Intestinal Obstruction from Congenital Bands at the Proximal Jejunum: A Case Report and Literature Review

Sarkar, Debkumar; Gongidi, Preetam; Presenza, Thomas; Scattergood, Emily

doi:10.4103/2156-7514.105130

Cited by 12 publications

(9 citation statements)

References 9 publications

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“…Additionally, congenital adhesion bands may cause an obstruction by an internal hernia, which has usually been reported in sporadic pediatric cases [11, 21]. However, in the present study, clinical cases ranged from the neonates to the elderly, and only one case of internal hernia was in the pediatric group.…”

Section: Discussionmentioning

confidence: 55%

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Congenital adhesion band causing small bowel obstruction: What’s the difference in various age groups, pediatric and adult patients?

Yang

Lee

et al. 2016

BMC Surg

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BackgroundA congenital adhesion band is a rare condition, but may induce a small bowel obstruction (SBO) at any age. However, only a few sporadic case reports exit. We aimed to identify the clinical characteristics of congenital adhesion band manifesting a SBO stratified by age group between pediatric and adult patients.MethodsThe medical records of all patients with a SBO between Jan 1, 2009 and Dec 31, 2015 were retrospectively reviewed. Cases associated with previous surgical procedure and cases of secondary obstruction due to inflammatory processes or tumor and other systemic diseases were excluded. The patients were divided into two groups according to age below or above 18 years: pediatric and adult. The basic clinical characteristics were analyzed and compared between groups.ResultsOf 251 patients with a SBO, 15 (5.9%) met the inclusion criteria; 10 cases in pediatric group (mean age 17.9 ± 38.7 months) and 5 cases in adult group (mean age 60.0 ± 19.7 years). The pediatric group (66.6%) included 3 neonates, 5 infants, and 2 school children. They usually presented with bilious vomiting (50.0%) and abdominal distention (60.0%), and demonstrated a high rate of early operation (80.0%) and bowel resection (70.0%). In contrast, the adult group (33.3%) presented with abdominal pain (100%) in all cases and underwent a relatively simple procedure of band release using a laparoscopic approach (60%). However, group differences did not reach statistical significance. In addition, two groups did not differ in the time interval to the operation or in the range of the operation (p = 0.089 vs. p = 0.329). No significant correlation was found between the time interval to the operation and the necessity of bowel resection (p = 0.136). There was no mortality in either group.ConclusionsCongenital adhesion band is a very rare condition with diverse clinical presentations across ages. Unlike adult patients, pediatric patients showed a high proportion of early operation and bowel resection. A good result can be expected with an early diagnosis and prompt management regardless of age.

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Section: Discussionmentioning

confidence: 55%

“…For these reasons, delayed diagnosis and treatment frequently occur in patients with an intestinal obstruction due to a congenital adhesion band. CT has been used to exclude other diseases in many cases [11–13], as well as in the present study. Ultimately, exploration is mandatory for both diagnosis and treatment.…”

Section: Discussionmentioning

confidence: 99%

Congenital adhesion band causing small bowel obstruction: What’s the difference in various age groups, pediatric and adult patients?

Yang

Lee

et al. 2016

BMC Surg

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“…Uncommonly, intestinal obstruction may be secondary to embryological remnants of the vitelline vessels, omphalomesenteric ducts, or mesourachus; these are typically recognized by their anatomical location [ 13 ]. Rarely, obstruction may be caused by anomalous congenital bands without apparent embryogenic origin [ 14 – 17 ]. While their etiology is not well understood, it has been suggested that these fibrous bands of tissue arise from a mesenteric anomaly occurring around the 4th week of gestation and are later associated with malrotation, anomalous intestinal fixation, and obstruction [ 14 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…Rarely, obstruction may be caused by anomalous congenital bands without apparent embryogenic origin [ 14 – 17 ]. While their etiology is not well understood, it has been suggested that these fibrous bands of tissue arise from a mesenteric anomaly occurring around the 4th week of gestation and are later associated with malrotation, anomalous intestinal fixation, and obstruction [ 14 , 17 ]. In our case, we also found evidence of several anomalous congenital bands associated with an intestinal rotational abnormality resulting in complete obstruction, therefore raising the suspicion of an early mesenteric developmental abnormality.…”

Section: Discussionmentioning

confidence: 99%

Congenital Bands with Intestinal Malrotation after Propylthiouracil Exposure in Early Pregnancy

Leung

Yamamoto

Luca

et al. 2015

Case Reports in Endocrinology

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Exposure to propylthiouracil in early pregnancy may be associated with an increased risk of birth defects. But the spectrum of associated congenital anomalies is not yet well defined. While preliminary reports suggest that most cases of propylthiouracil-associated birth defects are restricted to the preauricular and urinary systems, careful consideration should be given to other possible manifestations of teratogenicity. We propose that congenital bands may potentially represent a rare yet serious complication of propylthiouracil exposure in early pregnancy, possibly arising from an early mesenteric developmental anomaly. We report a case of a 17-day-old girl that presented with acute small bowel obstruction associated with intestinal malrotation arising from several anomalous congenital bands. Her mother was treated for Graves' disease during pregnancy with first trimester exposure to propylthiouracil but remained clinically and biochemically euthyroid at conception and throughout the duration of pregnancy. This case suggests that the use of propylthiouracil in early pregnancy may be associated with congenital bands and intestinal malrotation. More reports are needed to further support this association.

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“…Congenital band adhesions are a rare cause of small bowel obstruction in adults 1. The proximal jejunum is infrequently affected by congenital bands according to limited published cases,1–3 with the ileum representing the most commonly affected site. Delayed diagnosis of mechanical obstruction can lead to irreversible bowel ischaemia or perforation, and presents a surgical emergency.…”

Section: Introductionmentioning

confidence: 99%

Congenital band adhesion causing a proximal jejunal obstruction: an uncommon presentation and diagnosis

Cruise¹,

Goddard²

2019

BMJ Case Rep

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A 20-year-old woman with no medical or surgical history presented with acute onset crampy abdominal pain on a background of uninvestigated similar chronic abdominal pain. She became obstructed during her admission and a contrast swallow showed a complete obstruction at the level of the proximal jejunum. A diagnostic laparoscopy revealed a congenital band adhesion from the greater omentum to the proximal jejunum to be the cause, and dissection of the band relieved her obstruction. This case presents a rare cause of mechanical obstruction, and highlights the seriousness of investigating obstructive symptoms even in atypical patient populations.

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Intestinal Obstruction from Congenital Bands at the Proximal Jejunum: A Case Report and Literature Review

Cited by 12 publications

References 9 publications

Congenital adhesion band causing small bowel obstruction: What’s the difference in various age groups, pediatric and adult patients?

Congenital adhesion band causing small bowel obstruction: What’s the difference in various age groups, pediatric and adult patients?

Congenital Bands with Intestinal Malrotation after Propylthiouracil Exposure in Early Pregnancy

Congenital band adhesion causing a proximal jejunal obstruction: an uncommon presentation and diagnosis

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