MyMedR

Fulltext Wandering spleen as a cause of acute abdomen: a surgical conundrum from acute appendicitis to splenic torsion and ischemic small bowel volvulus

Fatimah Najid, Sanjeev Sandrasecra, Mohd Zuki Asyraf, Chang Haur Lee, Nornazirah Azizan, Andee Dzulkarnaen Zakaria, et al.

Malaysian Journal of Medicine and Health Sciences, 2020;16(1):336-338.

MyJurnal

Wandering spleen is renowned as a surgical enigma due to its diverse presentations. Due to lack of its attaching ligaments which would usually place it at the left hypochondrium region, the spleen ‘wanders’ and may be located anywhere within the abdominal cavity. This condition has been associated with many complications such as splenic torsion, pancreatitis and portal hypertension. We report a case of a wandering spleen presenting as acute appen- dicitis in an 18-year-old young active sportsman. The patient developed post-operative ileus and later intestinal obstruction which necessitated exploratory laparatomy onto which the final diagnosis of splenic and small bowel infarct due to splenic torsion with small bowel volvulus was made. Splenectomy, small bowel resection and primary anastomosis were performed and the patient made a full recovery.

Matched MeSH terms: Intestinal Obstruction

Vesicolithotomy for acute intestinal obstruction

Mariappan P, Loong CW

J Urol, 2004 Mar;171(3):1233.

PMID: 14767310

Matched MeSH terms: Intestinal Obstruction/etiology*; Intestinal Obstruction/surgery*

Fulltext Two different surgical approaches for strangulated obturator hernias

Sze Li S, Kenneth Kher Ti V

Malays J Med Sci, 2012 Jan;19(1):69-72.

PMID: 22977378 MyJurnal

Obturator hernia is a rare condition that may present in an acute or subacute setting in correlation with the degree of small-bowel obstruction. Pre-operative diagnosis is difficult, as symptoms are often non-specific. A high index of suspicion should be maintained for emaciated elderly women with small-bowel obstruction without a previous abdominal operation and a positive Howship-Romberg sign. When diagnosis is in doubt, computed tomography scan of the abdomen and the pelvis (if available) or laparotomy should be performed immediately, as high mortality rate is related to the perforation of gangrenous bowels. We present 2 cases of strangulated obturator hernia, managed differently with both open and laparoscopic approaches. The diagnostic accuracy of computed tomography scan is highlighted followed by a brief literature review with an emphasis placed on surgical management.

Matched MeSH terms: Intestinal Obstruction

Three cases of Ascaris lumbricoides small bowel obstruction with volvulus

Roe TN, Lal K, Cawkell WA

Med J Malaya, 1968 Sep;23(1):78-9.

PMID: 4237564

Matched MeSH terms: Intestinal Obstruction/etiology*; Intestinal Obstruction/microbiology

Fulltext The surgical treatment of multiple small bowel strictures in Crohn's disease by combined resection and stricturoplasty

Kum CK, Sim EK, Ngoi SS, Goh P, Sinniah R

Med J Malaysia, 1992 Dec;47(4):323-7.

PMID: 1303488

Crohn's disease is extremely rare among Asians. Resection of strictures causing obstruction has traditionally been the accepted choice in surgical therapy. This may lead to problems such as iatrogenic short bowel syndrome and its sequelae. Stricturoplasty is an acceptable and safe alternative. We report a case where combined stricturoplasty and resection was performed safely and advocate its use.

Matched MeSH terms: Intestinal Obstruction/etiology; Intestinal Obstruction/pathology; Intestinal Obstruction/surgery*

Fulltext The girl with rapunzel syndrome

Norly, S., Noor Saadah, I., Ros'aini, P.

International Medical Journal Malaysia, 2015;14(1):99-101.

MyJurnal

Rapunzel syndrome is a syndrome whereby a gastric trichobezoar (hair ball) extends through the pylorus, in the form of a long tail, to cause gastric outlet obstruction. It was first described by Vaughan et al. in 1968. The syndrome is mostly seen in young females with psychiatric illness. Presentations can be non-specific especially in the early stages. If left untreated it may leads to severe complications, which may include gastric ulceration, intestinal obstruction, perforated viscus and obstructive jaundice. Treatment is essentially surgical and psychi- atric consultation is necessary to prevent relapses. We present the case of a 26-year-old mentally subnormal lady with gastric trichobezoar and provide a review of the literature.

Matched MeSH terms: Intestinal Obstruction

Fulltext The abdominal cocoon: a case report

Kyaw K

Singapore Med J, 1994 Dec;35(6):653-4.

PMID: 7761900

A 15-year-old Chinese girl, with abdominal cocoon, is reported. The literature (in English) concerning the condition was reviewed. Also, a possible cause is suggested and the various terms used for this condition are discussed.

Matched MeSH terms: Intestinal Obstruction/etiology*

The abdominal cocoon

Yip FW, Lee SH

Aust N Z J Surg, 1992 Aug;62(8):638-42.

PMID: 1642584

Since it was first described in 1978 the abdominal cocoon continues to be a rare cause of intestinal obstruction. So far this rare condition where the small intestine is encased in a fibrous membrane has been reported only in females. Diagnosis is usually made at laparotomy and the treatment of choice is lysis of adhesions. Proper recognition of this benign condition will result in the correct management of it and prevent unnecessary bowel resections. Five new cases including one male patient, together with a review of previous reports in the English literature, are presented.

Matched MeSH terms: Intestinal Obstruction/diagnosis; Intestinal Obstruction/etiology*; Intestinal Obstruction/pathology; Intestinal Obstruction/surgery

Tension enterothorax

Wong PS, Vendargon SJ

Asian Cardiovasc Thorac Ann, 2003 Dec;11(4):375.

PMID: 14681107

Matched MeSH terms: Intestinal Obstruction/etiology; Intestinal Obstruction/surgery

Surgical observations. Case of strangulated inguinal hernia -operation - cure

Smith GH

Lancet, 1841;36:117-121.

DOI: 10.1016/S0140-6736(02)37712-2

Matched MeSH terms: Intestinal Obstruction

Fulltext Small bowel obstruction secondary to obturator hernia: A pre-operative diagnosis at computed tomography

Marlina Tanty Ramli Hamid, Mohd Shukry Mohd Khalid, Kartini Rahmat

Journal of Clinical and Health Sciences, 2021;6(1):46-49.

MyJurnal

Obturator hernia is rare, but it must be considered in elderly patients who present with small
bowel obstruction. The diagnosis is challenging unless there is a high index of suspicion as
the presenting symptoms and signs are usually non-specific. Presence of positive HowshipRomberg sign is considered pathognomonic. Early diagnosis and rapid surgical intervention
will reduce the high morbidity and mortality associated with undiagnosed obturator hernia. We
report a case of a 93-year-old female patient who was admitted to our surgical department with
symptoms of intestinal obstruction of 3-days duration. Howship-Romberg sign was negative.
Computed tomography (CT) demonstrated the presence of left obturator hernia with proximal
small bowel obstruction and no sign of strangulation. The patient had emergency laparotomy
post-CT where the incarcerated bowel loop was released and the obstructed bowel was
decompressed without any complication. The hernial defect was close with a mesh and the
patient had an uneventful recovery post-surgery. In this case, we highlight that diagnosis of
obturator hernia must always be considered in elderly patients who present with intestinal
obstruction. Urgent CT could establish a rapid pre-operative diagnosis and aids in appropriate
surgical intervention planning which is crucial in optimising the outcome.

Matched MeSH terms: Intestinal Obstruction

Fulltext Recurrent gall-stone ileus: a case report

Baruah DR

Med J Malaysia, 1983 Sep;38(3):228-31.

PMID: 6672566

Gall stone is responsible for about 1% of total small bowel obstruction, 1.2 and recurrent gall stone ileus is even more unusual. 3 Gall stone ileus is caused by the impaction of the stone in bowel lumen. It was first described in a patient examined at autopsy by Bartholin in 1654. This paper based on unusual recurrent intestinal obstructions by a gall stone. The patient presented with large bowel obstruction and it was due to a large gall stone impacted in the pelvic colon. Four months later the same patient presented with small bowel obstruction due to large gall stone impacted in the terminal part of the ileum at 61 cms from the ileo-caecal valve. Gall stone obstruction of the colon is one of the rare complications. This rare complication usually occurs in elderly females' in whom there is frequently an underlying pathological condition at the site of obstruction in the colon. The calculus usually migrates through a cholecysto-colonic fistula in case of large bowel obstruction. In case of a small bowel obstruction the calculus usually migrates through a cholecysto-duodenal fistula. Diagnosis can be established by plain X-rays of the abdomen where there is gas shadow in the biliary system, sometimes the gall stone can be seen if it is radio opague (10-16% gall stone is radio opaque) at the site of obstruction. Otherwise diagnosis is always
made at laparotomy.

Matched MeSH terms: Intestinal Obstruction/etiology*

Fulltext Recurrent Intestinal Obstruction in a Patient with Selective IgA Deficiency

Hui CK

Malays J Med Sci, 2016 Nov;23(6):123-127.

PMID: 28090187 DOI: 10.21315/mjms2016.23.6.14

A 32 year old woman presented with acute onset of abdominal pain and fever. An urgent computerised tomography (CT) of the whole abdomen showed dilated loop at the terminal ileum in the right lower abdomen with thickening of the wall and oedema. The CT was suggestive of distal small bowel obstruction at the ileum with surrounding wall oedema. Multiple biopsies taken from the terminal ileum and colon on colonoscopy were all unremarkable. She represented one-year later with a recurrence of intestinal obstruction. CT enteroclysis showed collapse at the distal 3 cm segment of the terminal ileum. There was no associated wall thickening, active inflammatory changes or ileitis. This was suspicious of post-inflammatory change or fibrosis. She was subsequently found to have selective IgA deficiency with recurrent infection in the terminal ileum resulting in intestinal obstruction. In conclusion, selective IgA deficiency should be considered in patients with recurrent intestinal obstruction without anatomical obstructions.

Matched MeSH terms: Intestinal Obstruction

Pyloric obstruction due to formic acid ingestion

Lambeth J, Somasundaram K

Med J Malaya, 1970 Mar;24(3):187-9.

PMID: 4246798

Matched MeSH terms: Intestinal Obstruction/chemically induced*; Intestinal Obstruction/etiology

Primary extranodal diffuse large B-cell lymphoma of the uterine cervix

Akkour K, Alhulwah M, Alhalal H, Alqahtani N, Arafah M

Malays J Pathol, 2021 Aug;43(2):327-331.

PMID: 34448797

BACKGROUND: Small bowel volvulus is defined as the torsion of the small intestine, potentially leading to bowel obstruction, gangrene and perforation. It is a rare condition, especially in adults.

CASE PRESENTATION: A 30-year-old man was retrieved from the jungle with severe weight loss and abdominal symptoms. He succumbed to death despite 22 days of intensive medical treatment. An autopsy revealed a ruptured gangrenous ileal volvulus with peritonitis and subdiaphragmatic abscess. Further laboratory analysis detected systemic Candida tropicalis and intestinal gramnegative bacterial sepsis, systemic Zika virus viremia, leptospirosis complicating rhabdomyolysis and disseminated intravascular coagulopathy, Type I Herpes Simplex virus infection of the tongue and upper gastrointestinal tract. The cause of death was the ruptured ileal volvulus, complicated with upper gastrointestinal bleeding due to Herpes simplex virus esophagitis in a malnourished patient with resolving leptospirosis and underlying Zika virus co-infection.

CONCLUSION: Rare clinical scenarios of adult-onset intestinal volvulus with concomitant multiple infections precludes clinical diagnosis and early treatment, leading to devastating consequences of clinical outcome. The positive clinical and postmortem correlation is a good learning lesson in many disciplines of medicine and science.

Matched MeSH terms: Intestinal Obstruction*

Fulltext Prenatal diagnosis of intestinal obstruction due to ileal atresia

Raman S, Chan LL, Chang KW, Rachagan SP

Med J Malaysia, 1992 Sep;47(3):228-30.

PMID: 1491650

A case of intestinal obstruction due to ileal atresia where the diagnosis was made prenatally by ultrasound is presented. Close monitoring of the fetus was done ultrasonographically to look for any evidence of meconium peritonitis. The baby was delivered preterm but weighed 3.3 kg. Laparotomy and enterostomy was done and the baby is currently well.

Matched MeSH terms: Intestinal Obstruction/ultrasonography*

Pigbel in Papua New Guinea: an ancient disease rediscovered

Murrell TG

Int J Epidemiol, 1983 Jun;12(2):211-4.

PMID: 6307898

A hypothesis suggested in this paper is that pigbel, or enteritis necroticans was a common disease in mediaeval Europe when human habitats, food hygiene, protein deficiency and periodic meat feasting formed the basics of village life as they do in many Third World cultures today. Based on the Papua New Guinea experience with pigbel, it is suggested that health authorities should look closely at the epidemiology of the acute surgical abdomen in such communities. Enteritis necroticans may be the important predisposing lesion to mid-gut volvulus, jejunal and ileal ileus and other forms of small bowel strangulation in communities where protein deprivation, poor food hygiene, epochal meat feasting and staple diets containing trypsin inhibitors co-exist. Such human habitats occur in Central South America, Western Pacific, Asian and South-East Asian cultures. Isolated outbreaks of necrotising enteritis have been reported from Uganda, Malaysia and Indonesia but as yet no systematic epidemiological studies of the prevalence of small bowel strangulations have been described in the surgical literature of Third World countries. Now that enteritis necroticans is preventable by vaccination such studies should be undertaken.

Matched MeSH terms: Intestinal Obstruction/etiology*

Phytobezoar: a case report

Chellappa M, Ahmad K

Med J Malaysia, 1978 Mar;32(3):245-6.

PMID: 683051

Matched MeSH terms: Intestinal Obstruction/surgery*

Fulltext Perforated incisional littre’s hernia: a rare content of a common hernia

Kumarappan, A.l., Norly, S., Samuel Tay, Vicknesh, C.

International Medical Journal Malaysia, 2016;15(2):81-84.

MyJurnal

Anticipation of complications is of paramount importance for a surgeon. Incisional hernia is a well-known
complication for abdominal surgeries. Risk factors such as increasing age, obesity, male gender are well
known. Intestinal obstruction, strangulation and perforation are imminent complications of this type of
hernia if they become incarcerated. Common contents of a ventral incisional hernia are small bowel, large
bowel and omentum. Even though Meckel’s diverticulum is a common gastrointestinal anomaly, it is rarely
found to be the content of a hernial sac. A hernia sac containing Meckel’s diverticulum is also known as
Littre’s hernia. Only a few cases have been reported in the literature. Thus here we present a case of
perforated Meckel’s diverticulum that was entrapped in the ventral incisional hernia.

Matched MeSH terms: Intestinal Obstruction

Fulltext Paravertebral Abscess Caused By Bukholderia Pseudomallei In

Ahmad, S., Azura, L., Duski, S., Aziz, M.Y.

Malays Orthop J, 2009;3(1):88-90.

MyJurnal

A 53-year-old Malay man was admitted with intestinal obstruction, fever and lower limb weakness. Initial clinical impression was myelitis causing paralytic ilues and paraperesis. Blood culture showed Burkholderia pseudomallei infection and subsequent MRI showed paravertebral abscess. This case highlights a rare manifestation of melioidosis involving the spine and difficulties in establishing the diagnosis.

Matched MeSH terms: Intestinal Obstruction

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