Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pathophysiol. Sep 10, 2019; 10(2): 29-35
Published online Sep 10, 2019. doi: 10.4291/wjgp.v10.i2.29
Successful management of adhesion related small bowel ischemia without intestinal resection: A case report and review of literature
Pantelis Vassiliu, Vasiliki Ntella, George Theodoroleas, Zisis Mantanis, Ioanna Pentara, Eleni Papoutsi, Aikaterini Mastoraki, Nikolaos Arkadopoulos
Pantelis Vassiliu, Vasiliki Ntella, George Theodoroleas, Zisis Mantanis, Ioanna Pentara, Eleni Papoutsi, Aikaterini Mastoraki, Nikolaos Arkadopoulos, 4th Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens 12462, Greece
Author contributions: Vassiliu P, Mastoraki A and Arkadopoulos N designed the report; Mastoraki A, Ntella V and Theodoroleas G collected the patient’s clinical data; Mantanis Z, Pentara I and Papoutsi E provided relevant figures; Mastoraki A, Vassiliu P and Arkadopoulos N analysed the data and wrote the paper.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment. Nevertheless, patient’s initials or characteristics are not exposed.
Conflict-of-interest statement: The authors declare that no conflict of interest exists.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Aikaterini Mastoraki, MD, PhD, Academic Research, 4th Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Rimini street, 12462, Chaidari, Athens 12462, Greece. kmastoraki@med.uoa.gr
Telephone: +30-6932-577710 Fax: +30-21-05326412
Received: July 4, 2019
Peer-review started: July 16, 2019
First decision: August 2, 2019
Revised: August 16, 2019
Accepted: August 21, 2019
Article in press: August 21, 2019
Published online: September 10, 2019
Processing time: 67 Days and 15.1 Hours
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.

Keywords: Intraabdominal adhesions; Intestinal ischemia; Small bowel obstruction; Vacuum-pack technique; Case report; Conservative surgical approach

Core tip: Intraabdominal adhesions are the most common cause of small bowel obstruction which occasionally leads to intestinal ischemia (InIs). InIs can be a life-threatening condition that requires high index of suspicion because the clinical signs are mild and you should rely for diagnosis in computed tomography findings and lactate levels. Lactate, if present is a good indicator of the progress or regression of the disease. Diagnosis of InIs leads to immediate operation. Conservative surgical approach avoiding resection of ischemic bowel, could lead to reversal of InIs and should be used even when minimum signs of viability are present.