Ileosigmoid Knot: A Rare Cause of Intestinal Obstruction.

Ileosigmoid knotting also known as compound volvulus or double volvulus is a rare cause of intestinal obstruction. Here, we present a case of acute intestinal obstruction in shock. The patient was resuscitated taken up for an emergency exploratory laparotomy, which revealed a large volume of hemorrhagic fluid and dilated gangrenous loops of ileum and sigmoid. A loop of ileum had encircled the base of sigmoid to form a knot resulting in gangrene of both the ileum and the sigmoid colon. Resection of gangrenous ileum and sigmoid colon with ileo-ileal and colorectal anastomosis with a temporary diversion colostomy was done.

Eosinophilic Gastroenteritis Presenting as Small Bowel Obstruction.

Eosinophilic gastroenteritis is a rare disease of unknown etiology characterized by eosinophilic infiltration of bowel wall to a variable depth. A 38 year old female presented with loose stool and vomiting since 3 days. She gave history of pain abdomen and weight loss since six months. Barium study revealed ascending colon stricture just proximal to the hepatic flexure ? malignant. A colonic biopsy was done, which was reported as edematous colonic mucosa with mild increase in eosinophils. Intra-operatively, a dense long segment stricture was found in the ascending colon extending to the caecum which warranted a right hemicolectomy. Histopathology revealed dense infiltration of eosinophils in the entire thickness of ileal and caecal wall. The diagnosis of eosinophilic gastroenteritis was made. Patient responded well to steroids. The case is being reported to highlight its rarity due to caecal involvement, presentation as intestinal obstruction and missed diagnosis on endoscopic biopsy.

Pattern of intestinal obstruction in children - a review of 200 consecutive cases

To identify the various causes of intestinal obstruction in children. Retrospective study. Department of Paediatric Surgery, Allied Hospital, Faisalabad from July 1995 to June 2009. The record of all children, between the age of 1 to 14 years, who presented with intestinal obstruction during the study period was reviewed. Two hundred children presented with intestinal obstruction. It was not an uncommon cause for admission from the emergency department [12.1%] and constituted 7.4% of the children operated in the unit. They were predominantly males [75%]. Average duration of symptoms was 3 days. The commonest causes were adhesions [31%], Meckel's diverticulum with band [15.5%], volvulus [12%] and incarcerated inguinal hernia [11.5%]. Wound infection [11%] and wound dehiscence [4%] were the common complications. Mortality rate was 2.5%. Intestinal obstruction is seen not infrequently in children and is associated with significant morbidity. Adhesions especially post operative have emerged as a leading cause. Early recognition and prompt treatment are needed

Intestinal obstruction in children at El Obeid Hospital, Western Sudan

Intestinal obstruction is a common cause of childhood surgical emergency in the developing countries with considerable morbidity and mortality. To assess the magnitude, pattern and management outcomes of intestinal obstruction in children presenting to a General Surgical Unit at a rural setup, in Western Sudan. The clinical records of all children below 15 years of age admitted to the University General Surgical Unit at El Obeid Teaching Hospital, in Western Sudan with the diagnosis of intestinal obstruction during the period from 2006 to 2007 were retrospectively reviewed. The mean age, gender, causes of obstruction and management outcomes were studied and analyzed. There were 72 patients, 48 were males [66.7%]. Neonates and infants were 70% of patients. Hirschsprung's disease, intussusception, obstructed hernias and ano-rectal anomalies accounted for 21.8%, 19.4%, 16.7% and 13.9% respectively. Less common causes were pyloric stenosis 8.3% and gut atresia 6.9%. Lymphoma, adhesions, peritonitis and faecal impaction were 2% each. The overall mortality rate was 13.9%. The main causes of childhood intestinal obstruction at Western Sudan were congenital anomalies in neonates, intussusception in infants and obstructed hernias in elder children. The management was associated with high mortality due to poor hospital facilities and late presentations resulting in bowel ischaemia

Acute abdomen; causes

The term [acute abdomen] denotes any sudden spontaneous non-traumatic disorder whose chief manifestation is in the abdominal area. There is frequently a progressive underlying intra-abdominal disorder, the correct early diagnosis and treatment of which is essential for a favorable outcome. [I] To find out the most common causes of acute abdomen. [II] To compare the preoperative assessment with postoperative diagnosis. A Non-interventional Analytical [Comparative] study. Emergency department of Combined Military Hospital Kharian. Oct 2001 to Mar 2002. Total of 220 patients who presented with acute abdomen. The most frequent cause was found to be Acute Appendicitis, followed by Nonspecific abdominal pain, acute cholecystitis, acute intestinal obstruction and perforated duodenal ulcer. Preoperative diagnosis was wrong in 9.5% [n=21] of cases. Acute appendicitis was found to be the most common cause of acute abdomen and the single most important cause of acute abdominal pain causing great diagnostic difficulties, the preoperative diagnostic accuracy can be increased especially in female of child bearing age by using modern diagnostic tools especially laparoscopy

Causes of intestinal obstruction: a study of 257 patients

To find out the common causes of intestinal obstruction in our practice. Design: Descriptive study. Place and Duration: The study was conducted in Surgical Unit-I, Ward-3 of Jinnah Postgraduate Medical Centre, Karachi, Pakistan between February, 2000 to January, 2004. Patient And In this study we included only those patients of intestinal obstruction who underwent exploratory laparotomy. Total of 257 patients of intestinal obstruction were diagnosed on the basis of clinical history, examination, radiological findings and investigations. After resuscitation exploratory laparotomy was performed to confirm the diagnosis and relieve the obstruction. The most common cause of intestinal obstruction was tuberculosis, 38.13% followed by obstructed/strangulated hernia 26.84%, post-operative adhesions 17.12%, large gut malignancy 10.09%, volvulus 6.22% and small gut malignancy 0.77%. The causes of intestinal obstruction are variable in different parts of world. Tuberculosis is one of the leading cause of intestinal obstruction in Pakistan

Vomiting, abdominal distention and early feeding of banana (Musa paradisiaca) in neonates.

The objective of this cohort study was to assess the relationship between banana given as early solid food with the symptoms of intestinal obstruction (SIO) among neonates, in a rural community in West Lombok District, West Nusa Tenggara Province, Indonesia. Mothers having newborn infants were interviewed and 3,420 neonates were followed for 28 days. Compared with infants who were not given solid food, the relative risk (RR) for infants given food other than banana as early solid food was 1.87, 95% CI 0.48-8.24, p=0.4, while for infants given banana only as early solid food the RR was 9.15, 95% CI 1.96-42.58, p 0.0005. After adjustment for birthweight, colostrum, and breastfeeding, the odds ratio for infants given banana and the appearance of SIO was 2.99, 95% CI 2.65-5.14; p=0.0012. These data indicate that banana given as early solid food is an important risk factor for the appearance of SIO in neonates.

Mechanical bowel obstruction: the Chandigarh experience.

Intestinal obstruction is a fairly common surgical emergency in India, but there is little data available regarding the spectrum of intestinal obstruction in India, or its related complications. This paper represents a retrospective review of 97 patients who underwent surgery for intestinal obstruction at Government Medical College and Hospital, Chandigarh, India, over four years (1997-2000). The case files of all these patients were reviewed and analysed for patient particulars, pre-operative clinical examination and investigations, intraoperative findings, final diagnosis, post-operative morbidity, and mortality. The mean age of our patients was 39.46 years, with an overall male to female ratio of 2.46:1. Most of the patients were in the age group of 17 to 60 years (62.89%). A total of 107 causes for the obstruction could be identified at surgery, with intra-abdominal adhesions and bands (27.10%) being the commonest followed by obstructed herniae (22.43%). Strangulation was present in 21 patients at the time of surgery. This group of patients had a significantly higher post-operative morbidity than patients with simple obstruction, although no statistically significant difference was seen in between the mortality rates in these two groups.

Comparación de morbilidad entre cierre de colostomía en asa y restablecimiento de tránsito post operación de Hartmann / Morbidity comparison between loop closed colostomy and transit reconstruction post Hartmann's surgery

El cierre de la colestomía en asa (CCA) es una técnica sencilla en comparación con el restablecimiento de tránsito post operación de Hartmann (RT); en la literatura se le asigna una considerable morbilidad e incluso mortalidad, probablemente porque con frecuencia se presentan a ambos procedimientos en conjunto. El objetivo de este trabajo fue comparar 2 series contemporáneas de CCA y RT, realizadas por los mismos cirujanos entre enero de 1978 y diciembre de 1997, para demostrar diferencias significativas con respecto a la morbimortalidad, a favor del cierre de la colostomía en asa. Se compararon 75 casos de CCA con 63 de RT, similares en cuanto a edad, sexo, estado nutricional, enfermedades concomitantes y lapso entre la confección y el cierre de la colostomía. Las principales indicaciones de la colostomía. Las principales indicaciones de la colostomía en asa fueron el trauma colorrectal y la obstrucción del colon distal por cáncer (25,3 por ciento c/u), mientras que para la operación de Hartmann, fueron la diverticulitis complicada (25 por ciento) y el vólvulo del sigmoides (20 por ciento). Se observó una significativa menor morbilidad global en el CCA (8 por ciento) que en el RT (38,1 por ciento). Del mismo modo hubo menos infección de herida operatoria en el CCA (4 por ciento) que en el RT (19,1 por ciento) (p<0,01). Aunque no hubo diferencias estadísticamente significativas, la incidencia de reoperación también fue menor en el CCA que en el RT (1,3 por ciento v/s 4,8 por ciento). Asimismo, hubo menor mortalidad en el CCA (0 por ciento) que en el RT (3,2 por ciento), lo que clínicamente es importante

Vólvulos de sigmoide / Sigmoid volvulos

Se realiza un estudio retrospectivo de las Complicaciones del Megacolon Adquirido del Adulto, recopilando 186 casos, entre Julio/93 y Julio/98. Las dos complicaciones fueron el Fecalomas y el Vólvulos. Del análisis etiopatogénico resultaron 52 casos (27 por ciento) Chagásicos y 134 casos (72 por ciento) Inespecíficos. Se pone a consideración los métodos de tratamiento según el compromiso de viabilidad del asa (sin necrosis ó con necrosis) y se realiza un estudio de la incidencia de Morbimortalidad de las cuatro series de los últimos 30 años. Se llega a la conclusión que el Cuadro Oclusivo es el factor determinante, por los efectos locales y generales que produce, dependiendo de los días de evolución y del compromiso del asa los resultados terapéuticos. De los 186 casos de Megacolon Adquirido del Adulto y complicados, 124 casos (66,65 por ciento) fueron Fecalomas y 62 casos Vólvulos (33,35 por ciento). Se practicaron: 12 Desvolvulaciones. 33 Op. De Mikulics y 17 Op. de Hartmann. La mortalidad fue del 6,45 por ciento.

Cirugía de urgencia en obstrucción de intestino delgado: factores pronósticos que inciden en la mortalidad / Emergency surgery in intestinal obstruction: prognostic factors inciding in mortality

Se presenta trabajo retrospectivo en pacientes con obstrucción de intestino delgado atendidos entre enero de 1986 y diciembre de 1996. El objetivo del trabajo es determinar los factores pronósticos, en cirugía de urgencia, que inciden en la mortalidad. Los pacientes fueron divididos en dos grupos: 175 que sobreviven (grupo A) y 25 que fallecen (grupo B); enfrentando un conjunto de parámetros, realizando prueba de chi cuadrado, considerando estadísticamente significativos los valores con p < 0,05. Al comparar el grupo A con el B, los factores analizados que presentaron diferencias estadísticamente significativas fueron la presencia de: patología agregada (19,4 vs 88 por ciento) y dentro de éstas la hipertensión arterial (35,2 vs 72,7 por ciento) y neoplasias (14,7 vs 31,8 por ciento); taquicardia (43,4 vs 72 por ciento); nitrógeno ureico alto (51,4 vs 80 por ciento); tiempo transcurrido entre el ingreso y la cirugía mayor de 24 horas (24,5 vs 72 por ciento); tiempo quirúrgico mayor de 2 horas (33,1 vs 72 por ciento); presencia de necrosis de asa intestinal y necesidad de realizar resección con anastomosis (27,4 vs 72 por ciento); obstrucción causada por una neoplasia (2,8 vs 20 por ciento) y complicación postoperatoria que requirió una nueva cirugía (10,8 vs 64 por ciento). Según los resultados obtenidos en la presente experiencia, la mortalidad de esta entidad nosológica en cirugía de urgencia es multifactorial, participando el estado basal del paciente (patología agregada, repercusión sistémica del cuadro clínico (hipovolemia y sepsis), decisión y técnica quirúrgica, etiología de la obstrucción, estado del asa intestinal y la presencia de morbilidad postoperatoria que requiere de una nueva exploración quirúrgica

Ileo biliar: nuestra experiencia / Biliary ileum: our experience

Objetivos: el presente trabajo tiene por objetivo presentar la experiencia en nuestro hospital y en la práctica privada, sobre el estudio, epidemiología, fisiopatología, clínica y tratamiento del ileo biliar. Material y métodos: se analiza una serie de 28 casos del ileo biliar tratados entre los años 1982 y 1998 en el Servicio de Guardia del HIGA San Martín y en la práctica privada. Resultados: los 29 pacientes fueron resueltos quirúrgicamente. La certeza diagnóstica se tuvo en 11 de ellos (37,9 por ciento), se lo sospechó en 5 (17,2 por ciento) y se ignoró en 13 (44,9 por ciento). Los hallazgos operatorios fueron en 21 72,4 por ciento) cálculo único y en 8 (

Invagination et occlusions intestinales aigues (OIA) chez l'enfant: à propos de 127 observations

Il s'agit d'une etude retrospective de 07 ans sur les enfants de 0-15 ans admis dans le service de chirurgie infantile pour occlusions intestinales. Nous avons collige 127 cas. Les objectifs fixes etaient les suivants: determiner la frequence des affections responsables d'occlusions et invaginations; determiner la mortalite dans tous les cas; faire des recommandations allant dans le sens de l'amelioration du pronostic. En somme; il est a noter que les occlusions et invaginations occupent une place importante dans la chirurgie de l'enfant. En moyenne 18 cas

Principais causas de obstruçåo intestinal mecânica de tratamento cirúrgico, em crianças e em adultos / Main causes of mechanical bowel obstruction in surgically treated children and adults

A literatura vem registrando umamudança nas características etiológicas das obstruçÆes intestinais mecânicas. O seu padråo parece variar de acordo com o desenvolvimento das populaçÆes. A aparente ausência de estudos em nosso meio estimulou a presente investigaçåo. Foram estudadas 54 crianças e 320 adultos operados sucessivamente por obstruçÆes intestinais mecânicas, durante um período de 10 anos. Na infância, os principais agentes etiológicos das obstruçÆes foram as aderências, as invaginaçÆes, os volvos e as massas de áscaris. Nos adultos, predominaram as aderências, os volvos, os fecalomas e as neoplasias. O padråo observado nesta causuística equivale ao registrado nos países desenvolvidos

Le volvulus du caecum au CHU de Lome (Togo)

Une etude retrospective sur les cas de volvulus du caecum operes dans le service de chirurgie du C.H.U. de Lome du 1er janvier 1977 au 31 decembre 1986 est presentee. Le volvulus caecal s'est avere une affection tres rare : 3 cas en 10 ans et tous les 3 patients etaient de sexe masculain; ages respectivement de 20; 35 et 72 ans. Il y avait 2 cas de volvulus caeco-colique et 1 cas de volvulus ileo-caeco-colique. Les methodes therapeutiques utilisees etaient une detorsion; suivie de fixation; et une fois l'hemicolectomie droite. Un deces a ete deplore (patient de 72 ans)

Obstrucao intestinal: estudo de 80 casos / Intestinal obstruction: a study of 80 cases

Entre outubro de 1979 e novembro de 1991, 80 pacientes com diagnostico de obstrucao intestinal, os quais foram submetidos a tratamento cirurgico no Hospital de Florianopolis, em Florianopolis, Santa Catarina, sao analisados neste estudo. A media de idade dos pacientes foi de 13 aos 18 anos, sendo a distribuicao dos casos homogenea entre as diversas faixas etarias. Houve ligeiro predominio do sexo masculino com 53,75 por cento. As causas mais frequentes de obstrucao intestinal foram as bridas com 37,50 por cento, seguidas pelas hernias inguinai ou crurais encarceradas ou estranguladas com 16,25 por cento. O tempo medio de permanencia hospitalar entre os 70 pacientes que nao evoluiram para o obito, foi de 15,11 dias. Destes pacientes que nao evoluiram para o obito, estando este diretamente relacionado a presenca de afeccoes associadas debilitantes e a avancada idade deste grupo de pacientes.