Small intestinal obstruction resulting from ischemic enteritis: a case report

Abstract

A 69-year-old male was admitted to our institution because of a sudden onset of vomiting and abdominal distention. His past history of illness included femoral head fracture, congestive heart failure and ischaemic colitis. Plain abdominal computed tomography revealed extensively dilated small intestinal loops with a calibre change around the end of the ileum. Small intestinal obstruction was diagnosed and a transnasal ileus tube was placed. The ileus tube was constantly moved towards small intestine until it reached the distal ileum. Contrast medium from the ileus tube revealed a distal ileal stricture. Subsequently, transanal single balloon enteroscopy was performed to inspect the stricture, revealing a circumferential and afferent tubular ulcer in the distal ileum, 5 cm from the ileocecal valve; gastrofluorography confirmed the stricture. Although the stricture was dilated on several occasions using balloon catheters, the stricture could not be improved. However, during the treatment, his general condition worsened over time; thus, surgical treatment was decided. Operative findings revealed several circumferential ulcers with a clear margin 5–28 cm from the ileocecal valve: all lesions were successfully resected. Pathological findings were consistent with ischaemic enteritis. We report a case of small intestinal obstruction resulting from stenotic ischaemic enteritis.

Jejunal obstruction due to ischemic stricture: an unusual presentation

“…Severe fibrosis is seen within the sub mucosal layers and severe inflammatory cell invasion (primarily lymphocytes and plasma cells) with hemosiderin-laden macrophages scattered throughout the entire thickness of the intestine. 6 This case was consistent with ischaemic enteritis both macroscopically and microscopically. 13,14 They are however fraught with complications like bleeding and perforation and surgical options are stricturoplasty and resection anastomosis of the affected segment of intestine.…”

“…Koshikawa Y et al, strongly recommend use of enteroscopy to evaluate the stenosis. 6 Author did a CT scan and as the patient was not tolerating even liquids, decision was made in favor of exploration. The macroscopic characteristics of ischaemic enteritis are: afferent loop dilatation, circumferential stenosis with thickening of the intestinal wall.…”

“…Ischaemic strictures could have variable etiology, irrespective of which a resection and anastomosis with healthy edges is the preferred treatment of choice as is advocated by Koshikawa Y et al, the reason being the strictured segment is a compromised segment and is usually dependent on omental blood supply for its viability. 6 Lesser procedures like endoscopic techniques and stricturoplasty have shown poor results.…”

“…They require surgical intervention for their management. 6 A 40year-old diabetic female presented with complaints of pain abdomen for past two months and bilious vomiting which was progressive till she could not even retain fluids. Pain was colicky in nature and was relieved after vomiting which occurred half to one-hour post-meals.…”

Clinical Profile, Response to therapy and outcomes of post-ischemic intestinal stenosis Secondary to Acute Mesenteric Venous Thrombosis: a retrospective case series study

“…In addition, all patients underwent contrast-enhanced computed tomography (CT) to evaluate the venous drainage of the portal venous system, and nonvascular ndings can help assess intestinal damage [2]. Furthermore, enterography with gastrogra n was performed to evaluate intestinal patency and mucosal patterns in the ISC [13][14][15] (Brie y, gastrogra n was administered through a naso-intestinal tube, and serial images of the transit of gastrogra n was obtained by abdominal radiography to evaluate the ability of intestinal peristalsis and patency. Complete obstruction or appearance of contrast in the ascending colon was the ending criterion.…”