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BACKGROUND: Small bowel obstruction (SBO) is a complication of bariatric surgery. However, outcomes of surgical intervention for SBO among patients with prior bariatric surgery remain ill-defined. We used a nationally representative cohort to characterize the outcomes of the SBO management approach in patients with a prior bariatric operation. METHODS: All adult hospitalizations for SBO were tabulated from the 2018-2020 National Readmissions Database. Patients with a prior history of bariatric surgery comprised the Bariatric cohort (others: Non-Bariatric). Multivariable models were subsequently developed to evaluate the association of prior bariatric surgery with outcomes of interest. RESULTS: Of an estimated 299,983 hospitalizations for SBO, 15,788 (5.3 %) had a history of prior bariatric surgery. Compared to Non-Bariatric, Bariatric patients were younger (54 [46-62] vs 57 [47-64] years, P

IntroductionSmall bowel obstruction (SBO) is one of the most common causes for hospital admission in Ethiopia. The use of water-soluble contrast agents (WSCAs) such as Gastrografin to manage adhesive SBO can predict nonoperative resolution of SBO and reduce decision time to surgery and length of hospital stay. However, nothing is known about practice patterns and Gastrografin use in low-income settings. We sought to characterize current management practices, including use of WSCAs, as well as outcomes for patients with SBO in Addis Ababa, Ethiopia.MethodsWe conducted a mixed-methods study consisting of a survey of surgeons throughout Ethiopia and a retrospective record review at five public, tertiary care-level teaching hospitals in Addis Ababa.ResultsOf the 76 surgeons who completed the survey, 63% had heard of the use of WSCAs for SBO and only 11% used oral agents for its management. Chart review of 149 patients admitted with SBO showed the most common etiology was adhesion (39.6% of admissions), followed by small bowel volvulus (20.8%). Most patients (83.2%) underwent surgery during their admission. The most common diagnosis in patients who did not require surgery was also adhesion (68.0%), as well as for those who had surgery (33.9%), followed by small bowel volvulus (24.2%).ConclusionsThe etiology of SBO in Ethiopia may be changing, with postoperative adhesions becoming more common than other historically more prevalent causes. Although a Gastrografin protocol as a diagnostic and potentially therapeutic aid for SBO is feasible in this population and setting, challenges can be anticipated, and future studies of protocol implementation and effectiveness are needed to further inform its utility in Ethiopia and other low-income and middle-income countries.

Background: To study the effect of laparoscopic ileopexy in patients with afferent-loop syndrome (ALS) after restorative proctocolectomy (RP). Method: Ileopexy has been the treatment of choice in patients with ALS for the last 5 years at our department. All patients who had undergone ileopexy for ALS between January 2019 and August 2023 were identified. Data were extracted from the medical records. All patients were contacted and asked standardized questions regarding symptoms of ALS. A symptom score was calculated and compared before surgery and at the last follow-up. Results: Ten patients, who had undergone ileopexy for ALS, were identified. Eight of these (80%) had been admitted with small bowel obstruction due to ALS. The remaining 2 patients had other symptoms indicative of ALS. In all patients, ileopexy was immediately effective in reducing symptoms. Symptoms recurred after 16.5 weeks (2–80) in 8 patients. Repeat laparoscopy showed that the ileopexy had slipped in 6 of these. Six had a new ileopexy with mesh. Later, one of these developed recurrent symptoms and had a new mesh ileopexy performed. No mesh complications were seen. Symptom score was reduced from 6.5 (1–9) to 2 (0–7) (p = 0.02) at the last follow-up. Conclusions: In this study, ileopexy is effective in reducing symptoms of ALS after RP. In a high proportion of patients, it is necessary to use mesh to ensure long-term fixation of the ileum. [ABSTRACT FROM AUTHOR]

Background: Anaplastic large-cell lymphoma primarily involving the omentum is an extremely rare entity with variable clinical presentation. Owing to its rarity and nonspecific clinical manifestation, omental T-cell lymphoma is often diagnosed at a later stage, riddled with complications. While imaging modalities such as computed tomography scan can help a physician reach a diagnosis, cases that present with complications may require a multidisciplinary approach that combines surgical exploration along with consultation from Oncology. Case presentation: We hereby report a rare case of a 66-year-old African American male patient who presented to the emergency department with complaints of acute gastrointestinal obstruction. A computed tomography scan of the abdomen and pelvis revealed evidence of an internal hernia and surgical exploration revealed a hemorrhagic and infarcted omentum. Biopsies along with immunophenotypic studies confirmed the diagnosis of anaplastic T-cell lymphoma of the omentum complicated by Massilia timonae infection. Conclusion: The case highlights the significance of considering lymphoma, although rare, as a differential in a patient who presents with small bowel obstruction and the importance of investigating for malignancy for early diagnosis and treatment of primary omental lymphomas, before complications develop. [ABSTRACT FROM AUTHOR]

Background: Small bowel obstruction (SBO) is a significant cause of surgery in adult horses presenting with colic pain. SBOs often require resection and anastomosis. While various techniques for intestinal anastomoses have been developed, it remains uncertain if any fully meet our clinical needs. Objective: To conduct a scoping review of publications on anastomosis techniques and outcomes for the treatment of SBO. Study design: Scoping review. Methods: A literature review was conducted using the CAB, Web of Science, Scopus, and PubMed databases. Peer‐reviewed scientific articles in English, published between 1992 and 2023, were included. A quality assessment was performed for potentially eligible articles. Experimental studies, case reports, and case series with less than five cases were excluded and relevant data on study methods and sample size were extracted and charted from remaining articles. Anastomosis type and outcome were reported for articles considered potentially eligible for meta‐analysis. Articles in which only overall outcome was reported or details on type of anastomosis were not reported were excluded for the final charting. Results: Of 3024 articles, 210 underwent a quality assessment. The most common study designs were case reports and case series (64.3%), followed by experimental studies (17.1%). After further exclusions, 104 articles met the inclusion criteria. In only 42 articles detailed data on type of anastomosis and relative outcome were reported. A total of 23 anastomosis types were reported for the treatment of SBO, with 6 different outcomes evaluated. Both short‐ and long‐term survival rates consistently exceed 70% for all types of anastomosis (jejuno‐jejunal, jejuno‐ileal, and jejunocaecal). Main limitation: Non‐English language studies and conference proceedings were excluded. Conclusion: The body of literature focused on surgical treatment for SBO exhibits low‐quality evidence. Several techniques of anastomosis were described for different pathologies. However, there is a lack of homogeneity in reporting outcome for each surgical technique. Furthermore, outcomes considered varied significantly among studies and were sometimes poorly reported, although success rates are generally high. Overall, there is a need for better‐structured studies on existing and commonly used techniques before comparing techniques and exploring other innovative approaches. [ABSTRACT FROM AUTHOR]

Background: Small mesenteric hiatal hernias (SMHHs) are defined as a small group of internal hernias (IHs) that frequently diagnosed in children. However, SMHHs are relatively rare in adults. Bowel loop herniation via an abnormal mesenteric defect can lead to strangulated intestinal obstruction. Congenital SMHHs are commonly observed in pediatric patients, with some cases involving neonatal death. Case presentation: A 24-year-old healthy male patient visited our hospital with a 2-day history of a sudden onset lower abdominal pain. He was initially diagnosed with enteritis. However, his symptoms worsened, and he was brought to our hospital. Contrast-enhanced computed tomography (CT) scan showed formation of a closed loop in the small intestine within the pelvis and signs of ischemia. As the patient was diagnosed with small bowel obstruction (SBO) caused by IH, emergency laparoscopic surgery was performed to loosen the obstruction. The patient was found to have ascites and small-bowel necrosis. A part of the small intestine that measured 30 cm was strangulated via a large-diameter defect (17 × 11 cm) in the ileal mesentery. Via a small abdominal incision, the necrotic bowel was resected, and the mesenteric defect was repaired. Conclusion: SMHHs are rare in adults, and they should be considered as potential causes of strangulated intestinal obstruction in adults without a history of laparotomy or trauma. [ABSTRACT FROM AUTHOR]

Gallstone ileus results in a mechanical small bowel obstruction when an itinerant gallstone tumbles downstream and obstructs the bowel lumen. Associated proximal intestinal injury with perforation is rare, and concomitant perforation of multiple segments of bowel in the setting of gallstone ileus has never been reported in the literature. We are reporting the case of a 67-year-old female patient who had gallstone ileus causing perforation of multiple segments of small bowel. At operation, she was found to have a 3.2-cm gallstone lodged at the terminal ileum, perforation of both the mid ileum and mid jejunum, and gross enteric spillage. She underwent removal of the gallstone and small bowel resection × 2. She was initially left in discontinuity with an open abdomen. She returned to the operating room 2 days later for bowel anastomosis and abdominal closure. She recovered well after surgery and was discharged home. [ABSTRACT FROM AUTHOR]

Background: Performing emergency surgery for bowel obstruction continues to place a significant strain on the healthcare system. Conventional assessment methods for outcomes in bowel obstruction cases often concentrate on isolated factors, and the evaluation of results for individuals with bowel obstruction remains poorly studied. This study aimed to examine the risk factors associated with major postoperative complications. Methods: We retrospectively analyzed 99 patients undergoing surgery from 2015 to 2022. We divided the patients into two groups: (1) benign-related obstruction (n = 68) and (2) cancer-related obstruction (n = 31). We used logistic regression, KNN, and XGBOOST. We calculated the receiver operating characteristic curve and accuracy of the model. Results: Colon obstructions were more frequent in the cancer group (p = 0.005). Operative time, intestinal resection, and stoma were significantly more frequent in the cancer group. Major complications were at 41% for the cancer group vs. 20% in the benign group (p = 0.03). Uni- and multivariate analysis showed that the significant risk factors for major complications were cancer-related obstruction and CRP. The best model was KNN, with an accuracy of 0.82. Conclusions: Colonic obstruction is associated with tumor-related blockage. Malignant cancer and an increase in C-reactive protein (CRP) are significant risk factors for patients who have undergone emergency surgery due to major complications. KNN could improve the process of counseling and the perioperative management of patients with intestinal obstruction in emergency settings. [ABSTRACT FROM AUTHOR]

Intestinal obstruction is a common surgical emergency with high morbidity and mortality. Patients presenting with features of small bowel obstruction need urgent evaluation to avoid complications such as bowel gangrene, perforation, or peritonitis. Imaging is necessary in most cases of suspected bowel obstruction, to take an appropriate decision, for apt patient management. Among the common causes of small bowel obstruction, adhesions, external herniae, malignancies, and Crohn's disease top the chart. Imaging helps in determining the presence of obstruction, the severity of obstruction, transition point, cause of obstruction, and associated complications such as strangulation, bowel gangrene, and peritonitis. This review is based on the cases with unusual causes of bowel obstruction encountered during our routine practice and also on the extensive literature search through the standard textbooks and electronic databases. Through this review we want our readers to have sound knowledge of the imaging characteristics of the uncommon yet important causes of bowel obstruction. We have also revisited and structured a checklist to simplify the approach while reporting a suspected case of small bowel obstruction. Imaging plays a key role in the diagnosis of small bowel obstruction and in determining the cause and associated complications. Apart from the common causes of small bowel obstruction, we should also be aware of the uncommon causes of small bowel obstruction and their imaging characteristics to make an accurate diagnosis and for apt patient management. [ABSTRACT FROM AUTHOR]

Introduction: Small bowel obstruction (SBO) is a common cause of hospital admission leading to resource utilization. The majority of these patients require non-operative management (NOM) which can lead to increased length of stay (LOS), readmissions, resource utilization, and throughput delays. Early surgical consultation (SC) for SBO may improve efficiency and outcomes. Methods: We implemented an institution-wide intervention (INT) to encourage early SC (<1 day of diagnosis) for SBO patients in July 2022. A retrospective analysis was performed on all patients with SBO requiring NOM from January 2021 to June 2023, categorized into pre- and post-INT groups. The primary outcome was the number of SC's and secondary outcomes were early SC (<1 day of diagnosis), utilization of SBFT, LOS, 30-day readmission, and costs of admission. Results: A total of 670 patients were included, 438 in the pre-INT and 232 in the post-INT group. Overall, SBFT utilization was significantly higher in cases with SC (17.2% vs 41.4%, P < .001). Post-INT patients were more likely to receive SC (94.0% vs 83.3%, P < .001) and increased SBFT utilization (47.0% vs 33.6%, P = .001). Additionally, early SC improved significantly in the post-INT group (74.3% vs 65.7%, P = .03). There was no difference in LOS between groups (4.0 vs 3.8 days, P = .48). There was a trend toward decreased readmission rates in the INT group at 30 days (7.3% vs 11.0%, P = .13) and reduced direct costs in the INT group (US$/admission = 8467 vs 8708, P = .1). Conclusion: Hospital-wide interventions to increase early surgical involvement proved effective by improving early SC, increased SBFT utilization, and showed a trend towards decreased readmission rates and direct costs. [ABSTRACT FROM AUTHOR]

Small bowel obstruction (SBO) is one of the most frequent causes of general emergency surgery. The 30-day mortality rate post-surgery ranges widely from 2 to 30%, contingent upon the patient population, which renders risk assessment tools helpful. this study aimed to develop a 30-day point-scoring risk calculator designed for patients undergoing SBO surgery. Patients who underwent SBO surgery were identified in the ACS-NSQIP database from 2005 to 2021. Patients were randomly sampled into an experimental (2/3) and a validation (1/3) group. A weighted point scoring system was developed for the risk of 30-day mortality, utilizing multivariable regression on preoperative risk variables based on Sullivan's method. The risk scores underwent both internal and external validation. Furthermore, the efficacy of the risk score was evaluated in 30-day major surgical complications. A total of 93,517 patients were identified, with 63,521 and 29,996 assigned to the experimental and validation groups, respectively. The risk calculator is structured to assign points based on age (> 85 years, 4 points; 75–85 years, 3 points; 65–75 years, 2 points; 55–65 years, 1 point), disseminated cancer (2 points), American Society of Anesthesiology (ASA) score of 4 or 5 (1 point), preoperative sepsis (1 point), hypoalbuminemia (1 point), and fully dependent functional status (1 point). The risk calculator showed strong discrimination (c-statistic = 0.825, 95% CI 0.818–0.831) and good calibration (Brier score = 0.043) in the experimental group. The point scoring system was successfully translated from individual preoperative variables (c-statistic = 0.840, 95% CI 0.834–0.847) and was externally validated in ACS-NSQIP (c-statistic = 0.827, 95% = CI 0.834–0.847, Brier score = 0.043). The SBO risk score can effectively discriminate major surgical complications including major adverse cardiovascular events (c-statistic = 0.734), cardiac complications (c-statistic = 0.732), stroke (c-statistic = 0.725), pulmonary complications (c-statistic = 0.727), renal complications (c-statistic = 0.692), bleeding (c-statistic 0.674), sepsis (c-statistic = 0.670), with high predictive accuracy (all Brier scores < 0.1). This study developed and validated a concise yet robust 10-point risk scoring system for patients undergoing SBO surgery. It can be informative to determine treatment plans and to prepare for potential perioperative complications in patients undergoing SBO surgery. [ABSTRACT FROM AUTHOR]

Gallstone ileus is a relatively rare complication of cholelithiasis, and an uncommon cause of small bowel obstruction most commonly seen in elderly and debilitated people with associated comorbidities. Symptoms of gallstone ileus are insidious and may be vague while the delay in diagnosis results in a high mortality rate. Herein we report two cases of gallstone ileus in elderly patients with complex medical history who presented at the emergency department with abdominal pain and distension, vomiting and fluid/electrolyte disorders due to cholecysto-enteric fistula and bowel obstruction. [ABSTRACT FROM AUTHOR]

A 58-year-old female presented with abdominal pain, vomiting and constipation. Laboratory tests indicated elevated white blood cell count and C-reactive protein levels. Imaging via CT scan revealed a large cystic mass in the right ovary, abscesses and generalized small bowel distension, which initially raised suspicion of the existence of ovarian cancer with peritoneal carcinomatosis. Despite conservative management, the patient's condition did not improve, prompting a laparotomy. Intraoperative findings included generalized peritonitis, significant small bowel dilation due to inflammatory adhesions and a perforated dermoid ovarian cyst. The cyst was resected and a prophylactic ileostomy was installed. Histopathological examination confirmed the diagnosis of a benign dermoid ovarian cyst. This case illustrates the rare presentation of a perforated dermoid cyst mimicking peritoneal carcinomatosis and emphasizes the importance of considering such complications in the differential diagnosis of bowel obstruction and peritoneal disease. Early recognition and appropriate surgical intervention are crucial for optimal outcomes. [ABSTRACT FROM AUTHOR]

BACKGROUND: The optimal timing of surgical intervention for small bowel obstruction (SBO) remains debated. METHODS: All adults admitted for SBO were identified in the 2018-2019 National Inpatient Sample. Patients undergoing small bowel resection or lysis of adhesion after three days were considered part of the Delayed cohort. All others were classified as Early. Multivariable regressions were used to assess independent predictors of delayed surgical intervention as well as associations between delayed management and in-hospital mortality, major adverse events (MAE), perioperative complications, postoperative length of stay (LOS), hospitalization costs and non-home discharge. RESULTS: Among 28,440 patients who met study criteria, 52.0 % underwent delayed intervention. Black race (AOR 1.19, 95 % CI 1.03-1.36, ref.: White) and Medicare coverage (AOR 1.16, 95 % CI 1.01-1.33, ref.: private payer) were associated with increased odds of delayed surgical management. While delayed intervention was not significantly associated with death (AOR 1.27, 95 % CI 0.97-1.68), it was linked to greater odds of MAE (AOR 1.30, 95 % CI 1.16-1.45) and several perioperative complications. The Delayed cohort also faced an incremental increase in postoperative LOS (+1.29 days, 95 % CI 0.89-1.70) and hospitalization costs (+$11,000, 95 % CI 10,000-12,000). Moreover, delayed intervention was linked to increased odds of non-home discharge (AOR 1.64, 95 % CI 1.47-1.84). CONCLUSIONS: Delay in surgical management following SBO is linked to inferior clinical outcomes and increased resource use. Our findings highlight the need to ensure proper timing of surgery for SBO as well as efforts to standardize these practices across all demographics of patients.

Abstract Background Anaplastic large-cell lymphoma primarily involving the omentum is an extremely rare entity with variable clinical presentation. Owing to its rarity and nonspecific clinical manifestation, omental T-cell lymphoma is often diagnosed at a later stage, riddled with complications. While imaging modalities such as computed tomography scan can help a physician reach a diagnosis, cases that present with complications may require a multidisciplinary approach that combines surgical exploration along with consultation from Oncology. Case presentation We hereby report a rare case of a 66-year-old African American male patient who presented to the emergency department with complaints of acute gastrointestinal obstruction. A computed tomography scan of the abdomen and pelvis revealed evidence of an internal hernia and surgical exploration revealed a hemorrhagic and infarcted omentum. Biopsies along with immunophenotypic studies confirmed the diagnosis of anaplastic T-cell lymphoma of the omentum complicated by Massilia timonae infection. Conclusion The case highlights the significance of considering lymphoma, although rare, as a differential in a patient who presents with small bowel obstruction and the importance of investigating for malignancy for early diagnosis and treatment of primary omental lymphomas, before complications develop.

We report a case of small bowel obstruction (SBO) caused by internal hernia from Meckel's diverticulum (MD). Abdominal CT scan showed an abnormal dilated blind-ending structure in continuity with the distal ileum in the right lower quadrant, suggesting Meckel's diverticulum. MPR images revealed a “double beak-sign” at the point of MD and a collapsed closed loop with mesenteric vessels converging to the diverticulum. Since the patient has no prior history of abdominal surgery, the diagnosis of internal hernia caused by Meckel's diverticulum was considered. On laparoscopic exploration, an abnormal orifice for internal hernia created by adhesion from the tip of Meckel's diverticulum to the adjacent mesentery was revealed, confirming the diagnosis. The patient was discharged after 7 days without postoperative complications. MD-associated internal hernia is a rare cause of small bowel obstruction and should be considered to avoid delay in treatment. Multidetector Computed Tomography (MDCT) is the first-line imaging modality of choice and may offer some suggestive imaging features to make an accurate preoperative diagnosis.

Primary enterolith is also known as a gastrointestinal concretion. In this condition, stone formation occurs in small bowel. Enterolithiasis is an uncommon pathological condition in humans. Its prevalence is 0.3-10%. We present an uncomplicated case of primary enterolith in a small bowel. A 50-years old female patient came with abdominal pain due to small bowel obstruction and intestinal stricture on clinico radiological correlation. After clinical examination and investigations, she was taken up for exploratory laparotomy wherein segment of ileum was resected and sent for histopathology examination.

Background: A grading system was developed for computerized tomography (CT) scans evaluating patients with suspected small bowel obstruction (SBO). We hypothesized that patients with a higher grade of suspected SBO on CT scan would be more likely to require surgical intervention. Methods: Retrospective chart review of patients who presented to the Emergency Room (ER) who had a CT of the abdomen and pelvis for suspected SBO. Patients were divided into 5 groups: Grade 1 (SBO unlikely), Grade 2 (probable partial or early SBO), Grade 3 (probable high grade SBO), Grade 4 (SBO with changes concerning for ischemia) and Not Graded. Results: The CT scans of 655 patients were graded. Of the 22 patients with a grade 1 SBO, only 1 went for surgery (4.5 %). For grade 2 patients, 23 out of 299 had an operation (7.7 %), for grade 3 it was 84 out of 299 (28.1 %) and for grade 4 SBO, 25 out of 35 patients (71.4 %) had surgery. The p value is

Background: Black race has been associated with increased resource utilization after operation for small bowel obstruction (SBO). While prior literature has similarly demonstrated differences between urban and rural institutions, limited work has defined the impact of rurality on resource utilization by race. Methods: The 2016–2020 National Inpatient Sample was used to identify adults undergoing adhesiolysis after non-elective admission for SBO. The primary endpoint was hospitalization costs. Additional outcomes included surgical delay (≥ hospital day 3), length of stay (LOS), and nonhome discharge. Regression models were developed to identify the impact of Black race and rurality on the outcomes of interest with an interaction term to examine the incremental association of Black race on rurality. Results: Of an estimated 132,390 patients, 11.4 % were treated at an annual average of 377 rural hospitals (18.5 % of institutions). After adjustment, rural hospitals had higher costs (β + $4900, 95 % Confidence Interval [CI] [4200, 5700]), compared to others. However, rurality was associated with reduced odds of surgical delay (Adjusted Odds Ratio [AOR] 0. 76, CI[0.69, 0.85]), decreased LOS (β −1.66 days, CI[−1.99, −1.36]), and nonhome discharge (AOR 0.78, CI[0.70, 0.87]). While White patients experienced significant cost reductions at urban centers ($26,100 [25,800-26,300] vs $31,000 [30,300-31,700]), this was not noted for Black patients ($30,100 [29,400-30,700] vs $30,800 [29,300-32,400]). Conclusions: We found that Black patients do not benefit from the same cost protection afforded by urban settings as White patients after operative SBO admission. Future work should focus on setting-specific interventions to address drivers of disparities within each community.

Abstract Background Abdominal cocoon is a very uncommon yet dangerous cause of intestinal obstruction. Case presentation We present a case of a 62-year-old Asian male patient with a history of depression who exhibited an idiopathic abdominal cocoon complicated by necrosis. Upon laparotomy investigation, nearly the entire small intestine was enveloped in a thick membrane resembling a cocoon, and it was discovered that he lacked a greater omentum. The patient recovered well and was discharged on an oral diet on the 20th day following surgery. During the 3-month follow-up, the patient was asymptomatic, even gaining 10 kg in weight, and noted that his depression had improved. Conclusions Small bowel obstruction presents with nonspecific symptoms, posing challenges in differential diagnosis. Contrast-enhanced computed tomography is recommended since it facilitates precise preoperative assessment, optimizing surgical planning and reducing postoperative complications. Remarkably, cessation of antidepressant medication post-surgery hints at a potential correlation between omental deficit, gut microbiota alterations, and depressive symptoms.

Paraduodenal hernias are a rare but important clinical entity, as their presentation can be life-threatening if not properly diagnosed and managed appropriately. Additionally, this entity is defined by a unique and complex congenital anatomical abnormality which dictates a specific treatment algorithm. Here we present the cases of three patients from our clinical experience who all presented with either acute or chronic small bowel obstructions secondary to paraduodenal hernias. Two were left-sided paraduoenal hernias and one was right-sided. All three patients were successfully managed with surgical intervention. An appreciation of paraduodenal hernias, including the defining anatomy and methods of surgical management, is important for the general surgeon. [ABSTRACT FROM AUTHOR]

Ileo-ileal intussusception, an infrequent cause of small bowel obstruction in adults, can be initiated by inflammatory fibroid polyps. These are uncommon, benign submucosal lesions of the gastrointestinal tract. This case report explores an adult patient with inflammatory fibroid polyps-induced ileo-ileal intussusception. [ABSTRACT FROM AUTHOR]

Small bowel obstruction (SBO) is a common condition encountered by radiologists in the evaluation of patients with abdominal pain, and is an important diagnosis to be comfortable with given substantial associated morbidity and mortality. In this review, we summarize an imaging approach to evaluating patients with suspected SBO, discuss the role of certain imaging modalities such as radiography and small bowel follow through, CT, and MRI, as well as review some common and also less common causes of SBO such as internal hernia. We will also discuss tailoring the imaging approach to address specific clinical questions and special patient populations such as imaging the pregnant patient with suspected SBO, and the inflammatory bowel disease patient. [ABSTRACT FROM AUTHOR]

Background: Abdominal cocoon is a very uncommon yet dangerous cause of intestinal obstruction. Case presentation: We present a case of a 62-year-old Asian male patient with a history of depression who exhibited an idiopathic abdominal cocoon complicated by necrosis. Upon laparotomy investigation, nearly the entire small intestine was enveloped in a thick membrane resembling a cocoon, and it was discovered that he lacked a greater omentum. The patient recovered well and was discharged on an oral diet on the 20th day following surgery. During the 3-month follow-up, the patient was asymptomatic, even gaining 10 kg in weight, and noted that his depression had improved. Conclusions: Small bowel obstruction presents with nonspecific symptoms, posing challenges in differential diagnosis. Contrast-enhanced computed tomography is recommended since it facilitates precise preoperative assessment, optimizing surgical planning and reducing postoperative complications. Remarkably, cessation of antidepressant medication post-surgery hints at a potential correlation between omental deficit, gut microbiota alterations, and depressive symptoms. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic bariatric surgery relies on technically challenging intracorporeal suturing for critical parts of the operation. Barbed sutures have been developed to provide an alternative to suturing for certain manoeuvres within a procedure. Barbed sutures theoretically negate the need for knot tying and allow for continuous application of tension; however the barbs can unintentionally adhere to surrounding tissues. We describe a case series of three patients who developed V‐Loc™ (barbed) suture related small bowel obstruction (SBO) to promote awareness of this unusual but preventable complication. Methods: Medical records of patients diagnosed with V‐Loc™ related SBO between 2018 and 2021 at a tertiary centre were reviewed. Data regarding presentation, diagnosis, management and outcomes were obtained. Results: Three patients were identified where V‐Loc™ sutures were aetiologically related to early post‐surgical small bowel obstruction secondary to small bowel adherence to barbed suture tail or adhesions between barbed suture tail and unintended viscera. In these cases, non‐absorbable V‐Loc™ sutures were used to close the small bowel mesenteric defect at Roux‐en‐Y gastric bypass surgery. All patients required adhesiolysis at re‐look laparoscopy prior to resolution. All patients were discharged home well after relook laparoscopy. Conclusion: Overly long or exposed V‐Loc™ suture tails can result in SBO following laparoscopic bariatric surgery. Cutting the suture tail as close as practical to the final throw of the suture and/or covering exposed suture ends may prevent this complication. [ABSTRACT FROM AUTHOR]

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Richter's hernia is a rare but serious surgical emergency involving the entrapment or strangulation of part of the bowel's circumference in the hernial orifice, often without causing complete luminal obstruction. This case report describes a man in his 70s presenting with a 3-day history of abdominal pain and vomiting, despite normal bowel movements. Blood results revealed raised inflammatory markers, and computed tomography imaging suggested small bowel obstruction due to an incarcerated left inguinal hernia. Emergency surgery confirmed a Richter's hernia with a strangulated but viable bowel loop. Early surgical intervention led to a positive outcome. This case underscores the importance of high suspicion, early referral, and timely imaging in managing Richter's hernia to prevent severe complications, such as gangrene and perforation. Despite the absence of obstructive symptoms, early surgical intervention is critical when there is clinical concern regarding strangulation. [ABSTRACT FROM AUTHOR]

Internal hernia through a defect in the broad ligament of the uterus is a very rare condition. We review a case of a 55-years-old female with small bowel obstruction due to herniation of a small bowel loop through a defect in the broad ligament of the uterus on the right side. Computed tomography of the abdomen reported finding of small bowel obstruction, a small bowel loop seen between the uterus and urinary bladder in the right lower pelvis with surrounding inflammatory changes, possibility of an Internal hernia through a defect in the broad ligament. This was managed laparoscopically. [ABSTRACT FROM AUTHOR]

Extramedullary hematopoiesis (EMH) is a rare disorder, defined as the appearance of hematopoietic elements outside the bone marrow or peripheral blood due to ineffective erythropoiesis or inadequate bone marrow activity in a variety of hematological diseases. EMH often manifests as hemopoietic masses in a variety of normal and abnormal bodily sites. We present a 21-year-old man with a medical history of beta thalassemia since he was nine months old. The primary clinical symptom was mild abdominal pain. In this case, we describe a rare instance of small bowel obstruction due to EMH and portal hypertension. Surgery solved the clinical problems, and the patient was discharged home.

BackgroundSmall bowel obstruction (SBO) is common and its management has evolved in recent years.Study designThe literature describing adhesive small bowel obstruction (aSBO) treatment was reviewed, and a formal systematic review was performed to identify publications reporting results of aSBO treatment without NGTs.ResultsThe annual rate of hospital admission for SBO in the US has increased, with 340,100 admissions in 2019 alone. SBO is usually treated with bowel rest, intravenous hydration and NGT placement. In recent years, water soluble contrast (WSC) has been used as a cathartic to simulate bowel function and may reduce hospital length of stay (HLOS) by 1.95 days (95%CI 0.56-3.3). There were 3 articles of the initial 1650 screened that reported outcomes of SBO treatment without NGTs. These articles included 759 patients, of whom 272 (36%) with aSBO were managed successfully without NGTs. When comparing outcomes to patients who did receive NGT decompression, there were no significant differences in operative rates (28.6% v 16.5%, risk ratio 1.34, 95% CI 1.0, 1.8). Mortality and rates of bowel resection were also not affected by NGT decompression (risk ratio 1.98, 95% CI 0.43, 9.10 and risk ratio 1.56, 95% CI 0.92, 2.65, respectively).ConclusionSBO is a common disease process with increasing annual incidence. Use of WSC stimulates the bowel and may reduce HLOS. Modern aSBO treatment protocols should include NGT decompression with consideration of WSC administration. Selection of patients for treatment without NGT decompression requires further investigation.

Abstract Background Small bowel obstruction can occur during pregnancy, which, if missed, can lead to dire consequences for both the mother and foetus. Management of this condition usually requires surgical intervention. However, only a small number of patients are treated conservatively. Objective The objective was to review the literature to determine the feasibility of conservative management for small bowel obstruction. Methods A systematic search of the PubMed and Embase databases was performed using the keywords [small bowel obstruction AND pregnancy]. All original articles were then reviewed and included in this review if deemed suitable. Conclusion Conservative management of small bowel obstruction in pregnant women is feasible if the patient is clinically stable and after ruling out bowel ischaemia and closed-loop obstruction.

Small bowel internal hernias (IHs), a rare cause of small bowel occlusion (SBO) and small bowel strangulation, while more commonly seen in young adults, can also affect elderly patients and pose a significant diagnostic challenge due to their nonspecific symptoms. In most cases, laparotomy was used to diagnose IHs. However, multidetector computed tomography (MDCT) is usually the best imaging tool to use in the emergency setting for the diagnosis of IHs. An 83-year-old man was admitted to emergency with acute abdominal pain and a coffee-ground vomitus. The abdominal MDCT showed a clustered-like appearance of proximal jejunal loops at the level of the Treitz ligament with the absence of transit of the medium water-soluble iodine oral contrast agent (Gastrografin). Mesenteric edema was also present with initial suffering of the intestinal wall. A left paraduodenal hernia (LPDH) with strangulation was suspected following the radiological report. The emergency laparotomy revealed about 20 cm of proximal jejunal loops herniated through a 3 cm wide hernia orifice (HO) along the Treitz ligament, at the level of Landzert fossa, located in the confluence of the descending mesocolon, posterior to the inferior mesenteric vein (IMV) and confirming the LPDH. The patient was discharged in good condition some days later. IHs do not have sufficient coverage in literature, especially in cases regarding elderly patients, however, they can be a cause of SBO in people older than 80 years of age. Radiologists and surgeons should be aware of the anatomical aspects of the IHs.

OBJECTIVE: To determine the diagnostic accuracy of computed tomography (CT) scan in small bowel obstruction, (SBO), utilizing operative findings as the gold standard. METHODS: This descriptive cross-sectional study was conducted at Dr. Ruth K.M. Pfau Civil Hospital Karachi, Pakistan from September 2019 to August 2020. A comprehensive assessment, including plain and contrast-enhanced CT scans of the abdomen, was performed on 267 patients with clinically suspected acute SBO. Operative findings were compared with CT results to determine diagnostic accuracy. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy were evaluated, considering operative findings as the gold standard. RESULTS: Out of 267 patients, 162 (60.7%) were males, and 105 (39.3%) were females, with a mean age of 33.03±10.58 years. The mean duration of symptoms was 12.11±4.13 days. Overall sensitivity, specificity, PPV, NPV, and diagnostic accuracy of the CT scan were 92.2%, 87.8%, 87.4%, 92.4%, and 89.9%, respectively. Common CT findings included dilated small bowel loops (128 cases, 100%), the point of transition (105 cases, 82%), and bowel wall thickening (71 cases, 55.5%). Post-operative analysis revealed 118 out of 128 confirmed cases and 17 additional cases initially missed by CT. Tuberculosis emerged as the leading histopathological cause (25.9%), followed by obstructed/strangulated hernias (22.2%) and adhesions (17.7%). CONCLUSION: This study emphasizes the superior diagnostic precision of CT scans in determining the level and cause of SBO, reflecting a high sensitivity (92.2%) and specificity (87.8%). Common CT findings, including dilated bowel loops, contribute to precise identification, guiding effective clinical management.

Background: Small bowel obstruction (SBO) is a complication of bariatric surgery. However, outcomes of surgical intervention for SBO among patients with prior bariatric surgery remain ill-defined. We used a nationally representative cohort to characterize the outcomes of the SBO management approach in patients with a prior bariatric operation. Methods: All adult hospitalizations for SBO were tabulated from the 2018–2020 National Readmissions Database. Patients with a prior history of bariatric surgery comprised the Bariatric cohort (others: Non-Bariatric). Multivariable models were subsequently developed to evaluate the association of prior bariatric surgery with outcomes of interest. Results: Of an estimated 299,983 hospitalizations for SBO, 15,788 (5.3 %) had a history of prior bariatric surgery. Compared to Non-Bariatric, Bariatric patients were younger (54 [46–62] vs 57 [47–64] years, P

Gallstone ileus, a rare complication of cholelithiasis, presents significant morbidity and mortality challenges, with no established consensus on optimal management. This study aimed to highlight the complexities surrounding its occurrence and emphasize the need for tailored therapeutic strategies. An 88-year-old female, with a history of type 2 diabetes mellitus presented with diffuse abdominal pain and vomiting. Clinical evaluation revealed signs of small-bowel obstruction. Radiological assessments, including Computed Tomography CT) scans, confirmed biliary ileus, showcasing a sizable gallstone causing subacute obstruction. Emergency surgery involving enterolithotomy was performed, successfully addressing the immediate concerns. Postoperative follow-up demonstrated a one-year asymptomatic period, emphasizing the effectiveness of the chosen intervention. Gallstone ileus typically follows acute cholecystitis, leading to gallstone erosion and fistula formation commonly in the duodenum. Diagnosis is challenging because of nonspecific symptoms, necessitating a high index of suspicion. Computed tomography (CT) plays a pivotal role in accurate and rapid diagnoses. This study delves into the intricate details of gallstone ileus presentation, complications, and the debate surrounding optimal surgical management, acknowledging the effectiveness of the two-stage procedure and emerging laparoscopic approaches. This case provides valuable insights into the intricate facets of gallstone ileus and emphasizes the need for individualized treatment strategies. Successful management, as demonstrated in our case, underscores the importance of considering patient-specific factors when choosing between the surgical approaches. This study supports recent reports advocating for laparoscopic interventions, encouraging further exploration of evolving therapeutic modalities for gallstone ileus.

Aim: Reporting of participant descriptors in studies of adhesive small bowel obstruction (ASBO) can help identify characteristics associated with favourable outcomes and allow comparison with other studies and real‐world clinical populations. The aim was to identify the pattern of participant descriptors reported in studies assessing interventions for ASBO. Method: This systematic review was registered with PROSPERO (CRD42021281031) and reported in line with the PRISMA checklist. Systematic searches of Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) were undertaken to identify studies assessing operative and non‐operative interventions for adults with ASBO. Studies were dual screened for inclusion. Descriptors were categorised into conceptual domains by the research team. Results: Searches identified 2648 studies, of which 73 were included. A total of 156 unique descriptors were identified. On average, studies reported 12 descriptors. The most frequently reported descriptors were sex, age, SBO aetiology, history of abdominal surgery, BMI and ASA classification. The highest number of descriptors in a single study was 34, compared to the lowest number of descriptors which was one. Pathway factors were the least frequently described domain. Overall, 37 descriptors were reported in just one study. Conclusion: There is a lack of consistency in participant descriptors reported in studies of SBO. Furthermore, a significant proportion of the descriptors were used infrequently. This makes it challenging to assess whether study participants are representative of the wider population. Further work is required to develop a Core Descriptor Set to standardise the reporting of patient characteristics and reduce heterogeneity between studies. [ABSTRACT FROM AUTHOR]

Biliary endoprostheses are widely used in the treatment of biliary lithiasis, malignant and benign strictures, and occasionally in long-lasting biliary fistulas. They can be placed endoscopically during endoscopic retrograde cholangiopancreatography and radiologically (percutaneous) when the endoscopic route is not feasible. Complications associated with the endoscopic placement of biliary endoprostheses are well described in the literature, with migration being the most common. Intestinal obstruction is a rare complication associated with the migration of these devices. There are no reports in the literature of this complication occurring after percutaneous placement. We present a case of a patient who arrived at the emergency department with ileal obstruction secondary to the migration and concurrent embedding of a covered stent placed radiologically to treat a biliary leak after surgery. The patient underwent diagnostic laparoscopic and ileal resection, revealing a lithiasic concretion at the tip of the stent, causing the small bowel obstruction. [ABSTRACT FROM AUTHOR]

Background: Small bowel obstruction can occur during pregnancy, which, if missed, can lead to dire consequences for both the mother and foetus. Management of this condition usually requires surgical intervention. However, only a small number of patients are treated conservatively. Objective: The objective was to review the literature to determine the feasibility of conservative management for small bowel obstruction. Methods: A systematic search of the PubMed and Embase databases was performed using the keywords [small bowel obstruction AND pregnancy]. All original articles were then reviewed and included in this review if deemed suitable. Conclusion: Conservative management of small bowel obstruction in pregnant women is feasible if the patient is clinically stable and after ruling out bowel ischaemia and closed-loop obstruction. [ABSTRACT FROM AUTHOR]

A 74-year-old man visited a nearby hospital because of vomiting and abdominal pain. An abdominal CT scan revealed a tumor measuring 35mm in the terminal ileum, accompanied by calcification, as well as dilation of the proximal small bowel. Four years earlier, a similar tumor was incidentally pointed out, but no further investigation was conducted at that time. Although the size of the tumor had not increased since the previous examination, the patient had developed bowel obstruction, requiring surgical intervention after improvement of bowel distension. Since the possibility of malignancy could not be ruled out, a laparoscopic ileocecal resection was performed, including lymphadenectomy of the surrounding small bowel mesentery. Macroscopic examination of the resected specimen showed a yellowish, well-circumscribed lesion with calcification inside. The histopathological examination revealed a nodular lesion measuring 40×35×32 mm, primarily involving the muscularis propria in the terminal ileum. The tumor was positive for desmin and α-SMA, while c-kit was negative by immunohistochemical staining and leiomyoma was diagnosed. The patient was discharged on the 7th postoperative day. At the one-year follow-up, no recurrence of the leiomyoma was observed. [ABSTRACT FROM AUTHOR]

Purpose: Small bowel obstruction (SBO) after bariatric surgery is an uncommon but important complication. We sought to characterize bariatric surgery patients who developed SBO, to compare 30-day complications, and to determine the influence of patient and procedure factors on the development of SBO. Methods and Materials: All data was extracted from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database using the 2020 operative year. Multivariable logistic regression modelling was used to determine the influence of patient and operative factors on the development of SBO. Results: Of a total of 142 111 patients, 408 (0.3%) were identified as having developed an SBO. SBO patients were older (45.7 ± 11.5 vs. 43.5 ± 11.9 years; p = 0.0002), of reduced BMI (43.6 ± 6.8 vs. 45.1 ± 7.7; p = 0.0001), and more likely to be of female sex (92.2% vs. 81.1%; p < 0.0001). At 30 days post-operation, serious complications were increased in SBO patients. Roux-en-Y gastric bypass (RYGB) was the largest independent predicator of the development of SBO (OR 11.91; 95% CI 8.92–15.90; p < 0.0001). With regard to patient factors, COPD (OR 2.60; 95% CI 1.54–4.38; p < 0.0001) and prior DVT (OR 2.37; 95% CI 1.49–3.77; p < 0.0001) were found to be independently predictive of the development of SBO. Additionally having a lower BMI and being of female sex were found to be independently predictive. Conclusion: SBO occurred in approximately 0.3% of MBSAQIP cases. SBO is associated with serious outcome measures and patients of female sex and reduced index BMI, and those undergoing RYGB may be at an increased risk. [ABSTRACT FROM AUTHOR]

The utilization rates of laparoscopic gastric banding (LAGB) declined worldwide from 42.3% in 2008 to 1.8% in 2018. Rates of complications requiring removal may reach 40–50% in the medium to long term. Bowel obstruction is a rare but severe complication that occurs after LAGB. A comprehensive literature search in PubMed was carried out to identify all available case reports of intestinal obstruction after gastric banding. The search terms were as follows: "intestinal obstruction", "small bowel obstruction", "gastric band", "gastric banding", "gastric band complications", and "laparoscopic gastric band obstruction". The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) flowchart was used. Forty-three case reports were included in our review. Laparotomy was necessary in 18/43 (41%) of patients. Vomit was not always reported, while abdominal pain was constantly present. A CT scan was the preferred diagnostic tool. The main causes of occlusion were found to be the erosion of the gastrointestinal tract or internal hernia due to a loose tube loop. Forty-six percent of cases occurred within 5 years from insertion. Even if rare, small bowel obstruction after LAGB requires surgical intervention often with an open approach. The absence of vomit masks symptoms, but an obstruction must be always suspected in the case of severe colicky abdominal pain. A CT scan is recommended for making diagnoses. [ABSTRACT FROM AUTHOR]

Trocar site hernia is a rare, serious operation-related complication after robotic gynecologic surgery. Here, we present two 8-mm port-site hernia cases after three-port robotic myomectomy with a review of reported previous cases. In the first case, small bowel obstruction was found postoperatively due to herniation at the left mid-axillary line 8-mm trocar site. Small bowel herniation through the same site as the first case was found in the second case. Emergency exploration was performed in both cases by extending the left trocar site. There was no sign of bowel ischemia, and successful bowel reduction and hernia repair were done. Unlike previously reported cases, these cases occurred in a normal body mass index (BMI) patient (first case 20.28 kg/m2, second case BMI 24.80 kg/m2) and were pelvic drain insertion sites. These sites were the weak points of the abdominal muscle coverage. Therefore, the closure of 8-mm trocar sites should be considered. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to investigate whether the incidence, patterns, and surgical outcomes of small bowel obstruction (SBO) have changed in the era of minimally invasive surgery (MIS) for primary colorectal cancer (CRC). Methods: Consecutive patients who underwent laparotomy for SBO were divided into MIS and traditional open surgery (TOS) groups based on the previous colorectal cancer operation technique used. The MIS group was selected from 1544 consecutive patients who underwent MIS as a treatment for primary CRCs between 2014 and 2022, while the TOS group was selected from 1604 consecutive patients who underwent TOS as a treatment for primary CRCs between 2004 and 2013. The demographics, clinicopathological features, and surgical outcomes were compared between the two groups. Results: The SBO incidence in patients who underwent MIS for primary CRC was significantly lower than that in patients who underwent TOS (4.4%, n=68/1544 vs. 9.7%, n=156/1604, P<0.0001). Compared with the TOS group, the MIS group had significantly different (P<0.0001) SBO patterns: adhesion (48.5 vs. 91.7%), internal herniation (23.5 vs. 2.6%), external herniation (11.8 vs. 1.9%), twisted bowel limbs (4.4 vs. 0.6%), ileal volvulus with pelvic floor adhesion (5.9 vs. 1.9%), and nonspecific external compression (5.9 vs. 1.3%). A subset analysis of patients with adhesive SBO (ASBO) showed that the MIS group tended to (P <0.0001) have bands or simple adhesions (75.8%), whereas the TOS group predominantly had matted-type adhesions (59.4%). Furthermore, SBO in the MIS group had an acute (<3 months) or early (3-12 months) onset (64.7%), while that in the TOS group (P <0.0001) had an intermediate or a late onset. When the surgical outcomes of SBO were evaluated, the TOS group had significantly more (P< 0.0001) blood loss and longer operation time; however, no significant difference was observed in the surgical morbidity/mortality (Clavien--Dindo classification ≥3, 11.8 vs. 14.1%, P=0.6367), hospitalization, and readmission rates between the two groups. Postoperative follow-up showed that the estimated 3-year (11.37 vs. 18.8%) and 6-year (25.54 vs. 67.4%) recurrence rates of SBO were significantly lower (P=0.016) in the MIS group than in the TOS group. Conclusions: The wide adoption of MIS to treat primary CRC has led to a lower incidence, altered patterns, and reduced recurrence rates of SBO. Awareness of this new trend will help develop surgical techniques to prevent incomplete restoration of anatomical defects and bowel malalignments specifically associated with MIS for CRC, as well as facilitate timely and appropriate management of SBO complications whenever they occur. [ABSTRACT FROM AUTHOR]