intestinal obstruction

Background: Intestinal obstruction (IO) is defined as a partial or complete blockage of the bowel that results in the failure of intestinal contents to pass through. It is a common cause of emergency surgical problems. IO has been the leading cause of acute abdomen in several African countries. Objective: To assess surgical management outcome of intestinal obstruction by IESO professionals and its associated factors of intestinal obstruction in surgically treated patients at South Wollo zone. Method: A cross-sectional study was done on 216 patients ‘the data was collected from medical cards of the patient by using a pretested data abstraction format. Three nurses were involved in the process of data collection. The collected data was cleaned, coded and analyzed by SPSS version 23 statistical package. First descriptive statics was done for categorical and analyzed using frequencies and percentage. Multivariable logistic regression models was used to determine the association factors on the management outcome of intestinal obstruction when p - value < 0.05 and the strength of statistical association was measured by adjusting odds ratio and 95% confidence interval. Statistical significance was taken at p - value < 0.05. Results: From all study participants about 177 (82%) of them had good surgical outcome. Study participants who were managed by 1-3 years of work experience of IESO {(p = 0.004, AOR (95% CI) = 7.2[1.89, 27.68]}, preoperatively diagnosed as small bowel obstruction {(p = 0.001, AOR (95% CI) = 4.5[1.91, 10.40], Surgery conducted at day time {(p = 0.03, AOR (95% CI) = 2.8[1.06, 7.16]} had shown positive association with management outcome of intestinal obstruction conducted by IESO professionals. Conclusion and recommendation: Majority patients with intestinal obstruction had good surgical outcome done by IESO professionals. Year of experience of IESO Workers, preoperative diagnosis and time of surgery of the respondents had shown positive association for the occurrence of chronic liver disease whereas. In this study we can conclude that surgeries of intestinal obstruction conducted by IESO professionals are as good as intestinal obstruction surgeries conducted by physicians so there is a need to train more IESO professionals to deliver decentralized surgical service for rural areas.

Morgagni hernia represents 2-4% of congenital diaphragmatic hernias. Only one-third of them are symptomatic, due to the hernia of abdominal viscera in the thoracic cavity, causing respiratory and digestive problems, some of them serious ones, such as intestinal obstruction. Acute presentation with incarceration of the contents is rare; there are only 7 cases described in the literature. We are presenting a case of diaphragmatic hernia that began with obstruction of the colon and secondary ischemia, requiring emergency surgery in two phases: first surgery to control the damage, with an open right hemicolectomy, and then later surgery to repair the hernia and perform bowel transit reconstruction, with proper postoperative evolution and no evidence of relapse. The treatment of Morgagni diaphragmatic hernia is surgical. Also in asymptomatic cases, due to the risk of incarceration, the most appropriate way to enter is abdominally, whether by way of laparotomy or laparoscopy, for the reduction of the contents of the hernia sac, the repair of the defect, as well as the performing of associated techniques on herniated viscera, as occurred in our case. A complicated congenital hernia is an infrequent pathology, and there is little experience in handling it. Acute presentation requires a combined treatment of the abdominal symptoms and repair of the hernia defect. The carrying over of surgical techniques for damage control into non-traumatic surgery in the face of serious hemodynamic instability is a widespread, accepted practice with the benefits of reducing mortality in critical patients and at times allowing the avoidance of ostomies.

A gossypiboma is a mass of cotton material from any source, left in a body cavity after a surgical procedure. This enhances the morbidity, cost of treatment and potential mortality to the patient with the addition of medicolegal issues. We report a case of a 32 year old lady who presented with complaints of central abdominal pain and vomiting for 1 month, fever for 20 days and non-passage of flatus and faeces for 5 days. She had undergone a total abdominal hysterectomy 4 months prior. On clinical examination, adhesive small intestinal obstruction was suspected. On CECT evaluation, a gossypiboma was suggested to have possibly migrated into the small bowel. Laparotomy revealed the presence of clumped bowel loops, which on dissection got torn and showed a gauze like material within the bowel lumen. A diagnosis of gossypiboma with intestinal migration of a retained surgical sponge was ascertained. The possibility of a gossypiboma, particularly in previously operated cases, must be kept in mind and measures must be taken to prevent such incidences.

A term neonate was transferred from a Local Neonatal Unit to our surgical Neonatal Intensive Care Unit on Day 2 due to abdominal distension with radiological appearances suggestive of intestinal obstruction. He was born by Caesarean section with no risk factors for sepsis. He was intubated at birth for increased work of breathing and failed planned extubation on Day 1. 

Coronary artery aneurysm is an uncommon condition defined as abnormal dilatation of the coronary artery.We report the case of a man admitted to the Emergency Department for suspected intestinal obstruction. At abdominal/thoracic Computed Tomography (CT) it was reported a suspected pericardial cyst. Contrast echocardiography showed a clear pattern of blood flow inside the mass with a probable origin at a very limited region where it was also possible to sample an ECG-synchronized system-diastolic Pulse-Wave (PW)-Doppler pattern, typical for a coronary artery flow. Our suspicion of a giant coronary artery aneurysm was then confirmed by coronary CT and coronary angiography. The patient was transferred to a Cardiac Surgery center where he underwent surgical treatment for the aneurysm.Most coronary aneurysms are clinically silent and are often incidentally detected. Coronary angiography is the ‘‘gold standard’’ for diagnosis and evaluation of coronary artery aneurysms. Among non-invasive diagnostic techniques, Computed Tomography Coronary Angiography is the best method for coronary artery anatomy and coronary abnormalities. However, echocardiography with the use of a contrast agent, a cost-effective non-radiation nature, and a widespread use method, maybe a reliable method to detect and characterize the masses, allowing a differential diagnosis.Learning objective1.    Recognition and evaluation of cardiac masses require first-line imaging methods such as echocardiography.2.    The use of additional non-invasive (cardiac CT or MRI) and/or invasive imaging methods are often required. 3.    Contrast echocardiography may be helpful, as second-line imaging methods, to better characterize the mass and approach the correct diagnosis.

Intussusception is a leading cause of intestinal obstruction in young children, typically presenting with colicky abdominal pain and altered stool characteristics, before progressing to abdominal distension and bilious vomiting. This case report describes an 8-month-old male who presented with gastrointestinal symptoms, respiratory distress, and signs of intestinal obstruction. The patient was diagnosed with intussusception and found to be positive for Respiratory Syncytial Virus (RSV). After an attempted ultrasound-guided hydrostatic fluid enema, he underwent laparotomy to resolve the intussusception but developed post-operative complications, including delayed wound healing and wound dehiscence. The interplay of viral infections like RSV, and treatments such as steroids in pediatric surgical cases warrants further attention, especially concerning postoperative outcomes.

The prevalence of gallbladder stones is higher in Chronic Kidney Disease (CKD) patients and it has been shown to increase with the advancement of the disease stage, from 7.7% in stage 1% to 21.3% in stage 5. Gallstone ileus is a rare complication which presents in just 0.3% - 0.5% of patients with cholelithiasis. A 61-year-old female patient, with a known case of CKD on maintenance hemodialysis, (thrice a week) with primary disease of hypertensive and diabetic nephropathy; presented with multiple episodes of loose stool, vomiting, and diffuse abdominal pain for 2 days. Abdomen Ultrasonography (USG) was suggestive of intestinal obstruction. CT abdomen with oral contrast revealed grossly dilated jejuna loops with air-fluid levels and transition zone in the pelvis, in distal jejunal loops/proximal ileum with ovoid intraluminal filling defect cystic polyp and collapsed bowel loops. The patient underwent exploratory laparotomy in view of persistent small bowel obstruction. Resection and anastomosis of the mass-bearing small bowel segment were performed. On cutting and opening the specimen, a large stone was revealed. This gallstone was causing bowel obstruction-gall stone ileus. A gallstone 2.6 cm x 2.1 cm has traversed through a cholecysto-duodenal fistula and got stuck in the proximal ileum, causing small bowel obstruction. The lesson learned is uraemia can cause gastrointestinal symptoms like anorexia, abdominal pain, vomiting, and ileus and hence mimic serious differentials of the acute abdomen like gallstone ileus. Thus no stone should be left unturned especially when the prevalance of gallstones is high in chronic kidney disease patients.