Fig 2 - available from: World Journal of Emergency Surgery
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Small and large bowel obstructions are responsible for approximately 15% of hospital admissions for acute abdominal pain in the USA and ~ 20% of cases needing acute surgical care. Starting from the analysis of a common clinical problem, we want to guide primary care physicians in the initial management of a patient presenting with acute abdominal p...
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Context 1
... diagnostic accuracy of computed tomography with intravenous contrast is superior to that of conventional abdominal radiography and ultrasound (Fig. 2). In addition to its higher sensitivity and specificity, an important advantage of computed tomography is its ability to provide information about the underlying cause of obstruction or to provide information about an alternative diagnosis if no signs of bowel obstruction are present. Computed tomography leads to more accurate ...
Citations
... This type of volvulus is rare due to the short mesentery and the presence of hepatic and splenic attachments that typically prevent extensive twisting. 23 However, predisposing factors such as previous mobilization of the colonic flexures and chronic dilatation of the colon may contribute to its occurrence. ...
Key Clinical Message
Transverse colonic volvulus (TCV) is a serious condition with a mortality rate of up to 33%. It is very rare, especially in children. Despite its rarity, surgeons should have a high index of suspicion and include it in the list of differential diagnoses, especially in patients with developmental delays and associated uncommon syndromes. Resection and anastomosis, whether as a one‐stage or two‐stage procedure, proved to be the best treatment options for children. Since prompt identification and management are vital, this paper presents useful information on the presentation, treatment, and outcome of this case report.
... 39 Common findings on contrast enhanced abdominal CT include one or more transition points where there is an abrupt change in bowel calibre, dilated loops of bowel proximal to the transition point, collapsed or normal calibre bowel distal to the transition point, mural thickening of the bowel wall and mesenteric fat stranding or oedema. 42,43 It is of vital importance to assess the viability of the involved bowel and to interrogate the images for the presence of any possible complications of MBO, such as bowel wall hypo-enhancement, suggestive of ischaemia, pneumoperitoneum, indicative of perforation, or closed-loop obstruction. 42,43 Treatment of MBO consists of supportive care including IV hydration and nutritional therapy, often parenteral. ...
... 42,43 It is of vital importance to assess the viability of the involved bowel and to interrogate the images for the presence of any possible complications of MBO, such as bowel wall hypo-enhancement, suggestive of ischaemia, pneumoperitoneum, indicative of perforation, or closed-loop obstruction. 42,43 Treatment of MBO consists of supportive care including IV hydration and nutritional therapy, often parenteral. 39 Temporary decompression for symptom relief may be achieved with nasogastric tube placement and anti-secretory medications may also be used. ...
Cancer is the second most common cause of death worldwide. Bowel emergencies in patients with cancer are becoming
increasingly more prevalent due to advances in cancer therapy and longer overall patient survival. When these patients present
acutely, they are often frail and may have pre-existing co-morbidities. This article discusses the imaging features of bowel
emergencies commonly encountered in oncological patients in clinical practice. These include chemotherapy related colitis,
neutropenia enterocolitis and typhlitis, toxic megacolon, bowel perforation, malignant bowel obstruction and gastrointestinal
haemorrhage. The radiologist plays a key role in identifying these oncological emergencies and guiding further management.
... For example, a prospective observational study of 150 adult patients admitted with AMBO found that the absence of passage of atus (90%) and/or feces (80.6%) and abdominal distension (65.3%) were the most common symptoms.. 8 Another systematic review of the clinical presentation, diagnosis, and treatment of small bowel obstruction found that acute small bowel obstruction presents with symptoms such as abdominal pain, nausea, vomiting, and obstipation, while chronic partial obstruction may present with intermittent abdominal pain, bloating, and diarrhea. 17 The varied clinical presentations of AMBO highlight the importance of a thorough clinical assessment and the need for individualized management strategies based on the speci c characteristics of each case. ...
In this study, researchers investigated a condition called acute mechanical bowel obstruction (AMBO). They wanted to understand why it occurs, how it can be treated, and what outcome patients can expect. They studied a group of patients with AMBO and examined their symptoms, treatments, and complications.
The researchers found that AMBO is more common in men, especially those between 31 and 60 years of age. The main symptoms are abdominal pain, bloating, and not being able to pass stool. Surgery was often required to fix the blockage in the intestines. The most common procedure involved removing the blocked part and reconnecting the healthy sections. Adhesions, which are scar tissue bands, were the main cause of AMBO.
During surgery, some patients experienced complications like reduced blood flow to the intestines or tearing of the bowel. However, most patients showed improvement and could leave the hospital. Wound infections were the most common complication after surgery. Some patients needed to stay in the intensive care unit for more specialized care.
These findings are important because they shed light on how AMBO can be managed and what patients can expect. By understanding the causes, symptoms, and treatments of AMBO, doctors can provide better care for patients with AMBO. Future research is needed to confirm these findings and explore ways to further improve outcomes for patients with this condition.
... Обтурационная кишечная непроходимость является частым заболеванием желудочно-кишечного тракта (ЖКТ), требующим хирургического лечения. Причинами обтурации являются опухоли кишки, инородные тела и инвагинация кишки [1][2][3][4][5][6][7][8]. Инвагинация -это самая частая причина непроходимости у детей, преимущественно раннего возраста [9,10]. ...
Introduction. Diabetic foot syndrome is one of the severe complications of diabetes mellitus. This combination of pathological processes occurring in the foot is induced and aggravated by diabetes mellitus. Most often, diabetic foot syndrome is a consequence of angiopathy, neuropathy, osteopathy; it may be accompanied by infectious and ulcera-tive lesions, leading to amputation of the extremity. The aim of the study. To assess the results of diagnosis and treatment of diabetic foot syndrome, following the intro-duction of a multidisciplinary approach. Materials and methods. A retrospective analysis of 151 medical records of patients diagnosed with diabetic foot syndrome was carried out. There were 87 (57.6 %) men and 64 (42.4 %) women; the mean age was 63.6 ± 1.0 years. The most of patients (139 (92.1 %)) were diagnosed with type 2 diabetes mellitus. Results. A multidisciplinary approach to the diagnosis and treatment of diabetic foot syndrome was achieved through the efforts of a team of specialists consisting of a surgeon, general practitioner, endocrinologist and vascular surgeon. The average glycemic level in the examined patients was higher than normal and amounted to 10.6 ± 0.4 mmol/l. In 111 of patients, the correction of carbohydrate metabolism was carried out with insulin, in the remaining observations – with tableted hypoglycemic drugs. All patients received treatment aimed at eliminating the main links in the pathogenesis of diabetic foot syndrome. Local conservative treatment was carried out in 66 cases, surgical treatment – in 85 cases. The majority of surgical interventions (40–47 %) were minor surgeries (preserving the supporting function of the leg), in 20 (23.5 %) patients surgeries were performed on the arteries, in 19 (22.4%) – high amputations (above the ankle joint), in 6 (7.1 %) – opening of foot phlegmon. The average duration of treatment for diabetic patients with diabetic foot syndrome was 17.1 ± 0.6 days. Conclusion. Patients with diabetic foot syndrome were diagnosed with severe disorders of carbohydrate metabolism with the presence of angiopathy and neuropathy. A multidisciplinary approach to the diagnosis and treatment of diabetic foot syndrome makes it possible to identify the main links in pathogenesis and, based on existing protocols, to per-sonalize the treatment. This makes it possible to preserve the supporting function of the extremity in most patients and to reduce the number of high amputations.
... Most of the obstructions in the large bowel are caused by cancer, volvulus, and diverticulitis. 9 Parasite infections like ascariasis are another cause of bowel obstruction, especially in developing countries with poor access to sanitary water and poor personal hygiene. 10 In an observational study of 3-5-year-old children in Kashmir who had a bowel obstruction, nearly 60 % of the cases had ascariasis. ...
... Di negara maju, penyebab utama adalah adhesi, sementara di negara berkembang, hernia mendominasi sebagai penyebab terbanyak, diikuti oleh tumor pada usus besar. Perbedaan ini mungkin terkait dengan perbedaan perilaku, gaya hidup masyarakat, serta kondisi lingkungan antara negara maju dan berkembang(13,14).Penelitian lain yang dilaksanakan oleh Dewi et al (15) di RSUP Wahidin Sudirohusodo Makassar menunjukkan bahwa adhesi merupakan penyebab utama, mencapai 38%. Berdasarkan pembahasan yang telah diuraikan, dapat ditarik kesimpulan bahwa kelompok usia paling umum pada pasien ileus obstruksi yang menjalani tindakan operasi adalah 51-60 tahun, sementara laki-laki memiliki risiko lebih tinggi dibandingkan perempuan. ...
Ileus obstruksi adalah keadaan darurat bedah umum yang disebabkan oleh penyumbatan mekanis usus, dan dapat dipicu oleh berbagai proses patologis. Di negara maju, adhesi menjadi penyebab utama, sementara di negara berkembang, hernia mendominasi. Ileus obstruksi dapat terjadi baik secara parsial maupun total, serta dapat bersifat strangulata atau non-strangulata. Keberagaman penyebab kondisi ini menjadi dasar minat penulis untuk mengeksplorasi gambaran terjadinya ileus obstruksi pada pasien yang menjalani tindakan operasi di RS Ibnu Sina Makassar selama periode 2020-2023. Tujuan penelitian ini adalah untuk memahami profil pasien ileus obstruksi di rumah sakit tersebut selama periode tersebut. Metode penelitian yang digunakan adalah deskriptif retrospektif dengan menggunakan data sekunder dari rekam medik antara Januari 2020 – September 2023. Hasil penelitian menunjukkan terdapat 43 kasus yang menjalani tindakan operasi, dengan usia terbanyak berada pada rentang 51-60 tahun (32,6%). Laki-laki mendominasi (67,4%), dan dan temuan operasi paling umum adalah adanya tumor sebagai penyebab ileus obstruksi (58,1%).
... The signs and symptoms of bowel obstruction include squeezing abdominal pain, vomiting, bloating, nau-sea, abdominal distension, and constipation [1,2]. In Korea, approximately 68,000 patients with intestinal obstruction were reported in 2022, half of which over 60 years old; the resulting medical expense was over 66 million US dollars [3]. As per a US report, bowel obstruction was responsible for 15% of hospital admissions with acute abdominal pain, and several cases required acute surgical care [4]. ...
... These include intraluminal causes such as tumors, impacted feces, and foreign bodies; intramural causes such as intussusception; and extramural causes such as strangulated hernias, adhesions, and volvuli. [7][8][9] Most of these are purely surgical causes. It is no surprise that this patient was managed by the general surgery team on her first admission. ...
Key Clinical Message
There are multiple atypical manifestations of Crohn's disease, which sometimes delay diagnosis or even more often result in complete misdiagnosis, especially in poorly equipped facilities. This is the case of an elderly woman with Crohn's disease who presented with gastritis and bowel obstruction. She had hitherto been wrongly managed for peptic ulcer disease and functional constipation based mainly on her symptoms. Her diagnosis was made only after years of failed symptomatic management. This case aims to highlight the uncommon and easily misdiagnosed gastroduodenal presentation of Crohn's disease, as well as clinical clues to correctly diagnosing the condition.
... Obstruction of the large or small bowel can be a surgical emergency and is a significant cause of morbidity and mortality accounting up to 15% of all hospital admissions for the acute abdomen [16]. The aetiology of bowel obstructions can range from intrinsic luminal obstruction, intramural pathologies, and extrinsic compression with the diagnosis made readily with comprehensive imaging modalities such as CT scans [2,16]. ...
... Obstruction of the large or small bowel can be a surgical emergency and is a significant cause of morbidity and mortality accounting up to 15% of all hospital admissions for the acute abdomen [16]. The aetiology of bowel obstructions can range from intrinsic luminal obstruction, intramural pathologies, and extrinsic compression with the diagnosis made readily with comprehensive imaging modalities such as CT scans [2,16]. Adhesions, hernias and neoplasm account for up to 90% of all SBO and alternatively 60% of all LBO are provoked by cancer, with volvulus and diverticular disease accounting for another 30% of aetiologies [16]. ...
... The aetiology of bowel obstructions can range from intrinsic luminal obstruction, intramural pathologies, and extrinsic compression with the diagnosis made readily with comprehensive imaging modalities such as CT scans [2,16]. Adhesions, hernias and neoplasm account for up to 90% of all SBO and alternatively 60% of all LBO are provoked by cancer, with volvulus and diverticular disease accounting for another 30% of aetiologies [16]. In the immunocompromised patient, clinical signs and laboratory assessment can be masked and at times unconvincing for underlying obstruction [17], as was ref lected in the relatively normal biochemical and blood results of Patient 1. ...
Bowel obstruction is a common cause for the acute abdomen with different aetiologies that shapes subsequent management plans. Small bowel obstruction often develop due to intra-abdominal adhesions in patients with prior abdominal surgery and for large bowel obstructions, more commonly due to tumours and lesions. Disruptions to normal intra-abdominal anatomy as seen in pancreatic–kidney transplantation or kidney transplant alone can result in increased risk of bowel obstruction—especially if the donor graft is implanted within the intraperitoneal plane. We present two patients from separate institutions with history of simultaneous pancreas–kidney (SPK) transplantation (Patient 1) and intraperitoneal renal (Patient 2) transplant whom both presented with bowel obstruction requiring surgical intervention. Given the specificity and operative intricacies of our cases, we aim to present our findings and surgical management of these rare presentations in hopes of increasing awareness to this uncommon but significant cause of bowel obstruction in a transplant patient.
... The primary causes in 90% of small bowel obstruction cases are adhesions, hernias, and neoplasms. Treatment for small intestine obstruction induced by small bowel tumors, including adenocarcinoma, neuroendocrine tumors, GI stromal tumors, and lymphomas, typically involves excision and anastomosis [15]. PET-CT is valuable for initially staging lymphoma accurately. ...
This case report presents a 43-year-old female with a history of common variable immunodeficiency (CVID) and a recent diagnosis of mesenteric volvulus. The patient presented with symptoms of partial small bowel obstruction and was diagnosed with obstruction and mesenteric volvulus primarily affecting the proximal jejunum. During the exploratory laparotomy, a probable polyposis syndrome and a possible adenocarcinoma of the small bowel were identified. Pathological examination confirmed the presence of B-cell lymphoma in the proximal jejunum. The patient underwent treatment with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (RCHOP) chemotherapy and showed improvement in symptoms. The case highlights the increased risk of malignancies, particularly lymphomas, in individuals with CVID and the challenges in diagnosing and treating lymphoid neoplasms in this population.
