جستجوی مقالات مرتبط با کلیدواژه « bowel obstruction » در نشریات گروه « پزشکی »

Meckel’s Diverticulum (MD) affects approximately 2% of the population. Phytobezoar is defined as a vegetable and fiber-based ball in the gastrointestinal tract. We report a rare case of phytobezoar within MD presenting with partial intestinal obstruction.

We hereby present a 20-year-old man who referred to the Emergency Department of a hospital with a two-day history of nausea, vomiting, abdominal pain, and constipation. He underwent a midline laparotomy with surgical exploration, which revealed an MD 60 cm proximal to ileocecal valve containing phytobezoar. Histopathology reported the extracted specimen as an MD without ectopic tissue.

Meckel’s diverticulum can be affected by bezoars as well as other parts of the gastrointestinal tract. We recommend that phytobezoar within MD be considered among differential diagnosis of bowel obstruction.

A 26-year-old female patient was admitted to our hospital, complaining of obstipation, nausea, and vomiting for the past 3 days. She had no significant medical and clinical history. The patient had no history of previous abdominal operations or medication use. Distension of the abdomen was the only finding on clinical examination. Plain abdominal radiography showed air-fluid levels and abdominal computed tomography (CT) showed the clustered terminal ileum and cecum, with dilatation at the proximal parts (figure 1). The findings of laboratory tests were within normal limits. Exploratory laparotomy was performed. At laparotomy, we found that loops of ileum and cecum were trapped in a fibrotic sac with a diameter of nearly 10 cm (figure 2).

Splenosis is a rare condition defined as a heterotopic auto-transplantation of splenic tissue, typically after blunt abdominal trauma. It can occur anywhere in the abdominal cavity, or even the chest. Splenosis found in clinical practice is relatively rare because most patients are asymptomatic. We report a rare case of abdominal splenosis in a 7-year-old boy, 3 years after an abdominal blunt trauma.

Intestinal obstructions are the most common surgical emergencies in the neonatal period. Neonatal intestinal obstruction occurring during the first month of life. Early and accurate diagnosis of intestinal obstruction is important for proper patient management. This presentation is a brief review of studies in Pubmed and Google scholar. For evaluation and diagnosis, intestinal obstruction in neonates can be divided into either high or low obstruction on the basis of dilated bowel loops present on abdominal radiographs. A few dilated bowel loops are seen with high intestinal obstruction and several bowel loops are generally seen with low intestinal obstruction. High intestinal obstructions are defined as occurring proximal to the ileum with differential diagnosis and radiographic appearance as below: 1) Gastric atresia: in microgastria a distended esophagus and a small midline stomach and In gastric atresia single bubble sign« with no distal gas. 2) Duodenal atresia: double bubble sign 3) Malrotation with Ladd bands and midgut volvulus can be partial or complete
obstruction: the abdominal radiograph in malrotation is nonspecific. It may be normal or may show a proximal bowel obstruction pattern, or show dilatation of multiple bowel loops. 4) Duodenal web partial obstruction with small amount of distal bowel gas. 5) Annular pancreas. 6) Preduodenal portal vein. 7) Jejunal atresia: triple-bubble sign with no gas in the distal bowel. Dilatation of the duodenum is a sign of chronic obstruction, therefore seen in duodenal atresia, duodenal web and annular pancreas. When obstruction occurs acutely after birth in midgut volvulus, the duodenum is not usually dilated on plain film. In complete obstruction in the high jejunum, no further roentgenographic studies are required, however, in partial obstruction (small amount of distal gas) upper GI study may be helpful to distinguish between duodenal web and malrotation with Ladd bands or midgut volvulus. The classic upper gastrointestinal appearance of malrotation with volvulus consists of an abnormal course of the duodenum that fails to cross the midline combined with a corkscrew appearance. In contrast, low intestinal obstructions involve the distal ileum or colon and typically result in diffuse dilatation of multiple small-bowel loops. If distal small bowel obstruction is suggested, a contrast enema usually is necessary. It is not possible to differentiate distal small bowel from colonic obstruction on the basis of plain abdominal roentgenograms, and consequently, contrast enema is necessary to clarify microcolon in ileal atresia and meconium ileus and differentioation from other pathology as below: 1) Meconium ileus: unused colon (i. e. , microcolon), within which are multiple small filling defects representing meconium concretions. If there is reflux of contrast material beyond the ileocecal valve, multiple small filling defects (meconium concretions) also may be seen in the terminal ileum. 2) Ileal atresia: Microcolon and blind ending ileum on contrast enema. 3) Meconium plug and small left colon syndrome: multiple filling defects (i. e. , meconium plugs) is seen in splenic flexure with left sided microcolon and with normal rectum. 4) Hirschsprung disease: abnormal rectosigmoid ratio ( Intestinal obstructions are the most common surgical emergencies in newborn infants which require early and accurate diagnosis. An understanding of the characteristic imaging appearance of various causes of neonatal bowel obstruction on abdominal X-ray can lead to correct diagnosis or leading a guide to the next appropriate step. After abdominal X-ray that shows the presence of a neonatal high intestinal obstruction, an upper gastrointestinal series is typically performed for further evaluation. However, neonates with classic radiographic findings of high intestinal obstruction, such as duodenal atresia, may undergo surgery without any additional imaging study. An enema examination is used for further investigation of low intestinal obstruction in neonates.

Fecaloma is a mass of hardened feces being impacted mostly in rectum and sigmoid. The most common sites of the fecaloma is the sigmoid colon and the rectum. There are several causes of fecaloma and have been described in association with Hirschsprung’s disease, psychiatric patients, Chagas disease, both inflammatory and neoplastic, and in patients suffering with chronic constipation. Up to now several cases of giant fecaloma has been reported in the literature most of them presenting with megacolon or urinary retention. We herein report a case of giant fecaloma leading to bowel obstruction who was successfully treated by surgery. A 30-yrar-old man presented with sign and symptoms of acute bowel obstruction. He underwent exploratory laparotomy and enterotomy. He was found to have a giant fecaloma causing bowel obstruction in the jejunum. He was discharged after the operation with good condition. Jejunal fecaloma is extremely rare condition.

To determine the epidemiological, clinical, laboratory characteristics as well as outcome of 411 patients with bowel obstruction in Southern Iran. This was a cross-sectional study being performed in Shahid Faghihi hospital of Shiraz between 2006 and 2012. We reviewed the medical charts of the 411 patients with initial diagnosis of bowel obstruction who were admitted to our center during the study period. The patients’ demographic, clinical and laboratory findings as well as their management and outcome was recorded in data gathering forms. The data were then analyzed according to the outcome and clinical characteristics. Among the 411 patients with initial diagnosis of bowel obstruction, 253 (61.5%) were men and 158 (38.5%) were women. The mean age of the patients was 48.2±19.7 years. Besides, 73.6% were observed and 26.4% were operated. Those who were operated had those who underwent operation had significantly lower frequency of obstipation (28.1% vs. 71.9%; p=0.045) and abdominal distention (32.3% vs. 67.7%; p=0.007). Intraoperative findings included adhesion band formation in 50 (48.1%), mass 18 (17.3%), and hernia 7 (6.7%). We found that the frequency of malignancy was significantly higher in those who were managed conservatively compared to those undergoing operation (64.3% vs. 35.7%; p=0.042). The mean hospital stay was significantly higher in those who underwent operation (8.1 ±7.5 vs. 2.6±2.2 days; p=0.035). The results of this study demonstrates although some signs and symptoms, such as abdominal pain, vomiting, abdominal tenderness, abdominal distention, and obstipation, were more common among the patients with bowel obstruction, they were not sensitive and specific enough for definite diagnosis. Due to the lack of positive predictive value of clinical signs and symptoms in diagnosis of bowel obstruction, a reasonable and logical modality is needed for bowel obstruction diagnosis with better accuracy.