1/13. Idiopathic ileoileal intussusception in an adult with spontaneous reduction during enteroclysis: a case report.We report a rare case of recurring idiopathic ileoileal intussusception in an adult. diagnosis was established with abdominal computed tomography (CT) and enteroclysis, which led to a spontaneous reduction of the invagination. After a short period of physical improvement, a follow-up CT showed a recurrence. Surgery proved the diagnosis, but no predisposing factor was found.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/13. Segmental dilatation of the ileum as an unusual cause of gastrointestinal bleeding: report of one case.We report a case of segmental dilatation of the ileum in a 10-month-old male infant. Intermittent loose black-colored stool passage and normocytic anemia were noted at the initial visits to our hospital. There was no symptom or sign of intestinal obstruction such as abdominal distention or vomiting. On physical examination, he was found to be pale but his abdomen was soft and flat. Digital examination revealed brownish stool tinged with black-colored oil-like stool but no polyp. Laboratory studies excluded coagulopathy, hemolytic anemia and lead poisoning. During hospitalization, he was treated with nothing per mouth, intravascular fluids, ranitidine, and transfusion of packed red blood cells. All examinations including panendoscopy, technetium-99m (99mTc)-pertechnetate Meckel's diverticulum scan, and double contrast colon series revealed no organic lesion except that 99mTc-red blood cell bleeding scans showed abnormal bleeding in the small intestine. Because of his persistent gastrointestinal bleeding with unknown cause, we did an exploratory laparotomy when the patient was 13 months old and idiopathic segmental dilatation of the ileum was confirmed. The dilated segment is supposed to be idiopathic because of histologically proven normal muscle layers without ectopic tissue. This case suggests that segmental dilatation of the ileum can only present as gastrointestinal bleeding without intestinal obstruction.- - - - - - - - - - ranking = 13.61947926552keywords = physical examination, physical (Clic here for more details about this article) |
3/13. Primary midgut volvulus in the adult: two case reports.Primary midgut volvulus is associated with a high mortality rate. The presentation and management of two patients with primary midgut volvulus are reviewed. Both presented with severe abdominal pain inconsistent with clinical findings. diagnosis was made intraoperatively in one case and at autopsy in the other. Surgeons need to suspect primary midgut volvulus when they encounter patients with atypical presentation of small bowel obstructions, i.e., when the severity of symptoms is inconsistent with physical findings. Primary midgut volvulus should be considered in the differential diagnosis in these patients, and, if suspected, emergent abdominal exploration is indicated.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/13. Ileosigmoid knotting: a case report and review.Ileosigmoid knotting, or compound volvulus, has not been reported previously in australia. A 41 year old woman of Anglo-Saxon origin presented with a short history of extreme abdominal pain that was out of proportion to her physical findings. At operation it was found that her entire ileum was tightly knotted around the redundant, twisted sigmoid colon. Both closed loops were gangrenous and it was impossible to unravel the bowel. She recovered uneventfully following resection and primary anastomosis of both portions of the intestine. Most patients with this uncommon condition have been reported from finland and eastern africa. An arrangement of the small bowel and sigmoid colon on long, narrow mesenteries would appear to be a prerequisite. The brevity of the history and the severity of the abdominal pain call for early laparotomy. Prolonged attempts to untie the knot are dangerous. It is safer to divide the ileum at the knot and resect it in order to release the sigmoid colon. Primary anastomosis is feasible where the history is short and the uninvolved intestine is clean and collapsed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/13. Small bowel obstruction by wireless enteroscopic capsule and unrecognized intestinal stricture.The wireless enteroscopy capsule (WEC) was approved for noninvasive visualization of small bowel. We report an unusual case of a previously healthy man with history of bowel resection and anastomosis who developed small bowel obstruction after ingestion of a WCE. At operation, an anastomotic stricture site was noted and the WEC was proximal to this stricture, causing obstruction. This case emphasizes the importance of a good history and physical examination, as well as vigilant follow-up and retrieval of WEC.- - - - - - - - - - ranking = 13.61947926552keywords = physical examination, physical (Clic here for more details about this article) |
6/13. Abscessed leiomyosarcoma of the ileum.A-49-year-old man was admitted because of a lower abdominal mass. During the five days prior to admission, he had noted fever and lower abdominal pain. palpation of the abdomen revealed a tender mass, 10 cm in diameter, in the suprapubic region. An x-ray revealed an irregular collection of gas, 9 cm in diameter, in the pelvic cavity, which appeared as a mirror image when the patient was upright. Based on the physical finding and the results of a barium enema, abdominal CT, MRI, and small intestine imaging, a diagnosis of leiomyosarcoma of the ileum was made. Excision of the tumor and part of the small intestine was performed. A saccular tumor, 11 x 6 x 5 cm, was found 1.0 m from the cecum and growing out of the wall of the ileum. A large amount of pus was found inside the cavity. The pathological diagnosis was leiomyosarcoma.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/13. Delayed presentation of perforation of the ileum following seat belt trauma.A 36-year-old man presented with an acute abdomen due to perforation of the terminal ileum, 26 days after sustaining blunt abdominal trauma from a seat belt. He had been completely well and undertaking vigorous physical exercise since the injury. This is the first reported case of this type of injury presenting after a long asymptomatic interval.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/13. Obturator hernia: a difficult diagnosis.We have presented the case of an elderly woman with severe kyphoscoliosis, osteoarthritis and left knee effusion who had symptoms and signs of intermittent intestinal obstruction. Operation showed a left-sided obturator hernia. In any elderly, debilitated, chronically ill woman, symptoms and signs of recurrent small-bowel obstruction (without a history of abdominal surgery or external hernias) and pain along the ipsilateral thigh and knee (Howship-Romberg sign) should raise suspicion for an obturator hernia. If the hernia is not palpable by physical examination, a CT scan of the pelvis and upper aspect of the thigh would confirm the diagnosis before operation and allow prompt treatment and better chance of patient survival.- - - - - - - - - - ranking = 13.61947926552keywords = physical examination, physical (Clic here for more details about this article) |
9/13. Small bowel phytobezoar mimicking presentation of Crohn's disease.A case of small bowel phytobezoar formed from unusual ingested vegetation is described. The patient presented with recurrent subacute obstruction and a right iliac fossa mass mimicking the presentation of Crohn's disease. None of the usual gastrointestinal disorders that predispose to bezoar formation were present. The phytobezoar passed spontaneously following small bowel enema and colonoscopy. It is possible that relaxation of the gut secondary to the antispasmodics administered at investigation or the physical disturbance during these procedures enabled migration through the ileocecal valve. Antispasmodics may be of use in the conservative management of bezoars obstructing otherwise normal bowel.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/13. Complications of acquired diverticula of the ileum.Acquired diverticula of the small bowel are extremely rare. These diverticula occur in less than one per cent of the population. Acquired diverticula of the ileum make up approximately ten per cent to 20 per cent of this number. Associated complications are noted in less than ten per cent of patients, but mortality rates related to these complications have been reported to range from 25 per cent to 50 per cent. Major reported complications include perforation, hemorrhage, and obstruction secondary to inflammation. Our experience with three cases of complicated ileal diverticula is presented. All patients presented with physical findings consistent with an acute abdomen, but the correct diagnosis was not made in any of these patients preoperatively. Two patients were found to have perforation of an ileal diverticulum: one with localized abscess formation and the other with diffuse peritonitis. The third patient had ileal diverticulitis without perforation. Two of the patients had resection and primary anastomosis. The third patient had resection and an ileostomy and mucous fistula created. Postoperatively, one patient died of a massive cerebrovascular accident. A thorough discussion of the literature concerning these rare acquired ileal diverticula is presented. Clinical manifestations, complications, and associated surgical therapy are discussed. Usually, resection of the involved segment with primary anastomosis can be performed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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