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Introduction: Congenital Treves’ field hernia is the herniation of a visceral segment through a defect in the terminal ileal mesentery, poses a high risk of strangulation and bowel gangrene. Its preoperative diagnosis is challenging due to its rarity, nonspecific presentation, and often inconclusive imaging. Case presentation: A previously healthy 7-month-old female infant presented with an 18-h history of intense diffuse abdominal pain, nausea, and bilious vomiting. On examination, she appeared ill and dehydrated, with tachycardia and tachypnea. Her abdomen was grossly distended, tense, and tender, with no visible scars or hernias. Blood tests, including a complete blood count, urea, and electrolytes, were normal except for an elevated white blood cell count. Abdominal X-rays and ultrasound revealed features consistent with distal small bowel obstruction, with no evidence of intussusception. Following resuscitation, an emergency laparotomy was performed for suspected acute abdomen due to distal small bowel obstruction. Intraoperatively, the jejunum and proximal ileum were dilated, and a portion of the ilium was found herniated through a 6 × 4 cm mesenteric defect. After reduction, approximately 25 cm of necrotic small bowel was resected, followed by an end-to-end anastomosis. The postoperative recovery was smooth, and she was discharged on day seven with no signs of short bowel syndrome on follow-up. Conclusion: Congenital Treves’ field transmesenteric hernia is a rare cause of intestinal obstruction in children that should be considered in cases of mechanical small bowel obstruction.

Abstract Background Eosinophilic enterocolitis is a rare disorder characterized by abnormal eosinophilic infiltration of the small intestine and the colon. Case presentation We report a case of a 29-year-old White man, who presented with an acute bowel obstruction. He had a history of a 2 months non-bloody diarrhea. An abdominal computed tomography (CT) and a MR enterography showed a multifocal extensive ileitis. White blood cell and eosinophilic polynuclei count was elevated (700/mm3). Ileo-colonoscopy showed normal ileum and segmental petechial colitis. Pathology showed a high eosinophilic infiltration in the colon. The patient was treated with steroids, with a clinical, biological and radiological recovery. Conclusion Eosinophilic enterocolitis should be kept in mind as a rare differential diagnosis in patients presenting with small bowel obstruction.

Most patients with severe acute small bowel obstruction in the early postoperative period require treatment in the intensive care unit. The main principles of intensive care are identifying major vital function disorders, their rapid correction, as well as supporting the functions of the affected organs and systems. The leading pathophysiological disorders that require intensive correction during small bowel obstruction are impaired intestinal barrier function (for bacteria and toxins), hypovolemia, hypotension and microcirculation disorders, primarily in the abdominal organs, fluid and electrolyte and acid-base disorders. Such disorders, in turn, could cause repeated development of intra-abdominal hypertension with impaired perfusion of the abdominal organs. Thus, the efficiency of intensive care for dynamic acute bowel obstruction primarily depends on the speed of correction of fluid and electrolyte disorders and restoration of intestinal blood flow, normalization of gut parietal digestion rather than on the quantity of the drugs that stimulate bowel movement. The primary method of gut microcirculation restoration is the ROSE approach to fluid resuscitation. The main criteria of the intensive care efficiency should be control of intra-abdominal pressure and timely treatment of intra-abdominal hypertension.

The article presents the main directions for the prevention of acute bowel obstruction in patients after surgery. The basis of prevention is the principle of rapid postoperative recovery accor­ding to the widely used ERAS program (Enhanced Recovery after Surgery). The basic principles of the ERAS program correspond to three periods: preoperative, intraoperative and postoperative. In the pre­operative period, much attention is paid to the preparation of a patient and the correction of conditions that may lead to prolonged recovery after surgery (eg, anaemia, etc). Intraoperatively, it is re­commended to apply combined principles of anaesthesia to reduce the use of opiates and anaesthetics, based on regional and local me­thods of anaesthesia. At this stage, thorough monitoring is important to prevent intraoperative hypo- and hypervolemia. Early activation of patients plays a key role in the postoperative period. Therefore, proper analgesia, prevention of nausea and vomiting will also lead to early mobilization and early enteral nutrition of the patients.

Congenital Treves' field hernia is the herniation of a visceral segment through a defect in the terminal ileal mesentery, poses a high risk of strangulation and bowel gangrene. Its preoperative diagnosis is challenging due to its rarity, nonspecific presentation, and often inconclusive imaging. A previously healthy 7-month-old female infant presented with an 18-h history of intense diffuse abdominal pain, nausea, and bilious vomiting. On examination, she appeared ill and dehydrated, with tachycardia and tachypnea. Her abdomen was grossly distended, tense, and tender, with no visible scars or hernias. Blood tests, including a complete blood count, urea, and electrolytes, were normal except for an elevated white blood cell count. Abdominal X-rays and ultrasound revealed features consistent with distal small bowel obstruction, with no evidence of intussusception. Following resuscitation, an emergency laparotomy was performed for suspected acute abdomen due to distal small bowel obstruction. Intraoperatively, the jejunum and proximal ileum were dilated, and a portion of the ilium was found herniated through a 6 × 4 cm mesenteric defect. After reduction, approximately 25 cm of necrotic small bowel was resected, followed by an end-to-end anastomosis. The postoperative recovery was smooth, and she was discharged on day seven with no signs of short bowel syndrome on follow-up. Congenital Treves' field transmesenteric hernia is a rare cause of intestinal obstruction in children that should be considered in cases of mechanical small bowel obstruction. [ABSTRACT FROM AUTHOR]

Purpose: Despite continuous improvement in minimally invasive surgery (MIS) and growing evidence for its superiority in procedures in various organ systems, a routinely application in patients with acute bowel obstruction (ABO) cannot be seen to date. Besides very general explanations for this attitude, not much is known about the decision process in a particular patient. This retrospective study aims at investigating surgeon- and patient-specific factors for or against MIS in acute bowel obstruction. Methods: A retrospective analysis of all patients undergoing either MIS or open surgery (OS) for ABO at a single center between 2009 and 2017 was performed. All available preoperative parameters were included in the analysis and subdivided into patient- (age, gender, BMI, previous abdominal procedures, inflammatory process, ASA score, bowel dilatation) and surgeon-specific (time of patient admission, senior surgeon performed the procedure or taught the case, availability of a surgical resident or junior doctor as assisting surgeon) factors. Statistical analysis was performed to reveal their influence on the surgeon's decision for or against MIS. Results: Of 106 patients requiring surgical intervention, 57 were treated by OS (53.77%) and 49 by MIS (46.23%). Patients with a higher ASA score (ASA III) and a bowel width of ≥ 3.8 cm in preoperative radiologic imaging were more likely to undergo OS (p < 0.01). Also, a late admission time to the hospital (x̄ = 14.78 h) was associated with OS (p = 0.01). Concerning previous abdominal surgical interventions, patients with prior appendectomy rather were assigned to MIS (p < 0.01) whereas those with prior colectomy to OS (p < 0.01). Conclusions: The choice of procedure in patients with bowel obstruction is a highly individualized decision. Whereas scientifically proven parameters, such as high age and BMI, had no influence on the decision process, impaired general health condition (ASA score), high bowel width, previous surgical intervention, and a late admission time influenced the decision process towards open surgery. Trial registration: Retrospectively registered with the German Clinical Trials Register: DRKS00021600. [ABSTRACT FROM AUTHOR]

Abstract Background Acute intestinal obstruction during pregnancy is a rare digestive surgical emergency with significant maternal and fetal mortality. Diagnosis is difficult, often delaying the management. Here, we report an exceptional association of mechanical acute intestinal obstruction due to compression by previa uterine leiomyoma, and a ruptured ectopic pregnancy. Case presentation This is the case report of a 43-year-old primiparous black woman from a rural area, who was admitted to the surgical emergency department for acute intestinal obstruction. At examination on admittance, our patient had a bad general condition with clinical anemia. She had an occlusive syndrome that had been evolving for 3 days. A physical examination of her abdomen showed a widespread distension with an irregular and polylobed solid mass occupying the whole of the lower-umbilical and hypogastric area. A rectal examination found an empty rectum, and the mass was perceptible in Douglas’s pouch. At the vaginal examination, we found the same mass and a finger holster was clean. The diagnosis of intestinal occlusion by a tumor was retained. The laparotomy revealed a distended intestine, a ruptured right tubal ectopic pregnancy and a polymyomatous uterus. The most massive previa leiomyoma was adhering and compressing the rectal and sigmoidal hinge. A total hysterectomy was performed and histopathological examination of specimens confirmed myoma and ectopic pregnancy. The surgical follow-up was uneventful, and our patient was discharged on postoperative day 12. Conclusions The etiological diagnosis of acute intestinal obstruction during pregnancy is not easy, especially in the context of a low-income country where the means of biological and radiological diagnosis are lacking. A laparotomy is required before diagnosis of acute surgical abdomen and its management will depend on the intraoperative findings and the condition of the patient.

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Objective: to improve the results of treatment of patients with colorectal cancer complicated by acute bowel obstruction and diastatic rupture.Materials and methods. Retrospective analysis of treatment outcomes of patients with complicated colorectal cancer, treated at the Clinic of Hospital Surgery of theI.I.MechnikovNorth-WestStateMedicalUniversity from 1986 till 2015.Results. Of the 1206 patients with colorectal cancer complicated by intestinal patency violation injury breach of intestinal, decompensated violation intestinal patency (ABO) was detected in 245 (20.3 %) cases. The main principle of treatment of colonic obstruction in cancer was the intention for the simultaneous elimination of obstruction and the radical removal of the tumor. Radical surgery was performed in 152 (62 %) of 245 cases with ABO. In case of right-sided colon tumors generally colon resection with anastomosis formation were performed, in case of left-sided tumors colon resection in the majority ended with the terminal colostomy formation. Palliative operations were performed to 93 (37.9 %) patients. Postoperative complications were detected in 51 (20.8 %) cases. The death rate was 11.8 %. The mortality after radical surgical operations was 6.6 %. Diastatic rupture was diagnosed in 15 (1.2 %) patients. Subtotal colectomy with the formation or anastamosis was performed to 3 patients, operation ended with ileostomy formation – in 9 cases.Conclusion. In case of the left-side cancer of colon, complicated by АВО, a radical surgical operation with colostomy formation is beneficial. In the case of colorectal cancer, complicated by the diastatic rupture the operation of choice is subtotal colectomy.

Background Conservative therapy for Crohn's disease (CD)-related acute bowel obstruction is essential to avoid emergent surgery. The present study aimed to evaluate the efficacy of using a long intestinal decompression tube (LT) in treatment of CD with acute intestinal obstruction. Methods This is a prospective observational study. Comparative analysis was performed in CD patients treated with LT (the LT group) and nasogastric tube (the GT group). The primary outcome was the avoidance of emergent surgery. Additionally, predictive factors for failure of decompression and subsequent surgery were investigated. Results There were 27 and 42 CD patients treated with LT and GT, respectively, in emergent situations. Twelve (44.4%) patients using LT were managed conservatively without laparotomy, while only nine (21.4%) patients in the GT group were spared from emergent surgery (P  < 0.05). Both in surgery-free and in surgery patients, the time to alleviation of symptoms was significantly shorter in the LT groups than in the GT groups (both P  < 0.01). C-reactive protein decrease after intubation and 48-hour drainage volume >500 mL were predictors of unavoidable surgery (both P  < 0.05). The rate of temporary stoma and incidence of incision infection in the LT surgery group were significantly lower than those in the GT group (both P  < 0.05). No significant differences were observed in the frequency of medical and surgical recurrences between the LT and GT groups (all P  > 0.05). Conclusions Endoscopic placement of LT could improve the emergent status in CD patients with acute bowel obstruction. The drainage output and changes in C-reactive protein after intubation could serve as practical predictive indices for subsequent surgery. Compared to traditional GT decompression, LT decompression was associated with fewer short-term complications and did not appear to affect long-term recurrence. [ABSTRACT FROM AUTHOR]

• Small bowel obstruction is a common surgical condition with diversity of causes. • Meckel's diverticulum is the most common congenital anomaly causing bowel obstruction. • Complicated Meckel's diverticulum in adults infected with parasitic infection is rare. Small bowel obstruction (SBO) is a common surgical condition, while Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal (GI) tract, for which differential diagnosis is considered among children. Intestinal parasitosis refers to a group of disease caused by one or more species of protozoa, cestodes, trematodes, and nematodes. Intestinal parasitic infections (IPIs) caused by pathogenic helminths and protozoan species are endemic throughout the world. The intestine is frequently involved during Schistosoma infection, especially with Schistosoma mansoni. A 41 years old Egyptian male with an unremarkable past medical or surgical history presented to the emergency department with two days history of abdominal pain associated with nausea, vomiting, and abdominal distention. The pain was colicky and started gradually without any bowel motion or flatus for two days. Patient had tachycardia with other vitals within the normal limit. The abdomen was found to be distended and tender all over with an empty rectum by digital rectal examination (DRE). Upright chest and abdominal X-rays showed multiple air fluid levels. CT abdomen showed dilated proximal small bowel loop and a picture of SBO at distal ileal loops. The patient was resuscitated with IV fluids and shifted to the operating room. Laparoscopic exploration showed dilated small bowel loops with collapsed distal ileum, and an inflammatory band was found 20 cm from ileocecal junction, originating from a small bowel diverticulum. The inflammatory band was released, and the diverticulum was resected at the base by gastrointestinal anastomosis (GIA). Postoperatively, the patient significantly improved, passed bowel motion and was discharged for home. The histopathology report showed MD with Schistosoma infection. The patient was then referred to the infectious disease department and praziquantel, a drug of choice for schistosomiasis, effective against all Schistosoma species was initiated. Schistosomiasis is a parasitic disease that is transmitted through contact with contaminated water sources. Our patient had complete SBO with significant symptoms. He was treated with the surgical approach with diverticulum resection. Intestinal schistosomiasis was found on histopathology testing. In summary, we report a rare presentation of acute small bowel obstruction with an inflammatory band around MD harboring parasitic infection. Diagnostic laparoscopy should be considered for all patients having virgin abdomen presenting with complete bowel obstruction. To the best of our knowledge from the literature review, this is the first case to be reported as acute SBO secondary to MD harbouring Schistosoma mansoni infection. [ABSTRACT FROM AUTHOR]

Background: Acute intestinal obstruction during pregnancy is a rare digestive surgical emergency with significant maternal and fetal mortality. Diagnosis is difficult, often delaying the management. Here, we report an exceptional association of mechanical acute intestinal obstruction due to compression by previa uterine leiomyoma, and a ruptured ectopic pregnancy.Case Presentation: This is the case report of a 43-year-old primiparous black woman from a rural area, who was admitted to the surgical emergency department for acute intestinal obstruction. At examination on admittance, our patient had a bad general condition with clinical anemia. She had an occlusive syndrome that had been evolving for 3 days. A physical examination of her abdomen showed a widespread distension with an irregular and polylobed solid mass occupying the whole of the lower-umbilical and hypogastric area. A rectal examination found an empty rectum, and the mass was perceptible in Douglas's pouch. At the vaginal examination, we found the same mass and a finger holster was clean. The diagnosis of intestinal occlusion by a tumor was retained. The laparotomy revealed a distended intestine, a ruptured right tubal ectopic pregnancy and a polymyomatous uterus. The most massive previa leiomyoma was adhering and compressing the rectal and sigmoidal hinge. A total hysterectomy was performed and histopathological examination of specimens confirmed myoma and ectopic pregnancy. The surgical follow-up was uneventful, and our patient was discharged on postoperative day 12.Conclusions: The etiological diagnosis of acute intestinal obstruction during pregnancy is not easy, especially in the context of a low-income country where the means of biological and radiological diagnosis are lacking. A laparotomy is required before diagnosis of acute surgical abdomen and its management will depend on the intraoperative findings and the condition of the patient. [ABSTRACT FROM AUTHOR]

Acute bowel obstruction due to ingested foreign body (FB) like sharp bone fragment is a rare entity. As preoperative diagnosis was uncertain due to lack of proper history, diagnosis is usually done intraoperatively. Even though it is rare, we should consider it as differential diagnosis in patients with recent dietary history. Herein, we are reporting a 38-year-old man, without any psychiatric illness or previous surgery presenting to emergency department with the features of acute bowel obstruction. CT scan shows high density object in ileum suspicious of foreign body. Patient underwent exploratory laparatomy which reveals dilated small bowel with sharp bony object in ileum, which was retrieved with enterotomy.

Introduction: Gastrointestinal endometriosis is an uncommon form of extragenital endometriosis. The ileum and appendix are the most affected sites following the rectosigmoid region. Case Report: Clinicopathological findings, diagnostic approaches and therapeutic outcomes of two intestinal endometriosis patients who presented with acute abdomen findings were reviewed. Conclusion: Although intestinal endometriosis is often difficult to diagnose using imaging methods, cyclic symptomatology and a history of obstetric/gynecologic surgery should alert clinicians to consider this diagnosis. Surgery seems to be the best treatment option and mainly depends on the affected site and clinical presentation. [ABSTRACT FROM AUTHOR]

The reported incidence of intestinal endometriosis varies between 22% and 37%, with bowel obstruction in only 2.3% of cases, but few series report acute obstruction. We report a rare case of acute bowel obstruction due to multiple bilateral deep intestinal endometriosis lesions localised in the ileum, ileocaecal valve and upper rectum, requiring synchronous resection in an emergency setting. A 42-year-old woman was referred to our clinic with a diagnosis of obstructing Crohn's disease based on abdominal computed tomography with oral contrast showing a thickened terminal ileum with stenosis, compression of the caecum and proximally dilated small bowel loops. Simultaneous ileocaecal resection and segmental resection of the upper rectum with handsewn end-to-end anastomosis between the sigmoid colon and rectum was performed. Owing to the advanced bowel obstruction and significant weight loss, a double barrelled ileoascendostomy was created. The patient had an uneventful recovery. Histological examination revealed transmural endometriosis with involvement of the pericolic fat in both specimens. Although intestinal endometriosis causing acute bowel obstruction is rare, it should be included among the differential diagnoses in young women with recurrent abdominal pain, intermittent diarrhoea and constipation without a family history for inflammatory bowel disease or cancer. Bleeding synchronous with menstruation is not typical for intestinal endometriosis. Right-sided intestinal endometriosis more frequently causes acute bowel obstruction, in most cases due to intussusception.

Self-expandable metal stents are often used to treat obstructive large bowel cancers. This study assessed the safety and efficacy of colonic stent insertion carried out in a district general hospital. Methods A retrospective review was carried out between 1 January 2007 and 28 February 2014 to identify patients who underwent stent insertion for malignant colorectal obstruction. Results Seventy-five patients (median age 75.2 years, 70.6% male) with primary colorectal cancer underwent stent insertion - 53 underwent semi-elective self-expanded metal stent insertion (for subacute bowel obstruction) and 22 had emergency stent inserted (for acute bowel obstruction). The majority (88%) had self-expanded metal stents inserted for palliation. Technical and clinical success rates were 98.7% and 91.2%, respectively. One patient had stent-related perforation; there was no procedure-related mortality. Conclusion This study shows that self-expanded metal stent insertion in malignant colorectal obstruction is safe and effective and can be successfully delivered in a district general hospital with high technical and clinical success rates.

Intestinal malrotation occurs when there is a disruption in the normal embryological development of the bowel. The majority of patients present with clinical features in childhood, though rarely a first presentation can take place in adulthood. Recurrent bowel obstruction in patients with previous abdominal operation for midgut malrotation is mostly due to adhesions but very few reported cases have been due to recurrent volvulus. We present the case of a 22-year-old gentleman who had laparotomy in childhood for small bowel volvulus and then presented with acute bowel obstruction. Preoperative computerised tomography scan showed small bowel obstruction and features in keeping with midgut malrotation. Emergency laparotomy findings confirmed midgut malrotation with absent appendix, abnormal location of caecum, ascending colon and small bowel. In addition, there were small bowel volvulus and a segment of terminal ileal stricture. Limited right hemicolectomy was performed with excellent postoperative recovery. This case is presented to illustrate a rare occurrence and raise an awareness of the possibility of dreadful recurrent volvulus even several years following an initial Ladd's procedure for midgut malrotation. Therefore, one will need to exercise a high index of suspicion and this becomes very crucial in order to ensure prompt surgical intervention and thereby preventing an attendant bowel ischaemia with its associated high fatality.