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Background: A bridge to surgery (BTS) after self-expandable metallic stent (SEMS) placement is a widely recognized treatment strategy for obstructive colorectal cancer. However, there is still a lack of evidence for the efficacy and safety of laparoscopic surgery following SEMS placement. The aim of this systematic review and meta-analysis was to compare the short-term and long-term outcomes of laparoscopic surgery with those of open surgery following SEMS placement in patients with obstructive colorectal cancer. Methods: An electronic literature search through to December 2022 was performed to identify studies comparing short-term and long-term outcomes between laparoscopic and open surgery following SEMS placement for obstructive colorectal cancer. The main outcome measures were postoperative complication rates and mortality. Secondary outcome measures were the 3-year recurrence-free survival (RFS) and 3-year overall survival (OS) rates. The meta-analysis was performed using fixed-effect or random-effects methods to calculate odds ratios (ORs) with 95% confidence intervals (95% CIs). Results: The meta-analysis included 15 studies and 883 patients, of whom 467 (52.9%) underwent laparoscopic surgery and 416 (47.1%) underwent open surgery following SEMS placement. The postoperative complication rate was significantly lower in the laparoscopic surgery group than in the open surgery group (OR 0.47, 95% CI 0.32–0.67, P < 0.001). There was no significant difference in the 3-year RFS rate or 3-year OS rate between the laparoscopic and open surgery groups (3-year RFS, OR 0.78, 95% CI 0.50–1.24, P = 0.30; 3-year OS, OR 0.68, 95% CI 0.41–1.12, P = 0.13). Conclusion: This meta-analysis found that the short-term outcome was better in patients who underwent laparoscopic surgery following SEMS placement than in those who underwent open surgery. Furthermore, there was no significant difference in long-term outcomes between the two groups. Laparoscopic surgery following SEMS placement may be a safe and effective treatment option for obstructive colorectal cancer. [ABSTRACT FROM AUTHOR]

Aims: To address the predictive factors of a successful voiding after bladder outflow resistance reduction surgery (BORRS) in men presenting with acute or chronic urinary retention (UR). Methods: A think tank (TT) of ICI‐RS was gathered in 2023, Bristol, UK, to discuss several aspects of the problem, such as the pathophysiology of UR, the clinical and urodynamic evaluation of men with UR and whether it is possible to predict which men will be able to successfully void after treatment with contemporary surgical options. Results: The TT agreed that successful voiding after BORRS depends on several factors but that a strong recommendation cannot be made regarding preoperative evaluation and whether there are predictive factors of success because of the heterogeneity of patients and methodology in published trials. The diagnosis of obstruction in men with UR may be challenging when there is apparent reduced detrusor contraction during urodynamic studies. Even in the absence of bladder contractility there is documentation of such cases that have voided adequately after BORRS. Still, detrusor underactivity and inadequate relief of prostatic obstruction are the main causes of an unsuccessful voiding after BORRS. Conventional resection and enucleation methods remain the most successful surgeries in relieving UR in men, whereas the efficacy of minimally invasive surgical treatments needs to be assessed further. Conclusion: Research is needed to understand the pathophysiology of UR and the predictors of successful voiding after different types of BORRS in men with UR. [ABSTRACT FROM AUTHOR]

Introduction: Intestinal musculature defects leading to intestinal obstruction and perforation in children are rare and poorly understood. Case presentation: Our case is of a 3-day-old term male infant who was brought to the emergency department with symptoms of bilious emesis and poor feeding, and not having passed meconium. Pre-natal assessment and antenatal assessments did not raise any concerns for serology abnormalities or dysmorphic features, and he had good APGAR scores. The patient had a patent anus with abdominal distension. Initially, a plain abdominal X-ray was suspicious for Hirschsprung's disease due to narrowing of the terminal descending colon. On day 7 of life, he developed spontaneous bowel perforation. A right hemicolectomy was performed on the same day, and subsequent gross pathological assessment demonstrated a focal muscularis propria defect. Histological examination confirmed the presence of ganglion cells, ruling out Hirschsprung's disease. Immunohistochemical stains confirmed the absence of muscularis mucosa in small foci, which lead to a diagnosis of segmental absence of intestinal musculature (SAIM). While a repeat laparotomy was required shortly after due to complications, he is now feeding well and gaining weight appropriately. Conclusion: Segmental absence of intestinal musculature should be included in the differential diagnosis of newborns with symptoms of functional intestinal obstruction in whom Hirschsprung's disease has been ruled out.

Purpose: To analyze the utility and outcomes of available endourologic options to treat ureteral stricture after kidney transplantation (KT). Methods: A systematic review was carried out for all English language articles from 2000 to 2023 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) standards using EMBASE, MEDLINE, SCOPUS, Google scholar, and Cochrane library. The search term combination for the string was follows: [(Ureteral stricture) OR (ureter stenosis) OR (ureteral stenosis) OR (Stricture ureter) OR (Narrowing ureter) OR (Ureter restriction) OR (ureteral restriction) OR (ureteral narrowing) OR (ureteral obstruction) OR (ureter obstruction) OR (obstructing ureter) OR (obstructive ureter) OR (narrow ureter) OR (ureteral narrow)] AND [(kidney transplant) OR (transplanted kidney) OR (transplant) OR (transplantation)] AND [(management) OR (Robotic) OR (laser) OR (stent) OR (dilatation) OR (dilation) OR (endoscopic) OR (endourological) OR (Urologic) OR (laparoscopic) OR (surgery) OR (treatment)]. Case reports, review articles, animal and laboratory studies were excluded. Risk of bias assessment was conducted using the RoB 2 and ROBINS-I tools. Results: A total of 1102 relevant articles published from 2000 to 2023 were found. After screening of titles and abstracts, a total of 19 articles were included in our systematic review. Ureteral stent/nephrostomy placement, balloon dilatation (ureteroplasty) with or without laser was used as initial approaches whereas follow-up and success rate were analyzed among other parameters. Conclusions: The management of ureteral strictures after KT is challenging and selecting the most appropriate treatment is crucial for successful outcomes. Our review suggests that, an endourologic management is a safe option with good long-term outcomes, especially in short and early strictures. [ABSTRACT FROM AUTHOR]

The term “paraduodenal hernia (PDH)” refers to a herniation of the entire/partial small bowel into a sac derived from folds of peritoneum and fossae normally found at the terminal or 4th portion of the duodenum. It is rare, having variable presentation, and the severity of symptoms/signs is directly proportional to the degree of obstruction. We present three cases of paraduodenal hernias presenting in emergency with signs of with acute intestinal obstruction. Here we attempt to re-evaluate the representative features of PDHs, and to highlight the perioperative complications and management strategies that surgeons need to be aware of.

Objective: In this study, we investigated the clinical characteristics of patients with Ebstein anomaly and left ventricular outflow tract (LVOT) obstruction as well as possible mechanisms of obstruction as assessed by 2-dimensional echocardiography. Methods: We queried our institutional echocardiography and surgical databases for patients with the diagnosis of Ebstein anomaly seen from 1985 through 2022. Fourteen patients had the additional diagnosis of LVOT obstruction identified from transthoracic echocardiography. Results: The mean age of the 14 patients at the time that LVOT obstruction was identified was 51.9 ± 9.9 years, and 11 (78%) were female. LVOT obstruction (mean gradient 61.0 ± 25.7 mm Hg) was documented at the time of initial diagnosis of Ebstein anomaly for 8, and in the remaining, was recognized on follow-up imaging. Dynamic LVOT obstruction with systolic anterior motion (SAM) was the most common mechanism and was mostly accompanied by leftward septal movement and septal hypertrophy. Seven of the 9 patients with SAM had the diagnosis of hypertrophic cardiomyopathy. Leftward bowing of the septum appeared to be the sole cause of LVOT obstruction in 3 and a contributing factor to SAM in 4. Among the 13 patients who underwent an operation for Ebstein anomaly, 7 had concomitant septal myectomy and 3 had a subsequent procedure. Conclusions: There are multiple mechanisms of LVOT obstruction in patients with Ebstein anomaly, including SAM and leftward bowing of the interventricular septum, which may exist alone or in combination. Septal myectomy at the time of tricuspid valvuloplasty is safe and effectively reduces gradients in the outflow tract and may prevent the need for subsequent reintervention.

Background: Morphophysiology makes it possible to understand the entire organism of an animal, enabling the identification of abnormalities and alterations. In view of this, it is extremely important to understand the gastrointestinal system and the nutrition of companion animals, particularly dogs, as they tend to ingest inedible objects, which can result in changes in behavior and nutrition. The foreign body refers to objects that are resistant to digestion by hydrochloric acids, such as thread, stones, plastic, and bones. When animals are affected, they may show several symptoms such as vomiting, gastric distention, and intestinal obstruction. In addition, depending on the region and severity, surgical intervention may be required to remove the foreign body. The aim of this study was to describe a case of gastrointestinal obstruction in a bitch, as well as to address the established drug therapy and describe the surgical technique. Case: A 1-year-and-1-month-old Shih-Tzu bitch, weighing 5.6 kg, was initially treated at a veterinary clinic in Imperatriz, Maranhão. The bitch presented with lethargy and intermittent vomiting. On physical examination, ocular secretion and pain on abdominal palpation were observed, but the other parameters were within the normal range. Several tests were performed. In addition, the complete blood count showed alteration, indicating leukocytosis due to neutrophilia, together with monocytosis and eosinophilia. However, the biochemistry results were within normal limits, and the 4dx rapid test did not indicate any parasitic disease. Abdominal ultrasonography was decisive in confirming the diagnosis of a foreign body. The patient was referred to another veterinary clinic to undergo gastrostomy and enterotomy surgeries for the removal of foreign bodies. Moments before the surgery, due to the animal's worsening condition with emesis, the surgery had to be initially interrupted. Afterwards, it was sent to the surgical center, where it underwent gastrostomy and enterotomy procedures to remove 3 round structures. In the postoperative period, he was followed up to monitor the parameters, with cases of hypoglycemia that were effectively managed through appropriate interventions. In the following days until the day of discharge, he showed significant improvement, returning 10 days later to the clinic to remove the stitches. Discussion: The habit of consuming foreign objects is common among small animals but tends to affect younger dogs, like the patient in this case. According to the literature, foreign body obstruction can generate different clinical signs according to the affected region. In this case, the dog only presented pain on palpation in the abdomen region, along with gastrointestinal distress. The treatment indicated for this case was surgical intervention, specifically gastrostomy and enterotomy procedures. The ultrasound examination played a crucial role in confirming the diagnosis by identifying abnormal structures present in the stomach and small intestine. Complementary tests were performed to complete the physical examination. During hospitalization to treat the clinical conditions of emesis, the drug therapy of choice was Omeprazole and Maropitant Citrate, and Buscofen (dipyrone and scopolamine). The animal showed improvement during the postoperative period and the monitoring of the clinical parameters allowed for better control of its condition. [ABSTRACT FROM AUTHOR]

The term "paraduodenal hernia (PDH)" refers to a herniation of the entire/partial small bowel into a sac derived from folds of peritoneum and fossae normally found at the terminal or 4th portion of the duodenum. It is rare, having variable presentation, and the severity of symptoms/signs is directly proportional to the degree of obstruction. We present three cases of paraduodenal hernias presenting in emergency with signs of with acute intestinal obstruction. Here we attempt to re-evaluate the representative features of PDHs, and to highlight the perioperative complications and management strategies that surgeons need to be aware of. [ABSTRACT FROM AUTHOR]

Bouveret syndrome, an uncommon complication of cholelithiasis, typically manifests with symptoms of gastric outlet obstruction. Despite its rarity, Bouveret syndrome carries significant morbidity and mortality. This paper presents a case study and explores diagnostic approaches and management options for this challenging condition. [ABSTRACT FROM AUTHOR]

This case report describes a postmenopausal woman presenting to the breast surgery clinic with right breast enlargement, new spider veins on the chest, dyspnea, and facial swelling. She was treated for lung cancer. Imaging showed her right hilar mass causing critical superior vena cava (SVC) stenosis. She was transferred to thoracic surgery, underwent SVC stent placement, and her symptoms improved. SVC syndrome as a cause of right breast enlargement is unusual; therefore, carefully reviewing symptoms, medical history, and physical examination is crucial for diagnosis.

Background: The annular pancreas is a rare congenital disorder of the pancreas first recognized in 1818. It is believed to result from faulty rotation of the ventral pancreatic bud in its course around the posterior aspect of the duodenal anlage. The duodenum is encircled and might be obstructed by normal pancreatic tissue. The management of the annular pancreas is still developing and under revision. Case Presentation: Six cases of neonatal intestinal obstruction secondary to the annular pancreas diagnosed, operated on, and involved in our study. Age, gender, maturity, age at referral, birth weight, clinical presentation, imaging findings, associated congenital anomalies, treatment, complications, and hospital stay were all studied. Polyhydramnios is found in 3 cases (50%). Down syndrome was diagnosed in one case. One patient has associated malrotation. Symptoms started earlier within the first 24 hours. Vomiting was bile stained in 4 cases (66.7%). Passing meconium, sometimes frequent, does not exclude the annular pancreas. Most patients show double bubbles sign on plain abdominal X-ray. All six neonates were treated with duodenoduodenostomy with excellent results. Survival was 100% and complications were minimum. Conclusion: The annular pancreas, although rare, is an important cause of neonatal duodenal obstruction. The accurate diagnosis is usually performed during laparotomy. Vomiting may contain bile or not, furthermore, passing meconium does not exclude this condition. The best and the excellent surgical option is diamond duodenoduodenostomy. This case series might be added to the registered cases of the annular pancreas to standardize the method of diagnosis and to define the best management.

Abstract Background The prognosis of obstructive colorectal cancer (oCRC) is worse than that of nonobstructive colorectal cancer. However, no previous study has established an individualized prediction model for the prognosis of patients with oCRC. We aimed to screen the factors that affect the prognosis of oCRC and to use these findings to establish a nomogram model that predicts the individual prognosis of patients with oCRC. Methods This retrospective study collected data of 181 patients with oCRC from three medical hospitals between February 2012 and December 2017. Among them, 129 patients from one hospital were used as the training cohort. Univariate and multivariate analyses were used in this training cohort to select independent risk factors that affect the prognosis of oCRC, and a nomogram model was established. The other 52 patients from two additional hospitals were used as the validation cohort to verify the model. Results Multivariate analysis showed that carcinoembryonic antigen level (p = 0.037, hazard ratio [HR] = 2.872 [1.065–7.740]), N stage (N1 vs. N0, p = 0.028, HR = 3.187 [1.137–8.938]; N2 vs. N0, p = 0.010, HR = 4.098 [1.393–12.051]), and surgical procedures (p = 0.002, HR = 0.299 [0.139–0.643]) were independent prognostic factors of overall survival in patients with oCRC. These factors were used to construct the nomogram model, which showed good concordance and accuracy. Conclusion Carcinoembryonic antigen, N stage, and surgical method are independent prognostic factors for overall survival in patients with oCRC, and the nomogram model can visually display these results.

Objective and Methods: Nasal obstruction after total nasal reconstruction is a serious complication that contributes to breathing difficulty, snoring, and obstructive sleep apnea, which can negatively influence daily activities. However, few treatments have been reported in detail for this condition. Here, a case of nasal vestibular obstruction after total nasal reconstruction that was treated with bilateral superior subcutaneous pedicle nasolabial flaps is reported. Results: An intranasal stent was used postoperatively for five months to prevent restenosis. Internal stenosis was not noted 25 months postoperatively. The patient could breathe easily through his nose and mouth dryness improved. Conclusion: The flap is relatively thin, easy to elevate with high flexibility and stable blood flow, and useful for nasal vestibular lining reconstruction.

Intussusception is a rare cause of intestinal obstruction in the postoperative setting. This report describes a rare case of intussusception in the early postoperative period following an emergent cesarean delivery of a premature triplet pregnancy, where the small intestine was fully transected. The intestine was repaired with a stapled primary side-to-side functional end-to-end anastomosis. Five days after being discharged, the patient was readmitted due to a small bowel obstruction due to intussusception. The anastomotic site was acting as the lead point, and it required resection. Bowel continuity was reestablished with a hand-sewn anastomosis in end-to-end fashion. The patient had an uneventful recovery and was discharged home. All three neonates were eventually discharged home and the patient was able to start breast feeding. This is believed to be the first case in the obstetric literature where intussusception occurred after intestinal repair of transected bowel during an obstetric emergency.

BackgroundGastric transcatheter chemoembolization (GTC) is an interventional minimal invasive method, which has never been mentioned in the previous literature for advanced gastric cancer with obstruction. The purpose of this study was to evaluate its safety and efficacy in treating advanced gastric cancer with obstruction.MethodsAdvanced gastric cancer patients with obstruction who underwent GTC were retrospectively analysed from June 2017 to January 2020. Baseline information, peri-intervention data, and post-intervention follow-up information were collected. Clinical data obtained before and after the GTC were compared, and the survival of all patients was analysed.ResultForty-Two patients were included in this study. 42 (100%) patients achieved technical success, and 22 (52.4%) achieved clinical success. The median time of the GTC was 83 (30.0–180.0) minutes, and the median time of hospitalization after GTC was 3 (1–6) days. One patient experienced abdominal pain during and after GTC. Twenty (47.6%) of the 42 patients underwent gastrectomy after intervention. The pre-intervention gastric outlet obstruction scoring system (GOOSS) was 1 (0–1) and the post-intervention GOOSS was 2 (0–3) (p = 0.000

Intussusception is when section of bowel is drawn into another. It is considered the commonest cause of intestinal obstruction in children. It is associated with a favorable outcome when diagnosis and management are prompt. Non-operative management techniques are employed in most cases with surgical reduction occurring in a third of cases. Situs anomalies are a rare spectrum of congenital anomalies involving malpositioning of the thoracoabdominal viscera. Situs inversus totalis is the commoner of the subdivision of the situs inversus spectrum. The condition is associated with several anomalies including, katagener's syndrome. Its association with intestinal obstruction is however extremely rare. There is no known reported case of intussusception occurring in a child with situs inversus totalis. Here, we report a case of seven (7) months old female diagnosed with intussusception and situs inversus totalis following clinical and radiological evaluation. She underwent open reduction and Ladd's procedure and made an uneventful recovery.

Abstract Background Intestinal obstruction is defined as a blockage or partial blockage of the passage of the intestinal contents. It is a potentially risky surgical emergency associated with high morbidity and mortality. Its pattern differs from country to country and even from place to place within a country. Therefore, this study aimed to find out the magnitude, pattern and management outcome of intestinal obstruction in Arba Minch General Hospital. Methods A retrospective cross-sectional study was conducted in Arba Minch General hospital from January 09, 2015, to November 09, 2018. The data collection period was from December 15, 2018, to February 09, 2019. A simple random technique was applied to select 801 study participants. Then, the required data entered into Epi Info version 7.2.1.0 and exported to the statistical package for the social sciences software package version 20 for analysis. The binary logistic regression analysis has been done to determine crude statistical associations between independent variables and dependent variables. Linearity, Multivariate normality and multicollinearity were checked between independent and dependent variables by using scatter plot and Q–Q plot respectively. Variables with a p-value of less than 0.25 in the binary logistic regression analysis were entered into multivariable logistic regression. Statistical significance factors were identified based on a p-value of

We report a case of colonic agenesis with anorectal malformation in a newborn girl. The patient also presented with congenital heart disease. We are presenting the clinical features, intraoperative findings, and treatment plan.

Duplex renal system, a common congenital anomaly of the kidney and urinary tract, is preferably identified through screening. For obstructed symptomatic duplications, prompt relief of obstruction to forestall renal parenchymal loss is recommended. We present a case of neglected obstruction of the right upper moiety in an adult female with discordant bilateral renal duplex system. A 49-year-old female with a 10-year history of recurrent right flank pain and fever presented for clinical evaluation and treatment. She had no such symptoms in early childhood. A diagnosis was made of obstructed right upper renal moiety in bilateral discordant renal duplication with complete moiety parenchymal destruction. She had right renal exploration with complete excision of the hydronephrotic sac and the grossly dilated moiety ureter down to the obstruction at the fusion of both upper and lower moiety ureters. Her postoperative period was uneventful. She is symptom-free and her urinary tract is structurally intact. Hitherto asymptomatic renal duplication can become symptomatic in early adulthood from intrinsic moiety ureter obstruction, suggesting a need for lifetime monitoring of persons with duplex renal systems. Late presentation with neglected symptoms, and consequent renal moiety destruction as seen here, is a result of the absence of such monitoring

Abdominal tuberculosis (TB) can affect any organ of the gastrointestinal tract, and as a result of its unspecific symptoms, it may even mimic neoplasia. Rare manifestations are difficult to detect even for the trained eye and require clinical suspicion. We report rare cases of a mechanical ileus due to peritoneal TB in a 41-year-old man and an isolated peripancreatic infection in a 54-year-old woman. While in one patient, suspected malignancy led to diagnostic laparoscopy, it led to a total pancreatectomy with splenectomy in the other case. However, both times histology ruled out malignancy and showed unexpected similarities with TB. The patients responded well to medical treatment, although one patient is struggling with pancreatogenic diabetes. [ABSTRACT FROM AUTHOR]

Background and Aim: The insertion of Ventriculoperitoneal (VP) or Ventriculoatrial (VA) shunt is the first line of treatment in patients with hydrocephalus and normal-pressure hydrocephalus. The provision of a safety profile for shunting in the treatment of hydrocephalus patients is very important. This study aimed to determine the success rates and complications of VP and VA shunting in patients with hydrocephalus. Methods and Materials/Patients: This systematic review investigated the complication rates of VP and VA shunting in managing patients with hydrocephalus. All the published studies were searched in three electronic databases of Web of Science, PubMed and Google Scholar from March 20 to April 10, 2020, using the keywords of “Ventriculoperitoneal” and “Ventriculoatrial” in combination with “Hydrocephalus”. Results: In total, nine articles met the eligibility criteria for being included in this review. Some studies showed a higher rate of shunt obstruction in patients undergoing VA shunting; however, other studies demonstrated no difference in terms of shunt obstruction. The rates of primary revision shunt were various within the ranges of 5.4%-48% and 9.1%-58% for VA and VP shunting, respectively. A higher rate of revision shunt was reported among the patients undergoing VP shunting, compared to that reported for VA shunting. The different mortality rates in various studies were estimated within the range of 0%-10% and at 13.9% for VA and VP shunting, respectively. Conclusion: In general, no difference was reported between VA and VP shunting regarding the rates of complications and mortality. Due to the ease of placement and revision, VP shunting could be considered the first-line treatment of hydrocephalus. However, this approach has been preferred in newborns, and there have been insufficient data on adults in this regard.

Introduction: Anderson-Hynes pyeloplasty has been gold standard in the management of pelviureteric junction obstruction (PUJO). It has evolved from open to laparoscopic and now robotic surgery. Open surgery has its drawback of long incision and scar mark, significant post-operative pain and long hospital stay. The main limitation of laparoscopic surgery had been the difficulty in endosuturing. Robotic surgery has incorporated the minimal access method of laparoscopy and endowrist movement of open surgery to overcome the challenge of intracorporeal suturing. Here, we present our initial experience of robotic pyeloplasty. Patients and Methods: A total of 30 patients underwent robot-assisted laparoscopic pyeloplasty (RALP) over 19 months. Diagnosis of PUJO was made by computed tomography urography, diuretic renogram and retrograde pyelogram in selected patients. All patients underwent RALP by colon reflecting approach. Post-operative evaluation was done by DTPA scan at 3- and 6-month follow-up. Data were analysed after a mean follow-up of 11 months. Results: The mean operative time was 148 min and the mean hospital stay was 3.5 days. While 93% of the patients showed objective improvement in their drainage pattern on DTPA renogram, 90% of the patients were symptom-free at the end of 6 months. Conclusions: Robotic pyeloplasty is a safe and easily conquerable technique with comparable outcomes in the hands of surgeons who are beginners in this technique.

Introduction: Thoracic endovascular aortic repair (TEVAR) is the treatment of choice for blunt thoracic aortic injury (BTAI) and has proven to be a good alternative to open surgery. TEVAR requires less operation time, has fewer complications, can be used for relatively unstable patients, and is associated with a significantly lower mortality rate. Moreover, long term follow up data demonstrate low re-intervention rates and stentgraft failure. Report: The case of a 21 year old man who sustained severe trauma, including a traumatic pseudoaneurysm of the descending thoracic aorta distal to the left subclavian artery in 2016, is presented. The patient was treated by TEVAR. Two years later, he presented with progressive paraplegia due to stentgraft occlusion occurring four days after a new high velocity motor vehicle accident. An axillofemoral bypass was performed to assure blood flow to the lower body. Two days later the stentgraft was removed via left thoracotomy and replaced by a Dacron graft. Gross examination showed severe thrombus formation at the proximal edge, and a thrombotic occlusion in the middle and distal third of the stent. After three months of hospitalisation the patient was discharged to a rehabilitation clinic with partial recovery of his paraplegia. As of June 2020, the patient was able to walk without assistance and his paraplegia improved with only loss of sensation of his lower legs. Conclusion: A serious thrombotic complication two years after TEVAR is described. Although TEVAR is the currently preferred treatment for BTAI, more research is needed to examine the mechanisms behind this thrombotic complication and to elucidate whether TEVAR is definitive treatment or a “bridge to further surgery”. Smaller diameter stentgrafts, anticoagulation, regular (lifelong) follow up imaging, and prophylactic surgical conversion in (selected) patients might help to prevent this serious complication.

Abstract Background The use of a self-expandable metallic stent (SEMS) as a bridge to surgery has increased for patients with obstructing colorectal cancer. However, relatively few reports have compared SEMS as a bridge to elective surgery for acute malignant obstruction of the right-sided colon (MORC) vs. emergency surgery (ES). This study aimed to evaluate the benefits of elective surgery after SEMS placement vs. ES for patients (including stage IV cases) with acute MORC. Methods Patients with acute MORC who underwent radical resection for a primary tumour from July 2008 to November 2016 at Zhongshan Hospital of Fudan University were retrospectively enrolled. Postoperative short-term outcomes, progression-free survival (PFS), and overall survival (OS) were compared between the SEMS and ES groups. Results In total, 107 patients with acute MORC (35 in the SEMS group and 72 in the ES group) were included for analysis. The Intensive Care Unit admission rate was lower (11.4% vs. 34.7%, P = 0.011), the incidence of complications was reduced (11.4% vs. 29.2%, P = 0.042), and the postoperative length of hospitalisation was significantly shorter (8.23 ± 6.50 vs. 11.18 ± 6.71 days, P = 0.033) for the SEMS group. Survival curves showed no significant difference in PFS (P = 0.506) or OS (P = 0.989) between groups. Also, there was no significant difference in PFS and OS rates between patients with stage II and III colon cancer. After colectomy for synchronous liver metastases among stage IV patients, the hepatectomy rates for the SEMS and ES groups were 85.7% and 14.3%, respectively (P = 0.029). The hazard ratio for colectomy alone vs. combined resection was 3.258 (95% CI 0.858–12.370; P = 0.041). Conclusion Stent placement offers significant advantages in terms of short-term outcomes and comparable prognoses for acute MORC patients. For synchronous liver metastases, SEMS placement better prepares the patient for resection of the primary tumour and liver metastasis, which contribute to improved survival.

Ogilvie's syndrome, or acute colonic pseudo-obstruction, is a rare presentation occasionally observed postpartum, particularly following caesarean sections. Challenges in diagnosis often lead to delays in initiation of treatment, which significantly increases complications, including caecal ischaemia, perforation, sepsis and death. This case report describes the development of Ogilvie's syndrome within 24 h of an emergency caesarean section which was promptly recognised and confirmed by computed tomography, which demonstrated caecal dilatation of 9.7 cm without evidence of mechanical obstruction. An elevated level of C-reactive protein of 320 mg/L raised early clinical suspicion of caecal ischaemia, and this was managed endoscopically. Fortunately, the patient did not have any significant complications despite the high morbidity and mortality rate associated with Ogilvie's syndrome, highlighting the importance of clinician awareness and early initiation of management.

Hydrocephalus is a common condition characterized by disturbed cerebrospinal fluid dynamics with subsequent accumulation inside the cerebral ventricles. Fourth ventricle outlet obstruction (FVOO) is a type of noncommunicating tetraventricular hydrocephalus, frequently characterized by a disproportionately enlarged fourth ventricle. In children, FVOO has been linked to congenital malformations and inflammatory processes. In contrast, the pathophysiology remains unclear in adults in whom several etiologies have been described. Recent evidence suggests that FVOO is underdiagnosed; and to date, there are no clear guidelines regarding the diagnosis and treatment of this condition. In this article, we present the case of an adult woman who presented to us for chronic headache, nausea, vomiting, and gait disturbance, found to have an FVOO with a membrane overlying the foramen of Magendie. We also provide a literature review of adult cases of membranous FVOO, suggest a diagnostic approach to the condition, and finally conclude with a treatment algorithm for cases of disproportionately enlarged fourth ventricle.

Objective:With the increasing popularity of minimally-invasive surgery, laparoscopic pyeloplasty has become a staple in the armamentarium of urologists. However, the surgery has a steep learning curve and longer operative time. In this study, we aimed to evaluate the results of initial 53 cases of laparoscopic dismembered pyeloplasty in our institute.Materials and Methods:A total 52 of patients with pelvi-ureteric junction (PUJ) obstruction, 30 male and 22 female, with the mean age of 23.5 years were managed by transperitoneal laparoscopic dismembered pyeloplasty. The patients were placed in full lateral position and surgery was done using a minimum of three ports, retrograde pyelography was done in all; initial access was done by using a Veress needle. The ureter was spatulated first, first suture taken and then the PUJ was dismembered to avoid rotation of the ureter. Antegrade DJ stenting was done in all patients and one drain was left in the retroperitoneum after surgery. DJ stent was removed six weeks after surgery.Results:Fifty two patients were managed by dismembered pyeloplasty. Six patients required preoperative urinary diversion. Intrarenal pelvis was seen in seven, crossing vessel in ten, high insertion of ureter in six and associated calculus in five patients. Conversion to open surgery was required in six patients. Initially, the operative time was more than three hours but after sufficient experience of 25 cases, it reduced drastically and in last 28 cases, the mean operative time was 123 minutes, with shortest time reported 97 minutes. Reintervention was required in eight patients and overall success rate was 87%.Conclusion:Laparoscopic pyeloplasty is a safe, minimally-invasive and viable alternative to open pyeloplasty for the management of PUJ obstruction.

Cecal volvulus is an uncommon cause of acute intestinal obstruction accounting for around 10% of intestinal volvuli. There are three main variants of cecal volvuli including the axial, loop, and bascule types. Diagnosis is confirmed via a computed tomography scan and surgery is the mainstay treatment due to a high risk of morbidity and mortality. Here we report a rare presentation of cecal volvulus in a COVID-19 positive patient that was complicated by an anastomotic leak.

PICO question In dogs with gastrointestinal foreign-body obstruction undergoing surgical correction, is the mortality rate in the perioperative period for those receiving resection and anastomosis higher, lower, or equivalent to those receiving an enterotomy? Clinical bottom line Category of research question Outcome The number and type of study designs reviewed Four retrospective studies were reviewed Strength of evidence Weak Outcomes reported It would appear that the mortality rate for resection and anastomosis for the purpose of foreign-body removal is higher than that of enterotomies performed for the same reason Conclusion There is insufficient evidence directly comparing enterotomies with resection and anastomoses in foreign-body obstructions to definitively state that the mortality rate is higher among resection and anastomosis procedures How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

A acute appendicitis caused by traditional Iraqi grilled fish bone (Masqouf), In Al-shifaa private hospital, Iraq, diyala governorate. [ABSTRACT FROM AUTHOR]

The Nellix® endovascular aneurysm sealing system (EVAS) is a relatively novel approach for the treatment of abdominal aortic aneurysms (AAAs). We present herein a case of duodenal obstruction (DO) which occurred following an EVAS treatment for the repair of an AAA. A 77-year old man was admitted to our hospital with acute abdominal pain and recurrent vomiting. Computed tomography (CT) revealed a retroperitoneal 66 × 59 × 90 mm (antero-posterior, AP; latero-lateral, LL; cranio-caudal: CC) solid mass located in the epigastrium, corresponding to the infrarenal abdominal aortic aneurysm sac, previously treated by EVAS. An exploratory laparotomy was performed, which revealed a retroperitoneal mass compressing the third and fourth parts of the duodenum. A gastroenteroanastomosis was performed in order to bypass the duodenal obstruction. An extensive search of biomedical literature databases was conducted to identify similar cases. To our knowledge, this is the first reported case of DO following an AAA repair with EVAS. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to analyze the possible change in the characteristics of patients with colonic ileus from obstructive colorectal cancer in UMHATEM "N. Pirogov ". Material and Methods: For two separate periods of 2 years in the Department of General, Visceral and Emergency Surgery in University Hospital "N. I. Pirogov" from ileus caused by colorectal carcinoma were operated respectively: Group A (1.1.2010-31.12.2011) - 187 patients (average 71.2 years, women were 88, men 99) Group B (1.1.2014-31.12.2015) - 141 patients (average 73.5 years, women were 69, men 72). Results: In group B there was an increase in the infected patients at an earlier stage. There was no significant difference in the localization of the tumor process in the two groups. In contrast to the increased number of patients hospitalized at an earlier ileus stage, there was no difference in the two groups according to the tumor stage. Conclusions: Emergency surgery is indicated for cases with full bowel obstruction and significant prediction of rupture. Surgery procedure like proximal colostomy is reccomended for elderly patients and complicated comorbidity. Primary procedure like segmental and subtotal colectomy is appropriate for patients in good condition. Segmental resection is favorable in elderly patients and those with shock who may not tolerate lengthy surgery.

Rabbits are complex animals with many requirements for them to thrive in the domestic environment. As prey animals, rabbits instinctively mask the signs of illness to avoid appearing vulnerable to predators. When they show signs of being unwell, it is likely that their condition is serious, and they should be presented to the veterinary surgeon promptly which was this case of a rabbit with an intestinal obstruction. [ABSTRACT FROM AUTHOR]

Abstract Background Approximately 20% of colorectal cancer patients show complete or incomplete bowel obstruction as an early symptom. Preoperative nonsurgical decompression such as placing a self-expanding metallic stent for malignant colorectal obstruction has been shown to be effective for reducing perioperative morbidity and mortality. However, there is a lack of published studies reporting robot-assisted laparoscopic surgery (RALS) after self-expanding metallic stent (SEMS) placement for malignant rectal obstruction (MRO). To our knowledge, this is the first report to do so. Case presentation An 80-year-old man with incomplete paralysis of the lower limbs as well as bladder–rectal disorder due to a spine fracture sustained in a fall accident 26 years ago presented with lower abdominal pain and vomiting. Abdominal multi-detector computed tomography revealed an obstructive rectal tumor with distended bowel on the oral side. Emergency colonoscopy was performed, and an SEMS placed. The patency of SEMS and decompression of the distended bowel was confirmed, and elective RALS was performed 29 days after SEMS placement. To our knowledge, this is the first report of RALS after decompression with SEMS placement for MRO. Conclusions RALS after SEMS placement is a safe and feasible therapeutic strategy for MRO.

Abstract Background Bezoars are rare but may cause gastrointestinal obstruction and ulcers. To the best of our knowledge, only two cases of bezoars in the reconstructed gastric conduit have been reported, but there has been no report on reconstructed gastric conduit obstruction due to bezoars. Case presentation A 60-year-old man presented to our clinic with abdominal pain and vomiting that occurred suddenly after dinner. Three years before presentation, he had undergone radical thoracoscopic esophagectomy followed by reconstruction of the gastric conduit through the posterior sternum, for esophageal cancer. Enhanced computed tomography scans showed distension of only the gastric conduit without ischemia and distension of the small intestine. According to our findings, we initially diagnosed the patient with postoperative intestinal obstruction caused by adhesions. After conservative treatment failed, the patient underwent an endoscopic study that showed a bezoar at the pylorus ring. We initially failed to remove the bezoar endoscopically because of its large size; hence, we attempted enzymatic dissolution. Three days after the first endoscopic study, the bezoar was disintegrated using a snare and extracted during a second endoscopy. The patient recovered uneventfully and presented with no complications during the 1-year follow-up interval. Conclusion In cases wherein the discharge of materials in the reconstructed gastric conduit is delayed, bezoars should be considered in the differential diagnosis, and an endoscopic study should be performed to verify the cause of obstruction.

Blunt abdominal trauma is a rare cause of small bowel obstruction thought to arise from either a sealed perforation of the small bowel or mesenteric injury resulting in adhesions. A 55-year-old gentleman presented with symptoms and signs of small bowel obstruction and a history of blunt abdominal trauma 14 months previously. Abdominal computed tomography showed a transition zone at the terminal ilium with proximal dilatation indicative of obstruction. At surgery, he had adhesions involving the terminal ilium with shortening and fibrosis of the supplying mesentery. Patients with a history of blunt abdominal trauma presenting with abdominal symptoms must be investigated to rule out bowel obstruction, with a low threshold for surgical intervention.

Groin hernioplasty is the most performed intervention in the adults worldwide, the minimally invasive inguinal hernia repair techniques widely used by surgeons today are transabdominal preperitoneal patch plasty (TAPP) and total extraperitoneal patch plasty (TEP). We report a 62-year-old man with bowel obstruction caused by the use of self-anchoring barbed suture to close the peritoneum 3 days after TAPP. Surgeons using the barbed suture should be alert to this possibility when encountering this complication of intestinal obstruction, so as to avoid more serious consequences.

Strong acid accidental ingestion is a common case in rural society and children. The effect of strong acids may cause injuries of the gastrointestinal tract. We present a case obstruction in the distal part of gastric after accidental sulfuric acid ingestion in children. Sulfuric acid ingestion is potential in children since its commercial product physical appearance looks like drink water. Then the patient was diagnosed with pyloric obstruction after barium meal examination and was treated using Jaboulay gastroduodenostomy procedure.

Background: The term "rabbit gastrointestinal syndrome" (RGIS) refers to a decrease in peristaltic movements, which in some cases can progress to absolute inactivity of the digestive apparatus. This condition is mostly secondary to others that promote changes in gastrointestinal motility, such as dehydration, fiber deficiency, excess carbohydrates in diets, stress, and acute or chronic painful processes. Clinical manifestations are mostly nonspecific. Thus, a case of RGIS resulting from environmental change in a domestic rabbit (Oryctolagus cuniculus) is reported. Case: A 4-month-old male domestic rabbit weighing 0.962 kg was referred to a university veterinary hospital. The patient had a history of absence of defecation and anorexia for the past two days. The owner reported that the patient was apathetic but became aggressive when manipulated. The changes started after a move of residence. On physical evaluation, an increase in abdominal volume and a painful response to touch on the abdomen were observed. Complementary examinations were performed, such as a blood count and an ultrasound study. The blood tests showed no alterations, but the ultrasound evaluation showed the presence of free abdominal fluid, dilated intestinal loops due to fluid content, reduced gastrointestinal motility, and a hyperechoic structure associated with acoustic shading in the small intestine, all findings suggestive of obstruction. Given the failure of clinical management, the patient was referred for an exploratory laparotomy procedure followed by enterotomy. The obstruction point was located near the ileocecal junction. After surgery, analgesics, antibiotics, fluid therapy, anti-inflammatory drugs, intestinal motility inducers, and probiotics were prescribed. One week after the surgical procedure, the patient showed improvement in the clinical condition, with normal appetite, defecation, and docility. Discussion: RGIS is diagnosed based on the clinical history, clinical manifestations, and complementary examinations. In the reported case, the patient presented apathy, anorexia, absence of defecation, and aggressiveness on manipulation, which were associated with abdominal pain. In cases of RGIS, hematological changes may or may not be present, which matches the findings in this report. Imaging exams provide important information, such as the patient's condition and evolution. Ultrasound evaluation showed the presence of free abdominal fluid, dilated intestinal loops due to fluid content, reduced gastrointestinal motility, and a hyperechoic, immobile acoustic shading structure in the small intestine. Ultrasound findings were compatible with those found in cases of foreign-body obstructions, a common complication in RGIS. Initially, a clinical approach was taken, but in view of the unfavorable evolution of the case, with worsening motility and alterations in the imaging examination, a surgical approach was instituted. Intestinal obstructions in rabbits are usually found either in the proximal duodenum or near the ileocecal junction. In the presently reported patient, an obstruction was identified in the ileocecal junction region and the content found was composed of hair and dehydrated food. There are several conditions that can alter intestinal peristalsis in rabbits; in the present case, it was considered that the distress caused by moving to a new household led to a condition of RGIS. Despite the reserved prognosis associated with surgical interventions in the gastrointestinal system of rabbits, as described in the literature, in the present case this approach made it possible to preserve the patient's life, which returned to its normal activities and behavior. [ABSTRACT FROM AUTHOR]

Primary lymphomas of the colon account for 0.5% of all primary colon malignancies. Burkitt’s lymphoma is a B-cell lymphoma with aggressive clinical behavior. Herein, we describe a case of a male patient who presented with signs of large bowel obstruction, underwent surgery and found to suffer from Burkitt’s lymphoma of the ileocecal region. The histopathological examination was indicative for Burkitt’s lymphoma. To the best of our insight this is one of the few reported cases of such type of lymphoma in an adult patient presenting with bowel obstruction. Burkitt’s lymphoma is a rare malignancy in adults affecting gastrointestinal tract. It has a high proliferation potential and can rapidly progress to advanced disease. Early diagnosis is necessary to prevent complications and improve overall prognosis.

Aim: To study the prevalence of associated anomalies with neonatal duodenal obstruction and factors impacting short-term survival. Material and methods: Records of 31 neonates with neonatal duodenal obstruction could be retrieved and analyzed for a 13.5-year-period (October 2003-May 2016). M:F ratio was 1.58:1. The mean birth weight was 2.15 kg; 12 patients were preterm. Etiologies included duodenal atresia (n=23), duodenal web (n=8) and malrotation of gut (n= 6). Results: Associated anomalies were seen in 19/31: Down’s syndrome (n=6), anorectal malformation (ARM) (n=5), annular pancreas (n=5), cardiac anomalies (n=4), esophageal atresia with trachea-esophageal fistula (EA with TEF) (n=3). Mortality in the series was 22.5%; 5 deaths and 2 patients left against medical advice in moribund state (hidden mortality). Mortality in associated anomalies group was 5/19; and 2/12 in the no anomalies group, though this difference was not statistically significant (p=0.676). Similarly, low birth weight (LBW) did not have impact on survival (p=0.639) but preterm status had highly significant p value (Conclusion: Duodenal atresia was the commonest cause of neonatal duodenal obstruction. Associated anomalies were noted in 61% patients, Down’s syndrome being the most frequent. These anomalies did not have any significant impact on the survival, nor did LBW. Preterm status had significant impact on prognosis.

Objective:Laparoscopic transperitoneal pyeloplasty (LTP) is being widely preferred in the treatment of ureteropelvic junction obstruction (UPJO). This study aims to assess the outcomes of treatment efficacy of LTP performed in our clinic for the treatment of UPJO in adult patients.Materials and Methods:Data of patients, who underwent LTP procedure in our clinic between 2004 and 2017, were reviewed retrospectively. Data of 116 patients in total were included in the study. The cases were reviewed in terms of demographic characteristics, complaints at admission, and clinical, laboratory and radiological findings. The patients were divided into two groups and correlation of demographic data (age, age group, and gender), side and presence of kidney stone with the presence of crossing vessel was investigated. Chi-square test, Student’s t-test and Fisher’s exact test were applied for statistical analysis.Results:The mean age of the patients was 29.9 (19-51) years. Eight patients were the secondary patients who underwent open surgery upon diagnosis of UPJO. Forty-one (35.3%) patients had the anomaly of crossing vessel compression, 17 (14.6%)-kidney stone, 5 (4.3%)-solitary kidney and 3 (2.5%) had horseshoe kidney. The mean operating time was 124 (80-245) minutes. No statistically significant correlation of the presence of crossing vessel with age, gender, side and presence of stone was found. The mean length of hospital stay was 3.05 (2-11) days and the mean postoperative follow-up time was 44 (12-120) months. Success rate was found to be 93.1%. One (0.8%) patient had perioperative and 10 (8.6%) patients had postoperative complications.Conclusion:LTP is a feasible, effective and reliable option in the treatment of UPJO with low complication rate and high success rate.

Abstract ᅟ Obstruction and perforation due to colorectal cancer represent challenging matters in terms of diagnosis, life-saving strategies, obstruction resolution and oncologic challenge. The aims of the current paper are to update the previous WSES guidelines for the management of large bowel perforation and obstructive left colon carcinoma (OLCC) and to develop new guidelines on obstructive right colon carcinoma (ORCC). Methods The literature was extensively queried for focused publication until December 2017. Precise analysis and grading of the literature has been performed by a working group formed by a pool of experts: the statements and literature review were presented, discussed and voted at the Consensus Conference of the 4th Congress of the World Society of Emergency Surgery (WSES) held in Campinas in May 2017. Results CT scan is the best imaging technique to evaluate large bowel obstruction and perforation. For OLCC, self-expandable metallic stent (SEMS), when available, offers interesting advantages as compared to emergency surgery; however, the positioning of SEMS for surgically treatable causes carries some long-term oncologic disadvantages, which are still under analysis. In the context of emergency surgery, resection and primary anastomosis (RPA) is preferable to Hartmann’s procedure, whenever the characteristics of the patient and the surgeon are permissive. Right-sided loop colostomy is preferable in rectal cancer, when preoperative therapies are predicted. With regards to the treatment of ORCC, right colectomy represents the procedure of choice; alternatives, such as internal bypass and loop ileostomy, are of limited value. Clinical scenarios in the case of perforation might be dramatic, especially in case of free faecal peritonitis. The importance of an appropriate balance between life-saving surgical procedures and respect of oncologic caveats must be stressed. In selected cases, a damage control approach may be required. Medical treatments including appropriate fluid resuscitation, early antibiotic treatment and management of co-existing medical conditions according to international guidelines must be delivered to all patients at presentation. Conclusions The current guidelines offer an extensive overview of available evidence and a qualitative consensus regarding management of large bowel obstruction and perforation due to colorectal cancer.

Kelly M Caldwell,1 Seeyuen J Lee,1 Phillip L Leggett,1 Kulvinder S Bajwa,1 Sheilendra S Mehta,1 Shinil K Shah1,2 1Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA; 2Michael E. Debakey Institute for Comparative Cardiovascular Science and Biomedical Devices, Texas A&M University, College Station, TX, USA Abstract: Bouveret syndrome is a rare complication of cholelithiasis that usually presents with signs and symptoms of gastric outlet obstruction. Given the relative rarity of this condition, there are no standardized guidelines for the management of this condition. In this paper, we review the diagnosis and management options (endoscopic, laparoscopic, and open approaches) of patients with Bouveret syndrome, including a report of one case to illustrate some of the endoscopic and surgical principles of management. Keywords: Bouveret syndrome, gallstone ileus, obstruction, endoscopy, surgery