[Gallstone ileus as a cause of mechanical intestinal obstruction: a case report]. / íleo biliar como causa de obstrucción intestinal mecánica: reporte de un caso.

Biliary ileus is a mechanical intestinal obstruction characterized by symptoms such as abdominal pain, jaundice and fever. The treatment of choice in these cases is associated with a surgical approach according to the clinical condition of the patient. It is important to study this pathology since its timely diagnosis and treatment are essential to avoid serious complications associated with high morbidity and mortality. This article describes a case related to biliary ileus.

Cecal volvulus - a rare cause of acute abdomen with ileus.

In this article, we present case reports of two patients admitted to the University Hospital in Pilsen for acute abdomen due to a disorder of the passage through the gastrointestinal tract (GIT). Both were indicated for surgery. The patients were diagnosed intraoperatively with rarely occurring cecal volvulus (CV). The findings required an ileocecal resection; nevertheless, both patients fully recovered despite the need the resection.

Gastric ischemia secondary to intestinal occlusion due to gallstone ileus.

Gallstone ileus is a rare complication of cholecystoduodenal fistula. Gastric ischemia due to intestinal obstruction is an extremely rare event that, if not diagnosed in time, can have a fatal outcome. We present the case of a patient with intestinal occlusion due to a gallstone obstructing the middle jejunum in which gastric ischemia was diagnosed intraoperatively due to the distension caused by the intestinal obstruction.

Mechanical ileus of the small bowel due to an inflamed Meckel's diverticulum with an enterolith - a case report with literature review.

BACKGROUND: Meckel's diverticula result from incomplete obliteration and regression of the omphaloenteric duct and are the most common congenital intestinal malformations. Many Meckel's diverticula remain asymptomatic and are discovered as incidental findings. They present a diagnostic challenge. METHODS: We report the case of a 35-year-old man who presented with an acute abdomen and ileus. Computed tomography of the abdomen showed a mechanical small bowel ileus. There was a calibre jump in the terminal ileum with a round endoluminal definable hyperdense structure of almost 2 cm in diameter. RESULTS: An exploratory laparoscopy was performed revealing an inflamed Meckel's diverticulum with impacted enterolith as the cause of the intestinal obstruction. CONCLUSION: In symptomatic Meckel's diverticula, haemorrhage and obstruction are the most common complications. The development of ileus due to a Meckel's diverticulum with an enterolith is considered extremely rare but should be taken into account.

Gallstone ileus. / Gallesteinsileus.

Gallstones are common, but rarely cause ileus. This case report illustrates the clinical course of a patient who developed gallstone ileus without any previously identified gallstone symptoms.

[A Case of Sigmoid Colon Cancer with Liver Metastasis and Gastric Infiltration for Which Ileus Surgery Was the Impetus for Surgery].

The case is a woman in her 60s. Sigmoid colon cancer surgery, liver metastasis surgery, and adjuvant chemotherapy were performed at another hospital 2 years ago. Later, she developed a metastasis in her liver and was recommended surgery, but she refused treatment and was transferred. Her liver metastasis had invaded the stomach and formed a giant gastric ulcer. This time she had an adhesive ileus and underwent laparoscopic surgery at our hospital. At that time, we observed the state of liver metastasis and gastric infiltration by laparoscopy, so we thought that palliative surgery was possible and recommended it. Although she initially refused treatment, the relative ease with which her ileus surgery was performed encouraged her to undergo palliative surgery. Laparoscopic-assisted gastrectomy and partial hepatectomy were performed, and she was discharged on hospital day 13 after surgery. She subsequently developed liver metastases and died 8 months after palliative surgery, although she was able to eat and maintain her ADL until the end of life. By staying close to the patient, we were able to lead the patient from refusal of surgery to palliative surgery, and we felt that we were able to make the patient reach a favorable end.

[A Case of Clostridium difficile Enteritis with Ileostomy for Rectal Cancer Surgery].

A 74-year-old male presenting with bloody stools was diagnosed with advanced rectal cancer. He underwent robot- assisted low anterior resection and temporary ileostomy. Cefmetazole(CMZ)was administered during surgery and on postoperative day(POD)1. His postoperative course was generally good. On POD8, he developed abdominal fullness, vomiting, renal dysfunction, and hyperkalemia. Plain CT revealed small bowel ileus and outlet obstruction with ileostomy was suspected. A nasogastric tube was placed in the stomach, and a balloon catheter was inserted from the ileostomy to the oral side of the ileum. The patient went into shock on the same day and was transferred to a high-care unit. Contrast-enhanced CT indicated pneumatosis intestinalis of the small bowel and portal venous gas. However, the wall of the small bowel was enhanced, so the patient was observed carefully without attempting an operation. The patient's condition improved with systemic management. On POD10, a stool culture from the ileostomy tested positive for CD toxin. Clostridium difficile enteritis(CDE)was diagnosed. The condition improved with systemic control. On POD52, paralytic ileus recurred, and his stool tested positive for the CD toxin again. The ileus improved with conservative treatment. On POD70, the patient was transferred to the hospital for rehabilitation. We report a case of CDE with ileostomy for rectal cancer surgery.

Laparoscopic versus open repair of congenital duodenal obstruction: a systematic review and meta-analysis.

PURPOSE: To assess the safety and efficacy of laparoscopic versus open repair of congenital duodenal obstruction (CDO), we conducted a systematic review and meta-analysis (CDO). METHODS: A literature search was conducted to identify studies that compared laparoscopic surgery (LS) and open surgery (OS) for neonates with CDO. Meta-analysis was used to pool and compare variables such as operative time, time to feeding, length of hospital stay, anastomotic leak or stricture, postoperative ileus, wound infection, and overall postoperative complications. RESULTS: Among the 1348 neonatal participants with CDO in the ten studies, 304 received LS and 1044 received OS. When compared to the OS approach, the LS approach resulted in shorter hospital stays, faster time to initial and full feeding, longer operative time, and less wound infection. However, no significant difference in secondary outcomes such as anastomotic leak or stricture, postoperative ileus, and overall postoperative complications was found between LS and OS. CONCLUSIONS: LS is a safe, feasible and effective surgical procedure for neonatal CDO when compared to OS. Compared with OS, LS has a faster time to feeding, a shorter hospital stay, and less wound infection. Furthermore, in terms of anastomotic leak or stricture, postoperative ileus, and overall postoperative complications, LS is equivalent to OS. We conclude that LS should be considered an acceptable option for CDO.

Factors Determining Postoperative Ileus After Surgery for Colon Cancer: Comparison of Right- and Left-Sided Resections.

INTRODUCTION: The passage of flatus and stool, as well as tolerating a solid diet, represents a crucial moment in recovery after colonic resections. The present study compares functional recovery after left and right colectomies for colon cancer. MATERIALS AND METHODS: This is a retrospective analysis. Consecutive patients with elective left and right colon resections were examined. Primary analysis compared time to first bowel motion and development of postoperative ileus. Secondary analyses tried to define risk factors for prolonged restoration of bowel function in right- and left-sided resection groups. RESULTS: In total, 147 patients were included. While laparoscopic approach was preferred for both sides (87% vs. 87%; p=0.496), left colectomies took longer (183 vs. 153 min; p=0.012), the lymph node harvest was smaller (16 vs. 20; p=0.005), and there was an increased need for perioperative fluids (4451 vs. 4039ml; p=0.006). Epidural use, postoperative potassium level, and glycemia were similar. Also, no significant differences were observed for complications and length of stay. First flatus was observed at postoperative day 1, 9 (left), and 2.5 (right), respectively (p=0.002). There was no significant difference in passage of first stool and intake of first solid food. Twenty-seven patients (35%) needed a postoperative nasogastric tube after right colectomy compared to 11 patients (16%) after left colectomy (p=0.012). Right-sided colectomies required the tube for longer (6.1 vs. 3.4; p=0.005). CONCLUSIONS: Postoperative ileus was more frequent after right-sided colectomies despite shorter operative time. The reason for this finding is currently unknown and deserves further attention. For the time being, we can just be more cautious with early feeding after right colectomy.

[A Case of Wernicke Encephalopathy with Ileus by Small Intestinal Cancer].

The patient was a 74 year-old woman. She came to the hospital with the chief complaint of vomiting, difficulty walking, and disorientation. The MRI study showed increased FLAIR and DWI signals in the bilateral medial thalamus. Abdominal enhanced CT scan showed a 2.4 cm tumor in the jejunum. And ileus due to small intestinal tumor was observed. She diagnosed Wernicke's encephalopathy associated with gastrointestinal transit disorder. Vitamin B1 300 mg/day for 3 days was started, and eye movements and disorientation improved on the day following the start of administration. On the 10th day after admission, partial resection of the small intestine was performed for a small intestinal tumor. She was diagnosed as small intestinal cancer. She was transferred to the hospital on the 20th postoperative day.

[A Case of Laparoscopic Ileus Release for Intestinal Obstruction Due to Small Intestinal Metastasis Four Years after Penile Cancer Surgery].

We report a rare case of metastatic small intestine cancer originating from penile cancer triggered by intestinal obstruction, with some review of the literature. The case was a 78-year-old man at the first visit. Partial penile resection was performed for penile cancer. Histopathological findings were squamous cell carcinoma, and the surgical margin was negative. The stage at the time of the first surgery was T2N0M0, Stage Ⅱ. He came to the hospital with a complaint of abdominal pain 4 years after the operation. He was diagnosed with intestinal obstruction and was treated medically. He underwent medical treatment for 12 days, but did not improve, so he underwent laparoscopic ileus release. Surgical findings showed a neoplastic lesion in the abdominal cavity, and the site was obstructed, and partial resection of the small intestine including the neoplastic lesion was performed. Pathological examination revealed small intestinal metastasis of penile cancer. Postoperative intestinal obstruction improved and he was discharged without complications. After discharge, he underwent systemic chemotherapy at an outpatient clinic, but died of the primary disease 181 days after intestinal obstruction.

FORECASTING THE DEVELOPMENT OF PURULENT-INFLAMMATORY POSTOPERATIVE COMPLICATIONS IN PATIENTS WITH OBSTRUCTIVE BOWEL OBSTRUCTION.

OBJECTIVE: The aim: The purpose of the study is to improve the results of treatment of patients with acute intestinal obstruction of tumor origin by developing individualized surgical tactics considering the level of cryoglobulins. PATIENTS AND METHODS: Materials and methods: 96 patients with ileus of tumor origin were studied. The mean age of patients was 54.7 ± 5.9 years. 30 patients were diagnosed with colorectal cancer, 35 patients - with sigmoid cancer, 13 patients - with cecum and ascending colon, 11 patients - with transverse colon cancer, and 7 patients with descending colon cancer. Isolation of cryoglobulins from blood serum was performed by the method of A. E. Kalovidoris with modifications. The content of Ig A, Ig M, Ig G, total Ig E in the serum was investigated using enzyme-linked immunosorbent assay systems "Granum-Ukraine", the content of allergen-specific Ig E was investigated using enzyme-linked immunosorbent assay systems produced by "Microgen". RESULTS: Results: As a result of treatment of 96 patients, it was found that the level of development of postoperative purulent complications was significantly influenced by the level of cryoglobulinemia and the volume of surgery (CMU, p <0.05). It was found that in patients with decompensated intestinal obstruction, the initial concentration of cryoglobulins was 16.4% higher than in the group with compensated intestinal obstruction (CMU, p <0,05). CONCLUSION: Conclusions: Determination of cryoglobulinemia on admission of patients with acute obstructive ileus of tumor origin is a simple and effective method for predicting the development of purulent-inflammatory complications in the postoperative period and can influence the choice of treatment tactics.

Ileus as a complication of butterfly wing disease case report.

Epidermolysis bullosa or butterfly wing disease is a rare genetic disorder of connective tissue associated with the formation of blisters. The clinical manifestations are very diverse and affect not only the skin cover, but also mucosal surfaces of the gastrointestinal, urogenital and respiratory systems. A large proportion of patients suffer from severe constipation with the development of megacolon. The case report describes intestinal obstruction in a patient with a dystrophic form of epidermolysis bullosa which required surgical treatment.

Allen-Masters syndrome as a cause of status ileus - case report.

INTRODUCTION: Internal hernias are rare and are encountered in a small percentage of cases. The hernia in the broad ligament of uterus (Allen-Masters syndrome) is a unique type of internal hernia which represents only approximately 4% of all internal hernias. CASE REPORT: We present the case of a 39-year-old woman admitted for clinical signs of mechanical bowel obstruction. CT examination revealed a dilated loop of small intestine in the left lower abdomen. The patient underwent laparoscopic surgery with the finding of an incarcerated small bowel loop in the ligamentum latum uteri. Small bowel deliberation and ligament defect suture were performed. CONCLUSION: A defect in the ligamentum latum uteri (Allen-Masters syndrome) is a rare diagnosis, usually discovered as an incidental finding in female patients with ileus. This syndrome may explain the vague problems of many patients whose symptoms include dyspareunia, dysmenorrhea, acute and chronic pelvic pain. Allen-Masters syndrome can be diagnosed and successfully managed by laparoscopic approach.

Laparoscopic management of cholecysto-duodenal fistula after spontaneous resolution of intestinal obstruction component of gallstone Ileus case report and literature review.

Gallstone ileus is a rare complication of gallstones and is a comparatively unique cause of intestinal obstruction. It involves the development of a cholecysto-enteric fistula through which a gallstone can pass into the gastrointestinal tract. Spontaneous resolution of intestinal obstruction in gallstone ileus is extremely rare. We report a 71-year-old patient who presented with right hypochondrial pain for four months. She had a three-day history of absolute constipation and abdominal distention two months before presentation that resolved spontaneously. Computed tomography revealed pneumobilia. Laparoscopic exploration showed a cholecysto-duodenal fistula that was divided, the opening in the first part duodenum was closed and cholecystectomy was completed successfully. The presence of pneumobilia in a patient with gallstones should raise the suspicion of bilio-enteric fistula. The obstruction component of gallstone ileus can resolve spontaneously in rare occasions. Single stage laparoscopic management of cholecysto-duodenal fistula is safe and feasible in the presence of an experienced laparoscopic surgeon.

Prophylactic biological mesh reinforcement versus standard closure of stoma site (ROCSS): a multicentre, randomised controlled trial.

BACKGROUND: Closure of an abdominal stoma, a common elective operation, is associated with frequent complications; one of the commonest and impactful is incisional hernia formation. We aimed to investigate whether biological mesh (collagen tissue matrix) can safely reduce the incidence of incisional hernias at the stoma closure site. METHODS: In this randomised controlled trial (ROCSS) done in 37 hospitals across three European countries (35 UK, one Denmark, one Netherlands), patients aged 18 years or older undergoing elective ileostomy or colostomy closure were randomly assigned using a computer-based algorithm in a 1:1 ratio to either biological mesh reinforcement or closure with sutures alone (control). Training in the novel technique was standardised across hospitals. Patients and outcome assessors were masked to treatment allocation. The primary outcome measure was occurrence of clinically detectable hernia 2 years after randomisation (intention to treat). A sample size of 790 patients was required to identify a 40% reduction (25% to 15%), with 90% power (15% drop-out rate). This study is registered with ClinicalTrials.gov, NCT02238964. FINDINGS: Between Nov 28, 2012, and Nov 11, 2015, of 1286 screened patients, 790 were randomly assigned. 394 (50%) patients were randomly assigned to mesh closure and 396 (50%) to standard closure. In the mesh group, 373 (95%) of 394 patients successfully received mesh and in the control group, three patients received mesh. The clinically detectable hernia rate, the primary outcome, at 2 years was 12% (39 of 323) in the mesh group and 20% (64 of 327) in the control group (adjusted relative risk [RR] 0·62, 95% CI 0·43-0·90; p=0·012). In 455 patients for whom 1 year postoperative CT scans were available, there was a lower radiologically defined hernia rate in mesh versus control groups (20 [9%] of 229 vs 47 [21%] of 226, adjusted RR 0·42, 95% CI 0·26-0·69; p<0·001). There was also a reduction in symptomatic hernia (16%, 52 of 329 vs 19%, 64 of 331; adjusted relative risk 0·83, 0·60-1·16; p=0·29) and surgical reintervention (12%, 42 of 344 vs 16%, 54 of 346: adjusted relative risk 0·78, 0·54-1·13; p=0·19) at 2 years, but this result did not reach statistical significance. No significant differences were seen in wound infection rate, seroma rate, quality of life, pain scores, or serious adverse events. INTERPRETATION: Reinforcement of the abdominal wall with a biological mesh at the time of stoma closure reduced clinically detectable incisional hernia within 24 months of surgery and with an acceptable safety profile. The results of this study support the use of biological mesh in stoma closure site reinforcement to reduce the early formation of incisional hernias. FUNDING: National Institute for Health Research Research for Patient Benefit and Allergan.

[A Case of Primary Jejunal Cancer Treated with Laparoscopic Jejunectomy with Appearance of Ileus].

An 83-year-old man visited our hospital for vomiting. Chest-abdominal computed tomography(CT)revealed that a tumor whose inside was imaged in the jejunum about 15 cm after leaving the Treitz ligament was pointed out, and dilation of the oral intestinal tract of the tumor was observed. Upper gastrointestinal endoscopy showed a type 3 circumferential tumor at the jejunum. He was diagnosed with obstructive ileus due to jejunal cancer. Laparoscopic-assisted partial jejunal resection was performed. Although the patient was followed up without chemotherapy, CT showed multiple lung and liver metastases and a mass lesion was found in the right entire chest, and a biopsy revealed skin metastasis 6 months after the operation. The patient is being followed up 10 months after surgery, there is no progression of liver, lung, and skin metastasis.

Delayed bowel obstruction after seat belt injury: a case report.

BACKGROUND: Delayed bowel obstruction due to seat belt injury is extremely rare. The delayed onset of nonspecific symptoms makes a timely diagnosis difficult. A deep understanding of the characteristics of this condition is helpful for early diagnosis and treatment. CASE PRESENTATION: A 39-year-old male was transferred to our hospital from another hospital complaints of progressive abdominal distension and severe weakness. In the previous hospital, he was diagnosed with "adult megacolon" and was recommended for surgical treatment. In our hospital, he was diagnosed with delayed bowel obstruction due to seat belt injury and underwent surgical intervention. Following laparoscopic adhesiolysis and resection of the narrow small intestine, his symptoms improved rapidly, and he was discharged. CONCLUSION: Delayed bowel obstruction due to seat belt injury may present clinical symptoms any time after the injury. Imaging examination, ileus tube and small colonoscopy may provide us with valuable cues for the diagnosis and treatment of delayed bowel obstruction, and laparoscopy may be an alternative approach in surgical intervention.

Endoscopic decompression of acute intestinal distension is associated with reduced mortality in critically ill patients.

BACKGROUND: Endoscopic placement of intestinal decompression tubes is a feasible technique for treatment of acute intestinal dilation. Given the heterogeneity of the underlying diseases leading to intestinal obstruction data on the significance of endoscopic procedures for treatment of these conditions are sparse. METHODS: In the study period from 2008 to 2019 all patients receiving a decompression tube were identified by retrospective chart review and analyzed. RESULTS: A total of 59 decompression tubes were placed in 50 patients. Technical success was achieved in 98% (58/59 tubes). As major complication one small bowel perforation occurred (1/59; 1.7%). Causes for impaired intestinal transit comprised tumor stenoses 22% (11/50), infections 18% (9/50), post-operative paralysis 14% (7/50), neurological diseases 8% (4/50), trauma 2% (1/50) and others 36% (18/50). Most patients (74%; 37/50) were critically ill and treated on intensive care unit. Treatment response after tube insertion was documented in 76% of patients (38/50) whereas 24% (12/50) did not fulfill response criteria. Patients with treatment response showed a significantly better outcome compared to non-responders. Responders had a median survival of 113 days (95% CI 41-186) compared to 15 days (95% CI 6-24) in non-responders (p = 0.002). Analysis of laboratory parameters after stratification in responders and non-responders to endoscopic therapy showed that non-responders had significantly higher levels of CRP and lower platelet count at baseline (CRP 262 mg/L (IQR 101-307) vs. 94 mg/L (IQR 26-153): p = 0.027; platelets 69 thsd/µL (IQR 33-161) vs. 199 thsd/µL (IQR 138-289): p = 0.009). CONCLUSIONS: Endoscopic decompression is a safe procedure for acute management of impaired intestinal transit even in critically ill patients. Response to therapy is associated with improved outcome and markers of inflammation and organ function such as CRP, platelet count and serum lactate have to be taken into account for therapy monitoring and evaluation of prognosis.

Prognostic relevance of pre- and postoperative plasma l-lactate measurements in calves with acute abdominal emergencies.

In both human and veterinary medicine, l-lactate is a well-established prognostic biomarker of disease severity and mortality and has also attracted increasing attention in bovine medicine due to the availability and validation of cheap and portable l-lactate analyzers. The aim of the present study was to evaluate the prognostic accuracy of plasma L-lactate measurements in calves with acute abdominal emergencies before and during the initial therapeutic period after surgical intervention. A prospective observational study was carried out involving 83 hospitalized calves up to an age of 7 mo, which required surgical intervention for reasons of an acute abdominal emergency such as gastrointestinal ileus or peritonitis. Plasma l-lactate (L-LAC) concentrations were determined immediately before initiation of surgery and 6, 12, 24, 48, and 72 h later. The outcome of calves was evaluated 3 mo after discharge by a phone call to the farmer, and a positive outcome was defined if the calf was still alive and the owner was satisfied with the animal's postsurgical progress. A total of 29% of calves were discharged from the hospital and the proportion of calves with a positive outcome after the 3-mo period was 24%. At all sampling times during the first 48 h after initiation of surgical intervention, calves with a negative outcome had significantly higher L-LAC than calves with a positive outcome. A binary logistic regression analysis indicated that the odds for a negative outcome during the 3-mo observation period increased by a factor of 1.23 [95% confidence interval (CI): 1.04-1.44] for every mmol/L increase of L-LAC before initiation of surgical intervention, but by a factor of 5.29 (95% CI: 1.69-16.6) and 5.92 (95% CI: 1.29-27.3) at 12 and 24 h, respectively. The largest area under the receiver operating characteristic curve for L-LAC was observed at 12 h (0.91; 95% CI: 0.83-0.99), and a cut-point of 2.75 mmol/L was identified that had a sensitivity and specificity for predicting a negative outcome of 68 and 100%, respectively. In conclusion, persistent hyper-l-lactatemia during the early postoperative period is a more reliable indicator for a negative outcome in calves with acute surgical abdominal emergencies than hyper-l-lactatemia before initiation of surgical intervention. Postoperative measurements of L-LAC are therefore a clinically useful tool to identify patients with an increased risk for a negative outcome at an early stage after surgical intervention was carried out.