Elective laparoscopy for small bowel obstruction

We performed elective laparoscopic adhesiolysis in 21 patients with small bowel obstruction. The procedure was completely laparoscopic or laparoscopy assisted in 17 patients, but 4 patients required full laparotomy due to internal hernia in 2, perforation of the small bowel associated with dense adhesions in 1, and carcinoma of the cecum in 1. In patients with a laparoscopic or laparoscopy-assisted procedure, the mean operating time, mean time until the return of bowel function, and mean postoperative stay were 94 minutes, 3.3 days, and 9.9 days, respectively. During follow-up for 14 to 44 months, 3 patients developed recurrent obstruction, 1 patient suffered from catheter-induced thrombosis, and 1 patient died from lung cancer. Elective laparoscopy can be performed safely and effectively in selected patients with intermittent small bowel obstruction.     

Feasibility of laparoscopy for small bowel obstruction

Background  

Adherential pathology is the most common cause of small bowel obstruction. Laparoscopy in small bowel obstruction does not have a clear role yet; surely it doesn't always represent only a therapeutic act, but it is always a diagnostic act, which doesn't interfere with abdominal wall integrity.     

The role of video-assisted laparoscopy in management of patients with small bowel injuries in abdominal trauma

Background  Patients with small bowel injuries (SBI) in abdominal trauma have no clear clinical or radiological signs on initial examination. This leads to delay in appropriate surgical interventions with consequent high morbidity and mortality. In this paper we demonstrate the role of video-assisted laparoscopy (VAL) in management of such patients. Methods and materials  819 patients with SBI were evaluated retrospectively between 1994 and 2003. The mechanism of the trauma was blunt in 146 (17.8%) patients and stab wounds in 640; routine investigations and VAL were used for triage of the subjects. All the victims underwent laparotomy or video-assisted laparoscopy. Demographic information, incidence of organs injuries, types of surgery, complications, associated injuries, and hospital mortality were analyzed. Results  Diagnostic video laparoscopy was sufficient for 518 (63.2%) patients. Small bowel repair was performed in 332 (40.6%) patients, clipping of mesenteric blood vessels in 27 (3.4%) patients, and coagulation and ligation of omental blood vessels in 48 (5.9%) patients. Ninety-seven (11.8%) patients with small bowel injury were associated with postoperative complications. There were 19 (2.3%) deaths associated with hemoperitoneum, severe head injury, and multiple ribs fracture. Generalized peritonitis was revealed in one case and focal abscesses between intestinal loops were identified in another one patient. Conclusion  The DVAL findings of visceral injuries give optimal approach for management of small bowel injuries in abdominal trauma.     

Survey of opinions on operative management of adhesive small bowel obstruction: laparoscopy versus laparotomy in the state of Connecticut

Background  

This study sought to know the opinions of general surgeons registered in the state of Connecticut about their use of laparoscopic lysis of adhesions (LLA) to manage adhesive small bowel obstruction (SBO) compared with open lysis of adhesions (OLA) in terms of safety, contraindications, and outcomes.     

Elective laparoscopy in diagnosis and treatment of recurrent small bowel obstruction

BACKGROUND: To evaluate the feasibility, efficacy, and safety of laparoscopy in diagnosis and treatment of recurrent small bowel obstruction. METHODS: Retrospective analysis of 253 patients who underwent therapeutic laparoscopy for recurrent small bowel obstruction from June 1996 to May 2005 was carried out. Patients with acute small bowel obstruction, bowel obstruction due to tumor, and obstructed inguinal hernias were excluded from analysis. RESULTS: Laparoscopy diagnosed cause of obstruction in all except 3 (1.18%) patients. The etiology included adhesions (38%), incarcerated ventral incisional hernias (32%), Meckel diverticulum (7%), stricture (14%), volvulus (3%), intussusception (4%). One hundred sixty nine patients were managed totally laparoscopically with adhesiolysis. Therapeutic bowel intervention other than adhesiolysis was required in 84 patients, of which 33 procedures were performed totally laparoscopically and remaining 51 procedures were completed with laparoscopically guided target incision. Five patients required conversion to open celiotomy. Iatrogenic enterotomies occurred in 3 patients and small bowel perforation during manipulation occurred in 1 patient. Postoperative procedure-related complications were seen in 44 patients. There was one mortality due to postoperative arrhythmia and cardiac failure. CONCLUSIONS: Laparoscopic diagnosis and treatment of recurrent small bowel obstruction is feasible, safe, and can be performed electively in selected cases.     

腹腔镜诊治急性小肠梗阻的应用体会

目的:探讨腹腔镜技术诊治急性小肠梗阻的应用价值。方法:回顾分析2010年8月至2013年10月于全麻下为55例急性小肠梗阻患者行腹腔镜探查的临床资料。结果:55例患者均得到确诊,其中2例小肠恶性间质瘤、2例小肠恶性淋巴瘤患者,因肿瘤直径大于5.0 cm且肿瘤破裂,中转开腹;余51例均完成腹腔镜手术。术后1例闭孔疝患者(84岁)因出现房颤、急性心衰家属放弃治疗自动出院,余均无手术死亡及相关并发症发生。结论:腹腔镜探查术可明确急性小肠梗阻的原因,术中具有放大术野的优势,可进行适当地粘连分离、精细操作,具有住院时间短、并发症少、手术时间短、减少腹腔粘连形成等优势,治疗大多数急性小肠梗阻是安全、有效的。     

Outcomes of small bowel obstruction in patients with previous gynecologic malignancies

BackgroundFeatures predictive of malignant small bowel obstructions among patients with previous gynecologic malignancies remain undetermined.MethodsPredictors of malignancy and mortality among patients with gynecologic malignancies and bowel obstructions were identified through a retrospective review of records.ResultsMalignancy was noted among 69.8% of 189 patients included in the analysis. Advanced-stage cancer (P = .006, odds ratio [OR] = 6.62), ovarian malignancy (P = .001, OR = 25.64), and early-onset obstruction (P = .014) predicted malignant etiology, whereas chemotherapy (P < .001, OR = .02) or radiation therapy (P = .027, OR = .09) predicted benign obstruction. The average survival was 9 months versus 49 months for malignant and benign obstructions, respectively. Ovarian cancer (P = .009, hazard ratio [HR] = 4.45), anemia (P = .001, HR = 1.11), and renal dysfunction (P < .001, HR 1.81) impaired survival.ConclusionsPalliative care should be considered for patients with advanced-stage cancer, ovarian malignancy, and a shorter time interval between cancer diagnosis and bowel obstruction, especially in the setting of anemia and renal dysfunction.     

Is laparotomy for small bowel obstruction justified in patients with previously treated malignancy?

We report 53 patients who developed small bowel obstruction some time after the treatment of a primary malignant tumour. Previous treatment of the primary tumour in these patients had been by abdominal surgery (22 patients) or pelvic radiotherapy (20 patients) but 11 of the patients had not received previous abdominal surgery or radiotherapy. All the patients had a laparotomy in an attempt to relieve the obstruction. Seventeen patients had a cause for the obstruction other than secondary malignancy. This was noted particularly when the patients had had pelvic radiotherapy, when radiation change of the ileum causing obstruction was common. Thirty-six patients had obstruction due to secondary tumour and it was found possible to overcome the obstruction in all but two of these. The operative mortality in the patients with secondary malignancy was 19 per cent, but 15 patients (42 per cent) survived for more than a year and the median survival was 11 months. It is concluded that a policy of aggressive surgical intervention is desirable in patients who develop small bowel obstruction after previous treatment for malignant disease.     

A case report of endometriosis presenting as an acute small bowel obstruction

IntroductionEndometriosis is a common and benign condition that causes significant morbidity to women of childbearing age. It uncommonly affects the gastrointestinal tract and rarely manifests as an acute small bowel obstruction.Presentation of caseA 46-year old female presented to the emergency department with signs and symptoms consistent with an acute small bowel obstruction. She had a paucity of background surgical history, having only had a laparoscopic cholecystectomy. Her CT demonstrated small bowel obstruction with a transition point in the distal ileum. Given the site of obstruction was remote from previous surgery, a high index of suspicion was maintained and early laparoscopy performed the same day. Operative findings were consistent with an endometrial stricture of the distal ileum and a formal resection was performed.DiscussionEndometriosis that affects the gastrointestinal tract often presents with non-specific symptoms. This is a rare case of an acute small bowel obstruction as the index symptom of endometriosis in a peri-menopausal patient. This is the first case in the literature to describe same day laparoscopy and small bowel resection of such a case and a prolonged preoperative period and misdiagnoses previously described were avoided due to clinical suspicion.ConclusionEndometriosis as a differential should be considered with a high index of suspicion in pre-menopausal women, particularly in patients with negligible previous surgical history. There should be a low threshold for early laparoscopy and resection of affected bowel in these patients.     

Long-term prognosis after operation for adhesive small bowel obstruction

AIM OF STUDY: The objective of this study was to determine the pattern of recurrence after one or more episodes of adhesive small bowel obstruction (ASBO) during a follow-up period of up to 40 years. Furthermore, we wanted to analyze possible factors with an influence on the recurrence rate and to study the magnitude of "everyday" abdominal pain among these patients. PATIENTS AND METHODS: Hospital records of 500 patients operated on for adhesive obstruction at Haukeland University Hospital from 1961 to 1995 were studied. The patients were followed until death, loss to follow-up, or end of study (February 2002), with a median follow-up of 10 years and a maximum follow-up time of 40 years. A questionnaire was sent to all living patients to obtain information on recurrences and abdominal complaints. RESULTS: The cumulative recurrence rate for patients operated once for ASBO was 18% after 10 years and 29% at 30 years. For patients admitted several times for ASBO, the relative risk of recurrent ASBO increased with increasing number of prior ASBO episodes. The cumulative recurrence rate reached 81% for patients with 4 or more ASBO admissions. Other factors influencing the recurrence rate were the method of treatment of the last previous ASBO episode (conservative versus surgical) and the number of abdominal operations prior to the initial ASBO operation. Compared to results from the general populations, more ASBO patients suffer from abdominal pain at home. Women and patients having matted adhesions have significantly more complaints about abdominal pain than men and patients with band adhesions. CONCLUSION: The risk of recurrence increased with increasing number of ASBO episodes. Most recurrent ASBO episodes occur within 5 years after the previous one, but a considerable risk is still present 10 to 20 years after an ASBO episode. Surgical treatment decreased the risk of future admissions for ASBO, but the risk of new surgically treated ASBO episodes was the same regardless of the method of treatment. People treated for ASBO seem to be more prone to experiencing abdominal pain than the normal population, especially those having matted adhesions.     

Ileal fecalomas causing small bowel obstruction: A case report

IntroductionFecaloma is an accumulation of feces that has formed a mass and has failed to be expelled spontaneously. Because fecal matter is harder and firmer in the left side of colon, and the diameter of the bowel is smaller compared to the right, fecalomas mostly form in recto-sigmoid area. Small bowel fecaloma formation is an extremely rare condition.Case presentationWe report a 49 years old man who presented with small bowel obstruction due to ileal fecalomas for whom enterotomy and removal of fecaloma was done with good outcome.DiscussionFecal matter can accumulate in the intestinal lumen to form a mass separate from other intestinal contents which eventually becomes fecaloma. Formation is usually related to chronic constipation, conditions causing intestinal motility disorder, or in psychiatric patients who could have ingested extraordinary substances. Fecaloma can present as abdominal mass, stercoral colitis, urinary retention or intestinal obstruction. Treatment options include conservative management with bowel rest, laxatives, endoscopic removal, laparotomy and removal via enterotomy.ConclusionFecaloma can be considered in patients who present with small bowel obstruction without any risk factors. Initial noninvasive management should be considered. Failed conservative treatment can be followed by laparotomy and fecaloma removal.     

Ovarian teratoma presenting as small bowel obstruction in an elderly lady-A case report

Teratomas of the ovary are of the mature or immature type. The mature variety is called dermoid cysts, which is the most frequent benign germ cell tumour of the ovary in the reproductive age group. They are usually asymptomatic until they reach a significant dimension.(1) Pressure effect, torsion and rupture of an ovarian cyst may present as an acute abdomen. A case is presented where an elderly lady presented with small bowel obstruction due to a very large, non-adherent to the intestine, dermoid cyst.