Medicine › Surgery

Intestinal and Peritoneal Adhesions

Works Count: 37418

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Description

This cluster of papers focuses on the etiology, pathophysiology, clinical significance, and management of peritoneal adhesions, particularly in the context of small bowel obstruction and abdominal surgery. It covers topics such as adhesion prevention, use of adhesion barriers, surgical management (including laparoscopic approaches), postoperative complications, and the impact of gastrointestinal bezoars. The cluster reflects a comprehensive exploration of the challenges and advancements in understanding and addressing peritoneal adhesions.

Keywords

Peritoneal Adhesions; Small Bowel Obstruction; Adhesion Prevention; Surgical Management; Pathophysiology; Clinical Significance; Adhesion Barriers; Postoperative Complications; Laparoscopic Surgery; Gastrointestinal Bezoars

Reduction of adhesions after uterine myomectomy by Seprafilm membrane (HAL-F): a blinded, prospective, randomized, multicenter clinical study

1996-12-01

Michael P. Diamond , Type Diabetes TrialNet Study Group

Prevention of postoperative abdominal adhesions by a sodium hyaluronate-based bioresorbable membrane: a prospective, randomized, double-blind multicenter study.

1996-10-01

James T. Becker , Merril T. Dayton , V. W. Fazio +7 more

Preoperative recognition of intestinal strangulation obstruction

1983-01-01

Michael G. Sarr , Gregory B. Bulkley , George D. Zuidema

Contemporary adhesion prevention

1994-02-01

Gere S. diZerega

Intestinal obstruction from adhesions--how big is the problem?

1990-01-01

D Menzies , Harold Ellis

Apart from one post-mortem study, the incidence of adhesions following laparotomy has not been well documented. 1. In a prospective analysis of 210 patients undergoing a laparotomy, who had previously … Apart from one post-mortem study, the incidence of adhesions following laparotomy has not been well documented. 1. In a prospective analysis of 210 patients undergoing a laparotomy, who had previously had one or more abdominal operations, we found that 93% had intra-abdominal adhesions that were a result of their previous surgery. This compared with 115 first-time laparotomies in which 10.4% had adhesions. 2. Over a 25-year period, 261 of 28 297 adult general surgical admissions were for intestinal obstruction from adhesions (0.9%). Of 4502 laparotomies, 148 were for adhesive obstruction (3.3%). 3. Over a 13-year period all laparotomies were followed up for an average of 14.5 months (range 0-91 months). From these 2708 laparotomies, 26 developed intestinal obstruction due to postoperative adhesions within 1 year of surgery (1%). Fourteen did so within 1 month of surgery (0.5%). 4. The majority of the operations producing intestinal obstruction were lower abdominal, principally involving the colon. The volume of general surgical work from adhesions is large and the incidence of early intestinal obstruction is high.

Biodegradable and injectable in situ cross-linking chitosan-hyaluronic acid based hydrogels for postoperative adhesion prevention

2014-02-04

Ling Li , Ning Wang , Xun Jin +6 more

Biodegradable and thermoreversible PCLA–PEG–PCLA hydrogel as a barrier for prevention of post-operative adhesion

2011-04-19

Zheng Zhang , Jian Ni , Liang Chen +3 more

Natural history of patients with adhesive small bowel obstruction

2000-09-01

George H. Miller , Jason Boman , Ian Shrier +1 more

Small bowel obstruction (SBO) is a major cause of morbidity and financial expenditure. The goals of this study were to determine factors predisposing to adhesive SBO, to note the long-term … Small bowel obstruction (SBO) is a major cause of morbidity and financial expenditure. The goals of this study were to determine factors predisposing to adhesive SBO, to note the long-term prognosis and recurrence rates for operative and non-operative treatment, to elicit the complication rate of operations and to highlight factors predictive of recurrence.The medical records of all patients admitted to one hospital between 1986 and 1996 with the diagnosis of SBO were reviewed retrospectively. This included 410 patients accounting for 675 admissions.The frequency of previous operation by procedure type was colorectal surgery (24 per cent), followed by gynaecological surgery (22 per cent), herniorrhaphy (15 per cent) and appendicectomy (14 per cent). A history of colorectal surgery (odds 2.7) and vertical incisions (odds 2.5) tended to predispose to multiple matted adhesions rather than an obstructive band. At initial admission 36 per cent of patients were treated by means of operation. As the number of admissions increased, the recurrence rate increased while the time interval between admissions decreased. Patients with an adhesive band had a 25 per cent readmission rate, compared with a 49 per cent rate for patients with matted adhesions (P<0.004). At the initial admission 36 per cent of patients were treated surgically. Patients treated without operation had a 34 per cent readmission rate, compared with 32 per cent for those treated surgically (P not significant), a shorter time to readmission (median 0.7 versus 2.0 years; P<0.05), no difference in reoperation rate (14 versus 11 per cent; P not significant) and fewer inpatient days over all admissions (4 versus 12 days; P<0.0001).The likelihood of reobstruction increases and the time to reobstruction decreases with increasing number of previous episodes of obstruction. Patients with matted adhesions have a greater recurrence rate than those with band adhesions. Non-operative treatment for adhesions in stable patients results in a shorter hospital stay and similar recurrence and reoperation rates, but a reduced interval to reobstruction when compared with operative treatment.

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Postoperative adhesions

2001-06-01

Mike Parker , Harold Ellis , Brendan Moran +7 more

PURPOSE: Postoperative adhesions are a significant problem after colorectal surgery. However, the basic epidemiology and clinical burden are unknown. The Surgical and Clinical Adhesions Research Study has investigated the scale … PURPOSE: Postoperative adhesions are a significant problem after colorectal surgery. However, the basic epidemiology and clinical burden are unknown. The Surgical and Clinical Adhesions Research Study has investigated the scale of the problem in a population of 5 million. METHODS: Validated data from the Scottish National Health Service Medical Record Linkage Database were used to define a cohort of 12,584 patients undergoing open lower abdominal surgery in 1986. Readmissions for potential adhesion-related disease in the subsequent ten years were analyzed. The methodology was conservative in interpreting adhesion-related disease. RESULTS: In the study cohort 32.6 percent of patients were readmitted a mean of 2.2 times in the subsequent ten years for a potential adhesion-related problem. Although 25.4 percent of readmissions were in the first postoperative year, they continued steadily throughout the study period. After open lower abdominal surgery 7.3 percent (643) of readmissions (8,861) were directly related to adhesions. This varied according to operation site: colon (7.1 percent), rectum (8.8 percent), and small intestine (7.6 percent). The readmission rate was assessed to provide an indicator of relative risk of adhesion-related problems after initial surgery. The overall average rate of readmissions was 70.4 per 100 initial operations, with 5.1 directly related to adhesions. This rose to 116.4 and 116.5, respectively, after colonic or rectal surgery—with 8.2 and 10.3 directly related to adhesions. CONCLUSIONS: There is a high relative risk of adhesion-related problems after open lower abdominal surgery and a correspondingly high workload associated with these readmissions. This is influenced by the initial site of surgery, colon and rectum having both the greatest impact on workload and highest relative risk of directly adhesion-related problems. The study provides sound justification for improved adhesion prevention strategies.

Morbidity and mortality of inadvertent enterotomy during adhesiotomy

2000-04-01

A A van der Krabben , Frederika Dijkstra , Marieke E. van de Nieuwenhuijzen +3 more

Inadvertent enterotomy is a feared complication of adhesiotomy during abdominal reoperation. The nature and extent of this adhesion-associated problem are unknown.The records of all patients who underwent reoperation between July … Inadvertent enterotomy is a feared complication of adhesiotomy during abdominal reoperation. The nature and extent of this adhesion-associated problem are unknown.The records of all patients who underwent reoperation between July 1995 and September 1997 were reviewed retrospectively for inadvertent enterotomy, risk factors were analysed using univariate and multivariate parameters, and postoperative morbidity and mortality rates were assessed.Inadvertent enterotomy occurred in 52 (19 per cent) of 270 reoperations. Dividing adhesions in the lower abdomen and pelvis, in particular, caused bowel injury. In univariate analysis body mass index was significantly higher in patients with inadvertent enterotomy (mean(s.d.) 25.5(4.6) kg/m2 ) than in those without enterotomy (21.9(4.3) kg/m2 ) (P < 0.03). Patient age and three or more previous laparotomies appeared to be independent parameters predicting inadvertent enterotomy (odds ratio (95 per cent confidence interval) 1.9 (1.3-2.7) and 10.4 (5.0-21.6) respectively; P < 0.001). Patients with inadvertent enterotomy had significantly more postoperative complications (P < 0.01) and urgent relaparotomies (P < 0.001), a higher rate of admission to the intensive care unit (P < 0.001) and parenteral nutrition usage (P < 0.001), and a longer postoperative hospital stay (P < 0.001).The incidence of inadvertent enterotomy during reoperation is high. This adhesion-related complication has an impact on postoperative morbidity

Duration, complications, stress, and pain of open ovariohysterectomy versus a simple method of laparoscopic-assisted ovariohysterectomy in dogs

2005-09-01

Chad M. Devitt , Ray E. Cox , Jim J. Hailey

Abstract Objective —To describe a simple method of laparoscopic-assisted ovariohysterectomy (LAOHE) and compare duration of surgery, complications, measures of surgical stress, and postoperative pain with open ovariohysterectomy (OHE) in dogs. … Abstract Objective —To describe a simple method of laparoscopic-assisted ovariohysterectomy (LAOHE) and compare duration of surgery, complications, measures of surgical stress, and postoperative pain with open ovariohysterectomy (OHE) in dogs. Design —Randomized, prospective clinical trial. Animals —20 healthy sexually intact female dogs weighing > 10 kg (22 lb). Procedures —Dogs were randomly allocated to receive conventional OHE or LAOHE. Intraoperative complications, anesthetic complications, total anesthesia time, and total surgery time were recorded. Serum cortisol and glucose concentrations, temperature, heart rate, and respiratory rate were measured preoperatively and 1, 2, 4, 6, 12, and 24 hours postoperatively. Pain scores were assigned by a nonblinded observer at 1, 2, 4, 6, 12, and 24 hours postoperatively. Duration of surgery, pain scores, objective measures of surgical stress, anesthetic complications, and surgical complications were compared between OHE and LAOHE. Results —Age, weight, PCV, and duration of surgery did not differ between treatment groups. Nine of 10 dogs in the OHE group required additional pain medication on the basis of pain scores, whereas none of the dogs in the LAOHE group did. Blood glucose concentrations were significantly increased from preoperative concentrations in the OHE group at 1, 2, 4, and 6 hours postoperatively and at 1 hour postoperatively in the LAOHE group. Cortisol concentrations were significantly increased at 1 and 2 hours postoperatively in the OHE group. Conclusions and Clinical Relevance —LAOHE caused less pain and surgical stress than OHE and may be more appropriate for an outpatient setting. ( J Am Vet Med Assoc 2005;227:921–927)

Complications of laparoscopy: a prospective multicentre observational study

1997-05-01

Frank Willem Jansen , Kitty Kapiteyn , Trudy C.M. Trimbos-Kemper +2 more

Objective To determine the incidence and describe the complications of laparoscopic procedures in The Netherlands. Design A nationwide prospective multicentre observational study. Methods Data on complications were registered from 1 … Objective To determine the incidence and describe the complications of laparoscopic procedures in The Netherlands. Design A nationwide prospective multicentre observational study. Methods Data on complications were registered from 1 January to 31 December 1994 by 72 hospitals. Any unexpected or unplanned event requiring intra‐operative or post‐operative intervention was defined as a complication. Complications were classified in two groups: approach and technique related complications. Complication rates were compared with these already published. Results Of 25,764 laparoscopic procedures, 145 complications occurred (rate 5.7 per 1000 [% 0 ]); two deaths occurred. In 84 women laparotomy was necessary (rate 3.3% 0 ). In 83 cases (57%; 95% CI for approach = 49–65%) the complication was caused by the surgical approach; in 62 cases (43%) the technique was at fault. Haemorrhage of the epigastric vein and intestinal injury, often requiring laparotomy (90% of cases) were the most frequently observed complications. The complication rate was 2.7% 0 for diagnostic laparoscopic procedures, 4.5% 0 for sterilisation and 17.9% 0 (χ 2 = 127; dF = 2; P <0.001) for operative laparoscopy. The highest incidence was registered for complications occurring during laparoscopic (assisted) hysterectomy. Stepwise logistic regression analysis showed that previous laparotomy and surgical experience were associated with complications requiring laparotomy. Conclusions Most complications occurred during operative laparoscopic procedures (rate 17.9% 0 ). Residents in training are required to learn diagnostic laparoscopy and sterilisation and this training programme results in a fall in the risk of the complications. However, operative laparoscopic procedures are still hazardous, especially laparoscopic hysterectomy. Women with a previous laparotomy are particularly at risk.

Peritoneal adhesions and their relation to abdominal surgery

1973-09-01

M.-A. Weibel , Guido Majno

AGA technical review on intestinal ischemia

2000-05-01

Lawrence J. Brandt , Scott J. Boley

Abdominal Adhesiolysis: Inpatient Care and Expenditures in the United States in 1994

1998-01-01

Neelanjana Ray

Peritoneal Adhesions: Etiology, Pathophysiology, and Clinical Significance

2001-01-01

Theodore Liakakos , Nikolaos Thomakos , Paul Fine +2 more

Aim: To summarize the most common etiologic factors and describe the pathophysiology in the formation of peritoneal adhesions, to outline their clinical significance and consequences, and to evaluate the pharmacologic, … Aim: To summarize the most common etiologic factors and describe the pathophysiology in the formation of peritoneal adhesions, to outline their clinical significance and consequences, and to evaluate the pharmacologic, mechanical, and surgical adjuvant strategies to minimize peritoneal adhesion formation. Methods: We performed an extensive MEDLINE search of the internationally published English literature of all medical and epidemiological journal articles, textbooks, scientific reports, and scientific journals from 1940 to 1997. We also reviewed reference lists in all the articles retrieved in the search as well as those of major texts regarding intraperitoneal postsurgical adhesion formation. All sources identified were reviewed with particular attention to risk factors, pathophysiology, clinical manifestations, various methods, and innovative techniques for effectively and safely reducing the formation of postsurgical adhesions. Results: The formation of postoperative peritoneal adhesions is an important complication following gynecological and general abdominal surgery, leading to clinical and significant economical consequences. Adhesion occur in more than 90% of the patients following major abdominal surgery and in 55–100% of the women undergoing pelvic surgery. Small-bowel obstruction, infertility, chronic abdominal and pelvic pain, and difficult reoperative surgery are the most common consequences of peritoneal adhesions. Despite elaborate efforts to develop effective strategies to reduce or prevent adhesions, their formation remains a frequent occurrence after abdominal surgery. Conclusions: Until additional information and findings from future clinical investigations exist, only a meticulous surgical technique can be advocated in order to reduce unnecessary morbidity and mortality rates from these untoward effects of surgery.

Macroscopic characterization of ovarian tumors and the relation to the histological diagnosis: Criteria to be used for ultrasound evaluation

1989-11-01

S. Granberg , Matts Wikland , Inge Jansson

Etiology of small bowel obstruction

2000-07-01

George H. Miller , Jason Boman , Ian Shrier +1 more

A Prospective, Randomized, Multicenter, Controlled Study of the Safety of Seprafilm® Adhesion Barrier in Abdominopelvic Surgery of the Intestine

2003-10-01

David E. Beck , Zane Cohen , James W. Fleshman +3 more

INTRODUCTION: Seprafilm® adhesion barrier (Seprafilm®) has been proven to prevent adhesion formation after abdominal and pelvic surgery. This article reports safety results, including the postoperative incidence of abdominal and pelvic … INTRODUCTION: Seprafilm® adhesion barrier (Seprafilm®) has been proven to prevent adhesion formation after abdominal and pelvic surgery. This article reports safety results, including the postoperative incidence of abdominal and pelvic abscess and pulmonary embolism, from a large, multicenter trial designed to evaluate the safety and effectiveness of Seprafilm® for reduction of adhesion-related postoperative bowel obstruction after abdominopelvic surgery. METHODS: A total of 1,791 patients participated in this prospective, randomized, multicenter, multinational, single-blind, controlled study in patients undergoing abdominopelvic surgery, the majority of whom had inflammatory bowel disease. Just before closure of the abdomen, patients were randomized to a Seprafilm® or no-treatment control group. Patients received an average of 4.4 and as many as 10 Seprafilm® adhesion barriers applied to organs and tissue surfaces that sustained direct surgical trauma and to suspected adhesiogenic surfaces. Complications that occurred within the first month after surgery were evaluated. RESULTS: During the safety evaluation period, the difference between the Seprafilm® and control groups for the incidence of abscess (4vs.3 percent, respectively) or pulmonary embolism (<1 percent in both groups) was not statistically significant (P> 0.05). Foreign body reaction was not reported in either group. Fistula (2vs.<1 percent) and peritonitis (2vs.<1 percent) occurred more frequently (P≤ 0.05) in the Seprafilm® group. In a subpopulation of patients in whom Seprafilm® was wrapped around a fresh bowel anastomosis, leak-related events, which included anastomotic leak, fistula, peritonitis, abscess, and sepsis, occurred more frequently (P≤ 0.05). There were no other differences in the incidence, severity, or causative relationship of complications between study groups. CONCLUSIONS: This study confirmed the safety of Seprafilm® adhesion barrier with respect to abdominal abscess, pelvic abscess, and pulmonary embolism when administered to patients undergoing abdominopelvic surgery. Foreign body reaction was not reported for any patient. However, wrapping the suture or staple line of a fresh bowel anastomosis with Seprafilm® should be avoided, because the data suggest that this practice may increase the risk of sequelae associated with anastomotic leak.

Peritoneal repair and post-surgical adhesion formation

2001-11-01

Gere S. diZerega

It was shown in 1919 that peritoneal healing differs from that of skin. When a defect is made in the parietal peritoneum the entire surface becomes epithelialized simultaneously and not … It was shown in 1919 that peritoneal healing differs from that of skin. When a defect is made in the parietal peritoneum the entire surface becomes epithelialized simultaneously and not gradually from the borders as in epidermalization of skin wounds. While multiplication and migration of mesothelial cells from the margin of the wound may play a small part in the regenerative process, it cannot play a major role, since new mesothelium develops in the centre of a large wound at the same time as it develops in the centre of a smaller one. Development of intraperitoneal adhesions is a dynamic process whereby surgically traumatized tissues in apposition bind through fibrin bridges which become organized by wound repair cells, often supporting a rich vascular supply as well as neuronal elements

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Benefits and harms of adhesion barriers for abdominal surgery: a systematic review and meta-analysis

2013-09-27

Richard P. G. ten Broek , Martijn W.J. Stommel , Chema Strik +3 more

Isolation, culture and characterization of human peritoneal mesothelial cells

1990-06-01

Eleni Stylianou , L. A. Jenner , Malcolm Davies +2 more

The aetiology of post-operative abdominal adhesions an experimental study

1962-07-01

Harold Ellis

Journal Article The aetiology of post-operative abdominal adhesions an experimental study Get access Harold Ellis Harold Ellis Professor of Surgery Westminster Medical School, London Search for other works by this … Journal Article The aetiology of post-operative abdominal adhesions an experimental study Get access Harold Ellis Harold Ellis Professor of Surgery Westminster Medical School, London Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 50, Issue 219, July 1962, Pages 10–16, https://doi.org/10.1002/bjs.18005021904 Published: 06 December 2005

Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity

2004-07-01

Anthony N. Kalloo , Vikesh K. Singh , Sanjay Jagannath +5 more

Review of Internal Hernias: Radiographic and Clinical Findings

2006-02-24

Lucie C. Martin , Elmar M. Merkle , William M. Thompson

Internal hernias, including paraduodenal (traditionally the most common), pericecal, foramen of Winslow, and intersigmoid hernias, account for approximately 0.5-5.8% of all cases of intestinal obstruction and are associated with a … Internal hernias, including paraduodenal (traditionally the most common), pericecal, foramen of Winslow, and intersigmoid hernias, account for approximately 0.5-5.8% of all cases of intestinal obstruction and are associated with a high mortality rate, exceeding 50% in some series. To complicate matters, the incidence of internal hernias is increasing because of a number of relatively new surgical procedures now being performed, including liver transplantation and gastric bypass surgery. A significant increase in hernias is occurring in patients undergoing transmesenteric, transmesocolic, and retroanastomotic surgical procedures. It is important for radiologists to be familiar with and to understand the various types of internal hernias and their imaging features so that prompt and accurate diagnosis of these conditions can be made.This article illustrates the imaging findings of internal hernias, with emphasis placed on the CT findings, especially in transmesenteric, transmesocolic, and retroanastomotic types of internal hernias.

Consequences and complications of peritoneal adhesions

2007-09-04

Harry van Goor

Abstract Consequences and complications of postsurgical intra‐abdominal adhesion formation not including small bowel obstruction and secondary infertility are substantial but are under‐exposed in the literature. Inadvertent enterotomy during reopening of … Abstract Consequences and complications of postsurgical intra‐abdominal adhesion formation not including small bowel obstruction and secondary infertility are substantial but are under‐exposed in the literature. Inadvertent enterotomy during reopening of the abdomen or subsequent adhesion dissection is a feared complication of surgery after previous laparotomy. The incidence can be as high as 20% in open surgery and between 1% and 100% in laparoscopy depending on the underlying disease. Delayed postoperative detection of enterotomy is a particular feature of laparoscopy associated with significant morbidity and mortality. Adhesions to the ventral abdominal wall are responsible for the majority of trocar injuries. Both trocar injuries and inadvertent enterotomies result in conversion from laparoscopy to laparotomy in almost 100% of cases. There is a paucity of data on other organ injury, such as liver laceration or bladder perforation. Dissecting adhesions before executing the planned operation takes on average 20 min, being one‐fifth of the total operating time in patients having had previous open colorectal surgery. There is some evidence that postoperative morbidity and mortality of patients who need adhesiolysis is higher than that of patients with a virgin abdomen. The necessity to dissect adhesions is associated with increased hospital stay. Postsurgical adhesions are considered a main reason for conversion from laparoscopy to laparotomy in many types of procedures including laparoscopic colonic resection. Adhesion formation is part of the innate peritoneal defence mechanism in peritonitis. Abscess formation and bleeding, organ injury and fistula formation at ‘on demand’ relaparotomies are well‐known complications after surgery for intra‐abdominal sepsis associated with fibrinous adhesions. The clinical magnitude hereof is poorly researched. Postsurgical adhesions may cause pain as evidenced by pain mapping clinical experiments. Filmy adhesions between movable organs and the peritoneum appear to be worse in terms of generating pain. The high caseload of gynaecological and some colorectal practices suggest an enormous impact of adhesion‐related chronic abdominal and pelvic pain on patient’s wellbeing and socio‐economic costs. The significant risk of inadvertent enterotomy, conversion to laparotomy and trocar injury, and the associated postoperative morbidity and mortality and increased length of hospital stay warrant routine informed consent of adhesiolysis related complications in patients scheduled for abdominal or pelvic reoperation.

The treatment of acute diarrhea in children. An historical and physiological perspective

1980-03-01

Norbert Hirschhorn

Pathophysiology and prevention of postoperative peritoneal adhesions

2011-01-01

Willy Arung

Peritoneal adhesions represent an important clinical challenge in gastrointestinal surgery.Peritoneal adhesions are a consequence of peritoneal irritation by infection or surgical trauma, and may be considered as the pathological part … Peritoneal adhesions represent an important clinical challenge in gastrointestinal surgery.Peritoneal adhesions are a consequence of peritoneal irritation by infection or surgical trauma, and may be considered as the pathological part of healing following any peritoneal injury, particularly due to abdominal surgery.The critical in determining normal peritoneal healing or adhesion formation.Postoperative peritoneal adhesions are a major cause of morbidity resulting in multiple complications, many of which may manifest several years after the initial surgical procedure.In addition to acute small bowel obstruction, peritoneal adhesions may cause pelvic or abdominal pain, and infertility.In this paper, the authors reviewed the epidemiology, pathogenesis and various prevention strategies of adhesion formation, using Medline and PubMed search.Several preventive agents against postoperative peritoneal adhesions have been investigated.Their role lagen synthesis or creating a barrier between adjacent wound surfaces.Their results are encouraging but most of them are contradictory and achieved mostly clinical researches, only a meticulous surgery can be recommended to reduce unnecessary morbidity and mortality rates from these untoward effects of surgery.In the current state of knowledge, pre-clinical or clinical studies are still necessary to evaluate the effectiveness of the several proposed prevention strategies of postoperative peritoneal adhesions.

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Unusual small intestinal obstuction in adolescent girls: The abdominal cocoon

1978-06-01

Keong Tatt Foo , Kock Ng , A Rauff +2 more

Ten cases of small intestinal obstruction seen over a period of 6 years (1971-6) in young girls within the narrow age range of 13-18 years are described. The patients were … Ten cases of small intestinal obstruction seen over a period of 6 years (1971-6) in young girls within the narrow age range of 13-18 years are described. The patients were all within 2 years of menarche. In all these cases the obstruction was due to a membrane encasing the small intestine in the manner of a cocoon. There was no previous history of abdominal operation, peritonitis or prolonged drug intake. The clinical features, operative findings and management of the cases are presented. Possible causes of the condition are discussed. In view of the similar clinical presentation in all these patients, their conditions can be grouped as a clinical entity--'the abdominal cocoon'.

Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study

1999-05-01

Harold Ellis , Brendan Moran , J N Thompson +7 more

Peritoneal healing and adhesion formation/reformation

2001-11-01

Ying Cheong

Intra-abdominal adhesion formation and reformation after surgery is a cause of significant morbidity, resulting in infertility and pain. The understanding of the pathogenesis of adhesion formation and reformation especially at … Intra-abdominal adhesion formation and reformation after surgery is a cause of significant morbidity, resulting in infertility and pain. The understanding of the pathogenesis of adhesion formation and reformation especially at the cellular and molecular level can help to further develop more effective treatments for the prevention of adhesion formation and reformation. Following an injury to the peritoneum, fibrinolytic activity over the peritoneal surface decreases, leading to changes in the expression and synthesis of various cellular mediators and in the remodelling of the connective tissue. The cellular response to peritoneal injury and adhesion formation and reformation are reviewed. Analysis of the available literature data on the cellular mediators in the peritoneal fluid showed variation in results from different investigators. The potential sources of variability and error are examined. It is still unclear if there is significant individual variation in the peritoneal response to injury.

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Laparoscopic adhesiolysis in patients with chronic abdominal pain: a blinded randomised controlled multi-centre trial

2003-04-01

DJ Swank , S. C. G. Swank-Bordewijk , WCJ Hop +4 more

Reduction in Adhesive Small-Bowel Obstruction by Seprafilm® Adhesion Barrier After Intestinal Resection

2005-11-30

Victor W. Fazio , Zane Cohen , James W. Fleshman +7 more

Although Seprafilm has been demonstrated to reduce adhesion formation, it is not known whether its usage would translate into a reduction in adhesive small-bowel obstruction.This was a prospective, randomized, multicenter, … Although Seprafilm has been demonstrated to reduce adhesion formation, it is not known whether its usage would translate into a reduction in adhesive small-bowel obstruction.This was a prospective, randomized, multicenter, multinational, single-blind, controlled study. This report focuses on those patients who underwent intestinal resection (n = 1,701). Before closure of the abdomen, patients were randomized to receive Seprafilm or no treatment. Seprafilm was applied to adhesiogenic tissues throughout the abdomen. The incidence and type of bowel obstruction was compared between the two groups. Time to first adhesive small-bowel obstruction was compared during the course of the study by using survival analysis methods. The mean follow-up time for the occurrence of adhesive small-bowel obstruction was 3.5 years.There was no difference between the treatment and control group in overall rate of bowel obstruction. The incidence of adhesive small-bowel obstruction requiring reoperation was significantly lower for Seprafilm patients compared with no-treatment patients: 1.8 vs. 3.4 percent (P < 0.05). This finding represents an absolute reduction in adhesive small-bowel obstruction requiring reoperation of 1.6 percent and a relative reduction of 47 percent. In addition, a stepwise multivariate analysis indicated that the use of Seprafilm was the only predictive factor for reducing adhesive small-bowel obstruction requiring reoperation. In both groups, 50 percent of first adhesive small-bowel obstruction episodes occurred within 6 months after the initial surgery with nearly 30 percent occurring within the first 30 days. Additionally no first adhesive small-bowel obstruction events were reported in Years 4 and 5 of follow-up.The overall bowel obstruction rate was unchanged; however, adhesive small-bowel obstruction requiring reoperation was significantly reduced by the use of Seprafilm, which was the only factor that predicted this outcome.

Acute mechanical bowel obstruction: Clinical presentation, etiology, management and outcome

2007-01-01

Haridimos Markogiannakis

AIM: To identify and analyze the clinical presentation, management and outcome of patients with acute mechanical bowel obstruction along with the etiology of obstruction and the incidence and causes of … AIM: To identify and analyze the clinical presentation, management and outcome of patients with acute mechanical bowel obstruction along with the etiology of obstruction and the incidence and causes of bowel ischemia, necrosis, and perforation. METHODS:This is a prospective observational study of all adult patients admitted with acute mechanical bowel obstruction between 2001 and 2002. RESULTS:Of the 150 consecutive patients included in the study, 114 (76%) presented with small bowel and 36 (24%) with large bowel obstruction.Absence of passage of flatus (90%) and/or feces (80.6%) and abdominal distension (65.3%) were the most common symptoms and physical finding, respectively.Adhesions (64.8%), incarcerated hernias (14.8%), and large bowel cancer (13.4%) were the most frequent causes of obstruction.Eighty-eight patients (58.7%) were treated conservatively and 62 (41.3%) were operated (29 on the first day).Bowel ischemia was found in 21 cases (14%), necrosis in 14 (9.3%), and perforation in 8 (5.3%).Hernias, large bowel cancer, and adhesions were the most frequent causes of bowel ischemia (57.2%, 19.1%, 14.3%), necrosis (42.8%, 21.4%, 21.4%), and perforation (50%, 25%, 25%).A significantly higher risk of strangulation was noticed in incarcerated hernias than all the other obstruction causes. CONCLUSION:Absence of passage of flatus and/or feces and abdominal distension are the most common symptoms and physical finding of patients with acute mechanical bowel obstruction, respectively.Adhesions, hernias, and large bowel cancer are the most common causes of obstruction, as well as of bowel ischemia, necrosis, and perforation.Although an important proportion of these patients can be nonoperatively treated, a substantial portion requires immediate operation.Great caution should be taken for the treatment of these patients since the incidence of bowel ischemia, necrosis, and perforation is significantly high.

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Management of trichobezoar: case report and literature review

2010-03-05

Ramon R. Gorter , C. M. F. Kneepkens , E.C. Mattens +2 more

Trichobezoars (hair ball) are usually located in the stomach, but may extend through the pylorus into the duodenum and small bowel (Rapunzel syndrome). They are almost always associated with trichotillomania … Trichobezoars (hair ball) are usually located in the stomach, but may extend through the pylorus into the duodenum and small bowel (Rapunzel syndrome). They are almost always associated with trichotillomania and trichophagia or other psychiatric disorders. In the literature several treatment options are proposed, including removal by conventional laparotomy, laparoscopy and endoscopy. We present our experience with four patients and provide a review of the recent literature. According to our experience and in line with the published results, conventional laparotomy is still the treatment of choice. In addition, psychiatric consultation is necessary to prevent relapses.

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Textbook of Small Animal Surgery

1993-11-01

Alasdair Hotston Moore

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CT of Internal Hernias

2005-07-01

Nobuyuki Takeyama , Takehiko Gokan , Yoshimitsu Ohgiya +7 more

Computed tomography (CT) plays an important role in diagnosis of acute intestinal obstruction and planning of surgical treatment. Although internal hernias are uncommon, they may be included in the differential … Computed tomography (CT) plays an important role in diagnosis of acute intestinal obstruction and planning of surgical treatment. Although internal hernias are uncommon, they may be included in the differential diagnosis in cases of intestinal obstruction, especially in the absence of a history of abdominal surgery or trauma. CT findings of internal hernias include evidence of small bowel obstruction (SBO); the most common manifestation of internal hernias is strangulating SBO, which occurs after closed-loop obstruction. Therefore, in patients suspected to have internal hernias, early surgical intervention may be indicated to reduce the high morbidity and mortality rates. In a study of 13 cases of internal hernias, nine different types of internal hernias were found and the surgical and radiologic findings were correlated. The following factors may be helpful in preoperative diagnosis of internal hernias with CT: (a) knowledge of the normal anatomy of the peritoneal cavity and the characteristic anatomic location of each type of internal hernia; (b) observation of a saclike mass or cluster of dilated small bowel loops at an abnormal anatomic location in the presence of SBO; and (c) observation of an engorged, stretched, and displaced mesenteric vascular pedicle and of converging vessels at the hernial orifice.

Internal Hernia: Clinical and Imaging Findings in 17 Patients with Emphasis on CT Criteria

2001-01-01

Arye Blachar , Michael P. Federle , S. Forrest Dodson

To review the clinical and radiologic features of internal hernia and to derive useful radiographic and CT criteria to assist in diagnosis.Retrospective review of medical records revealed 17 patients with … To review the clinical and radiologic features of internal hernia and to derive useful radiographic and CT criteria to assist in diagnosis.Retrospective review of medical records revealed 17 patients with surgically proved internal hernia (three paraduodenal, 14 transmesenteric) who had 15 computed tomographic (CT) scans and three small-bowel follow-through (SBFT) images.CT signs common to all types of internal hernia included evidence of small-bowel obstruction; clustering of small bowel; stretched, displaced, crowded, and engorged mesenteric vessels; and displacement of other bowel segments, especially the transverse colon and fourth portion of the duodenum. Left-sided paraduodenal hernias demonstrated a sac-like mass of small-bowel loops interposed between the stomach and pancreatic tail and a posterior mass effect on the stomach. All three paraduodenal hernias were diagnosed confidently at retrospective review of CT and SBFT findings. Transmesenteric hernias demonstrated clustered small-bowel loops adjacent to the abdominal wall without overlying omental fat and central displacement of colon and were frequently complicated by small-bowel volvulus (five of 14) and bowel ischemia (six of 14). CT demonstrated signs of volvulus in four of six patients with ischemia. CT findings considered definitive or suggestive of internal hernia were demonstrated in 15 patients.Internal hernia is an important and underdiagnosed condition. Transmesenteric hernia is most common in our experience and is usually related to prior abdominal surgery, especially with creation of a Roux-en-Y anastomosis. CT may allow confident diagnosis in most patients.

Clinical implications of postsurgical adhesions

2001-11-01

Michael P. Diamond

Adhesion development can have a major impact on a patient’s subsequent health. Adhesions are a significant source of impaired organ functioning, decreased fertility, bowel obstruction, difficult re-operation, and possibly pain. … Adhesion development can have a major impact on a patient’s subsequent health. Adhesions are a significant source of impaired organ functioning, decreased fertility, bowel obstruction, difficult re-operation, and possibly pain. Consequently, their financial sequelae are also extraordinary, with more than one billion dollars spent in the USA in 1994 on the bowel obstruction component alone. Performing adhesiolysis for pain relief appears efficacious in certain subsets of women. Unfortunately even when lysed, adhesions have a great propensity to reform. Adhesions are prevalent in all surgical fields, and nearly any compartment of the body. For treatment of infertility and recurrent pregnancy loss, lysis of intrauterine adhesions results in improved fecundability and decreased pregnancy loss.

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Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis

2013-10-03

Richard P. G. ten Broek , Yama Issa , Evert J. P. van Santbrink +6 more

Objective To estimate the disease burden of the most important complications of postoperative abdominal adhesions: small bowel obstruction, difficulties at reoperation, infertility, and chronic pain. Design Systematic review and meta-analyses. … Objective To estimate the disease burden of the most important complications of postoperative abdominal adhesions: small bowel obstruction, difficulties at reoperation, infertility, and chronic pain. Design Systematic review and meta-analyses. Data sources Searches of PubMed, Embase, and Central, from January 1990 to December 2012, without restrictions to publication status or language. Study selection All types of studies reporting on the incidence of adhesion related complications were considered. Data extraction and analysis The primary outcome was the incidence of adhesive small bowel obstruction in patients with a history of abdominal surgery. Secondary outcomes were the incidence of small bowel obstruction by any cause, difference in operative time, enterotomy during adhesiolysis, and pregnancy rate after abdominal surgery. Subgroup and sensitivity analyses were done to study the robustness of the results. A random effects model was used to account for heterogeneity between studies. Results We identified 196 eligible papers. Heterogeneity was considerable for almost all meta-analyses. The origin of heterogeneity could not be explained by study design, study quality, publication date, anatomical site of operation, or operative technique. The incidence of small bowel obstruction by any cause after abdominal surgery was 9% (95% confidence interval 7% to 10%; I2=99%). the incidence of adhesive small bowel obstruction was 2% (2% to 3%; I2=93%); presence of adhesions was generally confirmed by emergent reoperation. In patients with a known cause of small bowel obstruction, adhesions were the single most common cause (56%, 49% to 64%; I2=96%). Operative time was prolonged by 15 minutes (95% confidence interval 9.3 to 21.1 minutes; I2=85%) in patients with previous surgery. Use of adhesiolysis resulted in a 6% (4% to 8%; I2=89%) incidence of iatrogenic bowel injury. The pregnancy rate after colorectal surgery in patients with inflammatory bowel disease was 50% (37% to 63%; I2=94%), which was significantly lower than the pregnancy rate in medically treated patients (82%, 70% to 94%; I2=97%). Conclusions This review provides detailed and systematically analysed knowledge of the disease burden of adhesions. Complications of postoperative adhesion formation are frequent, have a large negative effect on patients’ health, and increase workload in clinical practice. The quantitative effects should be interpreted with caution owing to large heterogeneity. Registration The review protocol was registered through PROSPERO (CRD42012003180).

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Review of the diagnosis and management of gastrointestinal bezoars

2015-01-01

Masaya Iwamuro , Hiroyuki Okada , Kazuhiro Matsueda +4 more

The formation of a bezoar is a relatively infrequent disorder that affects the gastrointestinal system.Bezoars are mainly classified into four types depending on the material constituting the indigestible mass of … The formation of a bezoar is a relatively infrequent disorder that affects the gastrointestinal system.Bezoars are mainly classified into four types depending on the material constituting the indigestible mass of the bezoar: phytobezoars, trichobezoars, pharmacobezoars, and lactobezoars.Gastric bezoars often cause ulcerative lesions in the stomach and subsequent bleeding, whereas small intestinal bezoars present with small bowel obstruction and ileus.A number of articles have emphasized the usefulness of Coca-Cola ® administration for the dissolution of phytobezoars.However, persimmon phytobezoars may be resistant to such dissolution treatment because of their harder consistency compared to other types of phytobezoars.Better understanding of the etiology and epidemiology of each type of bezoar will facilitate prompt diagnosis and management.Here we provide an overview of the prevalence, classification, predisposing factors, and manifestations of bezoars.Diagnosis and management strategies are also discussed, reviewing mainly our own case series.Recent progress in basic research regarding persimmon phytobezoars is also briefly reviewed.

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Fewer adhesions induced by laparoscopic surgery?

2004-04-22

Carsten N. Gutt , Traian Oniu , Peter Schemmer +2 more

The clinical significance of adhesions: focus on intestinal obstruction.

1997-01-01

Harold Ellis

Postoperative adhesions occur after almost every abdominal surgery and are the leading cause of intestinal obstruction, accounting for more than 40% of all cases and 60% to 70% of those … Postoperative adhesions occur after almost every abdominal surgery and are the leading cause of intestinal obstruction, accounting for more than 40% of all cases and 60% to 70% of those involving the small bowel. This contrasts with earlier experience in the Western World and current practice in the Third World, where abdominal operations are infrequent, hernias remain untreated, and strangulated hernia is common. These are among the findings of prospective and retrospective studies on adhesions conducted at the Westminster Medical School, University of London, London, UK, and of other published studies on the clinical consequences of postoperative intra-abdominal adhesions and resultant intestinal obstruction. In an analysis of 210 patients who had undergone at least one previous abdominal operation, 92.9% had postsurgical adhesions. This is not surprising, given the extreme delicacy of the peritoneum and the fact that apposition of two injured surfaces nearly always results in adhesion formation. Problems resulting from postsurgical adhesions create a considerable workload. At Westminster Hospital over 24 years, intestinal obstruction accounted for 0.9% of all admissions, 3.3% of major laparotomies and 28.8% of cases of large or small bowel obstructions. A 1992 British survey reported an annual total of 12,000 to 14,400 cases of adhesive intestinal obstruction. In 1988 in the United States, admissions for adhesiolysis accounted for nearly 950,000 days of inpatient care. Risk factors, such as type of surgery and site of adhesions, as well as timing and recurrence rate of adhesive obstruction, remain unpredictable or poorly understood. The type of surgery most frequently leading to adhesive obstruction includes colonic, and especially rectal surgery, appendicectomy, and gynecological procedures. Laparoscopy does not seem to eliminate the risk of adhesions and adhesive obstruction. Adhesions involving the small intestine occur less frequently than those involving the omentum, but are more likely to become obstructive. Follow-up of over 2,000 laparotomies at the Westminster Hospital demonstrated that 1% of patients developed adhesive obstruction within one year of surgery, and half of these occurred within the first postoperative month. However, obstruction may occur at any time, and some 20% of cases appeared more than 10 years later. Recurrent obstruction following adhesiolysis is common, but actuarial tables still need to be constructed. Adhesive obstruction is clinically challenging, since there is no simple way to differentiate between adhesive and strangulated obstructions. Mortality rates escalate from 3% for simple obstructions to 30% when the bowel becomes necrotic or perforated.

Small Intestinal Obstruction

1987-06-01

Peter Mucha

Intrauterine adhesions: an updated appraisal

1982-05-01

Edward E. Wallach , Joseph G. Schenker , Ehud J. Margalioth

Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group

2018-06-19

Richard P. G. ten Broek , Pepijn Krielen , Salomone Di Saverio +7 more

Adhesive small bowel obstruction (ASBO) is a common surgical emergency, causing high morbidity and even some mortality. The adhesions causing such bowel obstructions are typically the footprints of previous abdominal … Adhesive small bowel obstruction (ASBO) is a common surgical emergency, causing high morbidity and even some mortality. The adhesions causing such bowel obstructions are typically the footprints of previous abdominal surgical procedures. The present paper presents a revised version of the Bologna guidelines to evidence-based diagnosis and treatment of ASBO. The working group has added paragraphs on prevention of ASBO and special patient groups. The guideline was written under the auspices of the World Society of Emergency Surgery by the ASBO working group. A systematic literature search was performed prior to the update of the guidelines to identify relevant new papers on epidemiology, diagnosis, and treatment of ASBO. Literature was critically appraised according to an evidence-based guideline development method. Final recommendations were approved by the workgroup, taking into account the level of evidence of the conclusion. Adhesion formation might be reduced by minimally invasive surgical techniques and the use of adhesion barriers. Non-operative treatment is effective in most patients with ASBO. Contraindications for non-operative treatment include peritonitis, strangulation, and ischemia. When the adhesive etiology of obstruction is unsure, or when contraindications for non-operative management might be present, CT is the diagnostic technique of choice. The principles of non-operative treatment are nil per os, naso-gastric, or long-tube decompression, and intravenous supplementation with fluids and electrolytes. When operative treatment is required, a laparoscopic approach may be beneficial for selected cases of simple ASBO. Younger patients have a higher lifetime risk for recurrent ASBO and might therefore benefit from application of adhesion barriers as both primary and secondary prevention. This guideline presents recommendations that can be used by surgeons who treat patients with ASBO. Scientific evidence for some aspects of ASBO management is scarce, in particular aspects relating to special patient groups. Results of a randomized trial of laparoscopic versus open surgery for ASBO are awaited.

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Adhesion formation after laparoscopic surgery in tubal pregnancy: a randomized trial versus laparotomy

1991-05-01

Per Lundorff , Mats Hahlin , Björn Källfelt +2 more

A Sandwiched Patch for Prevention of Pelvic Adhesion After Uterine Operation.

2025-07-01

Weiying Liang , Dongmei Chen , Minzhi Hou +3 more | PubMed

The prevention of postoperative adhesions remains a critical clinical challenge in gynecological surgery, as these pathological formations may lead to intestinal obstruction, chronic pelvic pain, and reproductive complications. Regarding the … The prevention of postoperative adhesions remains a critical clinical challenge in gynecological surgery, as these pathological formations may lead to intestinal obstruction, chronic pelvic pain, and reproductive complications. Regarding the clinical application of anti-adhesion barriers, current products including but not limited to Interceed and chitosan-based dressings have demonstrated suboptimal efficacy in practice. We developed a triple-layer patch comprising: (1) a tissue-adhesive inner layer of polyacrylic acid-gelatin composite, (2) a mechanically dissipative intermediate layer of polyglycine, and (3) an anti-adhesive external layer of polyzwitterionic polymer. In this study, we investigated the antiadhesion effect of the triple-layer patch by using a uterine operation model in rats and reported that the triple-layer patch can inhibit the production of tumor necrosis factor-α and transforming growth factor beta 1, upregulate tissue-type plasminogen activator, and downregulate plasminogen activator inhibitor to inhibit inflammation and fibrosis. These findings substantiate that the triple-layer patch may have broad applicability to prevent postoperative adhesions through inhibition of inflammatory responses and fibrotic processes, demonstrating promising translational potential in gynecological surgery.

Hemoadhican-based self-leveling Janus patch for comprehensive prevention of postoperative adhesions

2025-06-24

Rui Fang , Ning Yu , Simeng Chen +2 more | Materials Today Bio

Beyond Inflammatory Bowel Disease: Calprotectin as a Marker for Trichobezoar? A Case Report

2025-06-24

Ammar Khayat | Case Reports in Gastroenterology

Trichobezoar is an aggregation of swallowed hair strands that entangle in the stomach. It presents with abdominal pain, vomiting, and diarrhea. Diagnosis is usually made by imaging and endoscopy. Surgical … Trichobezoar is an aggregation of swallowed hair strands that entangle in the stomach. It presents with abdominal pain, vomiting, and diarrhea. Diagnosis is usually made by imaging and endoscopy. Surgical removal is typically required, but endoscopic retrieval has been successful. Fecal calprotectin is a biomarker of inflammation that is typically elevated in inflammatory bowel disease (IBD) but is also elevated in other gastrointestinal (GI) disorders such as infections. Trichobezoar is not known to precipitate GI inflammation and has never been reported among the etiologies of elevated fecal calprotectin. Herein is a case presenting with vague abdominal pain and elevated fecal calprotectin that was attributed solely to a trichobezoar. A 7-year-old girl presented with abdominal pain for 6 months associated with occasional vomiting and diarrhea. Family history was positive for ulcerative colitis. Physical examination was unremarkable including normal growth. Diagnostic workup revealed elevated fecal calprotectin at 433.9 mg/kg. Upper and lower endoscopies were performed. A trichobezoar with Rapunzel syndrome was incidentally found in the stomach extending into the duodenum without frank obstruction. Histology showed reactive gastropathy in a few areas of mechanical rubbing by hair strands; otherwise, it was completely unremarkable in both upper and lower GI biopsies. Endoscopic retrieval of piecemeal hair locks was done. Surgical removal was subsequently done due to the generous size of the mass. Fecal calprotectin is an important biomarker for IBD, as well as other unusual GI pathologies, and clinical context is crucial when interpreting its value.

Comparative Diagnostic Accuracy of CT and Ultrasonography for Bowel Obstruction: A Systematic Review and Meta-Analysis

2025-06-24

Moch Nurul Jadid , Dono Marsetio Wibiseno | Open Access Indonesian Journal of Medical Reviews

The prompt and accurate diagnosis of bowel obstruction is a critical challenge. This systematic review and meta-analysis aimed to determine and compare the pooled diagnostic accuracy of computed tomography (CT) … The prompt and accurate diagnosis of bowel obstruction is a critical challenge. This systematic review and meta-analysis aimed to determine and compare the pooled diagnostic accuracy of computed tomography (CT) and ultrasonography (USG) for detecting bowel obstruction in adult patients. Following PRISMA-DTA guidelines, we systematically searched PubMed, ScienceDirect, and SagePub for primary diagnostic accuracy studies published between 2014 and 2024 that evaluated CT and/or USG against a reference standard (surgical findings or clinical follow-up). Two reviewers independently screened studies, extracted data, and assessed bias using the QUADAS-2 tool. Bivariate random-effects models were used to calculate pooled sensitivity and specificity. Our search yielded 15 studies comprising 2,876 patients. For the diagnosis of bowel obstruction, CT had a pooled sensitivity of 95.2% (95% CI: 92.8%–96.9%) and a pooled specificity of 96.1% (95% CI: 93.5%–97.7%). For USG, the pooled sensitivity was 91.5% (95% CI: 88.4%–93.8%), and the pooled specificity was 94.3% (95% CI: 91.2%–96.4%). The area under the summary receiver operating characteristic curve confirmed superior overall diagnostic performance for CT (0.98) compared to USG (0.95). In conclusion, CT demonstrates a slightly higher diagnostic accuracy than USG for bowel obstruction in adults. It should be considered the preferred modality for definitive evaluation, particularly for identifying etiology and complications. However, USG remains an excellent and highly accurate alternative, especially as a first-line, point-of-care tool in emergency settings, in pregnant patients, or where CT is contraindicated. The choice of modality should be guided by the specific clinical context.

Homocysteine(HCY), a novel biomarker for predicting irreversible transmural intestinal necrosis in patients with adhesive small bowel obstruction: results from a prospective observational study

2025-06-24

Youlong Zhu , Ruming Liu , Xuan Geng +4 more | World Journal of Emergency Surgery

Whether elevated homocysteine level is causally associated with small bowel necrosis remains unestablished. We conducted a prospective observational study to analyze the value of serum homocysteine (HCY) in predicting irreversible … Whether elevated homocysteine level is causally associated with small bowel necrosis remains unestablished. We conducted a prospective observational study to analyze the value of serum homocysteine (HCY) in predicting irreversible transmural intestinal necrosis (ITIN) of adhesive small bowel obstruction (ASBO). This prospective observational study was performed between Feb 2023 and Feb 2025 in patients with adhesive small bowel obstruction. The primary outcome was the occurrence of ITIN. The serum levels of different biomarkers in different groups were calculated and compared. Univariable analysis and multivariable analysis were used to assess the association between different biomarkers and ITIN. The Receiver Operating Characteristic Curve (ROC) was used to assess the value for predicting ITIN. The patients comprised 129(58.37%) male and 92(41.63%) female with a median age of 70(60-78)(range 18-85 years). Of the 221 patients included, 88(39.82%) received non-operative treatment, and 133(60.18%) underwent surgery. Intestinal resection and ITIN concerned 89(66.92%) and 68(51.13%) of patients who underwent surgery, respectively. Patients underwent surgery had significantly higher serum levels of HCY, ENDOTOXIN, IL-5, IL-6, Hs-CRP, IL-1β, and PCT (p<0.0001, respectively) than patients receiving non-operative treatment. The levels of the above seven markers (p<0.05, respectively) in patients with ITIN were significantly higher than in patients with non-necrosis. Univariable analysis and multivariable analysis showed that HCY、ENDOTOXIN and Hs-CRP were independent predictors for small bowel necrosis (odds ratio = 1.420, 1.061 and 1.032; p = 0 0.000, p = 0.001 and, p = 0.019, respectively). The AUC of HCY (0.9253, p<0.0001) was higher compared with ENDOTOXIN (0.8291, p<0.0001) and Hs-CRP (0.7023, p<0.0001). HCY had highest sensitivity (89.71%) and specificity (83.03%) compared with ENDOTOXIN (82.83%, 62.08%) and CRP (73.53%, 50.77%) for predicting small bowel necrosis. The serum HCY cutoff level for the diagnosis of small bowel necrosis was 15.53µmol/L. This study provides compelling evidence that homocysteine (HCY) levels can be a useful predictor of irreversible transmural intestinal necrosis that necessitates surgical resection in the setting of adhesive small bowel obstruction. Close monitoring of the HCY serum level could help avoid unnecessary laparotomy and resection, as well as complications due to unnnecessary surgery, and potentially decrease overall mortality rates.

Investigation of the Effect of Autologous Cytokine Rich Serum (ACRS) and Platelet Rich Plasma (PRP) Treatment on Experimental Uterine Horn Peritoneal Adhesion Model in Rats

2025-06-23

Hanifi Erol , Erol Karakaş , Mustafa Ermiş +3 more | Bratislavské lekárske listy/Bratislava medical journal

Abstract Background Adhesion formation is a complex biological process defined as adhesion of intra-abdominal organs to one another or to the abdominal wall with fibrous bands. In recent years, various … Abstract Background Adhesion formation is a complex biological process defined as adhesion of intra-abdominal organs to one another or to the abdominal wall with fibrous bands. In recent years, various methods and drugs have been used for preventing the abdominal adhesion. Autologous cytokine rich serum (ACRS) is a blood-derived product obtained by incubating and centrifuging whole blood. It contains various cytokines and factors. Platelet rich plasma (PRP) is a blood product and rich in growth factors. Objective The aim of this study is to compare and investigate the effects of PRP and ACRS on uterine horn peritoneal adhesion. Methods The animal material of the study was consisted 42 healthy, 4 months old, non-pregnant female Wistar-Albino rats with 150–200 g, body weight. While 6 of these 42 animals included in the study were used as donors to PRP and ACRS, 36 animals were divided into six groups with 6 rats in each group. Result Adhesion, inflammatory cell infiltration, TNF-α, IL-6, Col-I, α-SMA scores were compared between groups and ACRS group’s scores were significantly lower than other groups. Conclusion As result of this study, ACRS treatment has shown to provide more effective manipulation of the inflammatory response. Especially, ACRS treatment has more effective anti-inflammatory effect on peritoneal adhesion was seen with the histopathologic findings of this study. Our current findings suggest that ACRS has an anti-adhesion role by reducing the inflammatory response in adhesion tissues.

Internal Transmesenteric Hernia Causing Small Bowel Obstruction: A Case Report

2025-06-21

Pragya Sinha , Virendra S Chauhan , Surabhi Gupta | Cureus

Internal hernias often present with vague and nonspecific symptoms of bowel obstruction. However, they carry a potential for bowel ischemia; as such, they need immediate surgery. It is important to … Internal hernias often present with vague and nonspecific symptoms of bowel obstruction. However, they carry a potential for bowel ischemia; as such, they need immediate surgery. It is important to identify the etiology of small bowel obstruction as it may cause ischemia or strangulation of the bowel. Most guidelines suggest a wait-and-watch policy for small bowel obstruction. At the same time, if there are any signs of peritonitis, strangulation, or bowel ischemia, surgical exploration is recommended. We present a case of an 81-year-old man who came to the emergency department with complaints of vague but persistent abdominal pain. The pain was localized to the right flank and had become dull in nature. An abdominal X-ray showed a few air-fluid levels suggestive of subacute obstruction. The portable ultrasound was inconclusive. A non-contrast computed tomography (NCCT) scan of the abdomen was done for the non-resolution of pain. It revealed rotation/volvulus in the small bowel mesentery. A deeper look suggested the possibility of internal transmesenteric herniation with evidence of early bowel ischemia. Surgical exploration revealed ileal loops internally herniating inside a band of mesenteric tissue. The mesenteric band was cut, and the obstruction was relieved. Subsequently, the patient was discharged home.

The Effect of Thymoquinone and Platelet-Rich Plasma on Intra-Abdominal Adhesions

2025-06-20

Gökhan Karaca , Hakan Amioğlu , Mevlüt Recep PEKCİCİ +1 more | Medicina

Background and Objectives: At present, intra-abdominal adhesions (IAAs) continue to be an important problem in surgery due to morbidity and mortality risks. Thymoquinone (TQ) and platelet-rich plasma (PRP) are molecules … Background and Objectives: At present, intra-abdominal adhesions (IAAs) continue to be an important problem in surgery due to morbidity and mortality risks. Thymoquinone (TQ) and platelet-rich plasma (PRP) are molecules with known anti-inflammatory and antioxidant effects. However, a limited number of studies have investigated their efficacy in IAAs. In this study, we aimed to demonstrate the efficacy of TQ and PRP in reducing the development of IAAs and determine which molecule is more advantageous using an experimental animal model. Materials and Methods: Fifty-five male Wistar albino rats were included in the study. Five rats were used to obtain PRP, while fifty rats were randomly assigned to five groups (n = 10 per group): group I (sham) did not receive any treatment; group II (control) received no treatment after a cecum hemorrhage procedure; group III (saline) received 1 mL of saline treatment around the cecum after hemorrhage; group IV (PRP) received 1 mL of PRP (containing 3 × 106 platelets/mL) around the cecum after hemorrhage; and group V (TQ) received 1 mL of TQ (containing 2 mg/mL TQ) around the cecum after hemorrhage. On the 10th day, IL1-β, TNF-α, E-selectin, and P-selectin levels were measured from the blood serum samples, and the cecum was histopathologically evaluated. Results: The lowest adhesion formation in terms of biochemical parameters was obtained in the TQ group (p < 0.05). Histopathological evaluations showed that saline, PRP, and TQ treatments were all effective, but none was superior. Conclusions: When histopathologically evaluated, saline, TQ, and PRP have similar effects in IAAs. However, when evaluated in terms of biochemical parameters, TQ prevented the formation of intra-abdominal adhesions more effectively than saline or PRP, owing to its strong anti-inflammatory and antioxidant properties.

Retrospective Analysis of Etiology Treatment Outcomes and Risk Factors in Intestinal Obstruction

2025-06-20

Houhong Wang | Journal of Surgery & Anesthesia Research

Background: Intestinal Obstruction (IO) remains a critical gastrointestinal emergency with diverse etiologies. This study analyzed clinical characteristics, treatment outcomes, and risk factors for mortality in IO patients. Methods: Data from … Background: Intestinal Obstruction (IO) remains a critical gastrointestinal emergency with diverse etiologies. This study analyzed clinical characteristics, treatment outcomes, and risk factors for mortality in IO patients. Methods: Data from 500 IO patients (2021–2024) were retrospectively reviewed. Etiologies, treatment modalities (surgical/non-surgical), and outcomes were analyzed. Multivariate logistic regression identified risk factors for mortality. Results: Adhesive obstruction (45%) and malignancy (32%) were the most common etiologies. Surgical intervention was performed in 68% (340/500), with higher success rates in adhesive vs. malignant obstruction (82% vs. 55%, p<0.001). Overall mortality was 9% (45/500). Independent risk factors for mortality included age ≥65 years (OR=2.8, 95%CI:1.5–5.2, p=0.003), malignant etiology (OR=3.5, 95%CI:1.9–6.4, p<0.001), and delayed surgery (>48 hours, OR=2.1, 95%CI:1.2–3.7, p=0.012). Conclusion: Malignancy and advanced age are key risk factors for IO mortality. Timely surgery improves outcomes in adhesive obstruction, while multidisciplinary care is critical for malignant IO.

Giant Trichobezoar Extending to the Ileocecal Junction in a 3-Year-Old Female: A Rare Case Report

2025-06-20

Sachin Kumar , Ramesh K. Tripathi , Nitin Patel +2 more | Cureus

A Rare Case of Mechanical Small Bowel Obstruction Secondary to Herniation of a Part of the Ileum through a Defect in the Meso-appendix with Appendicitis and its Laparoscopic Management

2025-06-19

Pamathy Gnanaselvam , Pathiragoda Gabadage Don Harsha Dishantha , Wickramaratne Saranga Eshanie +2 more | Archives of Case Reports

Small Bowel Obstruction (SBO) resulting from internal herniation through a defect in the mesoappendix is extremely rare, with only a few documented cases found in the literature in the context … Small Bowel Obstruction (SBO) resulting from internal herniation through a defect in the mesoappendix is extremely rare, with only a few documented cases found in the literature in the context of acute appendicitis. We are presenting a case of a 79-year-old female who presented with atypical abdominal pain with a history of a fall. Due to persistent abdominal pain and tenderness on examination, further investigations were conducted. A Computed Tomography (CT) scan revealed SBO with a transition point at the terminal ileum, suspected to be caused by adhesions or mesenteric twisting. Laparoscopic exploration identified a herniated loop of the bowel through a defect in the mesoappendix, alongside an inflamed appendix containing fecaliths. The obstruction was successfully relieved via a laparoscopic approach, with an appendectomy performed concurrently. The postoperative period was uncomplicated. This case underscores the importance of considering rare causes of intestinal obstruction, particularly when clinical presentation is atypical. Early diagnosis and timely surgical intervention are crucial for favorable outcomes. In cases of SBO, rare pathologies should always be considered before making surgical decisions. This case also highlights the importance of considering the length of appendix and its associated risks in mechanical obstruction.

Recanalization of a Petersen Defect After Prophylactic Closure: A Case of Internal Hernia Following Laparoscopic Distal Gastrectomy

2025-06-19

Hiroki Makinodan , Kentoku Fujisawa , Takami Fukui +2 more | Cureus

Integrating Genomics and Molecular Biology in Understanding Peritoneal Adhesion

2025-06-19

Mirela Lungu , Claudiu N. Lungu , Andreea Crețeanu +1 more | Current Issues in Molecular Biology

Peritoneal adhesions following surgical injury remain a major clinical challenge, often resulting in severe complications, such as intestinal obstruction, chronic pain, and infertility. This review systematically integrates recent genomic and … Peritoneal adhesions following surgical injury remain a major clinical challenge, often resulting in severe complications, such as intestinal obstruction, chronic pain, and infertility. This review systematically integrates recent genomic and molecular biology insights into the pathogenesis of peritoneal adhesions, explicitly focusing on molecular pathways, including TGF-β signaling, COX-2-mediated inflammatory responses, fibrinolytic balance (tPA/PAI-1), angiogenesis pathways (VEGF, PDGF), and extracellular matrix remodeling (MMPs/TIMPs). Newly conducted transcriptomic and proteomic analyses highlight distinct changes in gene expression patterns in peritoneal fibroblasts during adhesion formation, pinpointing critical roles for integrins, cadherins, selectins, and immunoglobulin superfamily molecules. Recent studies indicate significant shifts in TGF-β isoforms expression, emphasizing isoform-specific impacts on fibrosis and scarring. These insights reveal substantial knowledge gaps, particularly the differential regulatory mechanisms involved in fibrosis versus normal reparative reperitonealization. Future therapeutic strategies could target these molecular pathways and inflammatory mediators to prevent or reduce adhesion formation. Further research into precise genetic markers and the exploration of targeted pharmacological interventions remain pivotal next steps in mitigating postoperative adhesion formation and improving clinical outcomes.

FRATURA PROXIMAL DE CALCÂNEO SEGUIDO POR RUPTURA DE TENDÃO GASTROCNÊMICO EM FELINO

2025-06-16

Thiarles Ferreira da Silva , André Luiz Borba do Nascimento , Ricardo Lima Salomão | Nucleus Animalium

A ruptura do tendão calcanear comum, é uma afecção cirúrgica em pequenos animais e tem como principal origem, traumática e degenerativa. Os sinais clínicos apresentados estão relacionados a claudicação e … A ruptura do tendão calcanear comum, é uma afecção cirúrgica em pequenos animais e tem como principal origem, traumática e degenerativa. Os sinais clínicos apresentados estão relacionados a claudicação e alterações posturais (andar palmar). Exames complementares como a ultrassonografia ou radiografia contribuem para o melhor diagnóstico desta patologia. Este trabalho objetivou relatar o caso atendido no Centro Médico Veterinário Carlos Rossato da FAFRAM de um felino, SRD, macho, de aproximadamente 1 ano de idade com ferida por avulsão no membro pélvico direito por suspeita de atropelamento, ao realizar a anamnese e exame físico verificou-se a ruptura do Tendão calcâneo. O tratamento realizado foi cirúrgico, por meio da osteossíntese, com sucesso, de retorno da deambulação.

Laparoscopic Repair of Transmesosigmoid Hernia Following Robot-Assisted Abdominoperineal Resection: A Case Report

2025-06-15

Hiroshi Saito , Masanori Kotake , Kaeko Oyama +2 more | Cureus

An unusually acute abdominal pain: A case report

2025-06-13

Ya-Chen Wang , Jianfeng Zhang , Hongyuan Shen +1 more | Medicine

Rationale: Acute abdominal pain is a common clinical symptom. Its etiology is complex and intricate. This is a case of small intestinal obstruction caused by bezoar combined with diabetes ketoacidosis, … Rationale: Acute abdominal pain is a common clinical symptom. Its etiology is complex and intricate. This is a case of small intestinal obstruction caused by bezoar combined with diabetes ketoacidosis, which leads to abdominal pain. The obstruction was caused by bezoars, which is rare in clinical practice, and worth summarizing and learning. Patient concerns: We reported a case of a 58-year-old female who was admitted to the hospital due to “upper abdominal pain for 3 days”. Diagnoses: Fasting blood glucose was 21 mmol/L, urinary ketone body 3+, pondus hydrogenii (pH) 7.309, actual and standard bicarbonate decreased, and abdominal enhanced computed tomography showed a rounded low-density shadow with sharp edges and well-defined borders in the lumen of the bowel on the left side of the abdomen, with a size of 6 cm, and no significant enhancement within the lesion. Interventions: Including hypoglycemic treatment, correction of acid–base imbalance and electrolyte disorders, and removal of gastric stones through laparoscopy, etc. Outcomes: This abdominal pain was caused by a small intestinal obstruction caused by bezoar combined with diabetes ketoacidosis. The patient was discharged successfully and remained symptom-free during follow-up. Lessons: There are many causes of acute abdominal pain. In clinical practice, we should comprehensively consider and diagnose the causes of abdominal pain based on the patient’s current medical history, past medical history, physical examination, and auxiliary examinations. We must be alert to rare and multiple causes that can jointly cause abdominal pain, and promptly deal with different causes.

A rare case of a volvulus of the ascending colon strangulated through the foramen of Winslow: “A case report and comprehensive literature review of this rare entity”

2025-06-03

Tom Vandaele , Noor Beneens , Marie De Ryck +4 more | Radiology Case Reports

Hernia abdominal paraduodenal izquierda estrangulada

2025-06-02

Alejandro Barboza Martinez , Joaquín Alejandro Solarana Ortíz , Gonzalo Gayo +1 more | Revista Argentina de Coloproctología

Background: Internal abdominal hernias, defined as the passage of internal organs through a peritoneal or mesenteric opening, leading to its entrapment within a compartment inside the abdominal cavity, are uncommon … Background: Internal abdominal hernias, defined as the passage of internal organs through a peritoneal or mesenteric opening, leading to its entrapment within a compartment inside the abdominal cavity, are uncommon entities, accounting for 1% of all hernias. Among internal abdominal hernias, paraduodenal hernias represent approximately 50% of the total, being the most common. They result from anomalies in the rotation of the intestine during intrauterine gestation and are associated with cases of intestinal obstruction. First described by Neubauer in 1786, there are few cases documented in the international literature. Despite the low incidence of such cases, their significance lies in the diagnostic challenge they pose. Clinical presentations are nonspecific, ranging from episodes of abdominal discomfort accompanied by nausea and vomiting to complete intestinal obstruction, potentially leading to complications such as peritonitis due to ischemic injury or perforation. Objective: To report our center's experience in the treatment of a 63-year-old female patient with a case of intestinal obstruction secondary to a strangulated paraduodenal hernia. Materials and Methods: The clinical case of a patient presenting with obstructive symptoms is described, necessitating reduction, resection and anastomosis of the involved intestinal segment via laparotomy.

Neurokinin B is a potential target for treating disruption of intestinal mucosal barrier in acute mechanical intestinal obstruction

2025-06-02

Feifan Wang , Xia Jiang , Zifeng Zhao +5 more | Peptides

Comparison of Simvastatin Gel and Amnion Membrane Gel for Preventing Postoperative Intra-abdominal Adhesion Formation in Rat Model

2025-06-01

Forouheh Moazezi , Roya Derakhshan , Yasamin Ostadi +6 more | Injury

Intestinal obstruction secondary to uterine broad ligament hernia

2025-06-01

Díaz L Rodríguez-Carreño , Moreno L Cadaval , Ismael Mora‐Guzmán | Cirugía Española (English Edition)

Preparation and characterization of hyaluronic acid-based fixable materials for prevention of postsurgical adhesion

2025-06-01

Hoonsik Shin , Seungwon Hong , Seongyeon Jo +2 more | APL Materials

Postsurgical adhesions are frequent complications of surgical procedures that cause significant morbidity in patients. Hyaluronic acid (HA)-based anti-adhesive materials prevent postsurgical adhesion; however, fixation of these materials at the surgical … Postsurgical adhesions are frequent complications of surgical procedures that cause significant morbidity in patients. Hyaluronic acid (HA)-based anti-adhesive materials prevent postsurgical adhesion; however, fixation of these materials at the surgical site remains an issue. In this study, we developed HA-based, fixable, self-healing materials to prevent postsurgical adhesions. Gallic acid-conjugated hyaluronic acid (HA-GA) was synthesized using adipic acid dihydrazide linkers and mixed with HA solution to prepare HA/HA-GA mixtures as fixable anti-adhesive materials. The HA/HA-GA mixtures with the 7:3 v/v ratios exhibited optimized elastic modulus (G′) values (1.97 ± 0.02 kPa) that were higher than those of the unmodified HA (12.6 ± 2.86 Pa) and lower than those of HA-GA (10.8 ± 1.70 kPa). In addition, in vitro immobilization experiments demonstrated that while HA alone flowed down a vertically oriented porcine intestinal surface within 1 min, the HA/HA-GA blend remained in place for the entire observation period (7 min). Moreover, the HA/HA-GA mixtures (7:3 v/v ratio) yielded markedly lower adhesion scores (1.3) than those of the control (5.3) and HA/HA-GA mixtures with a 9:1 v/v ratio (3). Thus, the HA/HA-GA mixture can be exploited as an anti-adhesion agent that effectively prevents postsurgical adhesion by immobilizing HA/HA-GA anti-adhesives at the surgical site and forming physical barriers.

[Diseases of the small intestine].

1960-03-15

Ernst Lauda