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Recurrent Small Bowel Obstruction


Presentation

  • A patient presenting with gallstone ileus was managed in our department by laparoscopic enterolithotomy. Postoperatively, the patient developed recurrent small bowel obstruction due to the presence of a second gallstone.[ncbi.nlm.nih.gov]
  • Two cases of primary small bowel tumors causing an acute intussusception are presented. In one case two polyps were found and in the other case a lipoma in the wall of the jejunum.[ncbi.nlm.nih.gov]
  • He re-presented in 2009 (six years after initial presentation) with very severe acute abdominal pain and vomiting. He had no recent change in weight or appetite, and had not had time off work.[ingentaconnect.com]
  • We present a rare case of left paraduodenal hernia presenting as recurrent intestinal obstruction, as well as a brief review of the literature.[webmedcentral.com]
  • These patients tend to present with nausea and vomiting, abdominal pain, weight loss or present with intestinal obstruction or bleeding. [ 14 ] . This patient presented with colicky abdominal pain, distention, vomiting and weight loss.[pubs.sciepub.com]
Chronic Abdominal Pain
  • These patients often present with chronic abdominal pain and vomiting with or without signs of intestinal obstruction or strangulation. Diagnosis requires a high index of suspicion.[ispub.com]
  • Symptoms of metastasis of MM to the small intestine include chronic abdominal pain with features of intestinal obstruction [ 7 ] .[pubs.sciepub.com]
  • abdominal pain, pelvic pain, and infertility. [25] Other animals [ edit ] References [ edit ] a b c d e f g h i j k l Gore, RM; Silvers, RI; Thakrar, KH; Wenzke, DR; Mehta, UK; Newmark, GM; Berlin, JW (November 2015).[en.wikipedia.org]
  • Links The role of laparoscopic adhesiolysis in the treatment of patients with chronic abdominal pain or recurrent bowel obstruction. Shayani V, Siegert C, Favia P.[laparoscopyhospital.com]
  • View Article Google Scholar Swank DJ, Swank-Bordewijk SC, Hop WC, van Erp WF, Janssen IM, Bonjer HJ, Jeekel J: Laparoscopic adhesiolysis in patients with chronic abdominal pain: a blinded randomised controlled multi-centre trial.[wjes.biomedcentral.com]
Recurrent Abdominal Pain
  • A 3-dimensional CT scan was needed to explain the cause of the recurrent abdominal pain, and the small bowel loop was freed from the connecting tube at laparoscopy.[ncbi.nlm.nih.gov]
  • Paraduodenal hernia presenting as unexplained recurrent abdominal pain. Am J Gastroenterol, 1999,94 : 3614-5. 2. Manji R., Warnock G. L. Left paraduodenal hernia : an unusual cause of small bowel obstruction. Can j surg, 2001, 44 : 455-7. 3.[webmedcentral.com]
High Pitched Bowel Sounds
  • The classic physical examination findings of abdominal distension, tympany to percussion, and high-pitched bowel sounds suggest the diagnosis.[aafp.org]
  • Clinical signs include abdominal distention, tympany due to an air-filled stomach and high-pitched bowel sounds. [ 9 ] History There is considerable overlap with the presentation of the various conditions although some features may be more prominent or[patient.info]
Hyperactive Bowel Sounds
  • Diagnosis: Factors predicting Bowel Obstruction History of prior surgery Constipation history Age over 50 years Vomiting Abdominal distention Hyperactive bowel sounds X.[fpnotebook.com]
Abdominal Pain Radiating to the Back
  • A 64-year-old man presented with acute central abdominal pain, radiating to his back, and profuse vomiting. He was diagnosed clinically with small bowel obstruction. He had had an episode of small bowel obstruction 6 years earlier.[ingentaconnect.com]

Workup

  • See Workup for more detail.[emedicine.medscape.com]
  • Surgical Bowel obstruction requires a swift workup to establish whether emergent surgery is necessary! References: [1] Prognosis[amboss.com]
  • Chronic pancreatitis requires an adequate diagnostic workup and systematic management, given its severity, frequency, chronicity, and negative impact on the quality of life and life expectancy. [Indexed for MEDLINE] Free full text[ncbi.nlm.nih.gov]
  • Recognition of risk factors can aid in the timely workup and diagnosis of an ill patient with bowel obstruction.[emdocs.net]
  • The workup should distinguish mechanical obstruction from ileus, determine the cause of the obstruction, and differentiate partial (low-grade) from complete (high-grade) obstructions.[east.org]

Treatment

  • After conservative treatment, elective laparoscopic treatment was attempted in 17 patients hospitalized for recurrent small bowel obstruction after abdominal or pelvic surgery.[ncbi.nlm.nih.gov]
  • To evaluate the feasibility, efficacy, and safety of laparoscopy in diagnosis and treatment of recurrent small bowel obstruction.[ncbi.nlm.nih.gov]
  • The treatment of recurrent small bowel obstruction due to postoperative adhesions has traditionally consisted of lysis at laparotomy. We report interval open laparoscopic lysis of adhesions to manage one patient.[ncbi.nlm.nih.gov]
  • We discuss the etiology and treatment of small bowel carcinoma. This case emphasizes that a high level of suspicion is required in order to diagnose early stage small bowel adenocarcinoma in celiac patients.[annalsgastro.gr]
  • .: An assessment of the surgical treatment of adhesive small bowel obstruction in infants and children. J. Ped. Surg. 16 :225, 1981 Google Scholar 12.[link.springer.com]

Prognosis

  • Prognosis [ edit ] The prognosis for non-ischemic cases of SBO is good with mortality rates of 3–5%, while prognosis for SBO with ischemia is fair with mortality rates as high as 30%. [23] Cases of SBO related to cancer are more complicated and require[en.wikipedia.org]
  • Metastatic melanoma has a very poor-prognosis. The averages mean survival being 6 to 8 months [ 22 ] .[pubs.sciepub.com]
  • Outlook (Prognosis) The outcome depends on the cause of the blockage. Most of the time, the cause is successfully treated.[mountsinai.org]
  • After surgery, more than 90% of the patients can expect to have a favorable prognosis.[journals.plos.org]
  • ] The prognosis of advanced carcinoma of the colon remains poor.[patient.info]

Etiology

  • The etiology included adhesions (38%), incarcerated ventral incisional hernias (32%), Meckel diverticulum (7%), stricture (14%), volvulus (3%), intussusception (4%).[ncbi.nlm.nih.gov]
  • We discuss the etiology and treatment of small bowel carcinoma. This case emphasizes that a high level of suspicion is required in order to diagnose early stage small bowel adenocarcinoma in celiac patients.[annalsgastro.gr]
  • The etiology of adhesions is incompletely understood and attempts to prevent their formation are of unproven value. Patients with recurrent acute obstruction that threatens strangulation, or that fails to subside, require laparotomy.[link.springer.com]
  • Patient was put on antitubercular treatment for nine months keeping in mind possibility of tubercular etiology and after that ileostomy closure was done and patient made uneventful recovery with more than 8 months follow up.[file.scirp.org]
  • : indicated in stable patients who do not need immediate surgical intervention to confirm and further characterize the SBO or LBO Abdominal ultrasound : used with increasing frequency in the ER to rule out SBO or diagnose abdominal pain of uncertain etiology[amboss.com]

Epidemiology

  • Insights from a population-based epidemiological study and implications in surgical management. Ann Surg 253:223–230 PubMed CrossRef Google Scholar Yousefzadeh DK (1983) Tubular colonic duplication: review of 1876–1981 literature.[link.springer.com]
  • Epidemiology Of all patients admitted to hospital with intestinal obstruction, most have small intestinal obstruction. Significant numbers of colorectal malignancies present with obstruction.[patient.info]
Sex distribution
Age distribution

Pathophysiology

  • The Pathophysiology is said to involve the local stimulation, damage and attempts at repair by the mucosa in patients using NSAIDs for a long time ( 4 ).[academic.oup.com]
  • In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. . Accessed Sept. 10, 2015. Glancy DG. Intestinal obstruction. Surgery. 2014;34:204.[mayoclinic.org]
  • ., anticholinergics , opioids , antidepressants ) References: [1] [2] Pathophysiology Clinical features Nausea , vomiting (may be projectile vomiting) Dehydration (especially in SBO ), possible fever Constipation or obstipation with abdominal distention[amboss.com]
  • Andrus CH, Ponsky JL (1988) Bezoars: classification, pathophysiology, and treatment.Am J Gastroenterol 83: 476-478.[omicsonline.org]
  • Hernias , adhesions (common), tumors, foreign body, Meckel diverticulum , Crohn disease (uncommon), Ascaris infestation, midgut volvulus, intussusception by tumor (rare) Neonates Meconium ileus , volvulus of a malrotated gut, atresia, intussusception Pathophysiology[merckmanuals.com]

Prevention

  • Use of an intraluminal tube stent in preventing recurrent small bowel obstruction due to adhesions is safe and effective when used on appropriately selected patients. Its effectiveness should be more widely recognized.[ncbi.nlm.nih.gov]
  • We describe three cases where erythromycin suspension has been used successfully in preventing recurrence of small bowel obstruction in patients with terminal illness and for whom it proved more effective than standard preparations such as metoclopramide[ncbi.nlm.nih.gov]
  • Ramsey-Stewart, G., Shun, A.: Nasogastrointestinal intraluminal tube stenting in the prevention of recurrent small bowel obstruction. Aust. N.Z. J.[link.springer.com]
  • A different possibility is to widen the hernia orifice to prevent future incarceration of bowel loops.[webmedcentral.com]
  • Fluids are important for keeping your skin, eyes and the lining of your mouth moist, and for preventing dehydration. Surgery and the Vicious Cycle Our experience has shown us that surgery is not the solution for preventing future obstructions.[clearpassage.com]

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