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Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Medical History and Clinical Findings:  A 43-year old male patient was admitted because of diffuse abdominal discomfort for two days, which had started in the upper abdomen; medical history, no previous surgical interventions at the abdomen., Investigations:  Gastroscopy and abdominal ultrasound revealed only a mild gastritis. Laboratory parameters: showed only a slight leucocytosis (10 610/µL). On the 1st day of the hospital stay, the patient developed a worsening of the abdominal symptoms with distended abdomen, sounding bowel movements and recurrent vomiting, which were interpreted as acute abdomen by the surgeon on call leading to the indication of a surgical intervention. CT scan revealed an intraluminal tumor., Diagnosis:  Suspicion of a mechanical ileus by an obstructing tumor of the small intestine., Therapy:  Median laparotomy of the lower abdomen revealed an invagination at the terminal ileum - after devagination, an invaginated Meckel's diverticulum was found. This was resected at its basis and the ileal wall was transversally sutured., Course:  The postoperative course was uneventful., Discussion (conclusion):  An invaginated Meckel's diverticulum belongs rather to the less frequent causes of an ileus of the small intestine and an unclear / acute abdomen in adults., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (© Georg Thieme Verlag KG Stuttgart · New York.)

In patients with ileus with dilated intestine in imaging studies, endoscopic decompression appears a feasible option. However, its use is often uncritical and without scientific evidence. Before considering endoscopic intervention, CT-imaging should differentiate between mechanical obstruction and paralytic ileus/intestinal pseudo-obstruction. Tumor diagnosis and localisation are essential because the latter determines the choice of the decompression procedure. Coecal dilatation of more than 12 cm indicates an increased risk of perforation. In patients with toxic megacolon, dilation of the transverse colon to more than 6 cm is considered critical without much prospective evidence. Endoscopic decompression has a high complication rate and should be performed electively, and not as an emergency procedure, whenever possible. The use of CO 2 insufflation rather than ambient air is strongly recommended, as is the availability of fluoroscopy. Prior trans-nasal or oral decompression-tube placement is routinely performed, and tracheobronchial intubation frequently required. In over 90 % of patients with pseudo-obstruction, conservative treatment is successful within 24 to 48 hours, and endoscopic decompression is, therefore, unnecessary. Placement of self-expanding metal stents to decompress a tumor stenosis is considered mostly for the left colon and rectum and burdened with significant risks of perforation and stent migration. Stent impact on oncological outcome is controversial because of possible tumor cell mobilization and increased postoperative cancer recurrence rates. Surgery, as primary intervention, achieves its objective in most cases. Decompression effect by endoscopic suctioning of gas and intestinal fluid is usually transient so that it is combined with transrectal decompression tubes insertion. This paper reviews the advantages and flaws of various decompression procedures in different clinical settings., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (© Georg Thieme Verlag KG Stuttgart · New York.)

Small bowel intussusception is a rare cause of abdominal pain in adult patients. Due to varying symptoms and different underlying causes its diagnosis and treatment is challenging for physicians. This case report describes recurrent intussusception in an adult female patient and celiac disease could only be diagnosed as the cause of these symptoms after surgery. In addition a review of the literature regarding adult intussusception is presented.

Ultrasonography is a very useful technique for diagnosing the cause of colic in cows. It allows visualisation of abnormal reticular contour and occasionally of abnormal contractility in cows with reticuloperitonitis. In right-displaced abomasum, the dilated abomasum can be detected between the right abdominal wall and the liver. Fluid ingesta are seen ventrally and a gas cap of varying size dorsally. Dilated loops of small intestines that are almost always static are the main diagnostic criterion for ileus of the small intestine, but the cause of the ileus can only rarely be determined. Cholestasis can almost always be diagnosed by imaging a dilated biliary system. With obstruction at the level of the hepatic portal, only the intrahepatic biliary ducts are dilated, while a dilatation of the entire biliary tract, including the gallbladder, occurs in the case of an obstruction near the duodenal papilla. Urinary tract diseases cause colic in cows when concrement or inflammatory products become lodged in a ureter. The importance of ultrasonography in the diagnosis of diseases causing colic in cows varies. For example, with colic attributable to ileus of the small intestines, cholestasis or urinary tract disease, ultrasonography is a very useful diagnostic tool. On the other hand, for diagnosis of left or right displacement of the abomasum or caecal dilatation, ultrasonography is generally not required, but it is helpful in difficult cases to confirm or rule out a tentative diagnosis and to avoid an unnecessary exploratory laparotomy.

History and Clinical Findings: A 72-year-old woman was admitted to the hospital with upper abdominal pain, nausea, vomiting, and obstipation., Investigations: Percutaneous ultrasound found aerobilia, a biliary-digestive fistula, and an ileus with gallstones within the small bowel. The findings were confirmed at computed tomography., Treatment and Course: A gallstone ileus on the basis of a biliary-digestive fistula was diagnosed. The patient was treated by surgery and with antibiotics., Conclusion: This case report demonstrates that percutaneous ultrasonography should be used as the first imaging procedure in the diagnosis of acute abdominal pain. This procedure makes it possible to detect a gallstone ileus. It is important also to define various intestinal structures accurately., (Georg Thieme Verlag KG Stuttgart, New York.)

Traumatic abdominal wall hernias are rare injuries despite the high incidence of blunt abdominal traumas. The mechanism of this injury includes a sudden increase in intra-abdominal pressure and extensive shear forces applied to the abdominal wall. The typical location is found at anatomic weak areas in the lower abdomen. Often, significant intra-abdominal injuries or injuries of the pelvis and chest are associated. We describe a case of an abdominal contusion trauma leading to a traumatic abdominal wall hernia beside the rectal sheath. In this case, parts of the small bowel penetrated through the ruptured muscle of the abdominal wall up to the subcutis. After appropriate diagnosis, the defect was repaired using a sheet of synthetic mesh to stabilize the abdominal wall. Based on this case, the management of blunt abdominal wall hernias and the literature are discussed.

In the early period following surgery, it is very important to reveal any complications. In this article the role of ultrasound in recognizing postoperative complications is demonstrated. Ultrasound findings in typical complications of abdominal surgery such as bleeding, abscess formation, acute cholecystitis, pancreatitis, and postoperative ileus are described. The diagnosis of postoperative bleeding, acute cholecystitis, and ileus is very reliable by ultrasound (sensitivity and specificity >95%). Ultrasonography is inferior to computed tomography in detecting pancreatitis and abscess formation. The guiding of interventions by ultrasound offers additional therapeutic options.

This case report demonstrates a post-traumatic right sided diaphragmal hernia presenting 17 years after trauma with acute abdominal pain. An incarcerated duodenal bowel loop was radiologically suspected and confirmed by subsequent surgery.