جستجوی مقالات مرتبط با کلیدواژه "intestinal obstruction" در نشریات گروه "پزشکی"

Congenital anomalies are main cause of intestinal obstruction that occur from neonates to adults. Frequently, obstruction is due to either incarcerated hernia, adhesive bands, volvulus and intussusception.
we illustrate all demographic & clinical data, imaging, surgical approach and outcome of unusual causes of pediatric intestinal obstruction. 

We document a retrospective review of ten pediatric cases of acute intestinal obstruction for whom surgery was indicated and showed rare causes and pathology between 2020 and 2023.

On exploration, first and second patient had non-Hodgkin intestinal lymphoma. Third case had a large polyp of Peutz– Jeghers syndrome as a nidus for jejunojejunal intussusception. Fourth patient had jeujunogastric intussusception whereas fifth case had chylous cyst, in the sixth patient, cecal duplication cyst was a cause of intussusception. Seventh case had volvulus of small gut due to entrapment through a mesenteric defect was detected whereas eighth case had ileal gel ball, ninth case had volvulus on top of mesenteric lymphangioma and tenth case had huge mesenteric chylous cyst. All causes of obstruction are rare either as a pathology or its age or presentation.

Suspicion, careful evaluation, and tailoring of appropriate treatment are corner stone for precise management of these unusual cases.

An inflammatory fibroid polyp is a rare benign lesion of the gastrointestinal tract, which can cause obstruction or intussusception when it reaches a large diameter. We present a case of a 46-year-old female admitted to our clinic with recurrent ileus attacks. We performed segmental resection of the small bowel due to a 3-cm pedunculated polypoid lesion located in the terminal ileum that caused ileo-ileal intussusception and whose pathology was reported as an inflammatory fibroid polyp. In adults presenting with ileus, the possibility of intussusception should be kept in mind.

 Bowel obstruction is a disorder in the passage of bowel contents, the etiology of which varies depending on temporal and geographical conditions. This study investigated the etiology of bowel obstruction in a large number of patients at an adult surgery referral center in southern Iran.

 In this cross-sectional study, we reviewed the medical records of all patients admitted to Shahid Faghihi hospital (Shiraz, Iran) between 2014 and 2020 with a diagnosis of small or large bowel obstruction. Patients with missing or obscure data on etiology were excluded. Data was collected on the patients’ age, gender, history of relevant surgeries, comorbidities, cause of obstruction, site/type of obstruction, treatment, intensive care unit (ICU) admission, length of hospital stay, and outcome. Statistical analyses were made using SPSS v. 25.0.

 A total of 2781 bowel obstruction patients (61.4% males, 38.6% females) with a median age of 58 (IQR 43-71) years were studied. Most responded to non-surgical treatment (61.3%). While the obstruction was mostly partial (65.5%), 94.4% of patients with complete obstruction required surgery. Small bowel obstruction (SBO) was almost three times more prevalent than large bowel obstruction (LBO). Adhesion bands were the leading cause of SBO (66.77%), while LBO was primarily due to colorectal tumors (33.9%).

 The predominant etiology of LBO was colorectal cancer, suggesting that policymakers should improve surveillance programs to detect the condition earlier. Regarding SBO, the leading cause was adhesion bands, indicating the necessity of further efforts to reduce the rate of adhesions following intra-abdominal operations.

The etiology of pelvic organ prolapse is multifactorial. Age and parity are especially the two most important risk factors for this condition. Small bowel obstruction is one of the most common clinical presentations to the emergency department that can result in significant morbidity and mortality.

A 79-year-old woman with a previous history of uterine prolapse and no previous history of intraabdominal surgery or malignancies presented with nausea and vomiting, abdominal pain, and constipation from 2 days ago. Upright and supine x-rays showed dilated small bowel loops and confirmed bowel obstruction. Due to primary obstruction, the patient was a candidate for surgery. During the surgery, we observed that 100 cm of the terminal ileum and the uterus protruded in the vaginal canal and the ileal loops were strangulated. We decided to perform a right hemicolectomy surgery.

In patients with uterine prolapse, we suggest a careful examination and consideration of the entrapment of small bowel loops in the prolapse site as a rare cause of small bowel obstruction.

Peritoneal tuberculosis (PTB) is a rare subset of extrapulmonary tuberculosis which account for only 0.5-1% of all cases. PTB diagnosis can be challenging due to nonspecific clinical manifestations. We present a known case of pulmonary tuberculosis that admitted to the surgery ward due to the major complaint of abdominal pain since ten days before admission. In imaging studies, positive findings favoring mechanical obstruction were detected. There were also several hypodense lesions in the liver suggestive of visceral tuberculosis. An adhesion was noted during exploratory laparotomy prior to the ileocecal valve responsible for intestinal obstruction, which was released. Pathology reports of excised tissues were consonant with the PTB diagnosis. PTB diagnosis can be challenging because of its presentation. This can delay the treatment of patients and thus increase morbidity and mortality. As a result, physicians should always be aware of the PTB diagnosis in patients with nonspecific abdominal involvement.

There are many ambiguities regarding the application of ultrasound in detection of intestinal obstruction. This study aimed to evaluate the diagnostic accuracy of ultrasound in diagnosis of intestinal obstruction.

This cross-sectional study was performed on patients with symptoms and signs of bowel obstruction between November19 and July 2020 in Shohadaye-Tajrish and Imam Hossein General Hospitals, Tehran, Iran. After a brief explanation and getting verbal consent, the patients underwent ultrasound examination in the emergency department by the emergency medicine resident. The results of ultrasound were compared with the surgical findings as the gold standard.

24 patients with the mean age of 57.50±18.26 (range: 28 – 81) years were studied (58.3% male). Ultrasonography findings revealed the lumen diameter ≥ 2.5 cm in 21 (87.5%) cases, wall thickness ≥ 3 mm in 3 (12.5%) cases and inter-loop free fluid in 3 (12.5%) cases. Sensitivity, positive predictive value, and accuracy of ultrasound in detection of intestinal obstruction were found to be 85.00% (95%CI: 61.13 – 96.03), 80.95% (95%CI: 57.42 – 93.71), and 70.83% (95%CI: 48.91 – 87.38), respectively.

It seems that point-of-care ultrasound has good sensitivity and accuracy in detection of intestinal obstruction when performed in the emergency department by a trained emergency medicine resident.

Adhesive intestinal obstruction is a common and potentially lethal complication after surgical interventions in the abdomen. Radiologic imaging is the main diagnostic method. This study aims to analyse the diagnostic value of spiral computed tomography with a novel method (n = 54). In this multidirectional cohort study, we present the data with non-parallel (historical) control. This study included the analysis of results of patients with a diagnosis of intestinal obstruction (n = 54) who were admitted to the surgical departments of the City Clinical Hospitals (Ufa city) from 2013 to 2019; the patients’ examination methods included computed tomography with conventional enhancement. The proposed novel enhancement method was implemented by ingesting a mixture containing 50 ml of the contrast Unigexol (300 mg) in 1.0 L cold mineral carbonated water, and Computed tomography (CT) was performed during 40 min after ingesting the contrast meal. Further, the patients with suspected obstruction in the colon were administered a pre-prepared contrast enema with a decoction of leaves of smoke-tree (100 g), chamomile flowers (100 g) and calendula flowers (100 g). Additionally, CT was performed. Obstruction was conservatively stopped in 24 (44.4%) patients of the main group. Remaining 30 (55.6%) patients from the main group were operated with minimal surgical access in the early stages. Owing to early diagnosis of intestinal obstruction and application of the phytocomposition during the examination, exerting various effects such as antispasmodic, analgesic, disinfectant, bactericidal, cicatrising, choleretic, tanning and decongestant, unnecessary surgical interventions were prevented.

We aimed to present a patient with phytobezoar causing small bowel obstruction after Roux-en-Y gastric bypass. Thirty-year-old woman with a history of prior Roux-en-Y gastric bypass due to morbid obesity three years ago presented with colicky abdominal pain, distention, nausea, vomiting, and obstipation. Initial abdominal X-ray showed various distended small bowel loops with air-fluid levels. The patient was taken to operation room for laparoscopic exploration, and a phytobezoar was found in distal jejunum. The bezoar was fragmented and flushed through cecum. The patient tolerated the surgery and her symptoms relieved without complication. Moreover, she received dietary consultation in order to prevent future recurrences. Small bowel obstruction in a patient with prior abdominal surgery is mainly caused due to adhesions, stenosis of anastomosis and hernias. An uncommon cause for obstruction is bezoar formation. The majority of patients with bezoars have a history of gastric surgery. Diagnostic imaging is not always helpful, and surgical exploration is sometimes required for diagnosis. Treatment is mainly surgical, but conservative medical treatment is also reported to be helpful. Apart from removal of bezoar, a dietary consultation is required to avoid eating habits leading to bezoar formation. Bariatric surgery is becoming more common; thus its complications are becoming more common as well. Majority of patients with bezoars have a prior history of gastric surgery. Therefore it is important to maintain a high level of suspicion for timely diagnosis of bezoars in patients with prior history of bariatric surgery, especially Roux-en-Y gastric bypass.

Volvulus is a rare cause of intestinal obstruction and occurs mostly in sigmoid colon and cecum. It is more common in patients with Down syndrome. In this condition, it is even more challenging to diagnose the cause of intestinal obstruction through history and physical examination alone. Early diagnosis and intervention are critical in this condition to prevent serious side effects. Simultaneous volvulus is a sporadic case in the surgical entity. We report a very rare case of simultaneous volvulus of cecum and transverse colon, its management, and outcomes in a 20-year-old known case of Down syndrome.

Bowel endometriosis affects about 3.8-37% of women with endometriosis diagnosis. Most of the time endometriosis involves the recto-sigmoid .Right colon involvement is not common in endometriosis and also a few studies have reported obstructive endometriosis of bowel. Here, a case of endometriosis was reported with the ileocolic intussusception and cecal mass. A 32y old woman was referred to Yas hospital due to severe low abdominal pain and vomiting. Ultrasonographic examination of her pelvis revealed bilateral ovarian cysts. Abdominal erect X-ray showed dilatation of small bowel segments. Diagnostic colonoscopy showed one small ulcer with the pressure effect of mass like lesion at cecum. The patient was taken to the operating room for excision of the mass; as a result the ileocolic intussusception was seen. After reduction, a firm mass was recognized at cecum so the ileocecal resection was performed. In pathologic examination of mass, endometriosis was reported. The postoperative period was uneventful. The diagnosis of bowel endometriosis is sometimes difficult. The case of bowel obstructive endometriosis is rare. Surgical excision of bowel endometriosis is necessary for symptomatic patients with bowel obstruction. Bowel endometriotic nodules are excised by nodulectomy or segmental resection.  

Gastrointestinal (GI) obstruction is one of the most important surgical emergencies in neonates. Surgeons should select between conservative and invasive strategies. Imaging modalities are important in proper diagnosis. This study evaluates the sensitivity of abdominal radiographies (with or without contrast) in detection of neonatal GI obstruction.
A cross-sectional study was performed on 62 neonates admitted in NICU of 22 Bahman and Dr. Sheikh Hospitals (Mashhad, Iran) from June 2013 for two years. Radiographic findings were recorded in questionnaires and compared with surgical results in patients who underwent surgery. Statistical analysis was used for determining the sensitivity of radiologic investigations in diagnosis of neonatal gastrointestinal obstruction.
From 62 neonates with GI obstruction, 46.8% of cases were female and the others were male. According to surgery results, the frequency of colon obstruction was 51.6% and small bowel obstruction, gastric outlet obstruction and esophageal obstruction were seen in 27.4%, 9.7% and 17.7% of cases, respectively. The sensitivity of radiographies (with or without contrast) in detection of upper GI obstruction was 100% and in lower GI obstruction was 95.2%.
Generally, sensitivity of radiologic studies (radiographies with and without contrast) in neonatal GI obstruction was 96.5%, so it is a valuable noninvasive diagnostic method in these diseases.

Neonatal intestinal obstruction NIO is one of the most common emergency conditions a pediatric surgeon is called to assess during neonatal period, Successful management of NIO depends on timely diagnosis and referrals for therapy (1).Neonatal intestinal obstructions have improved in many developed countries, but still show high morbidity and mortality in developing countries(2) .
This study was done to evaluate the incidence and short term outcome of neonatal intestinal obstruction at department of pediatric surgery, Zagazig university hospitals.
Patients and This retrospective study had done at department of pediatric surgery, Zagazig university hospitals, Egypt; include 84 patients presented by intestinal obstruction during the first month of life from Jan 2008 to Jan 2011and was managed surgically.
There were 84 patients presented by intestinal obstruction during the first month of life,50 males and 34 females; in which 10 patients(11.9%) with duodenal atresia, and 7 patients( 8.3%)with jejunoileal atresia, and 5 patients(5.9%) with meconium ileus with perforation, and 5 patient (5.9%) with volvulus ,and 5patients(5.9%)with colonic atresia ,and 15patients (17.8%)with Hirschsprung disease, and 17patients(20.2%)with obstructed congenital inguinal hernia, and 20 patients(23.8%) with anorectal malformations. The mean age at presentation to surgeon was 3.5(2-10) days for duodenal atresia,and2.5(3-5) days for jejunoileal atresia ,and 2 (1-10)days for meconium ileus with perforation, and 2(1-5)days for patients with volvulus ,and 7(5-20) days for colonic atresia , and 20(10-30) days for Hirschsprung disease, and 25(5-30) days for patients with obstructed congenital inguinal hernia, and 2(1-4)days for anorectal malformations. Surgery was done for all patients after resuscitation. The morality was happed in 10 patients (12%), in which 3 patients with jejunoileal atresia was developed leakage from anastomosis and re-operated and died, and 3 patients with duodenal atresia was died postoperative from sepsis and DIC, and 2 patients with high anorectal malformations was died 2 days post operative from associated cardiac anomalies, and 2 patients with colonic atresia was died post operative from sepsis and electrolyte imbalance.
From our study the most common cause of neonatal intestinal obstruction was anorectal malformations and obstructed congenital inguinal hernia. Mortality and morbidity is still high compared with statistics from developed countries due to late presentation to pediatric surgeon and there is no specific neonatal surgical intensive care unit beside the pediatric surgery department.v

Ileal diverticulum is a rare disease that presents with complications such as diverticulitis.
We present an 81-year-old man with partial small bowel obstruction having abdominal pain, nausea, vomiting for 48 hours and a mobile abdominal mass. After CT scan, exploratory laparoscopy and small bowel resection was done with primary anastomosis.
When adhesion, internal hernia and malignancy are ruled out in patient presenting with partial obstruction and abdominal mass, other causes like diverticula must be considered.

Primary enterolithiasis is a rare surgical ailment. The underlying cause is intestinal stasis. Numerous anatomical and micro environmental factors such as enteritis, incarcerated hernia, malignancy, diverticula, blind loops, and enteroenterostomy predispose to clinically significant concretions. Enterolithiasis in tuberculosis can be due to the presence of strictures, intestinal bands, or interbowel/parietal adhesions, leading to intestinal stasis. Secondary enterolithiasis is generally caused by gallstones or renal stones migrating to the gastrointestinal tract due to fistula formation. During stasis, food particles act as a nidus and calcium salts are deposited over the food particles, leading to stone formation. A 57-year-old male patient presented to the Emergency Department of Jawaharlal Nehru Medical College, AMU, Aligarh, with features of intestinal obstruction. The patient underwent emergency laparotomy, revealing 2 strictures in the distal ileum with 15.24cm of the bowel between them containing a 2×2 cm enterolith. The strictured segment was resected, and end ileostomy and mucus fistula were created. The patient’s postoperative recovery was fine, and he wasdischarged with ileostomy on antitubercular treatment (after histopathologicalconfirmation). Ileostomy closure wasplanned after 6 weeks. The incidence and prevalence of enterolithiasis has been on the rise recently because of advancement in radiological imaging studies. Endoscopic and surgical stone removal along with the treatment of the underlying pathology is recommended.

he incidence of the diverticulum of the small bowel varies from 0.2-1.3% in autopsy studies to 2.3% when assessed on enteroclysis. It occurs mostly in patients in the 6th decade of their life. Of all the small bowel diverticuli, jejunal diverticulum is the most common type. This rare entity is usually asymptomatic. However, they may cause chronic non-specific symptoms for a long period of time like dyspepsia, chronic postprandial pain, nausea, vomiting, borborgymi, alternating diarrhoea and constipation, weight loss, anaemia, steatorrhea or rarely lead to complications like haemorrhage, obstruction, perforation. Obstruction can be due to enterolith, adhesions, intussusception, and volvulus. The condition is difficult to diagnose because patients are generally presented with symptoms that mimic other diseases. It is important for clinicians to have awareness of this entity. Here, we present a case of multiple jejunal diverticuli with a history of repeated attacks of diverticulitis over past 20 years, which were misdiagnosed and now presented with intestinal obstruction due to volvulus of the involved segment along with mesentery around its axis. Resection of the diverticuli segment of jejunum was done with end-to-end jejuno-jejunal anastomosis. The patient is asymptomatic since 10 months of follow-up.

Nutritional status is very important especially in older adults because of its effects on quality of life. Phytobezoar, for instance, that can lead to small bowel obstruction has risk factors such as excessive consumption of foods with high fiber content and inadequate chewing. These factors are related to dietary habits. Furthermore, aging process and some of related physiologic changes can predispose one to phytobezoar formation. We describe a 61-yr-old man presented to the Emergency Department of Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran, in 2015 with small bowel obstruction due to phytobezoar following large amount of pomegranate seeds intake a few days before admission as an example of increased morbidity relating to unusual dietary habit.

An obstructed inguinal hernia is a common surgical emergency, which presents with a variety of contents like the small intestine, omentum, and colon. Intestinal knotting is a rare entity encountered in surgical practice; it occurs when one coil of intestine wraps around the other and eventually leads to complications such as intestinal obstruction, ischemia, and gangrene. Both conditions are considered surgical emergencies and should be dealt with through appropriate surgical measures forthwith. We report the case of an obstructed inguinal hernia, which, on exploration, showed an ileoileal knot as its content. Ileoileal knotting is a very rare phenomenon and, to the best of our knowledge, such an ileoileal knot as a content of obstructed inguinal hernia has not been reported in the surgical literature so far.