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A neural network was developed to detect and characterize bowel obstruction, a common cause of acute abdominal pain. In this retrospective study, 202 CT scans of 165 patients with bowel obstruction from March to June 2022 were included and partitioned into training and test data sets. A multi-channel neural network was trained to segment the gastrointestinal tract, and to predict the diameter and the longitudinal position (longitude) along the gastrointestinal tract using a novel embedding. Its performance was compared to manual segmentations using the Dice score, and to manual measurements of the diameter and longitude using intraclass correlation coefficients (ICC). ROC curves as well as sensitivity and specificity were calculated for diameters above a clinical threshold for obstruction, and for longitudes corresponding to small bowel. In the test data set, Dice score for segmentation of the gastrointestinal tract was 78 ± 8%. ICC between measured and predicted diameters was 0.72, indicating moderate agreement. ICC between measured and predicted longitude was 0.85, indicating good agreement. AUROC was 0.90 for detection of dilated bowel, and was 0.95 and 0.90 for differentiation of the proximal and distal gastrointestinal tract respectively. Overall sensitivity and specificity for dilated small bowel were 0.83 and 0.90. Since obstruction is diagnosed based on the diameter and longitude of the bowel, this neural network and embedding may enable detection and characterization of this important disease on CT.

Background: Myeloid sarcoma (MS) is an extramedullary tumor constituted by myeloid blasts or immature myeloid cells. It frequently occurs in conjunction with acute myeloid leukemia (AML); however, it can exceptionally manifest in patients without leukemia. Here, we present a rare case of primary MS originating in the small bowel without evidence of bone marrow involvement. Case representation: A 33 year-old female with no relevant medical history was admitted to our hospital with recurrent abdominal pain. Computed tomography (CT) revealed bowel obstruction due to thickening of the ileum wall, which was suspected to be an ileal tumor. Initially, ectopic endometriosis was suspected because of abdominal pain associated with the menstrual cycle and changes observed on a follow-up CT scan. The lesion could not be detected by double-balloon endoscopy. Despite conservative treatment, the obstruction persisted, and laparoscopic partial ileal resection was performed, which revealed extensive involvement of the ileum and mesentery. Additionally, the mesentery of the resected ileum was extremely thickened. Histopathological and immunohistochemical examinations of the surgical specimen indicated ileal MS. Bone marrow aspiration after discharge was negative for cytological findings of leukemia, leading to a final diagnosis of primary ileal MS. Her postoperative course was uneventful, and she is currently undergoing systemic chemotherapy tailored to AML at another hospital. Conclusions: Even though MS of the small bowel is rare and may not be considered preoperatively, similar surgical treatment to that of other small bowel malignancies can ensure proper postoperative diagnosis and appropriate chemotherapy. Given the potential need for chemotherapy, ensuring surgical safety that allows for its rapid initiation is critical. [ABSTRACT FROM AUTHOR]

Background: Intestinal tuberculosis (iTB) represents a potentially underrecognized clinical entity with limited clinical and radiological differentiating features. This study aims to assess the patterns of iTB clinical and radiological findings, along with the treatment approaches and the overall outcome. Methods: This retrospective cross-sectional study included patients with histopathologically confirmed iTB who presented with acute abdomen and were surgically managed between September 2005 and October 2023. Clinical and sociodemographic variables, imaging features, surgical treatments, and overall outcomes were retrospectively analyzed. Results: 96 patients with iTB were included, with a mean age of 36.1 ± 11.5 years and a relatively proportionate gender distribution. Abdominal pain was the most common presenting symptom (45.8%). The radiological features varied by the modality. Plain imaging showed non-specific findings, while ultrasonography showed loculated ascites (25%), and lymphadenopathy (22%). In computed tomography scans, multi-segmental symmetric intestinal thickening (53.1%) was the most prevalent finding. The most commonly performed surgical procedure was adhesiolysis (29.2%), with the ileocecal junction being the most commonly involved structure (39.6%). Histopathological examination of all the tissue biopsies revealed epithelioid granulomas. Postoperative complications occurred in 19 patients (19.8%), with surgical site infection being the most common complication (10.4%). Conclusion: Intestinal obstruction is an underrecognized manifestation of tuberculosis, particularly in endemic regions. The non-specific clinical presentation, coupled with the limited utility of laboratory and radiological tests, often leads to delayed recognition and treatment. Maintaining a high index of suspicion is essential, especially in younger patients, inhabitants of endemic areas, or those with laboratory findings indicative of chronic inflammation. Prompt recognition is crucial to ensure the timely initiation of anti-tuberculosis therapy and to optimize patient outcomes through appropriate follow-up. [ABSTRACT FROM AUTHOR]

Purpose Ileostomy volvulus is a rare cause of small bowel obstruction. We present an unusual case of ileostomy volvulus without the presence of adhesions. Additionally, a systematic literature review was performed to collate the current literature on the causes, diagnosis, treatment, and preventative measures of ileostomy-related small bowel obstruction. Methods PubMed (MEDLINE), Embase, Google Scholar, Scopus, and CENTRAL were searched from their inception up to August 2022. This study adhered to the PRISMA guidelines and was registered on PROSPERO. The primary outcomes included patients’ demographics, imaging modality, indication for initial surgery, type and configuration of stoma, surgical treatment, and recurrence of volvulus. The quality of included studies was assessed using the Murad tool. Written informed consent was obtained from the patient. Results Seven studies were included, comprising 967 patients. Stoma outlet obstruction (SOO) was reported in all 159 patients, and 12 had ileostomy volvulus as the cause. A majority of patients had loop ostomies for ileostomy volvulus. No complications or mortality were reported in the included studies, and half of the included studies were deemed to be of good quality. Conclusion This case demonstrates the need for high clinical suspicion of SOO in patients with loop ileostomy, and rapid management should be undertaken. Whilst loop ileostomies, increased rectus abdominal muscle thickness, and lower preoperative total glucocorticoid dosage are associated with SOO, large-scale retrospective studies are needed to validate our findings.

Bowel obstruction is a common cause of acute abdominal pain. The development of algorithms for automated detection and characterization of bowel obstruction on CT has been limited by the effort required for manual annotation. Visual image annotation with an eye tracking device may mitigate that limitation. The purpose of this study is to assess the agreement between visual and manual annotations for bowel segmentation and diameter measurement, and to assess agreement with convolutional neural networks (CNNs) trained using that data. Sixty CT scans of 50 patients with bowel obstruction from March to June 2022 were retrospectively included and partitioned into training and test data sets. An eye tracking device was used to record 3-dimensional coordinates within the scans, while a radiologist cast their gaze at the centerline of the bowel, and adjusted the size of a superimposed ROI to approximate the diameter of the bowel. For each scan, 59.4 ± 15.1 segments, 847.9 ± 228.1 gaze locations, and 5.8 ± 1.2 m of bowel were recorded. 2d and 3d CNNs were trained using this data to predict bowel segmentation and diameter maps from the CT scans. For comparisons between two repetitions of visual annotation, CNN predictions, and manual annotations, Dice scores for bowel segmentation ranged from 0.69 ± 0.17 to 0.81 ± 0.04 and intraclass correlations [95% CI] for diameter measurement ranged from 0.672 [0.490-0.782] to 0.940 [0.933-0.947]. Thus, visual image annotation is a promising technique for training CNNs to perform bowel segmentation and diameter measurement in CT scans of patients with bowel obstruction.

Sclerosing encapsulating peritonitis (SEP), or abdominal cocoon syndrome (ACS), is an uncommon disorder marked by a thick fibrotic membrane that completely or partially envelops the small bowel. For surgeons, preoperative diagnosis is difficult and challenging. The majority of documented, diagnosis were made during a laparotomy. We present a case of SEP that was diagnosed preoperatively. The patient had a complete small bowel obstruction that necessitated urgent surgery. We review the literature and discuss the causes, clinical manifestation, and management of the condition.

Key clinical message: Small cell lung cancer (SCLC), a neuroendocrine aggressive subtype of lung cancer, is associated with paraneoplastic disorders in about 9% of patients. In this report, we describe a middle‐aged man who presented with chronic bowel obstruction caused by chronic intestinal pseudo‐obstruction (CIPO) due to SCLC. [ABSTRACT FROM AUTHOR]

Background: Malignant bowel obstruction due to peritoneal carcinomatosis is a common problem. When surgery is not feasible in the context of a high intraperitoneal tumour burden, other techniques are required. Case report: We report the case of a 67-year-old female with malignant obstruction of the ascending colon. Following an unsuccessful surgical attempt, decompression was successfully achieved via percutaneous endoscopic colostomy using a lumen-apposing metal stent. The patient was able to resume a full oral diet within 2 days. However, local inflammatory complications arose due to faecal contamination of the sutures. Once the sutures were removed, no further interventions were required. Conclusion: Percutaneous endoscopic colostomy is a safe and viable alternative for decompression in malignant bowel obstruction when surgery is not feasible. However, limitations include the risk of local infection due to sutures and its applicability only in cases with distal stenosis.

Cecal endometriosis is an extremely rare condition. Mechanical intestinal obstruction is a rare clinical entity, particularly due to cecal endometriosis. We discuss a case of mechanical intestinal obstruction due to cecal endometriosis. A 28-year-old woman was admitted to the general surgery department with complaints of abdominal pain, nausea, vomiting, and obstipation for 1 week. A mass in the cecum was found, and right hemicolectomy was performed. Pathological examination revealed cecal endometriosis. Intestinal endometriosis is a diagnosis that should be considered in patients with nonspecific gastrointestinal complaints and masses causing mechanical intestinal obstruction in women of reproductive age.

Abstract Background Imperforate hymen is the most common congenital defect of the female urogenital tract. The spectrum of clinical manifestations is broad, ranging from mild cases undiagnosed until adolescence to severe cases of giant intraabdominal masses. The most common complication of hydrocolpos is bladder compression, resulting in obstructive uropathy and hydronephrosis. Case presentation We present here the case of a preterm neonate who was admitted to the surgical neonatal intensive care unit for bowel obstruction. The baby did not appear septic or unwell, a small amount of meconium passed frequently, and no bilious gastric residuals occurred. Based on these findings, acute abdominal obstruction was doubtful, and the surgeon chose a conservative (watch and wait) approach. Subsequently, we performed abdominal ultrasound and magnetic resonance imaging based on unclear information about a suspicious abdominal mass raised by the gynecologist shortly before the emergency C-section. The final diagnosis was congenital hydrocolpos due to imperforate hymen. The pediatric gynecologist indicated an incision of the imperforate hymen under general anesthesia. The incision resolved abdominal distention as well as the bowel obstruction. Conclusion The presentation of hydrocolpos was not typical (no bulging in the vaginal introitus) in our case, and clinical symptoms implied acute bowel obstruction shortly after birth. The surgeon chose a conservative (watch and wait) approach as the baby did not appear unwell on the second day of life. Fortunately, diagnostic laparotomy was not required as the next step in bowel obstruction management. All clinical symptoms resolved after a minor surgical procedure.

This review of the palliation of various gastro-intestinal (GI) symptoms encountered in cancer patients is by no means exhaustive. Frequent symptoms such as constipation, nausea and vomiting, bowel obstructions, ascites and bleeds will be discussed, focusing on their assessment and most importantly, how to control the associated symptoms. All of these symptoms and GI complications can significantly impact patients’ quality of life (QOL) and should be treated as quickly and aggressively as possible.

Ascaris-induced intestinal obstruction is a rare complication primarily seen in children in areas with a high prevalence of worm infestations. It can occur through 2 mechanisms: immune-mediated reactions releasing neurotoxins that cause contractions and inflammation in the small intestine (aperistalsis), or mechanical obstruction by adult worms, commonly at the ileocecal valve. Partial obstructions are managed conservatively, while complete obstructions often require surgical intervention. In a recent case, a 19-year-old male presented with persistent abdominal pain, vomiting, and inability to pass stools, and gas. Imaging revealed partial obstruction, and conservative management with fluids, a nasogastric tube, and antibiotics led to the spontaneous passage of worms, relieving symptoms. The patient was discharged with anthelmintics and advised on follow-up and sanitary measures. This case is notable for the uncommon occurrence of Ascaris-induced intestinal obstruction in adults and the successful conservative management resulting in early worm expulsion.

The vitellointestinal duct (VID) is an embryological remnant of the vitelline duct, a structure that connects the developing fetus to the yolk sac and is responsible for the nutritional support of the fetus during the early embryological days. The VID usually gets obliterated by the fifth to ninth week of gestational age after the establishment of placental nutrition. The patent VIDellointestinal duct is a relatively rare congenital condition that occurs in approximately 2% of the general population, with the most common presentation being Meckel's diverticulum. Complete patency is rarer, occurring in 0.1% of the general population. The complete persistence of the VID results in enterocutaneous fistula, and the presentation may vary, ranging from cutaneous manifestations like skin lesions, granulomas, abscesses, or umbilical discharge to abdominal symptoms including acute abdominal pain and hematochezia. Some patients are even asymptomatic and are detected incidentally. We present a rare case of complete patency of the VID in a 30-year-old adult male presenting with acute periumbilical pain. Imaging findings guided the diagnosis, and surgical resection with histopathological examination further confirmed the condition.

Ghulam Yahia Baset,1 Farukh Seyar,2 Zaker Hussain Hussain Pour,3 Qurban Ali Karimi4 1Faculty member, Department of Emergency Surgery and Trauma, Kabul University of Medical Science, Ali Abad Teaching Hospital, Kabul, Afghanistan; 2Faculty Member, Department of Abdominal Surgery, Kabul University of Medical Science, Ali Abad Teaching Hospital, Kabul, Afghanistan; 3Faculty Member, Department of Maternal and Child Health, Kabul University of Medical Science, Kabul, Afghanistan; 4Department of Research, Kabul University of Medical Science, Kabul, AfghanistanCorrespondence: Ghulam Yahia Baset, Tel +93783676086, Email Yahia.baset4321@gmail.comAbstract: gossypiboma is used to describe a retained surgical swab in the body after an operation. It remains an unwanted complication of surgical practice that increase morbidity and mortality of the patient and profound medico legal problems. Intra-abdominal gossypiboma can migrate in to the ileum, stomach, colon or bladder without any apparent opening in the wall of these luminal organs. Vigilant sponge counting during procedures and thorough exploration prior to closure of the abdomen, are essential practices to avoid such occurrences. Herein we present a case of gossypiboma in a 26-year old woman that was in the lumen of small bowel and caused acute intestinal obstruction.Keywords: Gossypiboma, bowel obstruction, transmural migration, surgical swab, cesarean section

A previous surgical incision can lead to an abdominal wall defect known as an incisional hernia. The protrusion of abdominal viscera, particularly bowel loops, through this defect can result in various complications and affect organ function. Bowel loops are frequently involved and can lead to incarceration, obstruction or even strangulation. A 38-year-old male with a history of open reduction internal fixation for the left iliac wing presented with abdominal pain, vomiting and obstipation. Abdominal examination revealed a tender, distended abdominal area with swelling on the left hip. Radiological examination revealed bowel obstruction at the previous surgery site. During surgery, an incisional hernia was confirmed, and the bowel was found viable. Incisional hernias can occur even many years after primary surgery and may remain asymptomatic until complications arise. Elective hernial repair is recommended in some cases, such as the one presented here, as complications can be fatal. [ABSTRACT FROM AUTHOR]

Background: Imperforate hymen is the most common congenital defect of the female urogenital tract. The spectrum of clinical manifestations is broad, ranging from mild cases undiagnosed until adolescence to severe cases of giant intraabdominal masses. The most common complication of hydrocolpos is bladder compression, resulting in obstructive uropathy and hydronephrosis. Case presentation: We present here the case of a preterm neonate who was admitted to the surgical neonatal intensive care unit for bowel obstruction. The baby did not appear septic or unwell, a small amount of meconium passed frequently, and no bilious gastric residuals occurred. Based on these findings, acute abdominal obstruction was doubtful, and the surgeon chose a conservative (watch and wait) approach. Subsequently, we performed abdominal ultrasound and magnetic resonance imaging based on unclear information about a suspicious abdominal mass raised by the gynecologist shortly before the emergency C-section. The final diagnosis was congenital hydrocolpos due to imperforate hymen. The pediatric gynecologist indicated an incision of the imperforate hymen under general anesthesia. The incision resolved abdominal distention as well as the bowel obstruction. Conclusion: The presentation of hydrocolpos was not typical (no bulging in the vaginal introitus) in our case, and clinical symptoms implied acute bowel obstruction shortly after birth. The surgeon chose a conservative (watch and wait) approach as the baby did not appear unwell on the second day of life. Fortunately, diagnostic laparotomy was not required as the next step in bowel obstruction management. All clinical symptoms resolved after a minor surgical procedure. [ABSTRACT FROM AUTHOR]

Background: Most colon cancers that develop in the intestinal tract within the inguinal hernia sac are identified by incarceration. However, treatment methods for these cases vary depending on the pathology. Cases showing perforation or abscess formation require emergency surgery for infection control, while cases with no infection generally involve oncological resection, with laparoscopic surgery also being an option. We encountered a case of Incomplete bowel obstruction secondary to sigmoid colon cancer within the hernial sac. We report the process leading to the selection of the treatment method and the surgical technique, along with a review of the literature. Case presentation: A 79-year-old man presented to our hospital complaining of a left inguinal bulge (hernia) and pain in the same area. The patient had the hernia for more than 20 years. Using computed tomography, we diagnosed an incomplete bowel obstruction caused by a tumor of the intestinal tract within the hernial sac. Since imaging examination showed no signs of strangulation or perforation, we decided to perform elective surgery after a definitive diagnosis. After colonoscopy, we diagnosed sigmoid colon cancer with extra-serosal invasion; however, we could not insert a colorectal tube. Although we proposed sigmoid resection and temporary ileostomy, we chose the open Hartmann procedure because the patient wanted a single surgery. For the hernia, we simultaneously used the Iliopubic Tract Repair method, which does not require a mesh. Eight months after the surgery, no recurrence of cancer or hernia was observed. Conclusions: We report a case of advanced sigmoid colon cancer with a long-standing inguinal hernia that later became incomplete bowel obstruction. Although previous studies have used various approaches among the available surgical methods for cancer within the hernial sac, such as inguinal incision, laparotomy, and laparoscopic surgery, most hernias are repaired during the initial surgery using a non-mesh method. For patients with inguinal hernias that have become difficult to treat, the complications of malignancy should be taken into consideration and the treatment option should be chosen according to the pathophysiology. [ABSTRACT FROM AUTHOR]

This review of the palliation of various gastro-intestinal (GI) symptoms encountered in cancer patients is by no means exhaustive. Frequent symptoms such as constipation, nausea and vomiting, bowel obstructions, ascites and bleeds will be discussed, focusing on their assessment and most importantly, how to control the associated symptoms. All of these symptoms and GI complications can significantly impact patients' quality of life (QOL) and should be treated as quickly and aggressively as possible. [ABSTRACT FROM AUTHOR]

Key clinical Message: This case highlights the significance of maintaining clinical suspicion for CPBs in adults presenting with SBO. Early surgical intervention, offering both diagnosis and treatment, is essential for managing this rare cause of SBO. Increased clinical awareness of CPBs will help ensure they are considered in the differential diagnosis of adult patients with bowel obstruction. [ABSTRACT FROM AUTHOR]

Urgent investigation is crucial for infants with bilious vomiting, potentially indicating bowel obstruction. Upper gastrointestinal fluoroscopy aids diagnosis, but is not without its challenges. This case report describes a rare case of neonatal intestinal malrotation and mid-gut volvulus with an additional complication of congenital peritoneal encapsulation. Contribution: This case study offers insights into associated diagnostic challenges and underscores the value of utilising fluoroscopy in diagnosing complex gastrointestinal conditions.

Key clinical message Small cell lung cancer (SCLC), a neuroendocrine aggressive subtype of lung cancer, is associated with paraneoplastic disorders in about 9% of patients. In this report, we describe a middle‐aged man who presented with chronic bowel obstruction caused by chronic intestinal pseudo‐obstruction (CIPO) due to SCLC.

Introduction Patients with colonic obstruction are at risk for emergency resection, which is a risk factor for increased mortality and morbidity. In left-sided obstructive colon cancer, the principle of bridge-to-surgery is already recommended to reduce complications. From this treatment strategy, the obstruction treatment is derived. In this treatment strategy, bowel wall distention is reduced by minimizing stool production through laxatives and dietary measures. Short-term outcomes have already shown promising results. This study aims to evaluate long-term outcomes in patients treated with this obstruction treatment.

Trichobezoar is a rare diagnosis among pediatric patients highlighting underlying psychiatric illness. Gastric bezoar with a long tail extending into small bowel may present with varied presentation including small bowel obstruction. Isolated small bowel trichobezoar is rare making diagnosis difficult highlighted in the index case.

The Rigler's Triad consists by three radiological signs, including intestinal obstruction, pneumobilia, and an aberrant gallstone in the bowel. It is an inconstant triad considered being pathognomonic of gallstone ileus. Gallstone ileus is an exceptional complication of cholelithiasis due to the passage of one or more gallstones from the bile ducts into the lumen of the bowel through a biliodigestive fistula. We report the case of an 83-year-old female patient with a history of ischemic heart disease and an asymptomatic large gallstone. The patient was admitted to the emergency department for bowel obstruction, abdominal pain, and bilious vomiting. A clinical examination found a patient with an alteration in general condition and a distended abdomen with tenderness. An abdominal CT scan revealed Rigler's triad, allowing the diagnosis of gallstone ileus. A midline exploratory laparotomy was performed to find a giant gallstone blocked in the last ileum loop. A simple enterolithotomy was performed, allowing the extraction of giant lithiasis from an 8-cm major axis. The postoperative evolution was uneventful, and the patient was discharged 4 days after surgical treatment.

Encapsulating peritoneal sclerosis (EPS) is a rare pathological entity that can be classified into an idiopathic or secondary affection. Bowel obstruction is a frequent complication that has a characteristic radiological finding, with a cocoon appearance. We present the case of a 40-year-old man who suffered an absolute constipation. He underwent a CT scan that was suggestive of encapsulating peritoneal sclerosis or abdominal cocoon responsible for small bowel obstruction.

Meckel's diverticulum (MD), a rare congenital abnormality, can lead to issues like diverticulitis and bleeding. Foreign bodies in MD are even rarer, causing vague symptoms and perforation, requiring urgent surgery. This case report highlights a patient with a foreign body in MD, focusing on clinical presentation and management. A 55-year-old male presented with abdominal pain, nausea, and vomiting. Computed tomography scan revealed a foreign body perforating the small bowel. Exploratory laparotomy found a partially perforated MD with a foreign body. Diverticulectomy was performed, and the patient recovered, discharged the next day. Foreign bodies in MD are exceedingly rare and can cause inflammation, infection, and perforation, mimicking appendicitis. Diagnosis is challenging due to nonspecific symptoms, with imaging and clinical evaluation crucial. Surgical intervention, like diverticulectomy, is primary. Early diagnosis and prompt surgery are critical in managing MD complicated by foreign bodies, ensuring favorable outcomes. This report underscores symptom recognition and effective management strategies. [ABSTRACT FROM AUTHOR]

Shimelis Abegaz Daba,1 Aderajew Walle Belete,1 Gelila Dejene Getachew2 1Department of Surgery, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 2Department of Obstetrics and Gynecology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, EthiopiaCorrespondence: Shimelis Abegaz Daba, St. Paul’s Hospital Millennium Medical College, Po. Box: 1271, Addis Ababa, Ethiopia, Email shimelis.abegaz@sphmmc.edu.etIntroduction: Intestinal knotting syndromes are rare causes of mechanical bowel obstruction, ileo-sigmoid knotting being the most common type. Ileocecal knotting is the rarest type among knot syndromes and there are few case reports across the world.Case Presentation: We present a case of ileocecal knotting in a postpartum patient with abdominal distention, vomiting and failure to pass feces and flatus. Plain abdominal radiograph revealed dilated small bowel loops with multiple air fluid levels. Exploratory laparotomy was performed with intra-operative finding of ileocecal knotting with viable bowel, mobile cecum and ascending colon and gangrenous tip of appendix. We untied the knot and performed an appendectomy. Due to intra-operative instability of the patient’s vital signs, right hemicolectomy was differed and cecum as well as ascending colon were fixed to right posterolateral abdominal wall.Clinical Discussion: Ileocecal knotting is a very rare finding, and few case reports have been published. The intra-operative findings of the mobile cecum and ascending colon are consistent with previous reports and it is a predisposing factor for knot besides low BMI and young age of our patient. Surgical management is dictated by intra-operative conditions such as viability of the bowel, intra-operative stability of the patient, extent of resection and length of the remaining bowel. Surgical options include en bloc resection of knot with gangrenous bowel and end to end anastomosis or end ileostomy with closure of distal end.Conclusion: Ileocecal knotting should be considered as a differential diagnosis for patients presenting with intestinal obstruction with unusual radiographic findings. Early diagnosis and prompt surgical intervention prevents bowel infarction and enhance the prognosis. Preoperative abdominal CT scan is helpful in such cases with unusual radiographic findings.Keywords: ileocecal knotting, bowel obstruction, knotting, acute abdomen, case report

Chronic granulomatous disease (CGD) is a rare inborn error of immunity that typically manifests with infectious complications. As the name suggest though, inflammatory complications are also common, often affecting the gastrointestinal, respiratory, urinary tracts and other tissues. These can be seen in all various types of CGD, from X-linked and autosomal recessive to X-linked carriers. The pathogenetic mechanisms underlying these complications are not well understood, but are likely multi-factorial and reflect the body's attempt to control infections. The different levels of neutrophil residual oxidase activity are thought to contribute to the large phenotypic variations. Immunosuppressive agents have traditionally been used to treat these complications, but their use is hindered by the fact that CGD patients are predisposed to infection. Novel therapeutic agents, like anti-TNFa monoclonal antibodies, anakinra, ustekinumab, and vedolizumab offer promise for the future, while hematopoietic stem cell transplantation should also be considered in these patients. [ABSTRACT FROM AUTHOR]

Uterine torsion is a rare condition. Even more so in cases of non-gravid torsion. We present the case of a post-menopausal woman in her 70s who arrived to our emergency department acutely unwell with abdominal pain and vomiting on a background of a large leiomyomatous uterus, complicated by aspiration pneumonia, acute anaemia, and acute kidney injury. Computed tomography demonstrated a small bowel obstruction secondary to a large heterogeneous calcified pelvic mass. Laparotomy performed demonstrated a large leimyomatous uterus that had torted on the cervical pedicle associated with perforation of the lower anterior segment. A short segment of healthy jejunum was adhered to the uterine fundus, which was easily mobilized. Total hysterectomy and bilateral oophorectomy was performed. The patient made a full recovery. Histopathology demonstrated a calcified leiomyomatous uterus with adjacent haemorrhagic infarction of the uterine wall. [ABSTRACT FROM AUTHOR]

Background: The objective of the study was to compare small intestinal obstruction and large intestinal obstruction. Bowel obstruction is one of the most common causes of acute abdomen and also a common surgical emergency till date. It is one of the gravest emergencies presenting to the surgeon in all aspects. They account for 12% to 16% of surgical admissions for acute abdominal complaints. Manifestations of acute intestinal obstruction can range from a fairly good appearance with only slight abdominal discomfort and distension to a state of hypovolemic or septic shock (or both) requiring an emergency operation. Methods: A total of 100 cases of acute intestinal obstruction admitted in all surgical wards, Department Of General Surgery SVRRGGH/SVMC, between November 2020 and August 2022. The Age, Sex detailed History relevant to the etiology were noted. The characteristic clinical features of acute intestinal obstruction were abdominal pain, vomiting, constipation, obstipation, Abdominal distension and clinical signs including Fever and tachycardia are noted. Results: In this study, Small bowel obstruction was more common than Large bowel obstruction, the incidence of intestinal obstruction is more common in males compared to females, post operative adhesions was found to be the leading cause of obstruction in this study. [ABSTRACT FROM AUTHOR]

Images from 64 patients undergoing an enhanced abdominal-pelvis scan at portal phase in dual-energy CT mode for the diagnosis of colitis or bowel obstruction were retrospectively analyzed. Acquisitions were performed on a third-generation dual-source CT (DSCT) 100/Sn150 kVp. Mixed images were generated, as well as virtual monoenergetic images (VMIs) at 40/50/60/70 keV. Objective image quality was assessed on VMIs and mixed images by measuring contrast, noise and contrast-to-noise ratio (CNR). Noise, smoothing and overall image quality were subjectively analyzed by two radiologists using Likert scales. For both patient groups, the noise decreased significantly according to the energy level from 40 to 60 keV by −47.2 ± 24.0% for bowel obstruction and −50.4 ± 18.2% for colitis. It was similar between 60 and 70 keV (p = 0.475 and 0.059, respectively). Noise values were significantly higher in VMIs than in mixed images, except for 70 keV (p = 0.53 and 0.071, respectively). Similar results were observed for contrast values, with a decrease between 40 and 70 keV of −56.3 ± 7.9% for bowel obstruction −56.2 ± 10.9% for colitis. The maximum CNR value was found at 60 keV compared to other energy levels and mixed images, but there was no significant difference with the other energy levels apart from 70 keV (−9.7 ± 9.8%) for bowel obstruction and 40 keV (−6.6 ± 8.2%) and 70 keV (−5.8 ± 9.2%) for colitis. The VMIs at 60 keV presented higher scores for all criteria for bowel obstruction and colitis, with no significant difference in smoothing score compared to mixed images (p = 0.119 and p = 0.888, respectively). [ABSTRACT FROM AUTHOR]

Introduction: Women with advanced ovarian cancer commonly present with peritoneal disease both at primary diagnosis and relapse, with risk of subsequent bowel obstruction. The aims of this study were to assess the cumulative incidence of and survival after intervention for bowel obstruction in women with advanced ovarian cancer, to identify factors predictive of survival and the extent to which the intended outcome of the intervention was achieved. Material and methods: Women diagnosed with advanced ovarian cancer stages III and IV in 2009–2011 and 2014–2016 in the Stockholm‐Gotland Region in Sweden were identified in the Swedish Quality Registry for Gynecologic Cancer. Through hospital records, types of intended and executed interventions for bowel obstruction were assessed, and as well as when in the course of oncologic treatment, the intervention was performed. Time from first intervention to death was analyzed with survival methodology and proportional hazard regression was used. Results: Of 751 identified women, 108 had an intervention for bowel obstruction. Laparotomy was the most prevalent intervention and was used in 87% (94/108) of all women, with a success rate of 87% (82/94). An intervention for bowel obstruction was performed before or during first line treatment in 32% (35/108) with a cumulative incidence in the whole cohort of 14% (108/751, 95% confidence interval [CI] 11–16). Median survival after intervention for bowel obstruction was 4 months (95% CI 3–6). The hazard of death increased when the intervention was performed after completion of primary treatment (HR 4.46, 95% CI 1.61–12.29, P < 0.01), with a median survival of 3 months. In women subjected to radical surgery during primary treatment, the hazard of death after intervention for bowel obstruction decreased (hazard ratio [HR] 0.54, 95% CI 0.32–0.91, P = 0.02). Conclusions: Women with advanced ovarian cancer undergoing intervention for bowel obstruction have a dismal prognosis, regardless of which line of oncologic treatment the intervention was performed. In the majority of women an intervention for bowel obstruction was performed in a relapse situation with an even worse survival. Our findings emphasize the importance of a holistic approach in the decision‐making before an intervention for bowel obstruction in women with advanced ovarian cancer. [ABSTRACT FROM AUTHOR]

Heterotaxy syndrome, also known as situs ambiguous, is a spectrum of pathology due to loss of the normal right-to-left asymmetry of the thoraco-abdominal organs. This report describes the case of a 39-year-old female, previously well, who presented with bowel obstruction. CT showed features of left isomerism, with malrotation and volvulus. Contribution: Heterotaxy syndrome consists of cardiac and non-cardiac manifestations. Imaging studies play a crucial role in the individualised management of the patient.

Introduction: Psoas abscess (PA) is an uncommon condition in children where pus accumulates in the psoas muscle. The disease symptoms are subtle and nonspecific, often causing delayed diagnosis. Case presentation: Our case describes an unusual manifestation of PA caused by methicillin-resistant Staphylococcus aureus (MRSA) when an 11-year-old male patient was admitted with suspected bloodstream infection from the gastrointestinal tract and bowel obstruction following closed trauma from a bicycle fall. An emergency laparotomy revealed turbid abdominal fluid with pseudomembranes and no apparent cause of peritonitis was found upon observing the entire abdominal cavity. On the fourth day after admission, blood, sputum, and peritoneal fluid cultures were all positive for MRSA. Despite broad-spectrum antibiotic treatment targeting MRSA, the patient's clinical condition did not improve. PA was confirmed via abdominal computed tomography on the ninth-day post-hospitalization with a persistent MRSA bloodstream infection. Successful treatment of PA was achieved through open surgery. The patient's condition improved and was discharged on the 40th day after admission. Conclusion: PA can present as bowel obstruction. Therefore, PA should be ruled out in patients with bowel obstruction of unknown etiology, especially if the patient has a history of trauma to the hip region.

Key clinical Message This case highlights the significance of maintaining clinical suspicion for CPBs in adults presenting with SBO. Early surgical intervention, offering both diagnosis and treatment, is essential for managing this rare cause of SBO. Increased clinical awareness of CPBs will help ensure they are considered in the differential diagnosis of adult patients with bowel obstruction.

Introduction: Eosinophilic colitis (EC) is an uncommon inflammatory condition with the lowest reporting rate among eosinophilic gastrointestinal disorders. EC, which is characterized by the accumulation of eosinophilic cells, is typically diagnosed by a combination of clinical, imaging, and microscopic evaluations. We present a rare case of complete colonic obstruction due to eosinophilic colitis (EC) in a neonate, which was successfully managed with surgical intervention. Case presentation: A 27-day-old female neonate presented with bloody diarrhea and anemia, followed by repeated bilious vomiting, feeding intolerance, and abdominal distention along with very limited bowel motion. Abdominal radiography showed contrast-medium retention in the colon with persistent bowel dilatation while a lower GI contrast enema indicated a cut-off sign at the level of the sigmoid colon. Subsequent colonoscopy revealed a rectosigmoid stricture with complete luminal obstruction 7 cm from the anal verge. Histopathological examination showed marked eosinophilic infiltration through all the layers of the colon. Exploratory laparotomy showed a 3-cm complete stricture with severe gross inflammation in the rectosigmoid colon. Resection of the affected segment and primary anastomosis was achieved successfully, and the patient showed an uneventful recovery with no symptoms at discharge as well as age-appropriate weight gain at the one-year follow-up examination. Conclusion: To our knowledge, this is the first reported case of rectosigmoid stricture caused by EC in a neonate, and it highlights the importance of including EC in the differential diagnosis of colonic obstruction in neonates as well as the need for surgical management in such cases.

Congenital band is a rare cause of bowel obstruction, most commonly occurring in childhood. We report a case of a young adult with no medical and surgical previous history who had symptoms of bowel obstruction evolving for 2 days. Computed tomography (CT) found an adhesive band causing a small bowel obstruction. An open laparotomy was performed, and the intraoperative findings were consistent with a congenital band compressing the ileum. Through this clinical case, we illustrate an uncommon cause of bowel obstruction and the interest of the CT for the management.

Complete annular pancreas (AP) is a congenital anomaly, in which the duodenum is either completely or partially encircled by the ring of pancreatic tissue, which eventually becomes continuous with the head of the pancreas. The incidence of AP is estimated to be around 0.02%. Reports from endoscopic retrograde cholangiopancreatography show an incidence of 0.4%. Partial AP (PAP) is a rarer entity, in which a band of pancreatic tissue in continuity with the head of the pancreas, incompletely encircles the duodenum. It may be asymptomatic or may present later in life with complications. We report a case of a 72-years old male with features of intermittent bowel obstruct which was later found to be having PAP on contrast-enhanced computed tomography imaging at the level of renal hilum characterized by “crocodile-jaw appearance.” The possibility of PAP should also be considered at the back of mind of the treating physician, if a patient presents with a long-term history of postprandial abdominal discomfort.

Telila Mesfin,1 Abdella Degefa,2 Ibsa Kedir Hassen,1 Degefa Gomora,3 Hamza Sultan,2 Kenbon Seyoum,3 Elias Ibrahim,2 Girma Geta,3 Neway Ejigu,3 Sisay Dadi Abebe,4 Teketel Tilahun,5 Demisu Zenbaba,6 Biniyam Sahiledengle,6 Fikreab Desta,6 Getu Kusa Wakoya,1 Saddam Abdirahman Mohamoud,7 Mesfin Tsegaye1 1Department of Medicine, Madda Walabu University Goba General Hospital, Goba, Oromia, Ethiopia; 2Department of Surgery, Madda Walabu University Goba General Hospital, Goba, Oromia, Ethiopia; 3Department of Midwifery, Madda Walabu University Goba General Hospital, Goba, Oromia, Ethiopia; 4Department of Internal Medicine, Madda Walabu University Goba General Hospital, Goba, Oromia, Ethiopia; 5Department of Public Health, Menelik II Comprehensive Specialized Hospital, Finfinnee, Oromia, Ethiopia; 6Department of Public Health, Madda Walabu University Goba General Hospital, Goba, Oromia, Ethiopia; 7Department of Anesthesiology, Kalkaal Specialized Hospital 4J, Yakshid, Mogadishu, SomaliaCorrespondence: Telila Mesfin, Department of Medicine, Madda Walabu University Goba General Hospital, P O Box 76, Goba, Oromia, Ethiopia, Tel +251931504321, Email telilamesfintadesse@gmail.comBackground: Small bowel obstruction is an acute surgical disease necessitating urgent diagnosis and intervention. Ileoileal knotting is a rare condition that can result in acute bowel obstruction and gangrene whereas ileosigmoid knotting is a relatively common surgical condition. There are few published studies so far on ileoileal knotting. Due to the scarcity of ileoileal knotting cases that have been published, the exact causes are not well known. We presenta rare case of small bowel obstruction which was managed successfully and had an uneventful postoperative period.Case: A 45-year-old farmer from the rural kebele of Goba district of Bale Zone visited our institution with a complaint of sudden, colicky pain of 6 hours duration. On presentation, the pain was localized to the periumbilical area and then involved the whole abdomen. Associated with this, he had vomiting of ingested matter of three episodes. Objectively, he was in severe pain and tachycardic. On abdominal examination, there was direct and rebound tenderness over the periumbilical region. Abdominopelvic ultrasound revealed long segment ileoileal intussusception with adjacent mesenteric significant edema and proximal small bowel loop dilatation which was later found to be ileoileal knotting intraoperatively. The patient was put on intravenous fluid and antibiotics with a diagnosis of acute abdomen secondary to ileoileal knotting at the surgical emergency department. Exploratory laparotomy plus resection plus end to side ileotransverse anastomosis was done after written informed consent was received.Conclusion: Ileoileal knotting is a rare condition that can result in acute bowel obstruction and gangrene. The diagnosis is usually made intraoperatively even though proper history, laboratory tests, and imaging are quite helpful. Clinicians should have a high index of suspicion of bowel knotting in patients with an acute abdomen and take early interventions to reduce the risk of gangrene.Keywords: ileoileal knotting, bowel obstruction, gangrene, laparotomy, resection

Abstract Background Using self-expanding metal stents (SEMS) and decompression tubes (DT) as a bridge-to-surgery (BTS) treatment may avoid emergency operations for patients with colorectal cancer-caused obstructions. This study aimed to evaluate the efficacy and safety of the two approaches. Methods We systematically retrieved literature from January 1, 2000, to May 30, 2023, from the PubMed, Embase, Web of Science, SinoMed, Wanfang Data, Chinese National Knowledge Infrastructure, and Cochrane Central Register of Clinical Trials databases. Randomized controlled trials (RCTs) or cohort studies of SEMS versus DT as BTS in colorectal cancer obstruction were selected. Risks of bias were assessed for RCTs and cohort studies using the Cochrane Risk of Bias tool version 2 and Risk of Bias in Nonrandomized Studies of Interventions. Certainty of evidence was determined using the Graded Recommendation Assessment. Odds ratio (OR), mean difference (MD), and 95% confidence interval (95% CI) were used to analyze measurement data. Results We included eight RCTs and eighteen cohort studies involving 2,061 patients (SEMS, 1,044; DT, 1,017). Pooled RCT and cohort data indicated the SEMS group had a significantly higher clinical success rate than the DT group (OR = 1.99, 95% CI 1.04, 3.81, P = 0.04), but no significant difference regarding technical success (OR = 1.29, 95% CI 0.56, 2.96, P = 0.55). SEMS had a shorter postoperative length of hospital stays (MD = − 4.47, 95% CI − 6.26, − 2.69, P

Abstract 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.

Trichobezoar is a rare diagnosis among pediatric patients highlighting underlying psychiatric illness. Gastric bezoar with a long tail extending into small bowel may present with varied presentation including small bowel obstruction. Isolated small bowel trichobezoar is rare making diagnosis difficult highlighted in the index case. [ABSTRACT FROM AUTHOR]

Peutz-Jeghers syndrome (PJS) is a rare genetic disorder causing gastrointestinal polyps and skin pigmentation. Our case report highlights a unique instance of jejuno-jejunal intussusception associated with PJS in a 28-year-old female patient who presented to the emergency department with colicky abdominal pain, tachycardia, and gastrointestinal symptoms. Physical examination revealed mucocutaneous hyperpigmentation. Imaging studies showed a U-shaped distension in the jejunum with thickening and pneumatosis. Laparotomy revealed a jejuno-jejunal volvulus with intussusception. Surgical resection successfully addressed gangrenous jejunal tissue and ileal polyps. Histopathology confirmed PJS polyps. Postoperatively, the patient recovered well and was discharged. Family history revealed similar skin lesions in her uncle. Our case highlights the need for prompt surgical intervention to address complications associated with PJS and elucidates a unique presentation of PJS involving jejuno-jejunal intussusception and volvulus leading to complete small bowel obstruction. We aim to deepen understanding and prompt discussions on optimal therapeutic strategies. [ABSTRACT FROM AUTHOR]

A gastrostomy is a common procedure for patients with swallowing problems or inability to maintain regular oral nutrition. These gastrostomy tubes need special attention, as complications can occur if the tubes are left unattended. In rare scenarios, these tubes can migrate and cause severe life-threatening difficulties such as bowel obstruction and pancreatitis. We present the case of a 76-year-old quadriplegic woman who had a gastrostomy tube. Suddenly, the tube was missing, and after urgent medical care, the gastrostomy tube was found within her bowel. After successful surgery, she recovered from this incident. [ABSTRACT FROM AUTHOR]

Internal herniation is an extremely rare cause of intestinal obstruction. Paraduodenal hernias result from abnormal rotation of the bowel. Symptoms that may range from recurrent abdominal pain to acute obstruction may occur. If it is not diagnosed and treated in time, the disease may result in intestinal ischemia. This article aimed to present the diagnosis and treatment process of a 47-yearold male presenting with acute abdomen symptoms by evaluating retrospectively with the accompaniment of literature. During the abdominal exploration of the patient, nearly all of the intestines were observed to be herniated from the right paraduodenal region to the posterior area. The opening of the hernial sac was repaired primarily by reducing the intestinal bowel loops into the intraperitoneal region. The patient undergoing anastomosis by performing resection of the ischemic part after reduction of herniated bowel loops was discharged uneventfully on the post-operative 10th day. Paraduodenal hernia is a condition that should be considered in patients with abdominal pain and intestinal obstruction symptoms. Early diagnosis is of vital importance to prevent the complications which can develop. [ABSTRACT FROM AUTHOR]

The patient was a woman in her 40s who was diagnosed with Crohn’s disease (CD) of the large and small intestines in 1996. In 2005, she was referred to our hospital for treatment. We treated her for 17 years with corticosteroids, biologics, immunosuppressive agents, 5-aminosalicylic acid, and nutrition care. However, her Crohn’s Disease Activity Index remained between 200 and 250, indicating refractory CD. During her medical treatment, the patient also underwent 3 operations. One year ago, the patient became pregnant through in vitro fertilization. Even after pregnancy was confirmed, the patient continued her treatment for refractory CD with ustekinumab, granulocyte apheresis, and budesonide. Nonetheless, her CD was highly active during pregnancy, and she experienced various complications: sigmoid volvulus at gestational week 15, venous thrombosis at gestational week 17, nontraumatic rib fracture due to fetal movement at gestational week 32, and sepsis from central venous catheter infection at gestational week 37. At gestational week 38, the patient gave birth by emergency cesarian delivery. This paper reports details of the case in which delivery was achieved after various complications were overcome and discusses previous relevant reports.

Intestinal hypoganglionosis in adults is quite uncommon, and hypoganglionosis of the ileum has not been documented to date. The majority of studies on this disorder are single case reports and brief case series. We describe a 30-year-old male patient with bowel obstruction and intestinal hypoganglionosis of the ileum and we review the literature on the disorder.

INTRODUCTION: Tuberculosis has been declared a global emergency by the World Health Organization (WHO) and is the most important communicable disease worldwide. The disease may involve any system of the body but abdomen is one of the commonest sites of involvement after lungs. Most patients with abdominal TB can be treated with anti TB therapy alone but some may require surgery to relieve the obstruction either by stricturoplasty or resection and anastomosis. AIM AND OBJECTIVES: To observe the incidence of Intestinal Tuberculosis among all the cases presenting to the acute surgical care, Osmania General Hospital as intestinal obstruction, various modes of management and outcome among these cases. MATERIALS AND METHODS: A retrospective study of 41 patients presenting to the acute surgical care unit of the upgraded department of General Surgery of Osmania General Hospital, Hyderabad, with Intestinal Obstruction due to Tuberculosis, from 2011 to 2014. The main inclusion criteria being the histopathological positivity of the specimen for tuberculosis. All cases of TB Peritonitis, Perforation due to TB have been excluded. RESULTS & CONCLUSION: Bowel obstruction resulting from intestinal tuberculosis is one of the most common abdominal surgical emergencies and contributes significantly to high morbidity and mortality. Young age at presentation, delayed presentation and high morbidity and mortality are among the hallmarks of the disease. A high index of suspicion, proper evaluation and therapeutic trial in suspected patients is essential for an early diagnosis and timely definitive treatment, in order to decrease the morbidity and mortality associated with this disease. [ABSTRACT FROM AUTHOR]

Bowel obstruction is a common cause for the acute abdomen with different aetiologies that shapes subsequent management plans. Small bowel obstruction often develop due to intra-abdominal adhesions in patients with prior abdominal surgery and for large bowel obstructions, more commonly due to tumours and lesions. Disruptions to normal intra-abdominal anatomy as seen in pancreatic–kidney transplantation or kidney transplant alone can result in increased risk of bowel obstruction—especially if the donor graft is implanted within the intraperitoneal plane. We present two patients from separate institutions with history of simultaneous pancreas–kidney (SPK) transplantation (Patient 1) and intraperitoneal renal (Patient 2) transplant whom both presented with bowel obstruction requiring surgical intervention. Given the specificity and operative intricacies of our cases, we aim to present our findings and surgical management of these rare presentations in hopes of increasing awareness to this uncommon but significant cause of bowel obstruction in a transplant patient. [ABSTRACT FROM AUTHOR]