Critical Operative Management of Small Bowel Obstruction

Stewardson, Richard; Bombeck, C. Thomas; Nyhus, Lloyd M.

doi:10.1097/00000658-197802000-00017

Cited by 162 publications

(62 citation statements)

References 15 publications

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“…Although preoperative diagnosis of intussusception is difficult due to the atypical and non-specific presentation in adults and it is generally determined at laparotomy, it may also be diagnosed by CT, especially in colo-colonic types caused by tumor lesions (17)(18)(19). It has been reported that CT is the most sensitive diagnostic test for the confirmation of intussusception with a diagnostic accuracy of 58%-100% (5,20).…”

Section: Discussionmentioning

confidence: 99%

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A rare cause of obstructive defecation in a 29-year-old woman: Ileo-colo-colonic intussusception treated by subtotal colectomy with posterior rectopexy

et al. 2018

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A rare cause of obstructive defecation in a 29-year-old woman: Ileo-colo-colonic intussusception treated by subtotal colectomy with posterior rectopexy Adult intussusception is a rare clinical condition. In majority of adult cases, there is an underlying cause such as polyps or colon cancers. In the present study, a 29-year-old woman with intermittent and colicky abdominal pain, constipation, and painful defecation, accompanied with distention and sense of rectal fullness, was evaluated with computed tomography. Ileo-colo-colic intussusception was determined. Subtotal colectomy with posterior rectopexy was performed. After the surgery, she was doing well at 13-month follow-up. Keywords: Obstructive defecation, intussusception, subtotal colectomy INTRODUCTIONIntussusception is the invagination of an intestinal segment to the continuing part of the intestine. Usually, it is a pediatric diagnosis due to benign pathologies (1, 2). Intussusception as the most common cause of intestinal obstruction occurs most frequently in infants (3, 4). However, less than 5% of the intussusception cases are seen in adults (5). Majority of the cases in children are idiopathic, but an organic cause, such as a polyp or colonic malignancy, is usually detected as the underlying cause of intussusception in adults (6, 7). Intussusception in adults most commonly appears as enteroenteric (limited to small intestine). It has been known that colo-colonic intussusception (limited in colon and rectum, without anal protrusion) is the least common type (8). In these circumstances, colonic tumors have been regarded to be the main cause (9). However, intussusception starting from the distal ileal segments to the rectum without proven gastrointestinal malignancy can be a very rare event in adults.In this paper, we present a young female patient with obstructive defecation caused by ileo-colo-colonic intussusception. CASE PRESENTATIONA 29-year-old woman with intermittent and colicky abdominal pain, constipation, and painful defecation, accompanied with distention and a sense of rectal fullness was hospitalized. Similar symptomatology was present for last three months. The patient was described fecal incontinence with a mass protruding from her anus during maximal discomfort. Physical examination revealed distended abdomen with mild tenderness. Patulous anus with a bulky mass protruding through the rectum mimicking prolapse was detected on rectal examination. Coronal curved multiplanar reconstruction of contrastenhanced computed tomography (CT) (Figure 1) showed bowel-within-bowel appearance of ileo-colocolic intussusception elongated from the cecum to the splenic flexure. Surgical intervention had been decided and informed consent had been received. At diagnostic laparoscopy, a dilated and partially invaginated bowel was observed. On conversion to laparotomy, ileo-colo-colic intussusception including terminal ileum and right, transverse, left, and sigmoid colon was determined. Subtotal colectomy had been initiated because all colonic segments invagin...

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Section: Discussionmentioning

confidence: 99%

“…Cecum (arrowhead) to splenic flexure (arrow) high rate of malignant causes, although the necessity and extent of the resection in each patient has been controversial (18). Intraoperative reduction has also often been discouraged for the fear of causing tumor rupture and potentially upstaging the cancer (8,17,22).…”

Section: Discussionmentioning

confidence: 99%

A rare cause of obstructive defecation in a 29-year-old woman: Ileo-colo-colonic intussusception treated by subtotal colectomy with posterior rectopexy

et al. 2018

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“…5 Stewardson et al emphasized a classic quartet of findings such as leucocytosis, fever, tachycardia and localized tenderness. 10 Plain radiographs may be normal or suggest bowel obstruction, but it is difficult to differentiate between SBV and other causes of obstruction that may resolve with conservative management.…”

Section: Discussionmentioning

confidence: 99%

Small bowel volvulus: a rare twist in an adult

2016

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<p class="abstract"><span lang="EN-US">Volvulus is a special form of mechanical intestinal obstruction. It is most commonly seen in sigmoid colon. It results from abnormal twisting of a loop of bowel around the axis of its own mesentery. Small bowel volvulus (SBV) is a rare condition even though the incidence in Africa and Asia is high. It is of two types; primary and secondary. It requires emergency surgical intervention; more so as consuming time increases the risk of bowel getting gangrenous. Here is a case of primary small bowel volvulus in an elderly man with evidence of ischemic bowel and perforation who was managed surgically by resection and anastomosis.</span></p>

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“…4 The main indications of surgery for intestinal obstruction are severe abdominal pain, dehydration, circulatory abnormalities of the digestive tract, and failure of conservative treatment to alleviate symptoms. 5,6 Kyphosis is a condition in which the posterior convex curvature of the spinal column is abnormally increased in the sagittal plane. 7,8 Although kyphosis often accompanies spinal caries, cases of degenerative age-related lumbar kyphosis and kyphotic changes due to osteoporotic spinal compression fractures have also been observed.…”

Section: Discussionmentioning

confidence: 99%

A Case of Intestinal Obstruction Caused by Prominent Kyphosis Resulting in Compression of the Intestine by the Costal Arch

Yoneyama

Kato

Yumoto

et al. 2013

International Surgery

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An 85-year-old woman with no history of abdominal surgery complained of abdominal pain and vomiting and was referred to us with a diagnosis of intestinal obstruction a few days later. Upon admission to our facility, she presented with marked abdominal swelling and prominent kyphosis. Because of the kyphosis, most of the dilated bowel was compressing her thoracic cavity. No obvious strangulation or free air was observed via abdominal computed tomography imaging. We attempted decompression using a nasogastric tube, but the symptoms persisted. Surgery was performed 2 days after admission. The origin of the obstruction was a compression of the ileocecal region by the costal arch. The bowel was discolored, and thus surgically excised. There were no major postsurgical complications other than a mild wound infection. Until now, there have been no reports of advanced kyphosis inducing ileus, but there are concerns of an increase in similar cases as society continues to age.

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Critical Operative Management of Small Bowel Obstruction

Cited by 162 publications

References 15 publications

A rare cause of obstructive defecation in a 29-year-old woman: Ileo-colo-colonic intussusception treated by subtotal colectomy with posterior rectopexy

A rare cause of obstructive defecation in a 29-year-old woman: Ileo-colo-colonic intussusception treated by subtotal colectomy with posterior rectopexy

Small bowel volvulus: a rare twist in an adult

A Case of Intestinal Obstruction Caused by Prominent Kyphosis Resulting in Compression of the Intestine by the Costal Arch

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