Acute appendicitis as a rare cause of mechanical small bowel obstruction case report.
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ABSTRACT:
SUBMITTER: Al-Qallaf A
PROVIDER: S-EPMC5494686 | biostudies-other | 2017
REPOSITORIES: biostudies-other
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Project description:Introduction Small bowel obstruction is a common surgical emergency abdominal condition in clinical practice. Fecalith is one of the rare causative factors, especially phytobezoars. Case Report We report the case of a 66-year-old man admitted with “abdominal pain with vomiting for 1 day.” Enhanced CT of the abdomen suggested incomplete small bowel obstruction. The symptomatic treatment with fasting, fluid replacement, gastrointestinal decompression, and antibiotics was conducted after the patient was admitted to the hospital. After 2 days of treatment, the patient's abdominal pain was not significantly relieved, so a decision was made to perform laparoscopic examination surgery. During surgery, a columnar foreign body was found embedded in the lumen of the small intestine about 10 cm away from the ileocecal region. Combined with the patient's preoperative history of consuming a large number of persimmons, the primary diagnosis of small intestinal fecalith obstruction was considered. We performed an enterotomy to remove the foreign body, and the procedure was uneventful. On postoperative day 7, the patient was successfully discharged. Conclusion When we encounter a patient with intestinal obstruction without a history of surgery in our clinical work, we should take a careful history, especially about the consumption of foods that can cause phytoliths. When a patient has consumed a large amount of food that can cause phytobezoars before the abdominal pain, we should diagnostically consider it as phytobezoars intestinal obstruction, which helps to reduce the incidence of misdiagnosis and allows the patient to receive treatment timely and effectively.
| S-EPMC9086506 | biostudies-literature
Project description:Intestinal obstruction is a common surgical emergency caused by varied conditions. Acute appendicitis is considered as one of the unusual cause of intestinal obstruction especially functional and very few cases of mechanical obstruction. Here we report a Case of 62-years-old male who presented here with a clinical picture of small bowel obstruction. On laparotomy, there was a dilated gut with long appendix having inflamed tip buried into adjoining mesentery and then appendectomy was done and obstruction was relieved. Also, bowel was found to be viable hence simple appendectomy was found to be sufficient treatment. Histopathological findings was suggestive of chronic fibrosing appendicitis. Hence, in cases of bowel obstruction in an elderly patients with clinical examination which was not typical for appendicitis can be managed with laparotomy and simple appendectomy when early intervention is made to avoid the risk of ischemia and gangrenous changes in intestinal mesentery which may require resection in later stages.
| S-EPMC7895704 | biostudies-literature
Project description:IntroductionSclerosing encapsulating peritonitis (SEP), or abdominal cocoon, is a remarkably rare entity. It consists of a fibrous layer or cocoon-like sac encasing, in most cases, the small bowel. The lack of specific symptoms makes preoperative diagnosis challenging.Case presentationA 50-year-old patient, with no history of abdominal surgery or medical diseases, was admitted for symptoms of small bowel obstruction. On examination, the patient was underweight with a BMI of 18 kg/m2. Vital signs were stable. His abdomen was mildly distended and soft. Abdominal CT scan showed signs in favor of a left paraduodenal hernia with incarcerated small bowel loops. Intraoperatively, the small bowels were encapsulated in a cocoon-like structure formed by thick fibrous tissue associated with multiple adhesions. Careful adhesiolysis with complete resection of the membrane was performed. The postoperative course was uneventful. One year later, the patient was symptom-free.DiscussionSEP is thought to be a persistent inflammatory disorder due to a cause that remains unidentified. It is divided into two categories based on its etiology: primary and secondary. The most common mode of SEP revelation is bowel obstruction. Because there is no clear consensus on SEP management, the therapeutic approach typically follows the management strategy of bowel obstruction.ConclusionSEP is an uncommon cause of bowel obstruction. Preoperative detection can be challenging in the absence of pathognomonic signs. Treatment is based on surgery, specifically entailing complete excision of the cocoon and adhesiolysis.
| S-EPMC10551648 | biostudies-literature
Project description:IntroductionThe sub-acute form of transverse colon volvulus manifests with signs and symptoms of large bowel obstruction. The diagnosis is most often done intraoperatively. We report a rare case of transverse colon volvulus in a 65-year-old female patient with no particular pathological or surgical history.Case presentationSub-acute transverse colon volvulus in an elderly woman with no pathological or surgical history. Manifested with signs and symptoms of colonic obstruction. Surgically treated by a two-stage procedure with good postoperative outcomes.DiscussionThe transverse colon volvulus represents only 2-4% of all colonic volvulus. We discuss the diagnostic and therapeutic approach of our case of transverse colon volvulus through a literature review.ConclusionTransverse colon volvulus should be considered as a differential diagnosis in the face of large bowel obstruction. Early diagnosis and treatment improve the prognosis.
| S-EPMC7890129 | biostudies-literature
Project description:BackgroundAdult intussusception is a relatively rare clinical entity. The majority of cases of intussusception in adults are due to a pathologic condition that serves as a lead point and requires surgery. Small bowel intussusception is usually caused by benign or malignant neoplasms appearing at the head of the invagination. Inflammatory fibroid polyp (IFP) of the small bowel is an unusual benign neoplastic lesion that has been rarely reported to cause intussusception, especially in the jejunum.Case presentationWe present a rare case of adult intussusception who presented with a triad of intestinal obstruction. Computed tomography revealed small bowel intussusception with bowel ischemia. Intraoperatively, she required resection of the small bowel and primary anastomosis. Macroscopic examination revealed a single pedunculated polyp, which is the lead point of intestinal obstruction and confirmed histologically.ConclusionInflammatory fibroid polyp should be considered as a cause of intussusception among adults with small bowel obstruction.
| S-EPMC7566945 | biostudies-literature
Project description:Introduction and importance Ascaris lumbricoides is a parasitic roundworm that spread through feces-oral routes and is endemic in many nations with poor sanitation. Case presentation We present a case of a 6-year-old boy who arrived in the emergency room with abdominal pain, constipation, and vomiting. Physical examination revealed abdominal distension, absence of bowel sounds, and abdominal tenderness. Abdominal radiographs, ultrasonography, and computed tomography established the diagnosis of intestinal obstruction by A. lumbricoides with associated acute appendicitis and surgical approach scheduled. A massive intraluminal nematode from the jejunum to the ileocecal valve was observed during an exploratory laparotomy. An ileal enterotomy was performed and the worms were removed. The patient was discharged without incident on the 12th day. Clinical discussion Ascariasis is the most common helminthic infection worldwide; reaching peak prevalence in children aged 2 to 10. The disease is prevalent in children with environmental and socioeconomic risk factors, causing serious problems such as intestinal obstruction (IO), volvulus, intussusception, and intestinal necrosis. Conclusion Ascaris lumbricoid is very prevalent in developing countries and should be kept in mind in preschool children with symptoms of sudden acute intestinal obstruction. The diagnosis of intestinal ascariasis can usually be made with plain radiography, barium examinations, and ultrasonography of the abdomen. Other modalities, such as CT, can also be used. Medical treatment of Ascaris infestation is usually successful; however, bowel obstruction may require surgery. Highlights • Ascaris lumbricoides infects 1.5 billion people worldwide, primarily in tropical and subtropical areas.• Volvulus, ileocecal intussusception, gangrene, and intestinal perforation are all possible complications.• Acute appendicitis may occur due to the occlusion of the appendiceal lumen by adult Ascaris worms or infection of Ascaris eggs.
| S-EPMC9206903 | biostudies-literature
Project description:Phytobezoars are concretions of indigested fruit and vegetables fibers in the gastrointestinal tract. The past of gastric surgery is most common risk factor of phytobezoar. We present the case of a 39-year-old female was admitted to the emergency department and who presented with small bowel obstruction due to phytobezoar, her past medical history was marqued by truncal vagotomy and simple suture recurrent perforated gastric ulcer 15 years earlier. Her postoperative recovery was uneventful.
| S-EPMC7847810 | biostudies-literature
Project description:IntroductionInternal hernia is a pathological condition resulting from abnormal protrusion of abdominal viscera through an opening in the intraperitoneal recesses of the abdominal cavity. Small bowel obstruction due to internal hernia is not common (0.25-0.9% of cases). The most common group is that of paraduodenal hernias (53%), of which the left-sided one is the most common type (75%).Presentation of caseWe report a case of a 43 year-old man with a history of recurrent abdominal pain, who was hospitalized because of an episode of acute small bowel obstruction. He had no previous surgery. Computed tomography revealed an encapsulated circumscribed cluster of jejunal loops in the left upper quadrant, near the ligament of Treitz, and the hernia orifice was adjacent to the left side of the inferior mesenteric vessels. Emergency laparoscopic surgery was performed: the small bowel was found completely herniated under the inferior mesenteric vessels. It was gradually reduced and the hernia space was closed with a running suture. The patient was discharged on the fourth day without complications.ConclusionLeft paraduodenal hernia is a rare cause of small bowel obstruction that should be taken into account in a patient with a history of recurrent abdominal pain or intestinal obstruction, and no previous surgery. Computed tomography is the standard for a correct diagnosis. Surgery is treatment of choice, because it reduces the risk of emergency and complications associated to hernia. Laparoscopic approach is feasible and effective, also in emergency situation.
| S-EPMC4818316 | biostudies-literature
Project description:RationaleComamonas species are rarely associated with human infections. Recent reports found that Comamonas kerstersii was associated with severe diseases such as abdominal infection and bacteremia. However, C. kerstersii maybe be confused with Comamonas testosteroni using the automatic bacterial identification systems currently available.Patient concernsA 31-year-old man who had onset of left upper abdominal pain developed clinical manifestations of right lower abdominal pain and classic migration of pain at the temperature of 39°C. The positive strain of aerobic and anaerobic bottles of blood cultures was identified.DiagnosesThe patient was diagnosed as acute peritonitis and perforated appendix with abdominal abscess.InterventionsThe bacterium was identified by routine methods, MALDI-TOF-MS and PCR amplification of the 16S rRNA. The patient was treated with exploratory laparotomy, appendectomy, tube drainage, and prescribing antibiotic treatment.OutcomesThe patients were discharged with complete recovery. The organisms were confirmed as C. kerstersii by MALDI-TOF-MS and a combination of the other results.LessonsOur findings suggest that C. kerstersii infection occurs most often in association with perforated appendix and bacteremia. We presume that C. kerstersii is an opportunistic pathogen or commensal with the digestive tract and appendix bacteria.
| S-EPMC5895375 | biostudies-literature
Project description:PurposeAtrophic visceral myopathy is a pathological diagnosis characterized by atrophy of the smooth muscle layers of the viscera with intact ganglia. Rarely, it can present acutely as an intestinal pseudo-obstruction. We describe a rare case report and explore how this diagnosis can be distinguished from other forms of intestinal obstruction.Case descriptionA 60-year-old male with a past medical history of hypothyroidism presented to the emergency department with a two-day history of worsening abdominal distention and pain associated with nausea and vomiting. Upon evaluation patient was found to have tachycardia, with abdominal distention and localized tenderness with peritonitis. Computed tomography demonstrated large bowel obstruction, likely caused by sigmoid volvulus. The patient underwent emergent laparotomy. Intra-operatively, the entire colon was found to be extremely dilated and redundant. With a working diagnosis of recurrent sigmoid volvulus causing intermittent large bowel obstruction, a sigmoid colectomy and primary anastomosis was performed. Pathology revealed atrophic visceral myopathy, with an extremely thin colonic wall and atrophic circumferential and longitudinal muscularis propria without inflammation or fibrosis. The ganglion cells and myenteric plexus were unaffected. Post-operatively, the patient developed prolonged ileus requiring nasogastric decompression and parenteral nutrition. The ileus resolved with pro-kinetic agents, and patient was discharged home on post-operative day fifteen.ConclusionsAtrophic visceral neuropathy is a rare cause of intestinal pseudo-obstruction. While often presenting with chronic obstruction in younger populations, we present a rare late-onset acute presentation that may have been secondary to underlying hypothyroidism.
| S-EPMC5350498 | biostudies-literature