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ABSTRACT: Peutz–Jeghar syndrome (PJS) is an inherited condition that puts people at an increased risk for developing hamarotmatous polyps in the digestive tract as well as cancers of the breast, colon, rectum, pancreas, stomach, testicles, ovaries, lung and cervix. With typical presentation, majority cases of PJS can be diagnosed in childhood. PJS is inherited by mutation in the STK II gene, also known as LKB1 gene. We describe the case of a 14-year-old male who presented to us with recurrent abdominal pain, vomiting and weight loss associated with growth failure. Classic melanin spots were present on lips and buccal mucosa. Diagnosis of PJS was established via clinical history, examination, CT scan, and endoscopy revealing the need for laparotomy for bowel obstruction secondary to chronic intermittent intussusception, enterotomy for small polyps. Polyp histopathology was consistent with hamartomatous polyps of PJS. [ABSTRACT FROM AUTHOR]

The ingestion of foreign bodies is common in small animals, especially in puppies. These objects can cause obstruction in the digestive system, leading to symptoms such as vomiting, diarrhea, constipation, and abdominal pain. Detecting and resolving the problem typically requires surgery or endoscopy. This study aims to describe the resolution of two cases of gastrointestinal obstruction in female puppy dogs through enterotomy and endoscopy. Both cases were successfully resolved. [ABSTRACT FROM AUTHOR]

Summary: Enterotomy of the pelvic flexure is commonly performed during colic surgery in the horse to empty the large colon of its contents. A two‐layer closure with absorbable suture material is recommended, but a consensus has not been established. Many different techniques have been described and tested to evaluate surgical time, luminal diameter reduction, bursting pressure and post‐operative complications including adhesion formation. The results of these studies vary within and between enterotomy techniques. The objective of this narrative review was to evaluate and summarise relevant published literature on pelvic flexure enterotomy techniques in the horse. [ABSTRACT FROM AUTHOR]

Background: Feline obstipation is a clinical condition often manifested by defecation inability that results in fecal impaction. This is frequently associated with a blunt traumatic injury that affects mostly the spine and surrounding structures in the caudal part of the back leading to vertebral compression. Case presentation: A 6-month-old, female, mixed-breed cat of 1.49-kg BW was presented with a history of prolonged constipation (i.e., obstipation) along with discomfort and weakness. Prior to the presentation, the cat was medically treated with dietary fibers, fecal softeners, and enemas, but obstipation persisted. Clinical examinations revealed that there was straining but not effective for defecation. In addition, the cat had poor appetite and dehydration, electrolyte abnormalities, and defects in posture and gait. The lumbosacral region showed a depression that was supposed to be the consequence of an old, untreated regional injury. Radiographic imaging indicated a marked ventral curvature in the lumbosacral spine including major deviations in the positions of the L6 and L7 vertebrae and the sacrum as well. A firm tubular structure was felt on ventral abdominal palpation, and further ultrasonography revealed the tubular impaction. Laparotomy exposed a definite large bowel impaction, and enterotomy was performed to evacuate the firm feces. Postoperatively, supportive medications and care were provided for better recovery. However, the impaction recurred within 3 months after surgery, and euthanasia was a further choice. Conclusions: Traumatic injuries involving the lumbosacral spine in cats might be serious enough to lead to severe constipation and thereby bowel impaction. Therefore, treatment should be prompt and accurate in any case of spinal injury to avoid further complications. [ABSTRACT FROM AUTHOR]

Summary: Horses with enterolithiasis may develop clinical signs of colic due to partial or complete obstruction of the right dorsal, transverse or small colon. Laparotomy followed by enterotomy at the site of obstruction or mobilisation of enteroliths to intestinal segments deemed more appropriate for incision is indicated in these cases. However, surgical removal of enteroliths lodged in nonexteriorisable intestinal segments and/or not amenable to mobilisation may be labour intensive and dangerous. Pneumatic impact (or ballistic) lithotripsy is a potential tool for surgical resolution of simple and complex cases of enterolithiasis in horses. This study describes the use of a pneumatic lithotripsy device for intraluminal enterolith fragmentation in five cases of enterolithiasis. Seven calculi were successfully fragmented. In four cases, fragmentation was achieved at the site of obstruction and fragments exteriorised through an enterotomy incision created for device introduction or advanced towards the rectum and removed. In two cases, enteroliths were manipulated back to the pelvic flexure, fragmented and removed. Findings of this study suggest that intraluminal enterolith fragmentation can be used to avoid long enterotomy incisions and facilitate removal of calculi lodged in bowel segments that cannot be exteriorised. However, it is important to be aware of the risks of enterolith fragmentation in nonexternalisable bowel segments that cannot be visualised for intestinal viability assessment. [ABSTRACT FROM AUTHOR]

A 6-yr-old captive-bred male black pine snake (Pituophis melanoleucus lodingi) weighing 0.49 kg with a snout-to-vent length of 127 cm was presented for evaluation of a caudal coelomic swelling that had been present for 3 days. Survey radiographs showed focal distention of the body wall with a mass of soft tissue and mineral opacity. Anti-inflammatory and empiric antibiotic treatments were initiated, with no significant improvement. Coelomic ultrasound showed effusion and intestinal changes consistent with an intussusception. On exploratory celiotomy, the mass was found to be a 10-cm-long colonic diverticulum. A colotomy was performed and inspissated fecal material was removed from the lumen of the diverticulum prior to its resection and closing of the bowel defect. Histological examination of the excised tissue was consistent with an intestinal diverticulum and complete absence of the smooth muscle layers, indicating nonperforating rupture of the bowel wall. The snake recovered uneventfully and began eating 5 days after surgery. On physical and ultrasound examinations 8 months after surgery, the snake's body condition had improved and there was no recurrence of clinical signs, with the snake remaining normal 30 months postsurgery at home. [ABSTRACT FROM AUTHOR]

Background: Gastrointestinal foreign bodies are a common indication for abdominal exploratory surgery. Objectives: The objective of this study was to evaluate the relationship of pre‐operative abdominal discomfort and duration of clinical signs with surgical resolution of canine small intestinal foreign body obstructions (SIFBO). Methods: We performed a retrospective study of 181 canine abdominal exploratory surgeries for confirmed SIFBO at two referral hospitals. Animals were categorized into five surgical groups (gastrotomy after manipulation into the stomach, enterotomy, resection‐and‐anastomosis [R&A], manipulated into colon, already in colon) and further grouped by whether entry into the gastrointestinal tract (GIT) was required. Results: Abdominal discomfort was noted in 107/181 cases (59.1%), but no significant differences in abdominal discomfort rates were present among the surgical groups or between GIT entry and no entry groups. Clinical sign duration was associated with surgical procedure; median durations were R&A = 3 days (range, 1–9), enterotomy = 2 days (range, 1–14), gastrotomy = 2 days (range, 1–6), already in colon = 1.5 days (range, 1–2), and manipulated into colon = 1 day (range, 1–7). In a pairwise comparison, differences in the duration of clinical signs were found for obstructions manipulated into the colon versus R&A, gastrotomy versus R&A, and in colon versus R&A. When patients were grouped according to GIT entry, cases with entry had a longer duration of clinical signs (median = 2 days [range, 1–14] versus 1 day [range, 1–7], respectively). Conclusions: Abdominal discomfort was not associated with surgical complexity; however, the duration of clinical signs was associated with surgical complexity, with longer duration being associated with entry into the GIT and R&A. Despite statistical significance, the maximum difference of 2 days between surgical groups is unlikely to be clinically relevant. [ABSTRACT FROM AUTHOR]

Gallstone ileus is a rare entity that causes bowel obstruction by gaining access through a cysto-enteric fistula. This is a case report of a 70-year-old man presenting with small bowel obstruction secondary to distal jejunal gallstone ileus impaction. He is not known to have any predisposing factors. He was managed effectively with an enterolithotomy. Early diagnosis is key to a good prognosis. Although other management options are available, enterolithotomy with or without cholecystectomy remains the gold standard of management. [ABSTRACT FROM AUTHOR]

A 6-yr-old captive-bred male black pine snake (Pituophis melanoleucus lodingi) weighing 0.49 kg with a snout-to-vent length of 127 cm was presented for evaluation of a caudal coelomic swelling that had been present for 3 days. Survey radiographs showed focal distention of the body wall with a mass of soft tissue and mineral opacity. Anti-inflammatory and empiric antibiotic treatments were initiated, with no significant improvement. Coelomic ultrasound showed effusion and intestinal changes consistent with an intussusception. On exploratory celiotomy, the mass was found to be a 10-cm-long colonic diverticulum. A colotomy was performed and inspissated fecal material was removed from the lumen of the diverticulum prior to its resection and closing of the bowel defect. Histological examination of the excised tissue was consistent with an intestinal diverticulum and complete absence of the smooth muscle layers, indicating nonperforating rupture of the bowel wall. The snake recovered uneventfully and began eating 5 days after surgery. On physical and ultrasound examinations 8 months after surgery, the snake's body condition had improved and there was no recurrence of clinical signs, with the snake remaining normal 30 months postsurgery at home. [ABSTRACT FROM AUTHOR]

Purpose: Bowel injury during laparoscopic and robotic ventral hernia repair is a rare but potentially serious complication. We sought to compare bowel injury rates during minimally invasive approaches to ventral hernia repair using a national hernia registry. Methods: Patients undergoing elective laparoscopic and robotic ventral hernia repair (including cases converted-to-open) between 2013 and 2021 were retrospectively identified in the Abdominal Core Health Quality Collaborative registry. The primary outcome was bowel injury, which included partial- and full-thickness injuries and re-operations for missed enterotomies. Statistical analysis was performed using multivariate logistic regression. Results: Overall, 10,660 patients were included (4116 laparoscopic, 6544 robotic). The laparoscopic group included more incisional hernias (68% vs 62%, p < 0.001) and similar rates of recurrent hernias (23% vs 22%, p = 0.26). A total of 109 bowel injuries were identified, with more occurring in the laparoscopic group (55 [1.3%] laparoscopic vs. 54 [0.8%] robotic; p = 0.01). Specifically, there were more full-thickness and missed enterotomies in the laparoscopic group (29 laparoscopic vs. 20 robotic; p = 0.012). Bowel injury resulted in higher rates of wound morbidity and major post-operative complications including sepsis, re-admission, and re-operation. Following adjustment for recurrent and incisional hernias, prior mesh, patient age, and hernia width, bowel injury during laparoscopic repair remained significantly more likely than bowel injury during robotic repair (OR 1.669 [95% C.I.: 1.141–2.440]; p = 0.008). Conclusion: In a large registry, laparoscopic ventral hernia repair is associated with an increased risk of bowel injury compared to repairs utilizing the robotic platform. Knowing the limitations of retrospective research, large national registries are well suited to explore rare outcomes which cannot be feasibly assessed with randomized controlled trials. [ABSTRACT FROM AUTHOR]

We present a case where ingestion of multiple bead magnets caused multiple perforations of small bowel and required surgical intervention. Pressure necrosis of intervening loops of small intestine led to tiny perforations at multiple sites without contamination of the abdomen. All of those magnets were retrieved by performing enterotomy and resection & anastomosis done at few sites. If unattended or missed out they can even lead to death. [ABSTRACT FROM AUTHOR]

Purpose: In this study, a three-step novel surgical technique was developed for incisional hernia, in which a laparoscopic procedure with a mini-laparotomy is combined: so-called 'three-step incisional hybrid repair'. The aim of this study was to reduce the risk of intestinal lacerations during adhesiolysis and recurrence rate by better symmetrical overlap placement of the mesh. Objectives: To evaluate first perioperative outcomes with this technique. Methods: From 2016 to 2020, 70 patients (65.7% females) with an incisional hernia of > 2 and ≤ 10 cm underwent a elective three-step incisional hybrid repair in two non-academic hospitals performed by two surgeons specialised in abdominal wall surgery. Intra- and postoperative complications, operation time, hospitalisation time and hernia recurrence were assessed. Results: Mean operation time was 100 min. Mean hernia size was 4.8 cm; 45 patients (64.3%) had a hernia of 1–5 cm, 25 patients (35.7%) of 6–10 cm. Eight patients had a grade 1 complication (11.4%), five patients a grade 2 (7.1%), two patients (2.8%) a grade 4 complication and one patient (1.4%) a grade 5 complication. Five patients had an intraoperative complication (7.0%), two enterotomies, one serosa injury, one omentum bleeding and one laceration of an epigastric vessel. Mean length of stay was 3.3 days. Four patients (5.6%) developed a hernia recurrence during a mean follow-up of 19.5 weeks. Conclusion: A three-step hybrid incisional hernia repair is a safe alternative for incisional hernia repair. Intraoperative complications rate was low. [ABSTRACT FROM AUTHOR]

Bouveret’s syndrome is a rare form of gallstone ileus. It refers to gastric outlet or small bowel obstruction caused by the formation of a biliary enteric fistula with subsequent migration and impaction of a large gallstone into stomach or small intestine. Its diagnosis is often delayed or overlooked. Diagnosis is based on the clinical manifestations, presence of pneumobilia, visualisation of stone and demonstration of small bowel obstruction on imaging. Enterotomy or gastrotomy with or without cholecystectomy and fistula repair is the most common surgical therapy. The aim of this case series was to analyse the presentation of Bouveret’s syndrome and strategise the optimum surgical approach based on the available literature and authors experience. Authors hereby report three cases of Bouveret’s syndrome encountered within last two years with clinical presentation, surgical approaches and operative findings. Computed Tomography (CT) scan is most commonly used to diagnose this rare entity. Early detection and optimum timing of surgery plays crucial role in outcome. It has high success rate, with acceptable surgical morbidity and mortality. Heightened awareness of this syndrome may lead to decreased morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background: Interleukin-10 (IL10) signalling pathway deficiency results in severe very early onset inflammatory bowel disease (VEOIBD), and enterostomy is often inevitable. However, studies in these surgical populations are lacking. This study aims to determine the enterostomy characteristics, postoperative complications and related risk factors in enterostomy patients.Methods: From March 1, 2015, to December 31, 2018, patients with IL10R-mutation who underwent enterostomy were recruited for analysis. We collected data on the patients' clinical characteristics, enterostomy characteristics, postoperative complications and related risk factors.Results: Twelve patients required emergency enterostomy, and 10 patients underwent elective enterostomy. Twelve patients experienced postoperative complications, including wound infection (27.3%), wound dehiscence (18.2%), reoperation (18.2%), etc. Compared with the pre-enterostomy values, there was a decrease in C-reactive protein (CRP) (P = 0.001), an increase in albumin (P = 0.001) and an improvement in the weight-for-age (P = 0.029) and body mass index (BMI) Z-scores (P = 0.004) after enterostomy. There was a significant difference between the pre-operation and postoperation medicine expenses (P = 0.002). Univariate binary logistic regression analysis revealed a statistically significant influence of CRP (OR: 1.43, 95% CI: 1.07-1.91, P = 0.016) and a tendency towards a significant influence of intestinal perforation, albumin level, BMI Z-score and weighted paediatric Crohn's disease activity index (wPCDAI). Multivariate logistic regression analysis showed that CRP (OR: 1.40), wPCDAI (OR: 2.88) and perforation (OR: 1.72) showed a tendency to behave as independent risk factors for postoperative complications, but the results were not significant (all P > 0.05).Conclusions: Surgery and enterostomy showed benefits for VEOIBD with IL-10 signalling deficiency. The timing of intervention, potential postoperative complications, economic burden and other related problems should be considered. [ABSTRACT FROM AUTHOR]

The objective of this retrospective study was to evaluate the positive and negative predictive values (PPV and NPV) of sonographic evidence of intestinal wall layering damage as a predictor for the operative necessity to perform enterectomy in dogs and cats with obstructive intestinal foreign bodies. Forty seven dogs and 5 cats with sonographic evidence of obstructive intestinal foreign bodies were used in this study. Sonographic reports of patients diagnosed with intestinal foreign body and treated surgically, between the years 2013-2018 were reviewed. Subjects were divided into two groups based on the integrity of their intestinal wall layering: Group I were subjects with sonographic loss of intestinal layering (LWL) and Group II were subjects with intact intestinal layering (IWL). Records were reviewed and the surgical procedure was classified as "Enterectomy" or "Enterotomy". Sensitivity, specificity, PPV and NPV of the sonographic evidence of loss of intestinal wall layering were calculated as a predictor for the enterectomy or enterotomy procedure. Enterectomies were performed in 36% (8/35) of the IWL and 89% (15/17) of the LWL cases. The sensitivity and specificity of the sonographic evidence of loss of intestinal wall layering as a predictor of enterectomy were 66% and 94% respectively. PPV calculated to be 89% and NPV 78%. Septic peritonitis was evident in 55% of LWL and 6% of IWL surgeries. It was concluded that sonographic evidence of loss of intestinal wall layering in dogs and cats with intestinal foreign bodies may serve as predictor suggestive for the need to select enterectomy versus enterotomy at the site of the intestine with questionable viability of the intestinal wall. The prevalence of septic peritonitis in cases with sonographic evidence of loss of intestinal wall layering was relatively high. A surgeon experienced with enterectomy techniques will help provide the best prognosis to the patient. [ABSTRACT FROM AUTHOR]

Foreign body ingestion is common in young children. Very few cases require surgical exploration for removal. We report a case of superabsorbent gel ball ingestion causing intestinal obstruction, managed by a combination of endoscopic and open surgical removal under intraoperative ultrasound guidance. [ABSTRACT FROM AUTHOR]

A young Labrador dog was presented with complaint of persistent vomiting for past one week. On palpation, a hard foreign body could be palpated in abdomen and was confirmed as radio opaque in radiograph. Patient was stabilized and enterotomy was performed for surgical removal of foreign body. A hard stone was removed and animal recovered successfully. [ABSTRACT FROM AUTHOR]

Gallstone ileus is a complication of biliary tree stones and was first described by Bartholin in 1654. In any localization, one or more gallstones may occlude as a result of access to the gastrointestinal tract via the bilioenteric fistula. In this article, we aimed to present a rare and operate with gallstone ileus cases of radiological and surgical imaging findings. A 74-year-old male patient presented with complaints of right upper quadrant pain, nausea, vomiting, and constipation in the last few days of the emergency department. Radiographical and computed tomography examination was done. The patient was urgently operated with gallstones. The ileal stone was removed in addition to cholecystectomy in the operation, and the cholecystododenal fistula detected during the operation was repaired. Gallstone ileus is an uncommon cause of a mechanical small bowel obstruction. Gallstone ileus should also be kept in mind in the elderly patients who have recurrent abdominal operation history with abdominal obesity findings of the omentum. In our case, we wanted to emphasize the importance of the radiological approach in diagnosing gallstone ileus disease in elderly patients with diabetes mellitus. [ABSTRACT FROM AUTHOR]

Purpose: The seroma rate following laparoscopic incisional ventral hernia repair (LIVHR) is up to 78%. LIVHR is connected to a relatively rare but dangerous complication, enterotomy, especially in cases with complex adhesiolysis. Closure of the fascial defect and extirpation of the hernia sack may reduce the risk of seromas and other hernia-site events. Our aim was to evaluate whether hybrid operation has a lower rate of the early complications compared to the standard LIVHR.Methods: This is a multicenter randomized-controlled clinical trial. From November 2012 to May 2015, 193 patients undergoing LIVHR for primary incisional hernia with fascial defect size from 2 to 7 cm were recruited in 11 Finnish hospitals. Patients were randomized to either a laparoscopic (LG) or to a hybrid (HG) repair group. The outcome measures were the incidence of clinically and radiologically detected seromas and their extent 1 month after surgery, peri/postoperative complications, and pain.Results: Bulging was observed by clinical evaluation in 46 (49%) LG patients and in 27 (31%) HG patients (p = 0.022). Ultrasound examination detected more seromas (67 vs. 45%, p = 0.004) and larger seromas (471 vs. 112 cm3, p = 0.025) after LG than after HG. In LG, there were 5 (5.3%) enterotomies compared to 1 (1.1%) in HG (p = 0.108). Adhesiolysis was more complex in LG than in HG (26.6 vs. 13.3%, p = 0.028). Patients in HG had higher pain scores on the first postoperative day (VAS 5.2 vs. 4.3, p = 0.019).Conclusion: Closure of the fascial defect and extirpation of the hernia sack reduce seroma formation. In hybrid operations, the risk of enterotomy seems to be lower than in laparoscopic repair, which should be considered in cases with complex adhesions.Clinical Trial Number: NCT02542085. [ABSTRACT FROM AUTHOR]

The creation of leakage holes in the intestinal wall by four types of swaged-on needles used to close enterotomy incisions in canine cadavers was studied. Twenty-four enterotomies were performed in 10 cm jejunal sections obtained from five dogs following euthanasia. After placement of Doyen intestinal forceps to the ends of each section, a 3 cm antimesenteric incision was performed and closed using 4-0 polydioxanone suture armed in a swaged-on needle in a simple interrupted pattern. One group served as control, with no enterotomies performed. The four groups that we used consisted of six sections each: group CC was closed with a polydioxanone suture armed in a conventional cutting needle, group RC was closed with a reversed cutting needle, group TPP was closed with a taper point plus needle, and group TC was closed with a taper cutting needle. Leak testing was performed by infusion of 13.5 mL methylene blue solution into the intestinal lumen. Significant differences between leakage and non-leakage sections of group CC were detected (P=.027). No statistical differences were detected among other groups. Conventional cutting needles seem to create leaking holes in cadaveric healthy jejunum during needle passage for closing an enterotomy incision. [ABSTRACT FROM AUTHOR]

A male pony was presented with no defecation and abdominal pain for last three days. Animal was having moderately distended abdomen and intermittent bouts of abdominal pain. On rectal and ultrasonographic examination, a hard impacted mass was found in right caudal of abdomen. Surgical intervention was opted as medicinal treatment had failed. On mid ventral incision, a hard faecolith was located in small colon and was exterorized with enterotomy. The incision of intestine and abdomen was closed in standard way. The animal had an uneventful recovery. [ABSTRACT FROM AUTHOR]

Introduction: Laparoscopic ventral hernia repair (LVHR) with intraperitoneal mesh placement is well established; however, the fate of patients requiring future abdominal operations is not well understood. This study identifies the characteristics of LVHR patients undergoing reoperation and the sequelae of reoperation.Methods: A retrospective review of a prospectively maintained database at a hernia referral center identified patients who underwent LVHR between 2005 and 2014 and then underwent a subsequent abdominal operation. The outcomes of those reoperations were collected. Data are presented as a mean with ranges.Results: A total of 733 patients underwent LVHR. The average age was 56.5 years, BMI 33.9 kg/m2, hernia size 115 cm2 (range 1-660 cm2), and mesh size 411 cm2 (range 17.7-1360 cm2). After a mean follow-up of 19.4 months, the overall hernia recurrence rate was 8.4 %. Subsequent abdominal operations were performed in 17 % (125 patients) at a mean 2.2 years. The most common indication for reoperation was recurrent hernia (33 patients, 26.4 %), followed by bowel obstruction (18 patients, 14.4 %), hepatopancreaticobiliary (17 patients, 13.6 %) and infected mesh removal (15 patients, 12 %), gynecologic (10 patients, 8 %), colorectal (8 patients, 6.4 %), bariatric (4 patients, 3 %), trauma (1 patient, 0.8 %), and other (19 patients, 15 %). The overall incidence of enterotomy or unplanned bowel resection (EBR) at reoperation was 4 %. This occurred exclusively in those reoperated for complete bowel obstruction, and the reason for EBR was mesh-bowel adhesions. No other indication for reoperation resulted in EBR. The incidence of secondary mesh infection after subsequent operation was 2.4 %.Conclusion: In a large consecutive series of LVHR, the rate of abdominal reoperation was 17 %. Generally, these reoperations can be performed safely. A reoperation for bowel obstruction, however, may carry an increased risk of EBR as a direct result of mesh-bowel adhesions. Secondary mesh infection after reoperation, although rare, may also occur. Surgeons should discuss with their patients the potential long-term implications of having an intraperitoneal mesh and how it may impact future abdominal surgery. [ABSTRACT FROM AUTHOR]

Background: Bezoars are an uncommon cause of mechanical intestinal occlusion. There are four different kinds of bezoars: phytobezoars, made of vegetables and fibers; trichobezoars, resulting from the ingestion of hair and frequently an expression of psychiatric disorders; lactobezoars, which are formed of milk curd; and pharmacobezoars, caused by drugs and medications. Symptoms are classically indistinguishable from one another and from more common causes of intestinal occlusion, so it can be difficult to establish a correct diagnosis in order to apply the correct treatment. We present a rare case of two different phytobezoars causing intestinal occlusion (gastric and jejunal). We also describe the correct techniques for making a correct and fast diagnosis of occlusion caused by phytobezoars, and the possible conservative and operative treatments. Case presentation: We present the case of a double phytobezoar that was surgically treated with a double enterotomy. Our patient was a 68-year-old Caucasian man with a medical history of hypertension, a previous open appendectomy, and open repair of a perforated gastric ulcer. He was admitted with a 5-day history of abdominal pain located in his upper quadrants along with vomiting. After a preoperative examination, he was taken to the operating room. He was discharged in a good clinical condition 11 days after surgical intervention. A physical examination at 6 months demonstrated our patient was in good health. Conclusions: Diagnosing bezoars is difficult because of their rarity. However, they must be taken into consideration in a differential diagnosis because their treatment is not always surgical. In fact, it may be conservative in many cases and a correct diagnosis will guide towards the correct therapy. [ABSTRACT FROM AUTHOR]

Sixteen cases of cloacal prolapse in raptors were reviewed in this study. Colonic prolapse was the most common presentation (56% of cases). Red-tailed hawks ( Buteo jamaicensis) were overrepresented, comprising 66% of colonic prolapse cases. In cases of colonic prolapse, postsurgical stricture formation was a commonly identified complication after resection and anastomosis of the colon. A novel technique was used in 2 cases of colonic prolapse, in which sterile, semirigid rubber tubing was placed in the distal colon and removed per-cloaca at the end of the procedure; this facilitated a secure, fluid-tight anastomosis while maintaining sufficient intestinal lumen. Oviductal prolapse (31% of cases) was associated with the most guarded prognosis (40% treatment success). Cloacoliths were treated successfully in 2 birds (13% of cases) by minimally invasive per-cloacal manual removal. [ABSTRACT FROM AUTHOR]

This report describes the use of a parainguinal approach to the abdomen to remove an obstruction in the small colon that could not be removed using an initial ventral midline approach. The use of a parainguinal approach should be considered for removal of an obstruction in the distal portion of the small colon. [ABSTRACT FROM AUTHOR]

Part 2: surgical techniques This article, the second on surgery of the small intestine in dogs and cats, will focus on the surgical techniques and closure modalities of the intestinal wound. Small intestine pathological conditions that require surgical intervention include intestinal obstruction and perforation, ischaemia, intussusception and mesenteric volvulus. [ABSTRACT FROM AUTHOR]

Background: During laparoscopic incisional hernia repair, conversion to open surgery is sometimes needed, especially in cases of large complicated incisional hernias. No guidelines exist for determining when conversions should be considered. This study aimed to investigate the safety of a combined technique as an alternative to conversion in the laparoscopic repair of large complicated incisional hernias and to evaluate the impact of early conversion to the combined technique on patient outcome. Methods: Beginning in November 2008, early conversion was initiated for patients with large complicated incisional hernia when dense extensive intraabdominal adhesions were present. Two cohorts of patients with large complicated incisional hernia were retrospectively analyzed: 21 patients before the initiation of early conversion (group 2) and 21 patients after its inception (group 1). The data analyzed included patient demographics, operative parameters, complications, and recurrence. Results: No significant differences were found between the two groups with respect to age, gender, body mass index, coexisting conditions, number of previous laparotomies, number of previous repairs, or features of the hernia. Groups 1 and 2 differed significantly in terms of mean operative time (110.7 vs 138.8 min), enterotomy rate (0 vs 29 %), and postoperative hospital stay (4.7 vs 6.1 days). In group 1, early conversion to the combined technique was necessary for 16 patients (76 %), and no delayed conversion occurred. In group 2, delayed conversion to the combined technique was necessary for 11 patients (52 %), and no early conversion occurred. During the follow-up period, neither wound/mesh infection nor trocar-site hernia occurred. Conclusion: The combined technique proved to be a safe and minimally invasive alternative to conversion in laparoscopic repair of large complicated incisional hernias. Early conversion to the combined technique was associated with less technical difficulty, deceased operative time, lower enterotomy rate, and shorter postoperative hospital stay. [ABSTRACT FROM AUTHOR]

Purpose: If a colonic or small bowel lesion is not accessible for endoscopic mucosal resection, enterotomy is a possible although rarely performed surgical technique. It has never been compared to circular anastomosis regarding leakage rate, bowel wall perfusion, and wound healing. Thus, the aim of this basic experimental scientific study was to investigate perianastomotic microcirculation and wound healing. Methods: Forty rats were divided into four groups (1 jejunal anastomosis, 2 jejunal enterotomy, 3 colonic anastomosis, and 4 colonic enterotomy). Following anastomosis and enterotomy, the intestinal perfusion was measured using laser fluorescence angiography (IC-View). On postoperative day 7, the surface of the mucosal villi, expression of matrix metalloproteinases (MMP) 2, 8, 9, and 13, and the number of proliferating cells (Ki67) as well as the collagen types I/III ratio were analyzed. Results: The perianastomotic microperfusion was significantly reduced in all groups compared to the reference region. The perianastomotic perfusion index was significantly reduced in group 1 compared with group 2, whereas the perfusion index in group 3 was slightly but not significantly reduced in comparison to group 4. Ki67 was elevated in both circular anastomosis groups. Surface of the mucosal villi, MMP expression, and collagen type I/III ratio revealed no significant differences. Conclusions: Our study affirms the theoretical consideration of a better microperfusion of the bowel wall following an antimesenterial enterotomy and demonstrates that enterotomy is not inferior compared to circular anastomosis. Even though enterotomy is a rarely used surgical technique, it should be regarded as a possible alternative in particular situations. [ABSTRACT FROM AUTHOR]

Background: Unidirectional, barbed suture allows knotless wound closure with potential value for the progression of advanced suturing techniques. This study compared an absorbable barbed suture device to a monofilament suture in a single-layer enterotomy closure model. Methods: A series of 10 enterotomies were created in the stomach, jejunum, and colon through midline laparotomy in 13 mongrels. The enterotomies were closed in a simple continuous pattern and randomized to either conventional suture secured with three square knots or a barbed suture device without knots. Closure time was recorded for each sample. Adhesion scores and biomechanical wound strengths were assessed at postoperative days 3, 10, and 21 by burst pressure testing. Results: Barbed suture provided a faster closure compared to conventional suture ( p ≤ .02). There was no significant difference in burst pressures or adhesion scores between barbed suture and monofilament suture enterotomy closures at day 3, 10, or 21. Conclusion: Enterotomy closure was faster using the barbed device as compared to conventional suture, with no significant difference in burst strength or adhesion scores at any time point. [ABSTRACT FROM AUTHOR]

Unlabelled: Introduction: Gallstone ileus is a rare cause of bowel obstruction and results from the passage of gallstones into the bowel.Case Presentation: We present the case of an 83-year-old Caucasian woman who had three episodes of gallstone ileus, each of which was managed with simple enterotomy. This sequence is one of the first reported in the medical literature and may be seen to challenge the traditional surgical approach of enterotomy alone.Conclusions: The available evidence comparing enterotomy alone with combined enterotomy, cholecystectomy, and fistula closure in the management of gallstone ileus is reviewed. Neither approach is clearly identified as superior, but available series suggest that simple enterotomy may be safer than a combined approach and does not result in a higher rate of recurrent biliary disease. [ABSTRACT FROM AUTHOR]

iasis is a helminthic infection of global distribution, and intestinal obstruction is its most common gastrointestinal complication. This is a case of a 7-year-old boy admitted to Pediatric Surgery because of intestinal obstruction caused by ascariasis. On admission, the patient presented with colicky abdominal pain, bile-stained vomiting and meteorism. On physical examination, the patient was thin, pale, and dehydrated. An abdominal examination showed distention and diffuse tenderness. After admission, the patient had fecal vomiting and expulsion of worms through the mouth. Laboratory-test results showed leucocytosis, eosinophilia, hypoalbuminaemia, and hypochloremia. Abdominal radiographs and ultrasound studies were indicative of small-bowel obstruction due to roundworms, which led to the performance of an exploratory laparotomy. On bowel exploration, an intraluminal mass, 10 by 6 cm in diameter, consisting of roundworms in the middle third of the ileum was found. A longitudinal enterotomy was performed, and the worms were meticulously extracted manually. Postoperatively, broad-spectrum antibiotics and antihelminthic drugs were administered. Our case of intestinal obstruction caused by ascariasis is the first to be reported in Serbia, according to the Serbian literature. [ABSTRACT FROM AUTHOR]

A retrospective study was conducted at SKIMS Medical College, Bernina from February 2012 to March 2016 where about 70 patients (children) of acute small gut obstruction were studied. The aim of this study was to find the commonest cause of obstruction in our population, study; age, sex and demographic distribution as per aetiology, and morbidity and mortality in patients that report late to hospital. It was observed that the leading cause of obstruction was due to ascariasis (73%) followed by adhesion obstruction (11.4%).The most vulnerable age group was between 4 to 11 years with peak between 4 to 7 years, and majority of patients were from rural background. Conservative treatment was effective in maximum number of patients (71%) and lesser number of patients (29%) needed surgery. Delayed reporting to hospital increased morbidity in worm obstruction patients. [ABSTRACT FROM AUTHOR]

Abstract: Natural Orifice Transluminal Endoscopic Surgery (NOTES) is the latest and perhaps most significant innovation in surgery since Phillipe Mouret of France performed the first laparoscopic cholecystectomy in 1987. This new “minimum-invasive” concept that promises scar-free surgery is steadily gathering momentum. It is another milestone in our quest to eliminate surgical trauma, speed patient recovery time and decrease surgical wound-related complications. On 22 July 2005, the Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR) published a white paper highlighting the barriers to NOTES development, which included the need for appropriate selection of access points, effective closure of the enterotomy site, innovative tools, stable platforms and improved endoscopic orientation. These are just some of the many issues that need to be resolved before the NOTES concept and technique could become a common feature of modern surgery. The publication of the white paper ushered in the beginning of multiple research projects using animal models to test the application of NOTES and its newly developed instruments. The success in animal models was followed by several highly selected successful human trials. National and international surgical innovation departments should now be created where medical industry personnel including inventors, designers and engineers can work together with the medical and surgical providers to address all the limitations affecting NOTES progress. [Copyright &y& Elsevier]

During laparoscopic ventral/incisional hernia repair (LVIHR), conversion to conventional (open) technique is required when safe adhesiolysis is not possible, incarcerated bowel in hernial sac cannot be reduced or for repair of iatrogenic enterotomies. A formal laparotomy in these circumstances entails significant morbidity due to factors such as wound infection, prolonged immobility, and longer hospital stay. During a period between 1994 and 2007, 1,503 LVIHRs were performed at our centre following a standardized protocol by five consultants and fellows. Out of these, 6 patients had a formal laparotomy in the initial part of our experience and 26 patients had a limited conversion to facilitate completion of LVIHR. We have devised the term “limited conversion” for the procedure wherein bowel reduction/adhesiolysis/enterotomy repair was performed through a small targeted skin incision. This was followed by laparoscopic placement of intraperitoneal mesh. Conversion to an open procedure was required in 32 (2.1%) out of 1,503 LVIHR procedures. Twenty-six patients underwent a limited conversion and completion of the repair by laparoscopy. All but one of these patients had intraperitoneal placement of mesh by laparoscopic route. The wound complication rate was 3.8% (one patient), the mean hospital stay was 2.1 days, and mean operative time was 124 min. Limited conversion offers a safe alternative to a formal laparotomy in patients with bowel incarcerated in hernial sacs or in patients requiring extensive bowel adhesiolysis. Patient morbidity is reduced due to the targeted skin incision whilst retaining several advantages of a minimal access approach viz. laparoscopic evaluation of the entire abdominal wall and placement of a large intraperitoneal prosthesis. [ABSTRACT FROM AUTHOR]

Consequences and complications of postsurgical intra-abdominal adhesion formation not including small bowel obstruction and secondary infertility are substantial but are under-exposed in the literature. Inadvertent enterotomy during reopening of the abdomen or subsequent adhesion dissection is a feared complication of surgery after previous laparotomy. The incidence can be as high as 20% in open surgery and between 1% and 100% in laparoscopy depending on the underlying disease. Delayed postoperative detection of enterotomy is a particular feature of laparoscopy associated with significant morbidity and mortality. Adhesions to the ventral abdominal wall are responsible for the majority of trocar injuries. Both trocar injuries and inadvertent enterotomies result in conversion from laparoscopy to laparotomy in almost 100% of cases. There is a paucity of data on other organ injury, such as liver laceration or bladder perforation. Dissecting adhesions before executing the planned operation takes on average 20 min, being one-fifth of the total operating time in patients having had previous open colorectal surgery. There is some evidence that postoperative morbidity and mortality of patients who need adhesiolysis is higher than that of patients with a virgin abdomen. The necessity to dissect adhesions is associated with increased hospital stay. Postsurgical adhesions are considered a main reason for conversion from laparoscopy to laparotomy in many types of procedures including laparoscopic colonic resection. Adhesion formation is part of the innate peritoneal defence mechanism in peritonitis. Abscess formation and bleeding, organ injury and fistula formation at ‘on demand’ relaparotomies are well-known complications after surgery for intra-abdominal sepsis associated with fibrinous adhesions. The clinical magnitude hereof is poorly researched. Postsurgical adhesions may cause pain as evidenced by pain mapping clinical experiments. Filmy adhesions between movable organs and the peritoneum appear to be worse in terms of generating pain. The high caseload of gynaecological and some colorectal practices suggest an enormous impact of adhesion-related chronic abdominal and pelvic pain on patient’s wellbeing and socio-economic costs. The significant risk of inadvertent enterotomy, conversion to laparotomy and trocar injury, and the associated postoperative morbidity and mortality and increased length of hospital stay warrant routine informed consent of adhesiolysis related complications in patients scheduled for abdominal or pelvic reoperation. [ABSTRACT FROM AUTHOR]

In the year 2003, five horses with signs of obstructive acute abdominal syndrome caused by gastrointestinal concretions were remitted to the Equine Hospital of the Department of Equine Medicine and Husbandry of the Faculty of Veterinary Medicine and Animal Husbandry-National Autonomous University of Mexico (DMZE-FMVZ-UNAM). Four of these cases (80%) came form the northeast region of Mexico City, and were horses used for pulling garbage carts in the dump areas. According to some studies, there are geographical regions where cases of enterolithiasis have more incidence; the cases reported in the studies include enteroliths as well as mineral concretions caused by foreign bodies. All of this cases have presented signs of partially obstructive acute abdominal syndrome (AAS) characterized by intermittent pain episodes, increased physiological frequencies, decreased abdominal sounds with presence of gas and constipation. Even though signs are not specific, assembled to the clinical history, they can be a very valuable key for diagnosis and prognosis of the patient. The definitive diagnosis is only made by enterotomy or necropsy. The prognosis of partial obstructive, acute abdominal syndrome caused by concretions is low vital, low functional in most of the cases, but there may be complications such as gastrointestinal rupture wich there may compromise the patient's life, if the disease is not diagnosed and treated soon. [ABSTRACT FROM AUTHOR]

Our first 100 patients and our second 100 patients who underwent a laparoscopic repair of incisional and ventral hernias were compared and evaluated. This analysis revealed that the second group was approximately 9 years older with more comorbid medical conditions. In all, 15% were incarcerated hernias, and 21% were recurrent. Seven operations were converted to the open repair because of adhesions in five patients and either a small or large bowel injury in two patients. There were no complications related to enterotomy. Older and more infirm patients in the second group did not significantly affect outcomes. The average size of the hernia defects was 111 cm2. The average size of the prosthesis was 257.5 cm2. Larger prostheses were used in the second group. With more experience, the recurrence rates have declined from 9% to 4%. The etiology of these recurrences differed in these two groups of patients. Removal of the prosthetic due to infection was a predictable recurrence in two patients. A new hernia below the original hernia has caused us to repair the entire incision that had the initial hernia. Only one technical failure was noted, due to fracture of the suture during transfascial placement and clamping of the suture. It is not recommended to grasp any suture that remains in the patient during this hernioplasty. Recurrences were reduced because of the use of an increased overlap of the biomaterial and the use of dual methods of fixation (tacks and transfascial sutures). [ABSTRACT FROM AUTHOR]

Ingestion of foreign body is a serious problem commonly encountered in our clinical practice. Most of them pass spontaneously, whereas in others endoscopic or surgical intervention is required because of complications or non-passage from the gastrointestinal tract. We present here a case of teaspoon ingestion, which did not pass spontaneously. Laparoscopic retrieval of teaspoon was done from mid jejunum after enterotomy and the patient recovered uneventfully. Right intervention at the right time is of paramount importance. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the patients who were operated on for acute mechanical intestinal obstruction secondary to intestinal bezoars. Materials and Methods: Eighteen patients who were operated on due to intestinal bezoars, were investigated according to their age, gender, preoperative diagnosis, type of operation, operation time and postoperative complications. Results: Ten of the 18 patients underwent segmental resection of the small intestine, while bezoar extraction and enterotomy was performed in eight patients. No difference was detected among investigated parameters between the two groups. Conclusion: Despite a variety of surgical, pharmacological, and endoscopic treatment modalities have been defined for intestinal bezoars, the standard model of treatment is still controversial. [ABSTRACT FROM AUTHOR]

Background: We report a case of heavy intestinal infestation with Ascaris lumbricoides complicating the surgical management of a gunshot injury to the abdomen. Co-existent traumatic and infectious pathologies in this case highlight the complex burden of illness among children living in areas of violent conflict, with clinical relevance to trauma surgeons in the tropics. [ABSTRACT FROM AUTHOR]

Pelvic irradiation as part of adjuvant therapy for rectal cancer is frought with many complications. We describe the case of a young man who presented with frequent intestinal obstruction after resection and radiotherapy for a low rectal cancer. Subsequent laparotomy and adhesiolysis resulted in a large defect at the previous anastomotic site. A loop of sigmoid colon was used to cover the pelvic brim in an effort to preserve the sphincter and intestinal continuity. [ABSTRACT FROM AUTHOR]

We investigated laparoendoscopy (laparoscopy-assisted small bowel enteroscopy) as an aid in managing the challenging diagnostic problem of occult small bowel hemorrhage. We performed laparoendoscopy on five nonconditioned dogs and five conditioned dogs. In each case, we laparoscopically inspected the small bowel from the ligament of Treitz to the ileocecal valve. Small bowel was exteriorized, an enterotomy was performed, and an Olympus CL-100L colonoscope was inserted and advanced proximally to the stomach and distally to the ileocecal valve. A segment of small bowel was arbitrarily designated as the site of bleeding, was exteriorized, and was resected. Bowel continuity was restored with a stapled anastomosis. The animals were euthanized and autopsied immediately after the procedure (n = 5) or a week following the procedure (n = 5), at which time the anastomoses were tested for leakage and patency. The entire small bowel was visualized in all animals. There were no anastomotic leaks. Laparoendoscopy may be of value in identifying and treating hemorrhagic origin of small bowel. Clinical trials are warranted. [ABSTRACT FROM AUTHOR]

A dog was presented with history of vomiting and anorexia for past two days and absence of defecation for past four days. Clinical examination revealed all parameters were within the physiological limit. Contrast radiography revealed barium stasis even after twenty four hours on administration suggestive of intestinal obstruction. Mid ventral exploratory laparotomy was performed. A small piece of corn cob obstructing the intestinal tract was identified and removed by enterotomy. The animal was maintained on fluids for seventy two hours along with antibiotic therapy. The animal recovered uneventfully. [ABSTRACT FROM AUTHOR]

Two pomeranian dogs were reported with loss of appetite, vomiting. The cases were confirmed as intestinal obstruction on abdominal palpation and radiographic examination. Enterotomy was performed and surgically removal of intestinal foreign bodies was carried out. The animals recovery successfully. [ABSTRACT FROM AUTHOR]

This is a retrospective review of laparoscopic repair for enterotomies created during therapeutic or diagnostic laparoscopy in 26 women. All patients had mechanical and antibiotic bowel preparation preoperatively. The indication for operative laparoscopy was endometriosis (18), severe abdominal adhesive disease (7), and adhesions with Crohn's disease (1). Enterotomies were secondary either to CO laser vaporization or excision of endometriosis and/or lysis of adhesions (23) and trocar insertion (3). The injuries included small-bowel enterotomies (9), colotomies (4), and rectotomies (13). No clinical complications related to enterotomy repair were noted. Twenty-three patients were discharged 1 day after surgery; one was discharged on postoperative day 2; and two were discharged on postoperative day 3. We concluded that small- and large-bowel enterotomies can be repaired safely via the laparoscope with minimum morbidity in patients with prepared bowel. [ABSTRACT FROM AUTHOR]