scholarly journals Phytobezoar causing intestinal obstruction in a neonate: A case report

2020 ◽  
Vol 10 ◽  
pp. 3
Author(s):  
Ravi Patcharu ◽  
Karunesh Chand ◽  
Badal Parikh
Keyword(s):  
Intestinal Obstruction ◽  
Clinical Skill ◽  
Exploratory Laparotomy ◽  
History Taking ◽  
Case Presentation ◽  
Detailed History ◽  
Radiological Features ◽  
Common Etiology ◽  
History Of ◽  
Vegetative Matter

Background: Phytobezoars are concretions of non-digestible vegetative matter in the gastroin­testinal tract and are a rare cause of intestinal obstruction in children. Case presentation: We report a case of intestinal obstruction in a 2-day-old neonate with no specific radiological features pointing to any common etiology. On exploratory laparotomy, a swollen raisin was found impacted in the ileum causing intestinal obstruction. The history taken in retrospect revealed that the elder sibling had witnessed her father perform a traditional ritual of putting a drop of honey into the mouth of the newborn and she imitated the same with a raisin, which led to the obstruction. Conclusion: A careful detailed history of local traditional rituals is at times, the most important pointer towards the etiology of a clinical condition. The basic clinical skill of history taking is still very important, despite the availability of advanced radiological investigations.

Reliability of history of acetaminophen ingestion in intentional drug overdose patients

2010 ◽  
Vol 30 (1) ◽  
pp. 44-50 ◽  
Author(s):  
Yedidia Bentur ◽  
Yael Lurie ◽  
Ada Tamir ◽  
Daniel C Keyes ◽  
Fuad Basis
Keyword(s):  
Drug Overdose ◽  
The Other ◽  
Limited Resources ◽  
Suicidal Patient ◽  
History Taking ◽  
Predictive Values ◽  
Detailed History ◽  
History Of ◽  
The Difference ◽  
Sensitivity Specificity

The objective of this study was to determine the reliability of denial of acetaminophen ingestion in intentional drug overdose patients. All intentional drug overdose patients admitted to an emergency department who were able to provide a history were included. A detailed history was obtained on names, timing and number of medications ingested, and serum acetaminophen was assayed. Multidrug ingestion was defined as the reporting of ≥2 medications. Patients were considered ‘reliable’ if they reported acetaminophen ingestion and had detectable acetaminophen levels or the other way around. Validity parameters of acetaminophen history were assessed by sensitivity, specificity and positive and negative predictive values. A total of 154 patients were included. History was significantly more reliable in patients who denied ingestion of acetaminophen (n = 107) compared with patients who reported it (n = 47; 95.3% vs 65.9%, respectively; p < 0.0001, 95% CI of the difference 17.5%—41.2%). No suicidal patient who denied both acetaminophen and multidrug ingestions had a detectable acetaminophen level (negative predictive value 1, 95% CI 0.93—1.0). It is suggested that denial of both acetaminophen and multidrug ingestions by intentional drug overdose patients after a thorough history taking can be considered reliable for acetaminophen history. In facilities with limited resources, these patients may not require routine acetaminophen screening.

scholarly journals Acute Intestinal Obstruction Complicating Abdominal Pregnancy: Conservative Management and Successful Outcome

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Gerald Okanandu Udigwe ◽  
George Uchenna Eleje ◽  
Eric Chukwudi Ihekwoaba ◽  
Onyebuchi Izuchukwu Udegbunam ◽  
Richard Obinwanne Egeonu ◽  
...  
Keyword(s):  
Intestinal Obstruction ◽  
Exploratory Laparotomy ◽  
Acute Intestinal Obstruction ◽  
University Teaching ◽  
Successful Outcome ◽  
Management Approach ◽  
Abdominal Pregnancy ◽  
Case Presentation ◽  
X Ray ◽  
Female Baby

Background. Acute intestinal obstruction during pregnancy is a very challenging and unusual nonobstetric surgical entity often linked with considerable fetomaternal morbidity and mortality. When it is synchronous with abdominal pregnancy, it is even rarer.Case Presentation. A 28-year-old lady in her second pregnancy was referred to Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria, at 27 weeks of gestation due to vomiting, constipation, and abdominal pain. Examination and ultrasound scan revealed a single live intra-abdominal extrauterine fetus. Plain abdominal X-ray was diagnostic of intestinal obstruction. Conservative treatment was successful till the 34-week gestational age when she had exploratory laparotomy. At surgery, the amniotic sac was intact and the placenta was found to be adherent to the gut. There was also a live female baby with birth weight of 2.3 kg and Apgar scores of 9 and 10 in the 1st and 5th minutes, respectively, with the baby having right clubbed foot. Adhesiolysis and right adnexectomy were done. The mother and her baby were well and were discharged home nine days postoperatively.Conclusion. To the best of our knowledge, this is the first report of abdominal pregnancy as the cause of acute intestinal obstruction in the published literature. Management approach is multidisciplinary.

scholarly journals Primary ileal volvulus: a rare cause of small intestinal obstruction

2020 ◽  
Vol 7 (4) ◽  
pp. 1304
Author(s):  
Syed Faizan ◽  
Amit Kumar C. Jain ◽  
Durganna Thimmappa
Keyword(s):  
Intestinal Obstruction ◽  
Iliac Fossa ◽  
Significant Risk ◽  
Exploratory Laparotomy ◽  
Small Bowel Volvulus ◽  
The Past ◽  
Risk Of Mortality ◽  
History Of ◽  
Abdominal Examination ◽  
Small Intestinal

A 50-year-old lady presented to us in the emergency department with history of acute abdominal pain and vomiting since the past 24 hours. Abdominal examination showed tenderness and guarding in the hypogastrium, lumbar and right iliac fossa region. Initial diagnosis of ruptured appendicitis was considered but exploratory laparotomy gave us an intra-operative surprise. Small bowel volvulus is extremely rare in clinical practice and their symptoms are usually nonspecific. The diagnosis is typically confirmed at surgery most of the time just like in this case. No etiology of this volvulus was found in this patient. Ileal volvulus carries a significant risk of mortality. Awareness of this condition among surgeons will help to reduce the morbidity and mortality associated with this unusual form of intestinal obstruction.

scholarly journals A STUDY OF INTESTINAL OBSTRUCTION CONSERVTIVE VERSUS SURGICAL MANAGEMENT

2020 ◽  
Vol 1 (2) ◽  
pp. 10-16
Author(s):  
MA Oyinlola ◽  
OA Omisakin
Keyword(s):  
Abdominal Surgery ◽  
Intestinal Obstruction ◽  
Surgical Management ◽  
Surgical Intervention ◽  
Exploratory Laparotomy ◽  
Related Factors ◽  
Previous Abdominal Surgery ◽  
Intestinal Contents ◽  
History Of ◽  
Obstructed Hernia

Intestinal obstruction refers to the impairment to the abnormal passage of intestinal contents which can be due to the mechanical obstruction or failure of normal intestinal motility in the absence of an obstructing lesion. Extra luminal, intrinsic, and intraluminal are three categories of small bowel obstruction. In this retrospective observational study, patients presenting to the A&E department of surgery unit who had similar condition were screened. The study is based on total of 60 patients out of which 22 patients managed conservatively whereas 38 patients were managed surgically. Common symptoms were abdominal pain and vomiting. 20 patients had previous abdominal surgery; 16 had exploratory laparotomy for abdominal trauma, perforation, gynae procedure, etc. 4 patients developed characteristic of obstruction following laproscopic. 14 patients undergone surgery while 6 patients were managed conservatively. Surgically managed duration was 2.8 days on average. Mean duration for conservatively managed patients was 2.9 days. Among the surgically managed patients, 11 had strictures, 14 had adhesion, 8 had obstructed hernia, 1 had intussusception, and 4 had abdominal TB. Based on the cause of the obstruction, surgical procedure was carried out. History of abdominal surgery was found to be more frequent in whom obstruction was relieved conservatively. The conclusion of the study is that adhesions based on previously conducted surgery are important causes of SBO. Two common method of managing the condition is conservative management and surgical management. The criteria for utilizing particular method is based on several patient related factors. Clinical decisions guide the management of SBO and timing of surgical intervention.

Recognizing Aphemia and How to Differentiate From Aphasia in the Era of Telemedicine

2021 ◽  
pp. 194187442199054
Author(s):  
Brittany M. Kasturiarachi ◽  
Balaji Krishnaiah
Keyword(s):  
Clinical Skill ◽  
Precentral Gyrus ◽  
Case Presentation ◽  
Her Family ◽  
Clinical Syndromes ◽  
History Of ◽  
Intimate Knowledge ◽  
Pars Opercularis ◽  
Pure Motor

Background: Aphemia, or pure motor mutism, is a phenomenon that has been reported previously in the literature and typically is associated with small infarcts in the inferior dominant precentral gyrus, pars opercularis, or inferior perirolandic gyrus. Clinically, it is important to distinguish aphemia from aphasia syndromes. Telemedicine is becoming more prevalent and involving neurologists across the country. This is an important consideration when addressing aphemic patients as many mistakes can be made during a virtual exam clouding a patient’s clinical picture. Case Presentation: Our patient is a 61-year-old female with a past medical history of hypertension, diabetes, and an old right frontoparietal stroke without any residual deficits. She presented after her family stated that she “quit speaking” for about seven hours. Initial neurological evaluation was done via telemedicine due to the COVID-19 pandemic and was pertinent for decreased consciousness, inability to answer either orientation question, a right facial droop, and aphasia. Later it was found that the patient exhibited a pure motor mutism rather than aphasia and had an MRI lesion in the left inferior precentral gyrus. Conclusion: Differentiating aphemia from aphasia is an important clinical skill for a neurologist to foster especially in the era of telemedicine. An intimate knowledge of the parts of a speech exam are vital in directing emergency staff during stroke evaluation. Additionally, distinguishing these clinical syndromes has implications with respect to prognosis and long-term rehabilitation.

scholarly journals Intestinal Obstruction in a Child with Massive Ascariasis

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Munanura Turyasiima ◽  
Paul Matovu ◽  
Gloria Kiconco ◽  
Walufu Ivan Egesa ◽  
Phillip Sunday ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Intestinal Obstruction ◽  
Clinical Presentation ◽  
Acute Abdominal Pain ◽  
Exploratory Laparotomy ◽  
Postoperative Management ◽  
Soft Mass ◽  
History Of ◽  
Abdominal Examination ◽  
The Tropics

Soil-transmitted helminths are so prevalent in the tropics and low developing countries. Pediatric clinical presentation of ascariasis, the most common helminth, as the intestinal obstruction is not only rare but also less described. We present a case of a 4-year-old girl with massive ascariasis. She presented with a 3-day history of acute abdominal pain associated with vomiting and an episode of passing long white roundworms, about 5 cm in length, through the nose. The child had mild constipation and passed pellets of hard stool once in the last 72 hours. She was in fair general condition at the examination but had significant findings on abdominal examination. On palpation, there was a soft mass localized in the left paraumbilical area and no tenderness, with normal bowel sounds on auscultation. Exploratory laparotomy was sanctioned where roundworms (Ascaris lumbricoides), saucepan full, were delivered through a 2.5 cm enterotomy incision. Postoperative management was carried out, and the child discharged on the 7th day of treatment including a 3-day course of albendazole 400 mg daily.

scholarly journals A rare case of ventriculoperitoneal shunt knot causing intestinal obstruction in an adult

2019 ◽  
Vol 6 (2) ◽  
pp. 640
Author(s):  
Mayank Bhasin ◽  
Karamjot Singh Bedi ◽  
Tarun Chaudhary ◽  
Gurvansh S. Sachdeva ◽  
Shantanu Kumar Sahu
Keyword(s):  
Intestinal Obstruction ◽  
Ventriculoperitoneal Shunt ◽  
Rare Complication ◽  
Exploratory Laparotomy ◽  
Vp Shunt ◽  
Primary Surgery ◽  
First Case ◽  
Ventriculoperitoneal Shunting ◽  
History Of ◽  
Low Incidence

Despite high incidence of complications, Ventriculoperitoneal shunting for hydrocephalus is the cornerstone and the most common neurosurgical procedure. Ventriculoperitoneal shunt knot causing intestinal obstruction is an extremely rare complication needing surgical intervention. A 19 years old male with history of VP shunting in infancy for hydrocephalus with no history of any revision surgery presented in emergency with pain abdomen and multiple episodes of vomiting for 2 days. X ray showed dilated bowel loops with a coiled up VP shunt in the abdomen. Exploratory laparotomy showed multiple dilated bowel loops with a loop of VP shunt around ileal segment with dense fibrotic adhesions causing obstruction. Extensive adhesiolysis was done. Procedure underwent uneventful. Patient recovered swiftly in postoperative period and is currently asymptomatic after 6 months of surgery. Improved surgery skills and shunt design have prevented much of the morbidity of VP shunting. Most of the cases reported earlier were paediatric patients with history of repetitive handling of catheter. We believe this to be the first case of intestinal obstruction by a VPS knot in an adult with no history of manipulation after primary surgery. Due to low incidence it is difficult to clinically suspect such an extremely rare complication. Therefore, an awareness of VP shunt related complications in adult is essential.

scholarly journals Gossypiboma with perforation of the umbilicus mimicking a complicated urachal cyst: a case report

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Mustapha S. Kabba ◽  
Martha Y. Forde ◽  
Kevin S. Beckley ◽  
Bernadette Johnny ◽  
Ann-Marie B. M. Jah-Kabba ◽  
...  
Keyword(s):  
Unusual Case ◽  
Open Appendectomy ◽  
Exploratory Laparotomy ◽  
Urachal Cyst ◽  
History Of Surgery ◽  
Surgical Sponge ◽  
Case Presentation ◽  
Retained Surgical Sponge ◽  
Peripheral Hospital ◽  
History Of

Abstract Background A retained surgical sponge, also known as a gossypiboma, is a rare cause of serious postoperative complications. Diverse retained surgical materials including instruments such as clamps and sutures have been reported, but surgical sponges are the most common material. We report an unusual case of a gossypiboma mimicking a complicated urachal cyst that led to perforation of the umbilicus. Case presentation A 38-year-old female patient presented in our facility with a palpable periumbilical mass and discharge of pus from the umbilicus for 7 months after an open appendectomy. Since the onset of symptoms, the patient had been treated conservatively in a peripheral hospital where she had been operated on. As no improvement was seen, an ultrasound scan was performed that suggested an intraperitoneal abscess adjacent to the umbilicus. Consequently, the patient was referred to our specialist outpatient department for surgical intervention. Suspecting a complicated urachal cyst, an exploratory laparotomy was performed but revealed a retained surgical sponge as the underlying cause. The gossypiboma was resected, and the postoperative period was unremarkable. Conclusion This case demonstrates that gossypibomas, even though rare, continue to occur. They may clinically and radiologically mimic other pathologies, especially abscesses and tumors. Preventive measures as well as the inclusion of gossypibomas in the differential diagnosis of intraabdominal masses or fistulation detected in patients with a history of surgery are of utmost importance to minimize morbidity, mortality, and potential medicolegal implications.

scholarly journals Primary abdominal cocoon with cryptorchidism: a case report

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Wei-Jie Song ◽  
Xin-Yi Liu ◽  
Galal Abdullah Ali Saad ◽  
Aawrish Khan ◽  
Kai-Yan Yang ◽  
...  
Keyword(s):  
Intestinal Obstruction ◽  
Poor Prognosis ◽  
Rare Case ◽  
Greater Omentum ◽  
Abdominal Cocoon ◽  
Case Presentation ◽  
Bilateral Cryptorchidism ◽  
Surgical Methods ◽  
Intestinal Adhesion ◽  
History Of

Abstract Background We report a rare case of primary abdominal cocoon with bilateral cryptorchidism. Case presentation The patient had a history of laparoscopic surgery for bilateral cryptorchidism 6 years earlier. He was admitted to the hospital again due to intestinal obstruction. Surgery was performed on the patient after the failure of conservative treatment. The patient was diagnosed with primary abdominal cocoon. Instead of the greater omentum, many cocoon-like tissues surrounding the bowel were seen during operation. Abdominal surgery can increase the risk of intestinal adhesion, which is one of the main causes of intestinal obstruction, especially in patients with abdominal cocoon. We hypothesize that the surgery 6 years earlier to address transabdominal bilateral cryptorchidism accelerated the patient’s intestinal obstruction. Conclusion This case implies that it is important for urologists to evaluate whether their patients exhibit abdominal cocoon before cryptorchidism surgery, to choose better surgical methods and reduce the risks of poor prognosis.

scholarly journals Sigmoid volvulus in pregnancy: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Jay Lodhia ◽  
Joachim Magoma ◽  
Joylene Tendai ◽  
David Msuya ◽  
Jamil Suleiman ◽  
...  
Keyword(s):  
Intestinal Obstruction ◽  
Preterm Labor ◽  
Fetal Death ◽  
Sigmoid Volvulus ◽  
Intrauterine Fetal Death ◽  
Emergency Laparotomy ◽  
Case Presentation ◽  
Radiological Features ◽  
High Degree ◽  
In Pregnancy

Abstract Introduction Sigmoid volvulus in pregnancy is a rare cause of intestinal obstruction with high maternal and fetal morbidity and mortality if not diagnosed and managed early. Case presentation A 29-year-old female (Chagga by tribe) presented with clinical features of intestinal obstruction 24 weeks into her second pregnancy. She had symptoms for one week. An emergency laparotomy was performed whereby gangrenous sigmoid volvulus was found; thus, it was resected and Hartmann’s colostomy was raised. Unfortunately, she experienced intrauterine fetal death post-operatively. She was discharged clinically stable. Conclusion Early diagnosis and management can prevent adverse effects such as bowel ischemia and preterm labor. Because classic clinical and radiological features may not be evident, high degree of suspicion is warranted.

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