Postoperative internal hernia is a rare clinical complication which often occurs after digestive tract reconstruction. Roux-en-Y anastomosis is a common type of digestive tract reconstruction. Internal hernia after Roux-en-Y reconstruction, which occurs mainly in the mesenteric defect caused by incomplete closure of mesenteric gaps in the process of digestive tract reconstruction, is systematically called, in our research, as mesenteric internal hernia after Roux-en-Y reconstruction. Such internal hernia can be divided, according to the different structures of mesentric defect, into 3 types: the type of mesenteric defect at the jejunojejunostomy (J type), the type of Petersen's defect (P type), and the type of mesenteric defect in the transverse mesocolon (M type). Because of huge differences in the number of cases and follow-up time among existing research reports, the morbidity of internal hernia after LRYGB fluctuates wildly between 0.2% and 9.0%. Delayed diagnosis and treatment of mesenteric internal hernia after Roux- en-Y reconstruction may result in disastrous consequences such as intestinal necrosis. Clinical manifestations of internal hernia vary from person to person: some, in mild cases, may have no symptoms at all while others in severe cases may experience acute intestinal obstruction. Despite the difference, one common manifestation of internal hernia is abdominal pain. Surgical treatment should be recommended for those diagnosed as internal hernia. A safer and more feasible way to conduct the manual reduction of the incarcerated hernia is to start from the distal normal empty bowel and trace back to the hernia ring mouth, enabling a faster identification of hernia ring and its track. The prevention of mesenteric internal hernia after Roux-en-Y reconstruction is related to the initial surgical approach and the technique of mesenteric closure. Significant controversy remains on whether or not the mesenteric defect should be closed in laparoscopic Roux-en-Y anastomosis. This article is to review the reports and researches on internal hernia resulting from the mesenteric defect after Roux-en-Y digestive tract reconstruction in recent years, so as to promote understanding and attention on this disease. And more active preventive measures are strongly suggested to be taken in operations where digestive tract reconstruction is involved.
Abdominal Pain ; diagnosis ; Anastomosis, Roux-en-Y ; adverse effects ; methods ; Gastric Bypass ; adverse effects ; methods ; Hernia, Abdominal ; diagnosis ; etiology ; prevention & control ; surgery ; Humans ; Intestinal Obstruction ; etiology ; Intestine, Small ; pathology ; surgery ; Laparoscopy ; adverse effects ; methods ; Mesentery ; pathology ; surgery ; Mesocolon ; pathology ; surgery ; Postoperative Complications ; prevention & control ; surgery ; Reconstructive Surgical Procedures ; adverse effects ; methods ; Retrospective Studies

No abstract available.
Humans ; Intestinal Obstruction/*diagnosis/etiology/surgery ; Male ; Meckel Diverticulum/complications/*diagnosis ; Middle Aged ; Radiography, Abdominal ; Tomography, X-Ray Computed

OBJECTIVEThe study aimed to review the treatment and prognosis of acute obstruction of colorectal cancers and to compare different treatment strategies of those cancers, and to evaluate the risk factors affecting perioperative complications.

METHODSClinical data of 184 patients with acute obstruction of colorectal cancer undergone operation were analyzed retrospectively.

RESULTSA total of 184 patients with acute obstruction of colorectal cancer was collected in this study, including 58 patients with proximal and 126 patients of distal colorectal cancers. Perioperative death occurred in 2/58 patients (3.4%) with distal colorectal cancer and 6/126 cases (4.8%) of distal colorectal cancer (P > 0.05). The overall perioperative complications in the two groups were not significantly different (P = 0.794). Among the 58 patients with proximal colorectal cancer, one patient underwent colostomy, but among the 126 patients with distal colorectal cancer, 41 patients underwent colostomy, showing a significant difference between the two groups (P = 0.002). ASA scores (grade 3 - 4), elderly age (≥ 70 years) and colon perforation peritonitis were independent prognostic factors associated with perioperative mortality and morbidity. Patients in the self-expandable metallic stent (SEMS) group had a significantly shorter hospital stay (25.4 ± 8.3) d than that in the emergency surgery group (32.8 ± 16.4) d, (P = 0.039).

CONCLUSIONSEndoscopic stent implantation provides an acceptable modality of palliation for acute proximal large bowel obstruction caused by malignancies. In acute colorectal cancer obstruction, SEMS can provide a minimally invasive management compared with surgical intervention.

Acute Disease ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Colorectal Neoplasms ; complications ; diagnosis ; surgery ; Colostomy ; Endoscopy ; Female ; Humans ; Intestinal Obstruction ; etiology ; therapy ; Intestinal Perforation ; etiology ; Intraoperative Complications ; Length of Stay ; Male ; Middle Aged ; Palliative Care ; methods ; Peritonitis ; etiology ; Prognosis ; Retrospective Studies ; Risk Factors ; Stents ; Young Adult

Peutz-Jeghers syndrome is an autosomal dominant inherited disorder characterized by multiple gastrointestinal hamartomatous polyps and mucocutaneous pigmentation. Peutz-Jeghers syndrome has an incidence of approximately 1 in 25,000 to 300,000 births. Crohn's disease is a chronic inflammatory bowel disease that typically manifests as regional enteritis with its incidence ranging from 3.1 to 14.6 cases per 100,000 person-years in North America. Herein, we report a case of a 30-year-old male patient who had both Peutz-Jeghers syndrome and Crohn's disease. We believe that this is the first case in Korea and the second report in the English literatures on Peutz-Jeghers syndrome coincidentally accompanied by Crohn's disease.
Adult ; Crohn Disease/complications/*diagnosis/pathology ; Endoscopy, Gastrointestinal ; Humans ; Intestinal Obstruction/etiology ; Intestinal Perforation/etiology ; Intestinal Polyps/pathology/surgery ; Male ; Peutz-Jeghers Syndrome/complications/*diagnosis/genetics ; Protein-Serine-Threonine Kinases/genetics

BACKGROUND/AIMS: Intussusception in adults is rarely seen and causes misdiagnosis due to its appearance with various clinical findings. The cause of intussusception in adults is frequently organic lesions. In this study, the underlying etiologic factors, diagnostic methods and alternative methods of treatment are discussed in the light of the literature. METHODS: In this study, a retrospective evaluation was performed on 47 cases with the diagnoses of intussusception, who were operated on for bowel obstruction between 1990-2011 in Department of Surgery of Necmettin Erbakan University Meram Medical Faculty. Data related to presentation, diagnosis, treatment and pathology were analyzed. RESULTS: Twenty-four of the patients (51%) were female, and 23 were male (49%). Mean age (year) was 49 (range: 23-78) in female group, and 50 (range: 17-72) in male group. All patients presented mechanical bowel obstruction findings and underwent operation. Intussusception was caused by benign and malignant tumors in 38 patients, and other reasons in 3 cases. No reason could be determined in the other 6 cases. Only small intestine resection was applied in 29 cases, and large intestine resection was also applied in 17 cases. Reduction and fixation surgery was performed in one patient. No postoperative mortality was observed. CONCLUSIONS: Adult intussusception remains a rare cause of abdominal pain. Diagnosis of intussusception in adults is still difficult. Main treatment was surgical in most cases.
Adolescent ; Adult ; Aged ; Colonoscopy ; Female ; Humans ; Intestinal Neoplasms/complications/diagnosis ; Intestinal Obstruction/*diagnosis/etiology/surgery ; Intussusception/*diagnosis/surgery/ultrasonography ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Retrospective Studies ; Tomography, X-Ray Computed ; Young Adult

OBJECTIVEThe aim of this study was to review the etiology and pathogenesis of patients who underwent surgery for mechanical bowel obstruction. The treatment and prognosis of bowel obstructions caused by intra-abdominal tumors were compared with those due to other causes.

METHODSThe clinical data of 203 patients with mechanical bowel obstruction undergoing operation were analyzed retrospectively. The tumor cases were classified as group I, and all other cases as group II. A range of factors were investigated to estimate the postoperative outcome: gender, age, comorbidities, symptoms and findings of physical and radiological examinations, sites of the obstruction, etiology, therapeutic approach, postoperative complications and mortality.

RESULTSGroup I included 73 patients and Group II 130. Large bowel carcinoma and peritoneal adhesions were the most common causes of Group I and II, contributing 58 and 86 of all cases, respectively. There was no significant difference in terms of gender between the two groups, but the rate of elderly (≥ 70 years) patients was significantly higher (53.4%) than that of the < 70 years old patients (35.4%) (P = 0.012). There was a significant difference between the patients with previous surgical operation history in the tumor group (23.3%) and non-tumor group (58.5%) (P < 0.001). In the 73 cases of the tumor group, the obstruction was located in the large bowel in 58 cases (79.5%), small bowel in 12 cases (16.4%), both small and large bowels in 2 cases (2.7%) and gastric cancer invading the splenic flexure of colon in 1 case, while in the non-tumor group, 111 cases (85.4%) of the obstruction was located in the small bowel and 19 cases (14.6%) and in the large bowel (P < 0.001). Sixty-six cases (90.4%) of the tumor-group underwent intestinal segment excision and 21 cases (28.8%) underwent intestinal fistulation in the tumor group, but in the non-tumor group 61 cases (46.9%) underwent intestinal segment excision and 5 cases (3.8%) underwent intestinal fistulation (all P < 0.001). The hospital stay was (18 ± 6) days in the tumor group and (11 ± 3) days in the non-tumor group (P < 0.01). The complication rate (P = 0.104) and mortality rate (P = 0.187) were not significantly different between the two groups.

CONCLUSIONSTumor mechanical bowel obstruction is more frequently seen in patients in elder age, with colorectal location and without previous operation history. CT scan may provide effective diagnosis and ascertain the presence of the malignant obstruction. Intestinal fistulation is more often needed in patients with tumor intestinal obstruction and endoscopic stenting is a safe option in selected patients with tumor intestinal obstruction.

Adult ; Age Factors ; Aged ; Aged, 80 and over ; Female ; Humans ; Intestinal Neoplasms ; complications ; diagnostic imaging ; surgery ; Intestinal Obstruction ; diagnosis ; diagnostic imaging ; etiology ; surgery ; Length of Stay ; Male ; Middle Aged ; Peritoneal Diseases ; complications ; diagnostic imaging ; surgery ; Postoperative Complications ; Retrospective Studies ; Tissue Adhesions ; complications ; diagnostic imaging ; surgery ; Tomography, X-Ray Computed ; Young Adult

Anisakiasis usually occurs in the stomach and can easily be diagnosed by digestive tract endoscopy as opposed to enteric anisakiasis which is very rare and difficult to be diagnosed definitively. The most important and useful tool in diagnosing enteric anisakiasis is obtaining an accurate patient history of having eaten raw fish before the onset of symptoms. We report a case of small bowel obstruction caused by acute invasive enteric anisakiasis. A 60-year-old woman visited the emergency room suffering from sudden abdominal pain. She had eaten raw fish 1 day before the onset of symptom. Radiologic studies showed small bowel obstruction. However, no definitive cause could be found. An emergency laparotomy revealed edematous and dilated proximal jejunum and a focal stenosis of the distal jejunum. Segmental resection of the jejunum was performed, and histopathological examination revealed enteric anisakiasis. The patient was discharged on the 7th day after surgery following an uneventful course of recovery.
Acute Disease ; Animals ; Anisakiasis/complications/*diagnosis/surgery ; Anisakis/isolation & purification ; Diagnosis, Differential ; Female ; Humans ; Intestinal Obstruction/*diagnosis/etiology/radiography ; Intestine, Small/pathology ; Middle Aged ; Tomography, X-Ray Computed

Paraduodenal hernias are a rare congenital malformation, but they are the most common internal hernias. They develop secondary to a failure in midgut rotation, which may lead to small bowel obstruction or other clinical manifestations. The authors recently experienced a case of a left paraduodenal hernia presenting with unusual symptoms of left flank pain and vomiting.
Adult ; Hernia/*complications/*diagnosis/pathology/surgery ; Humans ; Intestinal Obstruction/*etiology/surgery ; Male

OBJECTIVETo explore clinical features, diagnostic methods and treatment of gallstone ileus.

METHODSClinical data of 5 patients with gallstone ileus were analyzed retrospectively. Pertinent literature from China between 2000 and 2009 were reviewed. The disease onset, clinical manifestations, imaging characteristics, diagnosis and treatment of gallstone ileus were studied.

RESULTSFour out of 5 patients were female aged over 60, of whom 3 had a previous history of cholelithiasis, 2 had a history of cholangiojejunostomy internal drainage procedure. Four patients underwent enterotomy and gallstone extraction combined with hepatobiliary operation, while one underwent enterotomy alone. There was no postoperative recurrence. A review of the literature from China revealed 441 cases with intestinal obstruction caused by gallstone, consisting 1.15% of all the cases with bowel obstruction. 67.12% were female. 73.56% were elderly. 87.92% were from cystoenteral fistula. Site of bowel obstruction in ileum was 64.17% of the cases. 71.89% were misdiagnosed with other types of obstruction. Two hundred twenty-five patients underwent enterotomy and gallstone extraction combined with hepatobiliary operation, which carried a lower rate of postoperative recurrence and malignancy (P<0.05) than enterotomy alone. There were no statistical significant differences in the occurrence of postoperative cystoenteral fistula, wound infection, pulmonary infection, cure rate, and mortality(P>0.05).

CONCLUSIONSThe incidence of gallstone ileus is low and more common in female elderly. The gallstones often drain through cystoenteral fistula and lodge in the ileum. Enterotomy without hepatobiliary operation is associated with potential risk of recurrence and development of gallbladder malignancy. Combined hepatobiliary operation is recommended in patients without significant comorbidities.

Aged ; Female ; Gallstones ; complications ; diagnosis ; surgery ; Humans ; Intestinal Obstruction ; diagnosis ; etiology ; surgery ; Male ; Middle Aged ; Retrospective Studies

OBJECTIVETo evaluate the risk factors affecting the early postoperative outcomes in patients with small bowel obstruction.

METHODSClinical data of 193 patients with small bowel obstruction undergone operation were analyzed retrospectively. A range of factors were investigated to estimate postoperative outcome, including gender, age, comorbidities, etiology of obstruction, presence of strangulated bowel (viable or nonviable), leukocyte count, temperature, and heart rate. Logistic regression analysis was used to study the prognostic value of each significant variable in terms of postoperation.

RESULTSThe major causes of small bowel obstruction were adhesion and hernia, contributing 38.9% and 37.8% of all cases, respectively. Strangulation occurred in 42.0% and caused nonviable bowel in 23.3% of obstructing episodes. Elderly (>or=70 years), diabetes, malignant tumors WBC >15x10(9)/L were independent significant factors associated with bowel strangulation. The overall complication rate was 16.1%, the 30-day mortality was 4.1%, and the median postoperative hospital stay was 13 days. Age >or=70 years and bowel resection were significantly associated with postoperative complications in the univariate analysis. Only elderly and malignant obstruction were significantly associated with operative mortality in multivariate logistic regression.

CONCLUSIONSSurgery for small bowel obstruction is still associated with significant mortality and morbidity. Elderly is significantly associated with an increased incidence of strangulation, operative mortality, and complications.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Incidence ; Intestinal Obstruction ; diagnosis ; etiology ; surgery ; Intestinal Perforation ; epidemiology ; Intestine, Small ; surgery ; Logistic Models ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Young Adult