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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]
  • Abstract 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]
  • In 9 of 20 patients that received abdominal CT scans, “whirlpool sign” on the CT scan was present.[journals.plos.org]
Pain
  • The application of this mini-invasive approach has given the benefits of shorter hospital stay, less postoperative pain and quicker functional recovery.[ncbi.nlm.nih.gov]
  • Although intussusception caused by a benign tumor of the small bowel is a rare condition it should be taken into consideration in the differential diagnosis of abdominal pain of doubtful origin.[ncbi.nlm.nih.gov]
  • A 35-year old woman presented at the emergency department with progressive abdominal pain. The pain was coliky in nature predominantly involving the left upper part of the abdomen.[webmedcentral.com]
  • 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]
  • Keywords: Abdominal pain ; Meckel diverticulum ; Intestinal obstruction ; Laparoscopy[ekjm.org]
Swelling
  • This abdominal X-ray shows thickening of the bowel wall and swelling (distention) caused by a blockage (psudo-obstruction) in the intestines.[mountsinai.org]
  • Symptoms include Severe abdominal pain or cramping Vomiting Bloating Loud bowel sounds Swelling of the abdomen Inability to pass gas Constipation A complete intestinal obstruction is a medical emergency. It often requires surgery.[icdlist.com]
  • Pressure from this expansion causes swelling and edema. Fluid loss (from vomiting and edema) can cause dehydration and electrolyte imbalances, which can be severe and even life threatening.[metrowestdailynews.com]
  • This is to help relieve abdominal swelling (distention) and vomiting. Volvulus of the large bowel may be treated by passing a tube into the rectum. Surgery may be needed to relieve the obstruction if the tube does not relieve the symptoms.[medlineplus.gov]
  • Symptoms Signs and symptoms of intestinal obstruction include: Crampy abdominal pain that comes and goes Loss of appetite Constipation Vomiting Inability to have a bowel movement or pass gas Swelling of the abdomen When to see a doctor Because of the[mayoclinic.org]
Collapse
  • CT scan [Figure-1]revealed an abrupt collapse of small bowel loop distal to duodeno jejunal flexure with mild dilatation of stomach and proximal duodenum.[webmedcentral.com]
  • Inflammatory Bowel Disease — a condition in which the walls of the intestine become inflamed Tumors in the intestine that impede the flow A volvulus, or a twisting of the intestine Intussusception, a condition in which a segment of the intestine collapses[ddc.musc.edu]
  • The proximal bowel distends, and the distal segment collapses. The normal secretory and absorptive functions of the mucosa are depressed, and the bowel wall becomes edematous and congested.[msdmanuals.com]
  • Volvulus presents with irritability with bilious vomiting and later on bloody stools and eventually collapse due to intestinal ischemia. Chronic duodenal obstruction due to Ladd’s band may manifest as intermittent vomiting.[ispub.com]
Gangrene
  • Part of the herniated bowel loops were gangrenous and were resected jejuno-ileal anastamosis was done. The hernia orifice was closed with non-absorbable sutures. The postoperative course was uncomplicated.[webmedcentral.com]
  • Hernias, volvulus, and intussusception carry a higher gangrene risk. In a newborn, paralytic ileus that destroys the bowel wall (necrotizing enterocolitis) is a life-threatening condition. It may lead to blood and lung infections.[medlineplus.gov]
  • Out of the 31 patients, 15 with gangrenous small bowel had to undergo intestinal resection. Intestinal gangrene was present with higher neutrophils count ( p p 0.004). Three patients died of septic shock (9.68%), and the recurrence rate was 3.23%.[journals.plos.org]
  • In the acute symptomatic patient, only emergency laparotomy can provide the correct diagnosis and decrease the risk of bowel gangrene.[ispub.com]
Asymptomatic
  • He continued to be well and asymptomatic for a further 5 years on long-term maintenance low-dose steroids and 6-mercaptopurine. He re-presented in 2009 (six years after initial presentation) with very severe acute abdominal pain and vomiting.[ingentaconnect.com]
  • Although it is commonly asymptomatic in adults, Meckel diverticulum can lead to intussusception, volvulus, inflammatory adhesions, or an internal hernia. However, small bowel obstruction due to a mesodiverticular band of Meckel diverticulum is rare.[ekjm.org]
  • A paraduodenal hernia can be demonstrated by an upper gastrointestinal series performed during a period of acute symptoms, because examination during an asymptomatic interval may fail to show the hernia or merely demonstrate nonspecific dilatation, stasis[webmedcentral.com]
  • She was discharged on the eighth postoperative day and was asymptomatic on subsequent follow-ups.[ispub.com]
Intestinal Perforation
  • Conversion to laparotomy was required for 3 patients (17.6%) because of intestinal perforation (n 1) or a convoluted mass of adherent bowel (n 2). Long-term follow-up was possible in 16 patients.[ncbi.nlm.nih.gov]
  • Intussusception requires emergency treatment (barium enema or surgery) to prevent intestinal tissue death (necrosis), intestinal perforation, peritonitis, and death. A GI series in a patient with a twisted bowel (volvulus).[mountsinai.org]
  • Labs Complete Blood Count Leukocytosis may be significant in bacteremia and intestinal perforation Comprehensive Metabolic Panel Hypokalemia Contraction Alkalosis (dehydration) Acute Kidney Injury (increased Serum Creatinine ) Serum Lactic Acid Increased[fpnotebook.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]
  • 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]
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]
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]
Bilious Vomiting
  • She had experienced nausea and two episodes of bilious vomiting. There was no fever nor diarrhoea. Over the last few years, multiple short periods of abdominal pain had occurred, comparable to this event.[webmedcentral.com]
  • Case Report A 22-year-old female presented in emergency with complains of intermittent cramping abdominal pain and bilious vomiting for 2 days. There was a past history of recurrent vomiting with pain in the abdomen since childhood.[ispub.com]
Hypertension
  • Prior medical history includes hypertension and hypercholesterolemia, and she has a surgical history of two caesarean sections, bilateral tubal ligation, and open cholecystectomy.[emdocs.net]

Workup

  • Surgical Bowel obstruction requires a swift workup to establish whether emergent surgery is necessary! References: [1][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. Georg Thieme Verlag KG Stuttgart · New York.[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]
Small Bowel Mass
  • On explorative laparotomy a small bowel mass in the proximal ileum was excised. Pathology revealed ulcerated, well to moderately differentiated adenocarcinoma without regional nodal involvement.[annalsgastro.gr]
Polyps
  • In one case two polyps were found and in the other case a lipoma in the wall of the jejunum. In both cases there were symptoms of recurrent bowel obstruction for several months before the acute condition.[ncbi.nlm.nih.gov]
  • […] obstruction, intestinal obstruction due to chronic ulcerative pancolitis, intestinal obstruction due to chronic ulcerative proctitis, intestinal obstruction due to chronic ulcerative rectosigmoiditis, intestinal obstruction due to colonic inflammatory polyps[healthresearchfunding.org]
  • Causes: By Type Obturation Colonic Polyp Intussusception Children: Usually idiopathic Adults: 95% have underlying mechanical cause AIDS may predispose to Intussusception Gallstone s that have entered the bowel lumen More common in those over age 65 years[fpnotebook.com]

Treatment

  • METHODS: 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]
  • BACKGROUND: 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

  • 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]
  • Prognosis: Recurrence of obstruction due to adhesions Risk after first episode: 53% Risk after more than one episode: 83% Surgical Consultation to review elective surgery for reversible causes (e.g.[fpnotebook.com]

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]
  • Mechanical bowel obstruction : disturbance of bowel passage due to a structural barrier, resulting in disruption of intestinal transit Paralytic ileus : temporarily impaired peristalsis of the gastrointestinal tract in the absence of mechanical obstruction Etiology[amboss.com]
  • A more unusual etiology for bowel obstruction in this setting is intussusception. Intussusception is often a pediatric condition. Adult cases have rarely been reported, and are usually caused by a lead point. The paper published by Dr.[sciencedaily.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]
  • Pediatr Surg Int 25:795–798 PubMed CrossRef Google Scholar Carlyle BE, Borowitz DS, Glick PL (2012) A review of pathophysiology and management of fetuses and neonates with meconium ileus for the pediatric surgeon.[link.springer.com]
  • Pathophysiology: Process (Occurs quickly in closed loop obstruction) Obstruction forms in either Small Bowel (much more common) or Large Bowel Bowel dilates proximal to obstruction Flatus and Bowel Movement s cease Dehydration results from Vomiting, minimal[fpnotebook.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]
  • Abstract 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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