ABSTRACT
INTRODUCTION: Small bowel obstruction (SBO) is a common surgical emergency. Our report describes a case of a 61-year-old male who was found to have a PROLENE suture left in situ from a previous open appendectomy 22 years ago, over which a fibrous adhesive band had formed, resulting in a terminal ileal volvulus and subsequent SBO. CASE: A 61-year-old male presented with a 3-day history of severe lower abdominal cramps, nausea and constipation. A previous open appendectomy, performed 22 years ago, was the only significant detail in his medical history. A CT can with oral contrast was performed which showed dilatation of the terminal ileum and a complete absence of opacification of the cecum. Laparoscopy was then performed and a large adhesive band which formed over a suture from his previous open appendectomy was observed. On dissection of the adhesion, the bowel decompressed and returned to normal. Patient was discharged with no complications. DISCUSSION: This is quite a unique case due to the structure of the adhesive band that was formed and the resulting terminal ileal volvulus which is an uncommon occurrence. We could not find any similar reports in our search of the literature and believe our report is novel in this regard. CONCLUSION: We explored a novel etiology of adhesion formation over a foreign body left in situ and this should be considered by surgeons, especially when the clinical picture is uncommon such as a terminal ileal volvulus in this case.
ABSTRACT
INTRODUCTION AND IMPORTANCE: Gastro-oesophageal reflux disease (GORD) is a common chronic condition affecting up to 20 %. Proton pump inhibitor (PPI) is considered 1st line therapy however 10-40 % of patients do not respond adequately subsequently requiring further investigations. One of these investigations includes oesophageal pH testing via a wireless capsule placed into the oesophagus, which may remain there for up to 96 h before being self-displaced. Our report describes a rare case of oesophageal pH capsule retention and proposes a pragmatic approach to its management including endoscopic removal. CASE PRESENTATION: A 33 year-old male attended our out-patient clinic with ongoing reflux symptoms and intermittent dysphagia. His response to first line therapy including lifestyle modifications and with PPIs was unsatisfactory thus a plan for an oesophageal Ph capsule study was agreed and performed. On day 4 post-procedure he reported severe dysphagia to solid foods. A Chest X-ray was performed which confirmed the presence of the capsule 7 days post-procedure. On day 12 post-procedure, gastroscopy and retrieval of the capsule was performed successfully. CLINICAL DISCUSSION: We recommend gastroenterologists use submucosal elevation in combination with manual traction in order to detach the capsule from the underlying mucosa, followed by retrieval using forceps to grab the thread-end of the capsule. CONCLUSION: We hope our report raises awareness for this rare complication as well as providing education to practicing gastroenterologists on a formal manoeuvre for successful endoscopic management of a retained oesophageal pH capsule.
ABSTRACT
Intussusception is a common cause of acute and subacute small bowel obstruction in children, young, and older patients; however, despite increasing awareness of the condition and the number of patients diagnosed with it across all ages, its clinical and diagnostic approach remains challenging. A 17-year-old girl attended our gastroenterology outpatient department complaining of a 6-month history of recurrent right iliac fossa pain associated with nausea and vomiting at times with no past medical history of note. Initial blood tests revealed a slightly raised CRP (9.1 mg/L) and a significantly elevated fecal calprotectin (>1000 µg/g). Computed axial tomography scan of the abdomen and pelvis revealed ileocecal intussusception with no evidence of small or large bowel obstruction. On subsequent colonoscopy a 5-cm mass protruding through the ileocecal valve was identified and multiple biopsies were taken for histological analysis, which confirmed a diagnosis of Burkitt's lymphoma. The lesion was surgically resected and plans for adjuvant chemotherapy were discussed. The learning lessons to take from this case are to widen the list of differential diagnoses of unexplained recurrent abdominal pain to include intussusception and to actively rule it out with an appropriate diagnostic approach that addresses its potential malignant etiology across all ages.
