted Joseph P Welman
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Talisa Ross
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Sarah Brown
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Jason J Smith
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Nikhil Pawa
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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Kamat M, Singh N, Nattey K. A rare encounter of obstructed direct inguinal hernia of sliding variety. Int J Surg Case Rep 2018; 49:209-214. [PMID: 30031240 PMCID: PMC6076353 DOI: 10.1016/j.ijscr.2018.06.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 06/19/2018] [Accepted: 06/22/2018] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Direct Obstructed inguinal hernias of sliding variety with bladder as its content is extremely rare. CASE REPORT We report the case of an 83-year-old male known case of DM, presented with irreducible and painful swelling over the right inguinal region and cough impulse on right inguinal region. On exploration of the right side, the obstructed hernia was found to be a direct type sliding hernia with sac wall forming anterior covering layer and containing congested small bowel loops (ileum) and bladder forming the medial wall of the hernia sac. After gaining viability the content was reduced, posterior wall defect was closed and Lichtenstein tension free repair was done. CONCLUSION Direct inguinal hernia of sliding variety getting obstructed is rare. Direct Sliding hernia on right side with ileum as content and bladder forming the wall is extremely rare.
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Affiliation(s)
- Manmohan Kamat
- Nanavati Superspeciality Hospital, Mumbai, Maharashtra, India.
| | | | - Kartik Nattey
- Nanavati Superspeciality Hospital, Mumbai, Maharashtra, India.
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Bhandari TR, Shahi S, Gautam M, Pandey S. A rare case report of patent vitellointestinal duct causing bowel obstruction in an adult. Int J Surg Case Rep 2017; 39:231-234. [PMID: 28858741 PMCID: PMC5581374 DOI: 10.1016/j.ijscr.2017.08.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/12/2017] [Accepted: 08/13/2017] [Indexed: 11/17/2022] Open
Abstract
Patent vitellointestinal duct is very rare congenital condition. We report an unusual case of patent vitellointestinal duct causing intestinal obstruction in adult patient. Awareness of this a rare cause of bowel obstruction is important for appropriate management. Introduction Patent vitellointestinal duct occurs in about 2% of the population which unusually leads to small intestinal obstruction associated with high morbidity and mortality. Here we are reporting an unusual case of patent vitellointestinal duct causing small intestinal obstruction in an adult patient. Presentation of case A 22-year-old male without any medical illness presented as an emergency with a 3 day hystory of abdominal pain, multiple episode of vomiting and abdominal distention. Distended abdomen and sign of peritonitis were found on abdominal examination. Abdominal X-rays revealed multiple small intestinal air-fluid levels. A patent vitellointestinal duct extending from distal ileum to the posterior wall of the umbilicus was found causing closed loop ileal obstruction during laparotomy. Resection of a vitellointestinal duct along with gangrenous distal ileum and cecum with ileocolostomy was performed. He was discharged on the 8 th postoperative day. Discussion Diagnosing and management of cause of intestinal obstruction in patients without history of abdominal surgery is very challenging. Early resuscitation and timely surgical intervention of intestinal obstruction due to a rare patent vitellointestinal duct can be life-saving measure. Conclusion The patent vitellointestinal duct is an uncommon entity in adults and moreover this disorder leading to intestinal obstruction is very rare. Surgeons should be aware of this infrequent cause of small bowel obstruction to allow for early diagnosis and to facilitate better patient outcomes.
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Affiliation(s)
- Tika Ram Bhandari
- Department of General Surgery, Universal College of Medical Sciences, Bhairahawa 32900, Nepal.
| | - Sudha Shahi
- Department of ENT, National Academy of Medical Sciences, Kathmandu 44600, Nepal.
| | - Manish Gautam
- Department of General Surgery, Universal College of Medical Sciences, Bhairahawa 32900, Nepal.
| | - Sanjay Pandey
- Department of General Surgery, Universal College of Medical Sciences, Bhairahawa 32900, Nepal.
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Hajibandeh S, Hajibandeh S, Panda N, Khan RMA, Bandyopadhyay SK, Dalmia S, Malik S, Huq Z, Mansour M. Operative versus non-operative management of adhesive small bowel obstruction: A systematic review and meta-analysis. Int J Surg 2017; 45:58-66. [PMID: 28728984 DOI: 10.1016/j.ijsu.2017.07.073] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/08/2017] [Accepted: 07/15/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To investigate outcomes of operative and non-operative management of adhesive small bowel obstruction (SBO). METHODS We performed a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards. We conducted a search of electronic information sources to identify all randomised controlled trials (RCTs) and observational studies investigating outcomes of operative versus non-operative management of patients with adhesive SBO. We used the Cochrane risk of bias tool and the Newcastle-Ottawa scale to assess the risk of bias of RCTs and observational studies, respectively. Fixed-effect or random-effects models were applied to calculate pooled outcome data. RESULTS We found one RCT, two prospective and three retrospective observational studies, enrolling a total of 876 patients. The analyses showed that operative management of adhesive SBO was associated with a lower risk of future recurrence [odds ratio (OR) 0.54, 95% confidence interval (CI) 0.38-0.76, P = 0.0005] but a higher risk of mortality [risk difference (RD) 0.03, 95% CI 0.01-0.06, P = 0.01] and complications (OR 5.39, 95% CI 2.97-9.78, P < 0.00001). There was no difference in need for surgical re-intervention rate (OR 0.72, 95% CI 0.35-1.47, P = 0.36) and length of stay [mean difference (MD) 5.07, 95% CI -2.36-12.49, P = 1.0] between operative and non-operative managements. The baseline suspicion of strangulation was a major confounding factor. When the baseline suspicion of strangulation was higher in the operative group, the risk of mortality (RD 0.04, 95% CI 0.02-0.07, P = 0.0006) and complications (OR 8.14, 95% CI 4.16-15.94, P = 0.00001) were higher in the operative group but the risk of recurrence was lower (OR 0.62, 95% CI 0.43-0.90, P = 0.01). When the baseline suspicion of strangulation was low in both groups, there was no difference in any of the outcomes except recurrence (OR 0.09, 95% CI 0.02-0.37, P = 0.0009) which was lower in the operative group. CONCLUSIONS The difference in baseline suspicion of strangulation between operative and non-operative groups is a major confounding factor in current literature. The benefit of surgical treatment should be balanced with the risks associated with surgery, patient's co-morbidities, and presence or absence of strangulation. Based on the best available evidence it could be argued that surgical intervention could be preserved for cases with high suspicion or evidence of bowel strangulation. The controversy still remains for optimum length of conservative management and timing of surgery (early or late) for cases with low baseline suspicion of strangulation. Randomised controlled trials are required to compare outcomes of early operation (<24 h) versus late operation (>24 h) and early operation versus conservative management in patients with low suspicion of strangulation.
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Affiliation(s)
- Shahab Hajibandeh
- Department of General Surgery, North Manchester General Hospital, Manchester, UK.
| | - Shahin Hajibandeh
- Department of General Surgery, North Manchester General Hospital, Manchester, UK
| | - Nilanjan Panda
- Department of General Surgery, North Manchester General Hospital, Manchester, UK
| | | | | | - Sanjay Dalmia
- Department of General Surgery, North Manchester General Hospital, Manchester, UK
| | - Sohail Malik
- Department of General Surgery, North Manchester General Hospital, Manchester, UK
| | - Zahirul Huq
- Department of General Surgery, North Manchester General Hospital, Manchester, UK
| | - Moustafa Mansour
- Department of General Surgery, North Manchester General Hospital, Manchester, UK
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A Case of Midgut Volvulus Associated with a Jejunal Diverticulum. Case Rep Surg 2017; 2017:3173875. [PMID: 29410929 PMCID: PMC5749288 DOI: 10.1155/2017/3173875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 11/13/2017] [Indexed: 11/23/2022] Open
Abstract
Midgut volvulus in adults is a rare entity that may present with intermittent colicky abdominal pain mixed with completely asymptomatic episodes. This small bowel twist may result in complications of obstruction, ischemia, hemorrhage, or perforation. With a midgut volvulus, complications may be life-threatening, and emergent surgical intervention is the mainstay of treatment. This current case involves an 80-year-old woman with intermittent abdominal pain with increasing severity and decreasing interval of time to presentation. A CAT scan revealed mesenteric swirling with possible internal hernia. A diagnostic laparoscopy followed by laparotomy revealed a midgut volvulus, extensive adhesions involving the root of the mesentery, and a large jejunal diverticulum. The adhesions were lysed enabling untwisting of the bowel, allowing placement of the small bowel in the correct anatomic position and resection of the jejunal diverticulum. This is a rare case of midgut volvulus with intermittent abdominal pain, associated with jejunal diverticulum managed successfully. A midgut volvulus should be considered in the differential diagnosis of a patient who present with a small bowel obstruction secondary to an internal hernia, especially when a swirl sign is present on the CAT scan.
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13
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Meier RPH, de Saussure WO, Orci LA, Gutzwiller EM, Morel P, Ris F, Schwenter F. Clinical outcome in acute small bowel obstruction after surgical or conservative management. World J Surg 2015; 38:3082-8. [PMID: 25145820 PMCID: PMC4232739 DOI: 10.1007/s00268-014-2733-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Small bowel obstruction (SBO) is characterized by a high rate of recurrence. In the present study, we aimed to compare the outcomes of patients managed either by conservative treatment or surgical operation for an episode of SBO. METHODS The outcomes of all patients hospitalized at a single center for acute SBO between 2004 and 2007 were assessed. The occurrence of recurrent hospitalization, surgery, SBO symptoms at home, and mortality was determined. RESULTS Among 221 patients admitted with SBO, 136 underwent a surgical procedure (surgical group) and 85 were managed conservatively (conservative group). Baseline characteristics were similar between treatment groups. The median follow-up time (interquartile range) was 4.7 (3.7-5.8) years. Nineteen patients (14.0 %) of the surgical group were hospitalized for recurrent SBO versus 25 (29.4 %) of the conservative group [hazard ratio (HR), 0.5; 95 % CI, 0.3-0.9]. The need for a surgical management of a new SBO episode was similar between the two groups, ten patients (7.4 %) in the surgical group and six patients (7.1 %) in the conservative group (HR, 1.1; 95 % CI, 0.4-3.1). Five-year mortality from the date of hospital discharge was not significantly different between the two groups (age- and sex-adjusted HR, 1.1; 95 % CI, 0.6-2.1). A follow-up evaluation was obtained for 130 patients. Among them, 24 patients (34.8 %) of the surgical group and 35 patients (57.4 %) of the conservative group had recurrent SBO symptoms (odds ratio, 0.4; 95 % CI, 0.2-0.8). CONCLUSIONS The recurrence of SBO symptoms and new hospitalizations were significantly lower after surgical management of SBO compared with conservative treatment.
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Affiliation(s)
- Raphael P H Meier
- Visceral and Transplant Surgery, Department of Surgery, Geneva University Hospitals and Medical School, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland,
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Bauer J, Keeley B, Krieger B, Deliz J, Wallace K, Kruse D, Dallas K, Bornstein J, Chessin D, Gorfine S. Adhesive Small Bowel Obstruction: Early Operative versus Observational Management. Am Surg 2015. [DOI: 10.1177/000313481508100627] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We assessed the nonoperative and operative management of adhesive small bowel obstruction (ASBO) and compared complication rates and surgical outcomes. ASBO is a common complication of abdominopelvic surgery. Although patients may respond to nonoperative management, many require surgery. We retrospectively studied patients admitted to Mount Sinai Hospital with a diagnosis of complete ASBO to determine outcomes of nonoperative management. Patients admitted with complete ASBO from 2001 to 2011 were included. Patients with no previous abdominopelvic surgery, surgery within the six weeks preceding admission and obstruction due to other identifiable causes, such as incarcerated hernia, were excluded. Complication rates and outcomes were compared between patients managed with immediate surgery and those managed initially with non-operative strategies. Of 460 patients admitted with complete ASBO, 106 (23.0%) had surgery within 24 hours of admission. At surgery, 20 (18.9%) had ischemic bowel and 8 (7.5%) had perforations. The remaining 354 patients had a trial of nonoperative management lasting at least 24 hours. Of 354 patients managed initially without surgery, 100 (28.2%) patients were discharged without operative intervention during their index admissions. Among the patients having surgery more than 24 hours after admission, indications for surgery were generally failure to resolve, worsening clinical status, and change in imaging findings. Of those patients observed for at least 24 hours, 40 (15.7%) were found to have ischemic bowel and 5 (2.0%) had perforation at surgery. Rates of bowel resection, stoma creation and postoperative complications were similar for the immediate and delayed surgery groups. Among the delayed surgery group, 71 (28.0%) required a bowel resection and 11 (4.3%) stoma creation. Twenty one per cent had postoperative complications, most commonly ileus. There were no statistically significant differences in the outcomes between immediate and delayed groups regardless of duration of delay. Among patients observed with complete ASBO, 24.6 per cent of patients with adhesive obstruction resolved without surgery or readmission. Delaying operative management did not affect surgical findings or complication rates.
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Affiliation(s)
- Joel Bauer
- Department of Surgery, Icahn School of Medicine, Mount Sinai Hospital, New York, New York
| | - Brieze Keeley
- Department of Surgery, Icahn School of Medicine, Mount Sinai Hospital, New York, New York
| | - Beth Krieger
- Department of Surgery, Icahn School of Medicine, Mount Sinai Hospital, New York, New York
| | - Juan Deliz
- Department of Surgery, Icahn School of Medicine, Mount Sinai Hospital, New York, New York
| | - Kojo Wallace
- Department of Surgery, Icahn School of Medicine, Mount Sinai Hospital, New York, New York
| | - Danielle Kruse
- Department of Surgery, Icahn School of Medicine, Mount Sinai Hospital, New York, New York
| | - Kai Dallas
- Department of Surgery, Icahn School of Medicine, Mount Sinai Hospital, New York, New York
| | - Joseph Bornstein
- Department of Surgery, Icahn School of Medicine, Mount Sinai Hospital, New York, New York
| | - David Chessin
- Department of Surgery, Icahn School of Medicine, Mount Sinai Hospital, New York, New York
| | - Stephen Gorfine
- Department of Surgery, Icahn School of Medicine, Mount Sinai Hospital, New York, New York
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15
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Sippey M, Pender JR, Chapman WHH, Manwaring ML, Kasten KR, Pofahl WE, Spaniolas K. Delayed repair of obstructing ventral hernias is associated with higher mortality and morbidity. Am J Surg 2015; 210:833-7. [PMID: 26051745 DOI: 10.1016/j.amjsurg.2015.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 02/10/2015] [Accepted: 03/03/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Patients presenting with ventral hernia-related obstruction are commonly managed with emergent ventral hernia repair (VHR). Selected patients with resolution of obstruction may be managed in a delayed manner. This study sought to assess the effect of delay on VHR outcomes. METHODS The American College of Surgeons' National Surgical Quality Improvement Program database from 2005 to 2011 was queried using diagnosis codes for ventral hernia with obstruction. Those who underwent repair over 24 hours after admission were classified as delayed repair. Preoperative comorbid conditions, American Society of Anesthesiology (ASA) scores, and 30-day outcomes were evaluated. RESULTS We identified 16,881 patients with a mean age of 58 ± 15 years and body mass index of 36 ± 10. Delayed repair occurred in 27.7% of the patients. After controlling for comorbidities and ASA score, delayed VHR was independently associated with mortality (odds ratio [OR] 1.9, 95% confidence interval [CI] 1.41 to 2.48, P < .001), morbidity (OR 1.4, 95% CI 1.24 to 1.50, P < .001), surgical site infection (OR 1.2, 95% CI 1.03 to 1.35, P = .016), and concurrent bowel resection (OR 1.2, 95% CI 1.03 to 1.34, P = .016). CONCLUSIONS VHR for obstructed patients is frequently performed over 24 hours after admission. After adjusting for comorbid conditions and ASA score, delayed VHR is independently associated with worse outcomes. Prompt repair after appropriate resuscitation should be the management of choice.
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Affiliation(s)
- Megan Sippey
- Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Boulevard, Greenville, NC 27834, USA
| | - John R Pender
- Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Boulevard, Greenville, NC 27834, USA
| | - William H H Chapman
- Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Boulevard, Greenville, NC 27834, USA
| | - Mark L Manwaring
- Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Boulevard, Greenville, NC 27834, USA
| | - Kevin R Kasten
- Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Boulevard, Greenville, NC 27834, USA
| | - Walter E Pofahl
- Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Boulevard, Greenville, NC 27834, USA
| | - Konstantinos Spaniolas
- Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Boulevard, Greenville, NC 27834, USA.
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16
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Bozkurt MA, Gönenç M, Kocataxs A, Temizgönül KB, Unsal MG, Alixş H. Is Laparoscopy Needed for Incarcerated Hernias that Became Reducible during Induction of General Anesthesia? Am Surg 2015. [DOI: 10.1177/000313481508100205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Murat Gönenç
- General Surgery Department Dr. Sadi Konuk Training and Research Hospital Istanbul, Turkey
| | - Ali Kocataxs
- General Surgery Department Dr. Sadi Konuk Training and Research Hospital Istanbul, Turkey
| | - Kaplan Baha Temizgönül
- General Surgery Department Dr. Sadi Konuk Training and Research Hospital Istanbul, Turkey
| | - Mustafa Gökhan Unsal
- General Surgery Department Dr. Sadi Konuk Training and Research Hospital Istanbul, Turkey
| | - Halil Alixş
- General Surgery Department Dr. Sadi Konuk Training and Research Hospital Istanbul, Turkey
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17
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Abstract
Observation is an acceptable management strategy for asymptomatic and minimally symptomatic inguinal hernias because it is safe. The rate of hernia accident is very low and is not an indication for surgery. However, patients who present to their physician with a hernia will almost certainly undergo a hernia repair if they live long enough.
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18
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Humes DJ, Radcliffe RS, Camm C, West J. Population-based study of presentation and adverse outcomes after femoral hernia surgery. Br J Surg 2013; 100:1827-32. [DOI: 10.1002/bjs.9336] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2013] [Indexed: 11/08/2022]
Abstract
Abstract
Background
Rates of emergency admission with femoral hernia are high compared with those for other hernias. This study aimed to determine the modes and consequences of presentation to primary care before admission to hospital.
Methods
This was a population-based cohort study using healthcare records from the Clinical Practice Research Datalink linked to Hospital Episode Statistics data from 1997 to 2007. Length of hospital stay, bowel resection rates and 30-day mortality were calculated.
Results
A total of 885 patients (690 female, 78.0 per cent) underwent femoral hernia repair, with 406 operations (45·9 per cent) performed as an emergency. The majority of patients who were admitted as an emergency (331, 81·5 per cent) presented to the general practitioner for the first time with symptoms of a hernia in the 7 days before admission, compared with just ten (2·1 per cent) of 479 patients admitted electively (P < 0·001). The median (i.q.r.) length of stay for patients undergoing elective surgery was 1 (0–2) day compared with 5 (3–9) days for those having an emergency repair (P < 0·001). Adverse events were more common among patients operated on as emergency, with 94 (23·2 per cent) having a small bowel resection compared with one (0·2 per cent) who had elective surgery. There were no deaths within 30 days in the elective group, but seven (1·7 per cent) in the emergency group.
Conclusion
A large proportion of patients with femoral hernia present late to primary care and are operated on as an emergency, with worse outcomes.
Presented to the Annual Meeting of the Society of Academic and Research Surgery, Nottingham, UK, January 2012; published in abstract form as Br J Surg 2012; 99(Suppl 4): 18
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Affiliation(s)
- D J Humes
- Nottingham Digestive Disease Centre and Biomedical Research Unit, Queen's Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK
- Division of Epidemiology and Public Health, Nottingham City Hospital, Nottingham, UK
| | - R S Radcliffe
- Nottingham Digestive Disease Centre and Biomedical Research Unit, Queen's Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - C Camm
- Nottingham Digestive Disease Centre and Biomedical Research Unit, Queen's Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - J West
- Nottingham Digestive Disease Centre and Biomedical Research Unit, Queen's Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK
- Division of Epidemiology and Public Health, Nottingham City Hospital, Nottingham, UK
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19
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Fitzgibbons RJ, Ramanan B, Arya S, Turner SA, Li X, Gibbs JO, Reda DJ. Long-term Results of a Randomized Controlled Trial of a Nonoperative Strategy (Watchful Waiting) for Men With Minimally Symptomatic Inguinal Hernias. Ann Surg 2013; 258:508-15. [DOI: 10.1097/sla.0b013e3182a19725] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mora López L, Serra-Aracil X, Llaquet Bayo H, Navarro Soto S. [Use of Gastrografin(®) in the management of adhesion intestinal obstruction]. Cir Esp 2013; 91:384-8. [PMID: 23477447 DOI: 10.1016/j.ciresp.2012.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Revised: 09/25/2012] [Accepted: 10/06/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Adhesions are the most important cause of intestinal obstruction. Approximately 25% of surgical admissions for acute abdominal conditions are due to intestinal obstruction. Better diagnostic and treatment methods of intestinal obstruction could potentially reduce mortality rate to 5-10%. Gastrografin(®) could contribute to this achieve this. AIM To present a protocol to treat adhesion intestinal obstruction with Gastrografin(®) that is safe, and allows shorter hospital stays and shorter time between admission and surgery. MATERIAL AND METHODS All patients with adhesion intestinal obstruction without symptoms of strangulation were treated with Gastrografin(®), intravenous fluids and nasogastric tube. Those in whom contrast reach the colon in 8, 12 or 24hours were considered to have partial obstruction, and were fed orally. If Gastrografin(®) failed in the following 24hours, a laparotomy was performed. RESULTS Out of a total of 211 episodes (164 patients), 170 episodes received contrast and in 142 cases Gastrografin(®) reached the colon (104 episodes at 8h, 11 at 12h, and 27 at 24h). A laparotomy was required in 28 patients because of failed treatment, and in another 5 for other causes. CONCLUSIONS A management protocol for adhesion intestinal obstruction with Gastrografin(®) is safe, reduces morbidity and mortality, and leads to a shorter hospital stay.
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Affiliation(s)
- Laura Mora López
- Servicio de Cirugía General y del Aparato Digestivo, Corporació Sanitària i Universitària Parc Taulí, Sabadell, Barcelona, España.
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21
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Coccolini F, Ansaloni L, Manfredi R, Campanati L, Poiasina E, Bertoli P, Capponi MG, Sartelli M, Di Saverio S, Cucchi M, Lazzareschi D, Pisano M, Catena F. Peritoneal adhesion index (PAI): proposal of a score for the "ignored iceberg" of medicine and surgery. World J Emerg Surg 2013; 8:6. [PMID: 23369320 PMCID: PMC3573980 DOI: 10.1186/1749-7922-8-6] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 01/29/2013] [Indexed: 12/24/2022] Open
Abstract
Peritoneal adhesions describe a condition in which pathological bonds form between the omentum, the small and large bowels, the abdominal wall, and other intra-abdominal organs. Different classification systems have been proposed, but they do not resolve the underlying problem of ambiguity in the quantification and definition of adhesions. We therefore propose a standardized classification system of adhesions to universalize their definition based on the macroscopic appearance of adhesions and their diffusion to different regions of the abdomen. By scoring with these criteria, the peritoneal adhesion index (PAI) can range from 0 to 30, unambiguously specifying precise adhesion scenarios. The standardized classification and quantification of adhesions would enable different studies to more meaningfully integrate their results, thereby facilitating a more comprehensive approach to the treatment and management of this pathology.
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Affiliation(s)
- Federico Coccolini
- General and Emergency Surgery department, Papa Giovanni XXIII hospital, Piazza OMS-Organizzazione Mondiale della Sanità 1, 24128, Bergamo, Italy.
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22
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Slieker JC, Ditzel M, Harlaar JJ, Mulder IM, Deerenberg EB, Bastiaansen-Jenniskens YM, Kleinrensink GJJ, Jeekel J, Lange JF. Effects of new anti-adhesion polyvinyl alcohol gel on healing of colon anastomoses in rats. Surg Infect (Larchmt) 2012; 13:396-400. [PMID: 23240723 DOI: 10.1089/sur.2011.114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Adhesions follow abdominal surgery with an incidence as high as 95%, resulting in invalidating complications such as bowel obstruction, female infertility, and chronic pain. Searches have been performed for a safe and effective adhesion barrier; however, such barriers have impaired anastomotic site healing. The primary aim of this study was to investigate the effect of a new adhesion barrier, polyvinyl alcohol gel, on healing of colonic anastomoses using a rat model. METHODS Thirty-two Wistar rats were divided in two groups. In all animals, an anastomosis was constructed in the ascending colon. The first group received no adhesion barrier, whereas in the second group, 2 mL of polyvinyl alcohol gel (A-Part Gel(®); Aesculap AG, Tuttlingen, Germany) was applied circularly around the anastomosis. All animals were sacrificed on the seventh post-operative day, and the abdomen was inspected for signs of anastomotic leakage. The anastomotic bursting pressure, the adhesions around the anastomosis, and the collagen content of the excised anastomosis were measured. RESULTS No significant differences were observed between the two groups in the incidence of anastomotic leakage, the anastomotic bursting pressure (p=0.08), or the collagen concentration (p=0.91). No significant reduction in amount of adhesions was observed in the rats receiving polyvinyl alcohol gel. CONCLUSIONS This experimental study showed no significant differences in anastomotic leakage, anastomotic bursting pressure, or collagen content of the anastomosis when using the adhesion barrier polyvinyl alcohol around colonic anastomoses. The barrier did not prevent adhesion formation.
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Affiliation(s)
- Juliette C Slieker
- Department of Surgery, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands.
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Wadani HA, Al Awad NI, Hassan KA, Zakaria HM, Alaqeel FO. Role of water soluble contrast agents in assigning patients to a non-operative course in adhesive small bowel obstruction. Oman Med J 2012; 26:454-6. [PMID: 22253960 DOI: 10.5001/omj.2011.116] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 10/10/2011] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Adhesive small bowel obstruction (SBO) is a common surgical emergency. It is estimated that at least 60% of SBO are due to post-operative adhesions. Water soluble contrast agents (gastrografin) have been used to identify patients who might be treated non-operatively. This study aims to determine the role of gastrografin in adhesive intestinal obstruction patients. METHODS In this prospective study, 27 patients admitted between 1(st) August 2004 and 1(st) July 2006 with clinical signs suggestive of postoperative adhesive SBO met the inclusion criteria. After intravenous hydration, nasogastric tube insertion and complete suctioning of the gastric fluid, 100 ml of gastrograsfin was given and plain abdominal radiography was taken 6 hours and 24 hours if the contrast is not seen in the colon. Those in whom the contrast reached the colon in 24 hours were considered to have partial SBO and started oral intake. If gastrografin failed to reach the colon in 24 hours and the patient did not improve in the following 24 hours, laparotomy was performed. RESULTS Conservative treatment was successful in 31 cases (91%) and 3 (9%) required operation. Patients treated conservatively had short hospital stay (mean=4 days) and tolerated oral feeding with no morbidity or mortality. CONCLUSION Oral gastrografin helps in the management of patients with postoperative adhesive SBO.
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Affiliation(s)
- Hamid Ai Wadani
- Department of Surgery, King Fahd Hospital of the University, College of Medicine, Dammam University, Kingdom of Saudi Arabia, P.O. Box 40081, Al Khobar 31952, Saudi Arabia
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Hashimoto D, Hirota M, Matsukawa T, Yagi Y, Baba H. Clinical features of strangulated small bowel obstruction. Surg Today 2012; 42:1061-5. [PMID: 22661266 DOI: 10.1007/s00595-012-0207-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 08/19/2011] [Indexed: 12/27/2022]
Abstract
PURPOSE The causes of strangulated small bowel obstruction (SSBO) include a fibrous cord, torsion, and internal hernia. We conducted this study to define the clinical features of SSBO. METHODS We reviewed the clinical course and preoperative data of 74 patients treated for SSBO in Kumamoto Regional Medical Center between January 2004 and September 2010. RESULTS Twenty-one patients had no history of laparotomy. Computed tomography (CT) showed high positivity (86.3 %) of closed loops in the involved intestine. Postoperative complications developed in 23 patients, representing a morbidity rate of 31.1 %. Forty-four patients underwent resection of non-viable small intestine (non-viable group), and 30 did not require resection of the intestine (viable group). There were four hospital deaths in the non-viable group. The overall mortality rate and the mortality rate in the non-viable group were 5.4 and 9.1 %, respectively. CONCLUSION These findings indicate that SSBO can occur without a history of laparotomy, CT is useful in its diagnosis, and its associated morbidity and mortality are high.
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Affiliation(s)
- Daisuke Hashimoto
- Department of Surgery, Kumamoto Regional Medical Center, 5-16-10 Honjo, Kumamoto, 860-0811, Japan
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25
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Atta HM. Prevention of peritoneal adhesions: a promising role for gene therapy. World J Gastroenterol 2011; 17:5049-58. [PMID: 22171139 PMCID: PMC3235588 DOI: 10.3748/wjg.v17.i46.5049] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Revised: 07/14/2011] [Accepted: 07/21/2011] [Indexed: 02/06/2023] Open
Abstract
Adhesions are the most frequent complication of abdominopelvic surgery, yet the extent of the problem, and its serious consequences, has not been adequately recognized. Adhesions evolved as a life-saving mechanism to limit the spread of intraperitoneal inflammatory conditions. Three different pathophysiological mechanisms can independently trigger adhesion formation. Mesothelial cell injury and loss during operations, tissue hypoxia and inflammation each promotes adhesion formation separately, and potentiate the effect of each other. Studies have repeatedly demonstrated that interruption of a single pathway does not completely prevent adhesion formation. This review summarizes the pathogenesis of adhesion formation and the results of single gene therapy interventions. It explores the promising role of combinatorial gene therapy and vector modifications for the prevention of adhesion formation in order to stimulate new ideas and encourage rapid advancements in this field.
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26
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Omari AH, Alkhatib LL, Khammash MR. Changing pattern of intestinal obstruction in northern Jordan. World J Surg 2011; 36:437-40. [PMID: 22139327 DOI: 10.1007/s00268-011-1361-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Obstructed abdominal wall hernias have been reported to be the leading cause of mechanical intestinal obstruction (MIO) among adults in developing countries. In the developed countries, postoperative adhesions are the commonest cause. With the worldwide improvements in health services and education, especially in developing countries, we aimed to determine the effects of these improvements on the patterns and outcomes of management of MIO in Jordan METHODS The records of all patients who were treated for MIO between the years 2005 and 2010 were reviewed retrospectively. Causes of MIO, presenting symptoms, the main imaging study performed, and the results of management are described. The pattern was compared with that in a previous 1993 report from Jordan. RESULTS A total of 88 patients were treated for MIO. Postoperative adhesions in 52.5%, gastrointestinal tumors in 21.0%, and obstructed abdominal wall hernias in 9.5% were the three major causes of MIO. Three patients developed surgical-site infections (3.3%), and one developed a minor anastomotic leak that was treated accordingly (1.1%). There were no mortalities. In 1993, obstructed hernias accounted for 30% of the MIOs followed by postoperative adhesions and tumors (27 and 14%, respectively). There was a 7% mortality rate. CONCLUSIONS Our data confirmed that improved health education programs and services changed the pattern of causes improved the outcomes of management of MIO in Jordan.
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Affiliation(s)
- Abdulkareem H Omari
- Department of Surgery, King Abdulla Teaching Hospital and The Faculty of Medicine, Jordan University of Science and Technology, PO Box 3030, Irbid, 22100, Jordan
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Slesak G, Mounlaphome K, Inthalad S, Phoutsavath O, Mayxay M, Newton PN. Bowel obstruction from wild bananas: a neglected health problem in Laos. Trop Doct 2011; 41:85-90. [PMID: 21421885 PMCID: PMC3125700 DOI: 10.1258/td.2011.100293] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We investigated the significance and risk factors of bowel obstruction caused by the consumption of wild bananas (BOWB) in Laos. Of six patients with BOWB in Luang Namtha, North Laos, five required enterotomy for phytobezoars. All had eaten wild banana (WB) seeds. Of 227 other patients/relatives: 91.2% had eaten WB; 46.3% had also eaten the seeds and 45.4% knew of complications resulting from eating WB; 42.3% were aware of the complications of ingesting the seeds (constipation [37.9%], appendicitis/abdominal pain/vomiting [2.6% each] and bloated stomach/death [1.3% each]). Middle/highland Lao ethnicity was associated with WB and seed consumption (odds ratio [OR] 9.91 and 2.33), male sex with WB consumption and unawareness (OR 4.31 and 1.78). At all surgically-equipped hospitals in Laos, 33/44 doctors knew of BOWB, describing patients as young adults (16/30), male (24/30) and from middleland Lao (18/30). Countrywide, 46/48 patients with BOWB required laparotomy in 2009 (incidence 0.8/100,000). All consumed WB seeds. BOWB is widespread in Laos, especially among young middleland Lao men consuming WB seeds on an empty stomach.
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Is surgical repair of an asymptomatic groin hernia appropriate? A review. Hernia 2011; 15:251-9. [DOI: 10.1007/s10029-011-0796-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 01/16/2011] [Indexed: 10/18/2022]
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Vallicelli C, Coccolini F, Catena F, Ansaloni L, Montori G, Di Saverio S, Pinna AD. Small bowel emergency surgery: literature's review. World J Emerg Surg 2011; 6:1. [PMID: 21214933 PMCID: PMC3025845 DOI: 10.1186/1749-7922-6-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 01/07/2011] [Indexed: 12/15/2022] Open
Abstract
Emergency surgery of the small bowel represents a challenge for the surgeon, in the third millennium as well. There is a wide number of pathologies which involve the small bowel. The present review, by analyzing the recent and past literature, resumes the more commons. The aim of the present review is to provide the main indications to face the principal pathologies an emergency surgeon has to face with during his daily activity.
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Affiliation(s)
- Carlo Vallicelli
- General, Emergency and Transplant Surgery Dept., Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Federico Coccolini
- General, Emergency and Transplant Surgery Dept., Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Fausto Catena
- General, Emergency and Transplant Surgery Dept., Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Luca Ansaloni
- General and Emergency Surgery Dept., Ospedali Riuniti Hospital, Bergamo, Italy
| | - Giulia Montori
- General, Emergency and Transplant Surgery Dept., Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | | | - Antonio D Pinna
- General, Emergency and Transplant Surgery Dept., Sant'Orsola-Malpighi University Hospital, Bologna, Italy
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Atahan K, Aladağli I, Çökmez A, Gür S, Tarcan E. Hyperosmolar Water-Soluble Contrast Medium in the Management of Adhesive Small-Intestine Obstruction. J Int Med Res 2010; 38:2126-34. [DOI: 10.1177/147323001003800628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This prospective study investigated the value of the hyperosmolar water-soluble contrast medium Urografin® in choosing which patients with small-intestine obstruction, caused by post-operative adhesions, to treat conservatively. Thirty-seven patients with adhesive intestinal obstruction received Urografin® via a nasogastric tube. Direct abdominal radiographs were taken after 2, 4 and 8 h. Twenty-four patients (64.9%) had Urografin® in the right colon within 8 h and were considered to have partial obstruction. These patients commenced oral feeding even though abdominal radiographs revealed gas–fluid levels. In the remaining 13 patients (35.1%), Urografin® was not observed in the right colon within 8 h: three of the 13 patients (23.1%) were successfully treated conservatively; 10 of the 13 patients (76.9%) developed toxic signs and underwent surgery, with obstruction resulting from adhesive bands being confirmed at operation. Conservative treatment can be recommended for patients in whom contrast medium is observed in the right colon within 8 h following administration, regardless of the presence of obstruction signs. Absence of contrast medium in the right colon within 8 h cannot, however, be considered an indication for surgery.
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Affiliation(s)
- K Atahan
- First Surgical Department, Izmir Atatürk Training and Research Hospital, Izmir, Turkey
| | - I Aladağli
- First Surgical Department, Izmir Atatürk Training and Research Hospital, Izmir, Turkey
| | - A Çökmez
- First Surgical Department, Izmir Atatürk Training and Research Hospital, Izmir, Turkey
| | - S Gür
- First Surgical Department, Izmir Atatürk Training and Research Hospital, Izmir, Turkey
| | - E Tarcan
- First Surgical Department, Izmir Atatürk Training and Research Hospital, Izmir, Turkey
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31
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Clinical study of inguinal and femoral incarcerated hernias. Surg Today 2010; 40:1144-7. [DOI: 10.1007/s00595-009-4193-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2009] [Accepted: 11/09/2009] [Indexed: 11/30/2022]
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Malik AM, Shah M, Pathan R, Sufi K. Pattern of acute intestinal obstruction: is there a change in the underlying etiology? Saudi J Gastroenterol 2010; 16:272-4. [PMID: 20871192 PMCID: PMC2995096 DOI: 10.4103/1319-3767.70613] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND/AIM To study the changing pattern of acute intestinal obstruction at a teaching institute. PATIENTS AND METHODS It is a prospective descriptive study conducted at a teaching hospital during the period from June 2004 to June 2009. All patients with clinical or radiological evidence of acute intestinal obstruction were included in this study regardless of the gender of the patient. Patients below the age of 10 years were excluded from the study. The treatment strategy was planned ranging from conservative treatment to emergency laparotomy after resuscitation and rehydration of the patient. Details of individual patients were recorded on a pro forma sheet and data analyzed statistically on SPSS version 14. RESULTS A total of 229 patients with acute intestinal obstruction were admitted and treated. The mean age of the study population was 43.08 ± 13.07 years. Postoperative adhesions accounted for 41% (n = 95) of the total cases, followed by abdominal tuberculosis (25%, n = 58), obstructed/ strangulated hernias of different types (18%, n = 42). There was an obvious change in the pattern of etiology of acute intestinal obstruction as the common causes were postoperative adhesions and abdominal tuberculosis instead of obstructed inguinal hernias. CONCLUSION An increase in the adhesive obstruction and a concomitant decrease in the incidence of obstructed hernias indicate a changing trend towards early operation before it gets complicated. Abdominal tuberculosis is emerging as another common cause of acute bowel obstruction.
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Affiliation(s)
- Arshad M. Malik
- Department of Surgery, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan,Address for correspondence: Dr. Arshad M. Malik, Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan. E-mail:
| | - Madiha Shah
- Department of Surgery, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan
| | - Rafique Pathan
- Department of Surgery, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan
| | - Krishan Sufi
- Department of Surgery, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan
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33
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Carmichael JC, Mills S. Reoperation for small bowel obstruction--how critical is the timing? Clin Colon Rectal Surg 2010; 19:181-7. [PMID: 20011319 DOI: 10.1055/s-2006-956438] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The timing of reoperation for small bowel obstruction is a topic of significant debate. Any patient with evidence of strangulation should undergo urgent surgical intervention. However, predicting strangulation can be difficult. Because of this, previous authors have recommended everything from emergency operation for all patients presenting with small bowel obstruction to periods of observation that extend up to 14 days. Over the past century, the primary etiology of small bowel obstruction has shifted from hernias to postoperative adhesive disease, leading to a shift in the management paradigm. To manage small bowel obstruction successfully today, the clinician must distinguish the patient requiring urgent operation from those who benefit from nonoperative management. Furthermore, the clinician must be able to determine the appropriate length of time for conservative management. In this article we review the significant body of literature on this topic including the diagnostic workup and timing of potential operative intervention in the patient with small bowel obstruction.
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Affiliation(s)
- Joseph C Carmichael
- Division of Colon and Rectal Surgery, Department of Surgery, University of California, Irvine Medical Center, Orange, California 92868-3298, USA
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34
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Baxter G. Serosal adhesions - the next hurdle in colic surgery. Equine Vet J 2010. [DOI: 10.1111/j.2042-3306.1992.tb04787.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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35
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36
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Rochet N, Sterzing F, Jensen AD, Dinkel J, Herfarth KK, Schubert K, Eichbaum MH, Schneeweiss A, Sohn C, Debus J, Harms W. Intensity-modulated whole abdominal radiotherapy after surgery and carboplatin/taxane chemotherapy for advanced ovarian cancer: phase I study. Int J Radiat Oncol Biol Phys 2009; 76:1382-9. [PMID: 19628341 DOI: 10.1016/j.ijrobp.2009.03.061] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Revised: 03/12/2009] [Accepted: 03/24/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE To assess the feasibility and toxicity of consolidative intensity-modulated whole abdominal radiotherapy (WAR) after surgery and chemotherapy in high-risk patients with advanced ovarian cancer. METHODS AND MATERIALS Ten patients with optimally debulked ovarian cancer International Federation of Gynecology and Obstetrics Stage IIIc were treated in a Phase I study with intensity-modulated WAR up to a total dose of 30 Gy in 1.5-Gy fractions as consolidation therapy after adjuvant carboplatin/taxane chemotherapy. Treatment was delivered using intensity-modulated radiotherapy in a step-and-shoot technique (n = 3) or a helical tomotherapy technique (n = 7). The planning target volume included the entire peritoneal cavity and the pelvic and para-aortal node regions. Organs at risk were kidneys, liver, heart, vertebral bodies, and pelvic bones. RESULTS Intensity-modulated WAR resulted in an excellent coverage of the planning target volume and an effective sparing of the organs at risk. The treatment was well tolerated, and no severe Grade 4 acute side effects occurred. Common Toxicity Criteria Grade III toxicities were as follows: diarrhea (n = 1), thrombocytopenia (n = 1), and leukopenia (n = 3). Radiotherapy could be completed by all the patients without any toxicity-related interruption. Median follow-up was 23 months, and 4 patients had tumor recurrence (intraperitoneal progression, n = 3; hepatic metastasis, n = 1). Small bowel obstruction caused by adhesions occurred in 3 patients. CONCLUSIONS The results of this Phase I study showed for the first time, to our knowledge, the clinical feasibility of intensity-modulated whole abdominal radiotherapy, which could offer a new therapeutic option for consolidation treatment of advanced ovarian carcinoma after adjuvant chemotherapy in selected subgroups of patients. We initiated a Phase II study to further evaluate the toxicity of this intensive multimodal treatment.
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Affiliation(s)
- Nathalie Rochet
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany.
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Levard H, Mouro J, Schiffino L, Karayel M, Berthelot G, Dubois F. Laparoscopic treatment of small bowel obstruction: Prospective evaluation in 30 patients. MINIM INVASIV THER 2009. [DOI: 10.3109/13645709609153283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Yagci G, Kaymakcioglu N, Can MF, Peker Y, Cetiner S, Tufan T. Comparison of Urografin Versus Standard Therapy in Postoperative Small Bowel Obstruction. J INVEST SURG 2009; 18:315-20. [PMID: 16319052 DOI: 10.1080/08941930500328789] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Water-soluble contrast media (Urografin) cause redistribution of intravascular and extracellular fluid into intestinal lumen due to their hyperosmolarity. As a consequence, these media decrease intestinal wall edema and act as a direct stimulant to intestinal peristalsis. In this prospective study, we aimed to examine objectively the therapeutic role and ability of Urografin in patients with postoperative small bowel obstruction for whom failed to respond to conservative treatment. Three hundred and seventeen patients with postoperative small bowel obstruction due to intraperitoneal adhesions were included prospectively in this study. In the Urografin group, 40 mL Urografin diluted in 40 mL distilled water was administered through the nasogastric tube. No contrast media were administered in the control group, but the patients were decompressed via a nasogastric tube continuously. The number of obstruction episode in 317 patients was 338. In total, 199 patients were in the Urografin group, and 118 patients were in the control group. In the Urografin group, 178 (89.4%) patients responded successfully to the treatment, but 21 (11.6%) patients underwent surgical operation. Intensive intraabdominal adhesions and obstructing fibrous bands were observed and repaired in 15 (71.4%) patients at the operation, while 6 patients underwent segmental small intestine resection in control group, conventional management was successful in only 89 (75.4%) patients, and the remaining 29 (24.6%) patients underwent surgical intervention. In conclusion, it was suggested that in patients with intestinal obstruction due to postoperative intra-abdominal adhesion, water-soluble contrast media such as Urografin may be safely administered via a nasogastric tube or oral route and may decrease the need for surgical operation; furthermore, they may help the physician to operate the patients who needs surgery as early as possible.
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Affiliation(s)
- Gokhan Yagci
- Department of General Surgery, Gulhane Military Medical Academy, Ankara, Turkey.
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Abstract
A hernia is an area of weakness or complete disruption of the fibromuscular tissues of the body wall. In addition to the body wall, hernias can occur in the diaphragm, pelvic wall, perineum, pelvic floor, and internal abdominal viscera (hernias through omental or mesenteric defects, ligaments and folds). Surgical repair of different types of hernia is the most common general surgical procedure with more than 20 million hernioplasties performed each year. Abdominal wall hernias are not common during pregnancy. Hernias can be symptomless or have minimal symptoms, including slight discomfort or pain. Such hernias are not life-threatening and should be controlled on regular basis. After spontaneous delivery and uterine involution, they should be repaired on an elective basis. It is of utmost importance for a clinician to diagnose emergent situations, which include incarceration, strangulation and perforation caused by hernia because consultation with a surgeon and emergency operation are mandatory. There is still no consensus for irreducible hernia during pregnancy, but complications during pregnancy outweigh elective operation. Therefore, hernioplasty is recommended during pregnancy, especially in early gestation.
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Affiliation(s)
- Goran Augustin
- Department of Surgery, Division of Abdominal Surgery, Clinical Hospital Center Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia.
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40
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Chen XZ, Wei T, Jiang K, Yang K, Zhang B, Chen ZX, Chen JP, Hu JK. Etiological factors and mortality of acute intestinal obstruction: a review of 705 cases. ZHONG XI YI JIE HE XUE BAO = JOURNAL OF CHINESE INTEGRATIVE MEDICINE 2008; 6:1010-1016. [PMID: 18847534 DOI: 10.3736/jcim20081005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/23/2024]
Abstract
OBJECTIVE To figure out the etiological factors and overall mortality of the patients with acute intestinal obstruction, and to explore the rational period of conservative therapy before operation. METHODS Medical records of all the patients with acute intestinal obstruction admitted to West China Hospital from 1995 to 2002 were retrospectively reviewed. The etiology of the obstruction was categorized, and the correlation of mortality and time interval between conservative therapy and operation was analyzed. RESULTS There were 705 patients with acute intestinal obstruction included. There were 71.1% of the obstruction lesions located on the small bowel, and 82.6% of the patients experienced simple obstruction. The most frequent cause was adhesions (62.0%), and next was neoplasms (23.7%). There were 57.6% of the patients underwent the surgical treatment. The overall mortality rate was 1.6%, and the mortality rates in conservative therapy and surgical intervention groups were 1.3% and 1.7% respectively. The intestinal necrosis rate was increased gradually with the prolongation of time interval between conservative therapy and operation, and the death might occur 24 hours after strangulation. CONCLUSION The epidemiological transition to adhesive obstruction still exists in China, and it is similar to that in Western countries. In our experience, near half of the patients with simple obstruction may achieve palliation by conservative therapy. Surgical intervention is indicated for the patients with prolonged and non-palliated simple obstruction, or strangulation disease within the first 24 hours.
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Affiliation(s)
- Xin-Zu Chen
- Department of General Surgery, Multi-disciplinary Treatment Team of Gastrointestinal Tumors, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, China
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41
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Duron JJ, du Montcel ST, Berger A, Muscari F, Hennet H, Veyrieres M, Hay JM. Prevalence and risk factors of mortality and morbidity after operation for adhesive postoperative small bowel obstruction. Am J Surg 2008; 195:726-34. [PMID: 18367136 DOI: 10.1016/j.amjsurg.2007.04.019] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Revised: 04/25/2007] [Accepted: 04/25/2007] [Indexed: 11/26/2022]
Abstract
BACKGROUND Many factors are believed to influence the mortality and morbidity after operations for adhesive small bowel obstruction (SBO). METHODS In a multicenter prospective cohort of 286 patients operated on for adhesive postoperative SBO, we studied the in-hospital and 30-day postdischarge mortality (early mortality) and morbidity as well as long-term mortality using univariate and multivariate analysis. RESULTS In the present cohort, with a median follow-up of 41 months and 9% patients lost to follow-up at the end of the study, the prevalence of early postoperative mortality was 3%. All deceased patients were over 75 years old with an American Society of Anesthesiologists (ASA) class >/=III. The prevalence of long-term mortality was 7% with the following independent risk factors: age >75 years old (hazards ratio [HR] 6.6 [95% confidence interval [CI], 2.4-18.1]), medical complications (HR 7.4 [CI, 2.2-24.3]), and a mixed mechanism of obstruction (HR 4.5 [CI, 1.5-13.7]). Prevalence of medical and surgical morbidity was 8% and 6%, respectively. Independent risk factors for medical complications were ASA class >/=III (odds ratio [OR] 16.8 [CI, 2.1-133.1]) and bands (OR 14.1 [CI, 1.8-111.5]) and for the surgical complications the number of obstructive structures >/=10 (OR 8.3 [CI, 1.6-19.7]), a nonresected intestinal wall injury (OR 5.3 [CI, 1.5-18.3]), and intestinal necrosis (OR 5.6 [CI, 1.6-19.7]). Otherwise, 3 patients with "apparent" reversible ischemia developed a postoperative intestinal necrosis followed by 2 reoperations and 1 death. CONCLUSION The early postoperative mortality is strongly linked with the age and the ASA class and the long-term mortality with postoperative complications. More frequent bowel resections might be suggested for patients featuring a number of obstructive structures >/=10 and an intestinal wall injury, especially when associated with a reversible intestinal ischemia.
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Affiliation(s)
- Jean-Jacques Duron
- Department of General Surgery University Hospital La Pitié, Paris, France.
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Sakorafas GH, Peros G. Obstructing sigmoid cancer in a patient with a large, tender, non-reducible inguinal hernia: the obvious diagnosis is not always the correct one. Eur J Cancer Care (Engl) 2008; 17:72-3. [PMID: 18181894 DOI: 10.1111/j.1365-2354.2007.00811.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We present a 85-year-old patient with intestinal obstruction and a large, tender, non-reducible right inguinal hernia. He was operated with the presumed diagnosis of strangulated inguinal hernia. At surgery, a perforated obstructing sigmoid colon was diagnosed. A sigmoidectomy (Hartman procedure) and hernia repair (Bassini technique) was performed.
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Affiliation(s)
- G H Sakorafas
- 4th Department of Surgery, ATTIKON University Hospital, Athens University, Medical School, Athens, Greece.
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Lang RA, Grüntzig PM, Weisgerber C, Weis C, Odermatt EK, Kirschner MH. Polyvinyl alcohol gel prevents abdominal adhesion formation in a rabbit model. Fertil Steril 2007; 88:1180-6. [PMID: 17482168 DOI: 10.1016/j.fertnstert.2007.01.108] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2006] [Revised: 01/22/2007] [Accepted: 01/22/2007] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To evaluate the function and biocompatibility of the new adhesion barrier PVA gel (polyvinyl alcohol + carboxymethylated cellulose) in the prevention of postsurgical peritoneal adhesions in a rabbit sidewall model. To evaluate and compare the routinely used 4% icodextrin. DESIGN A prospective randomized controlled study was designed to evaluate the effectiveness of PVA gel in reducing postoperative adhesion formation. SETTING Clinical laboratory in Germany. ANIMAL(S) Eighty female albino rabbits (HM Small Russian; 2.4-3.6 kg). INTERVENTION(S) All animals underwent trauma of the abdominal sidewall at the clinical laboratory. The PVA gel was placed at the sidewall defect in 50 cases. In two further groups, 18 animals had no treatment (control group), and 12 animals were treated with 4% icodextrin. MAIN OUTCOME MEASURE(S) Biocompatibility, mechanical properties of PVA gel, adhesion development, and device handling were observed. RESULT(S) The PVA gel showed good biocompatibility, no side effects, and excellent adhesion prevention. Although 100% of the untreated control group as well as the animals treated with 4% icodextrin developed adhesion formation, only around 25% of those rabbits that were treated with PVA gel showed adhesions. CONCLUSION(S) These data show that PVA gel functions as an excellent adhesion barrier.
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Ergul E, Korukluoglu B. Peritoneal adhesions: facing the enemy. Int J Surg 2007; 6:253-60. [PMID: 17617231 DOI: 10.1016/j.ijsu.2007.05.010] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2007] [Revised: 05/10/2007] [Accepted: 05/24/2007] [Indexed: 11/21/2022]
Abstract
BACKGROUND Postsurgical adhesions severely affect the quality of life of millions of people worldwide. Numerous attempts have been made to prevent or reduce the incidence of peritoneal adhesions, but with limited success. DATA SOURCES An extensive Medline search, textbooks, scientific reports and scientific journals are the data sources. We also reviewed reference lists in all articles retrieved in the search as well as those of major texts regarding postsurgical intraperitoneal adhesion formation. CONCLUSIONS A multifactorial approach including minimizing tissue injury, prophylactic antibiotic usage to reduce infectious morbidity, and biochemical agents with or without biomechanical barriers will reduce the amount and severity of adhesions. However, further research is needed to establish the safety, effectiveness and also the cost/benefit ratio of these substances in human subjects.
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Affiliation(s)
- Emre Ergul
- Ankara Ataturk Teaching and Research Hospital, Bilkent, 06800 Ankara, Turkey.
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Abstract
OBJECTIVE To analyze mortality following groin hernia operations. SUMMARY BACKGROUND DATA It is well known that the incidence of groin hernia in men exceeds the incidence in women by a factor of 10. However, gender differences in mortality following groin hernia surgery have not been explored in detail. METHODS The study comprises all patients 15 years or older who underwent groin hernia repair between January 1, 1992 and December 31, 2005 at units participating in the Swedish Hernia Register (SHR). Postoperative mortality was defined as standardized mortality ratio (SMR) within 30 days, ie, observed deaths of operated patients over expected deaths considering age and gender of the population in Sweden. RESULTS A total of 107,838 groin hernia repairs (103,710 operations), were recorded prospectively. Of 104,911 inguinal hernias, 5280 (5.1%) were treated emergently, as compared with 1068 (36.5%) of 2927 femoral hernias. Femoral hernia operations comprised 1.1% of groin hernia operations on men and 22.4% of operations on women. After femoral hernia operation, the mortality risk was increased 7-fold for both men and women. Mortality risk was not raised above that of the background population for elective groin hernia repair, but it was increased 7-fold after emergency operations and 20-fold if bowel resection was undertaken. Overall SMR was 1.4 (95% confidence interval, 1.2-1.6) for men and 4.2 (95% confidence interval, 3.2-5.4) for women, in accordance with a greater proportion of emergency operations among women compared with men, 17.0%, versus 5.1%. CONCLUSIONS Mortality risk following elective hernia repair is low, even at high age. An emergency operation for groin hernia carries a substantial mortality risk. After groin hernia repair, women have a higher mortality risk than men due to a greater risk for emergency procedure irrespective of hernia anatomy and a greater proportion of femoral hernia.
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Affiliation(s)
- Hanna Nilsson
- Department of Surgery, Sahlgrenska University Hospital/Ostra, Gothenburg, Sweden
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Abstract
Inguinal hernia repair is one of the most common operations in general surgery with rates of repair ranging from 10 per 10,000 population in the United Kingdom to 28 per 10,000 in the United States. Most inguinal hernias cause mild to moderate discomfort, which increases with activity. Up to one-third of the patients with an inguinal hernia scheduled for surgery have an asymptomatic swelling. Inguinal hernias are a significant socioeconomic burden with direct costs to the health service and indirect costs to the economy due to time off work following operation. In addition, the morbidity associated with the operation is often underestimated. Therefore, it is important to critically review the risks and complications related to inguinal hernia repair in those with minimal symptoms to formulate the best management strategy for these patients.
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Affiliation(s)
- L Chung
- University Department of Surgery, Western Infirmary, Glasgow, Scotland
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Markogiannakis H, Theodorou D, Toutouzas KG, Drimousis P, Panoussopoulos SG, Katsaragakis S. Persistent omphalomesenteric duct causing small bowel obstruction in an adult. World J Gastroenterol 2007; 13:2258-60. [PMID: 17465515 PMCID: PMC4146858 DOI: 10.3748/wjg.v13.i15.2258] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
An extremely rare case of persistent omphalomesenteric duct causing small bowel obstruction is presented. A 20-year-old female patient without medical history presented with colicky abdominal pain, vomiting, absence of passage of gas and feces, and abdominal distension of 24 h duration. Physical examination and blood tests were normal. Abdominal X-ray showed small bowel obstruction. Computed tomography of the abdomen demonstrated dilated small bowel and a band originating from the umbilicus and continuing between the small bowel loops; an omphalomesenteric duct remnant was suspected. In exploratory laparotomy, persistent omphalomesenteric duct causing small bowel obstruction was identified and resected. The patient had an uneventful recovery and was discharged on the 5th postoperative day. Although persistent omphalomesenteric duct is an extremely infrequent cause of small bowel obstruction in adult patients, it should be taken into consideration in patients without any previous surgical history.
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Affiliation(s)
- Haridimos Markogiannakis
- Department of Propaedeutic Surgery, Hippokration Hospital, Athens Medical School, University of Athens, Kerasoudos 54 Street, 15771 Zografou, Athens, Greece.
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48
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Markogiannakis H, Messaris E, Dardamanis D, Pararas N, Tzertzemelis D, Giannopoulos P, Larentzakis A, Lagoudianakis E, Manouras A, Bramis I. Acute mechanical bowel obstruction: Clinical presentation, etiology, management and outcome. World J Gastroenterol 2007; 13:432-7. [PMID: 17230614 PMCID: PMC4065900 DOI: 10.3748/wjg.v13.i3.432] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To identify and analyze the clinical presentation, management and outcome of patients with acute mechanical bowel obstruction along with the etiology of obstruction and the incidence and causes of bowel ischemia, necrosis, and perforation.
METHODS: This is a prospective observational study of all adult patients admitted with acute mechanical bowel obstruction between 2001 and 2002.
RESULTS: Of the 150 consecutive patients included in the study, 114 (76%) presented with small bowel and 36 (24%) with large bowel obstruction. Absence of passage of flatus (90%) and/or feces (80.6%) and abdominal distension (65.3%) were the most common symptoms and physical finding, respectively. Adhesions (64.8%), incarcerated hernias (14.8%), and large bowel cancer (13.4%) were the most frequent causes of obstruction. Eighty-eight patients (58.7%) were treated conservatively and 62 (41.3%) were operated (29 on the first day). Bowel ischemia was found in 21 cases (14%), necrosis in 14 (9.3%), and perforation in 8 (5.3%). Hernias, large bowel cancer, and adhesions were the most frequent causes of bowel ischemia (57.2%, 19.1%, 14.3%), necrosis (42.8%, 21.4%, 21.4%), and perforation (50%, 25%, 25%). A significantly higher risk of strangulation was noticed in incarcerated hernias than all the other obstruction causes.
CONCLUSION: Absence of passage of flatus and/or feces and abdominal distension are the most common symptoms and physical finding of patients with acute mechanical bowel obstruction, respectively. Adhesions, hernias, and large bowel cancer are the most common causes of obstruction, as well as of bowel ischemia, necrosis, and perforation. Although an important proportion of these patients can be nonoperatively treated, a substantial portion requires immediate operation. Great caution should be taken for the treatment of these patients since the incidence of bowel ischemia, necrosis, and perforation is significantly high.
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Affiliation(s)
- Haridimos Markogiannakis
- 1st Department of Propaedeutic Surgery, Hippokration Hospital, Athens Medical School, University of Athens, Vasilissis Sofias 114 Avenue, Athens 11527, Greece.
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Akcakaya A, Sahin M, Coskun A, Demiray S. Comparison of mechanical bowel obstruction cases of intra-abdominal tumor and non-tumoral origin. World J Surg 2006; 30:1295-9. [PMID: 16773260 DOI: 10.1007/s00268-005-0440-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Mechanical bowel obstruction cases constitute an important place in emergency health care services. In this study, bowel obstructions caused by intra-abdominal tumors were compared with those without tumoral causes. PATIENTS AND METHODS A total of 155 cases of mechanical bowel obstruction diagnosed were retrospectively evaluated. The cases resulting from abdominal wall hernias were excluded. Neoplasia cases were classified as group I, and all other cases as group II. RESULTS Group I totaled 46 patients (30%); group II, 109 (70%). The difference between two groups in terms of gender was found to be statistically insignificant, but the difference in terms of age range was significant (P<0.05). The etiology of group II cases included intra-abdominal strictures (n=68), volvulus (n=15), internal herniation (n=7), Meckel's diverticulum (n=7), tuberculous peritonitis (n=4), foreign body (n=4), invagination (n=2), and inflammatory bowel disease (n=2). Previous surgical operations had been performed in 9 patients (19%) of group I and 52 patients (47%) of group II. The difference between two groups in terms of bowel obstruction localization was significant (chi2: 37.78, P<0.0001). Group I had a significantly higher morbidity and mortality than group II (P<0.01 and P<0.001). CONCLUSIONS Non-tumoral cases causing intra-abdominal mechanical bowel obstruction occur mostly in younger people and in patients with previous surgical operation. Patients in older ages or who haven't had any surgical intervention must be operated as soon as possible because of the high rate of malignancy.
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Affiliation(s)
- Adem Akcakaya
- First Department of Surgery, Vakif Gureba Training and Research Hospital, Istanbul, Turkey.
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Al Salamah SMA, Fahim F, Mirza SM. Value of Water-soluble Contrast (Meglumine Amidotrizoate) in the Diagnosis and Management of Small Bowel Obstruction. World J Surg 2006; 30:1290-4. [PMID: 16773262 DOI: 10.1007/s00268-005-0409-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The object of the present study was to determine the effectiveness of a water-soluble contrast follow-through study for differentiating complete from incomplete small bowel obstruction (SBO) and for predicting the need for surgery. METHODS This prospective study was conducted at Riyadh Medical Complex, Saudi Arabia and spanned 2 years. All adult patients admitted with SBO were included, except those with obstructed hernias, peritonitis, or postabdominal irradiation. The initial resuscitation meglumine amidotrizoate (Gastrografin) follow-though was performed and was considered positive for complete obstruction if the contrast failed to reach the colon as shown on the 24-hour film. Patients were operated on only if they developed signs of strangulation or failed to improve within 48 hours. RESULTS Our study group consisted of 73 patients, 48 (65.7%) of whom were male. The mean age was 35.70+/-12.65 years. In 60 (82.2%) patients, contrast reached the ascending colon within 24 hours, giving a definitive diagnosis of incomplete obstruction; among these 60 cases, 49 (81.7%) resolved on conservative management. The other 13 (17.8%) patients were diagnosed as having a complete obstruction; 4 (30.8%) of them were treated conservatively, and 9 (69.2%) underwent surgery. Therefore the sensitivity, specificity, positive predictive value, and negative predictive value for meglumine amidotrizoate follow-through as an indicator for operative treatment of SBO were 45.0, 92.5, 81.7, and 69.2, respectively. The P value using Fisher's exact test was 0.0006. CONCLUSIONS We can confidently diagnose complete and incomplete SBO and differentiate one from the other. This accurate diagnosis indicates a high chance of success with conservative management for incomplete obstruction but does not always correlate with the need for surgical intervention.
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Affiliation(s)
- Saleh Moh'd Al Al Salamah
- Department of Surgery, College of Medicine, King Saud University, University Unit, Riyadh Medical Complex, Riyadh, 11342, Kingdom of Saudi Arabia.
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