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.
Localised dilatation of a segment of the intestine without any macroscopically-identifiable cause is rare, and has been reported in association with omphalocoele in only 14 children up to 2006. In most of these cases, the segmental intestinal dilatation (SID) was either diagnosed incidentally, or due to presentation with partial or complete intestinal obstruction. We report, for the first time, a 37-week-old neonate with bowel perforation in SID associated with omphalocoele. In our case, a long thin vessel that resembled the mesodiverticular vessel of a Meckel's diverticulum was present in the dilated segment, supporting the view that SID and Meckel's diverticulum may be embryologically related.
Adult intussusception is a rare entity that may present in the acute and subacute setting principally related to the degree of bowel obstruction. Preoperative diagnosis of this condition may be difficult. The intussusception is usually due to a definable intraluminal lesion, most probably neoplasia, unlike intussusception in children. We present the cases of two adult male patients with intussusception. The first presented with acute small-bowel obstruction secondary to a retrograde ileojejunal intussusception with a pseudopolyp as the lead point. This was possibly due to a retrograde ball-valve effect. The intussuscepting segment was resected. The second patient presented with unexplained chronic diarrhoea and an intussusception occurring within the caecum, as demonstrated at colonoscopy, with a terminal ileal pedunculated fibroid polyp as the lead point. A limited right hemicolectomy was performed. Both patients recovered uneventfully and have remained well. A brief literature review of adult intussusception complements the case reports, with an emphasis on the pathogenesis of inflammatory polyps and recommended surgical management.
An internal hernia through the mesosalpinx is a rare condition which is often overlooked. We report the case of a 65-year-old lady who presented with features of small bowel obstruction. At laparotomy, a gangrenous ileum was found to have herniated through a defect in the right mesosalpinx. We discuss this rare cause of a small bowel obstruction and its diagnostic dilemma.
Meckel's diverticulum has several known complications including diverticulitis and perforation. The presence of mesodiverticular band or a band from the diverticulum to the anterior abdominal wall is also described and can cause obstruction or rotation of the small bowel leading to volvulus. Meckel's diverticulum is also well known as the lead point for intussusception. It may be lined by ectopic gastric mucosa and can cause life-threatening gastrointestinal bleeding. We report a neonate who presented with acute intestinal obstruction secondary to a large, mobile Meckel's diverticulum which due to a direct compression effect on the adjacent small bowel caused mechanical intestinal obstruction. Diagnosis was confirmed at laparoscopy, and treated by curative surgical resection. This is the first report of a large mobile Meckel's diverticulum causing small bowel obstruction due to direct compression that was managed by minimally invasive surgical resection.
A renal transplant patient presented with ileal perforation due to histoplasmosis 3 years after transplantation. Mesenteric lymph nodes and lungs were also affected by the disease. She was successfully treated with amphotericin B followed by ketoconazole.
Burkitt lymphoma is a rare entity especially in this part of the world. We had an 11-year-old patient presented with swelling of the mandible for a short one-month duration. He was planned for excision biopsy. However developed severe abdominal pain while in the hospital and was diagnosed as intussusception after ultrasound was done. We proceeded with right hemicolectomy and excision of buccal mass. Early recognition and close monitoring of insidious jaw lesions is recommended even in young adults not within the modal age category of endemic Burkitt.
We report for the first time from Malaysia a patient with Peutz-Jeghers syndrome complicated by successive intussusceptions requiring extensive small bowel resection. Our experience is compared with that of other authors by a review of the literature highlighting important points in the diagnosis and management of complications in Peutz-Jeghers syndrome.
Abdominal sacrocolpopexy is a well-established procedure for the reconstruction of apical support in pelvic organ prolapse. Its long-term efficacy is well known; however, it is also associated with higher perioperative morbidity when compared with the less invasive transvaginal approach. Long-term risk of bowel-related complication from abdominal sacrocolpopexy is rare, but can be significant as it is often serious and requires major surgical intervention. Here we highlight an unusual case of strangulated small bowel (in this instance complicated with sepsis secondary to peritonitis), 14 years after an abdominal sacrocolpopexy procedure. This example amplifies the need for proper preoperative counseling; also, life-long follow-up is necessary for patients undergoing this procedure.
Enteric duplication is an uncommon malformation of the gastrointestinal tract which is either asymptomatic or presents with vague symptoms mimicking other more common pathology. It is most commonly diagnosed when complications such as bleeding, intestinal obstruction or perforation occurs. This is a case report of a patient with this condition presenting with right iliac fossa pain and localised peritonitis mimicking acute appendicitis.
A case of primary non-Hodgkin's lymphoma of the terminal ileum with enterovesical fistula is reported. A 50-year-old Malay man presented with haematuria, dysuria and per-rectal bleeding. Intravenous urogram, double contrast enema and an MDP bone scintigram showed a fistulous communication between the bladder and distal ileum. At laparotomy, a large tumour attaching the terminal ileum to the dome of the bladder was found. Histopathological examination of resected small bowel revealed a diffuse histiocytic non-Hodgkin's lymphoma of the small bowel. The bladder mucosa was shown to be normal.
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.