Unusual causes of mechanical small bowel obstruction

We herein report our experience regarding unusual causes of bowel obstruction to increase the awareness of surgeons regarding this disease. From 1991 to 2003, we had experience at the University affiliated hospitals, northern Jordan with 24 patients with small bowel obstruction resulting from unusual causes. We retrospectively reviewed the medical records of these patients with regards to the mode of presentation, cause of obstruction, radiological and operative findings, management and outcome. We recorded 15 patients who underwent previous abdominal surgery. Preoperative diagnosis was correct in only one patient with an internal hernia, but the abdominal CT scan suggested the diagnosis in 5 of the 9 patients who had the scan. The final diagnosis was internal hernias in 11 patients, foreign bodies in 5, ischemic strictures in 3, carcinoid tumors in 2, endometriosis in 2, and metastatic deposit from interstitial bladder carcinoma in one patient. Nine of the 12 patients with recurrent obstruction had either short course or recurrence obstruction during the same hospital admission. W carried out bowel resections in 15 patients [5 resections were due to bowel strangulation]. Post operative death occurred in 4 patients. Awareness of these rare causes of intestinal obstruction even in patients with previous abdominal operation might improve the outcome. The tentative diagnosis of adhesion obstruction in patients with unusual obstructive etiology might lead to a higher rate of gangrenous complications. Rigorous preoperative evaluation including careful history and early abdominal CT may show the obstructive cause

Ingested chicken bone leading to aorto-esophageal fistula

We report a 38-year-old male patient who was referred to King Abdullah University Hospital, Irbid, Jordan with massive upper gastrointestinal bleeding. The bleeding proved to be due to aorto-esophageal fistula caused by accidental ingestion of a chicken wing bone 10 days earlier. The patient died during a salvage thoraco-laparotomy. Primary aorto-esophageal fistula is a very rare but catastrophic condition that is frequently missed preoperatively. A high index of suspicion is needed for early diagnosis, which might improve the chance of survival