Inflammatory fibroid polyp of the ileum presenting with small bowel obstruction in an adult patient: a case report

<p>Abstract</p> <p>Introduction</p> <p>Inflammatory fibroid polyps are rare benign tumors of the gastrointestinal tract with the gastric antrum being the most common site, followed by the ileum. Histogenesis is still unknown and controversial. Inflammatory fibroid polyps are one of the rare benign conditions leading to intestinal obstruction in adults.</p> <p>Case presentation</p> <p>A 54-year-old Caucasian man presented with acute abdomen pain and a two month history of intermittent cramping and lower abdominal pain. Computed tomography imaging demonstrated a partial intestinal obstruction in the location of the terminal ileum. An ileo-ileal intussusception due to a mass lesion 15 cm proximal to the caecum was found on exploratory laparotomy. Intussusception was spontaneously reduced during exploration and a wedge resection was performed to the affected bowel segment. Histopathologic examination showed the mass to be an inflammatory fibroid polyp.</p> <p>Conclusion</p> <p>Although inflammatory fibroid polyps are rare and benign, in the case of intestinal obstruction the only solution is a surgical approach.</p

Adult Intussusception Caused by an Inverted Meckel Diverticulum

Adult intussusception caused by an inverted Meckel diverticulum is rare. We report a 55-year-old Japanese man with intussusception. He was admitted to our hospital with vomiting and abdominal pain. The abdomen was hard with tenderness and muscle guarding. Computed tomography scanning demonstrated a typical inhomogeneous target-shaped mass in the right abdomen. We diagnosed intussusception and performed emergency surgery. At laparotomy, ileocolic intussusception was observed and the ileocecal segment was resected. The surgical specimen comprised an 84 cm segment of resected ileocecum with an elongated polypoid lesion measuring 11 × 2 cm within the ileal lumen. Histopathological examination demonstrated that the polypoid lesion was an inverted Meckel diverticulum. Postoperatively, the patient made an uneventful recovery

Compound double ileoileal and ileocecocolic intussusception caused by lipoma of the ileum in an adult patient: A case report

<p>Abstract</p> <p>Introduction</p> <p>The initial diagnosis of intussusception in adults very often can be missed and cause delayed treatment and possible serious complications. We report the case of an adult patient with complicated double ileoileal and ileocecocolic intussusception.</p> <p>Case presentation</p> <p>A 46-year-old Caucasian man was transferred from the gastroenterology service to the abdominal surgery service with severe abdominal pain, nausea, and vomiting. An abdominal ultrasound, barium enema, and abdominal computed tomography scan revealed an intraluminal obstruction of his ascending colon. Plain abdominal X-rays showed diffuse air-fluid levels in his small intestine. A double ileoileal and ileocecocolic intussusception was found during an emergent laparotomy. A right hemicolectomy, including resection of a long segment of his ileum, was performed. The postoperative period was complicated by acute renal failure, shock liver, and pulmonary thromboembolism. Our patient was discharged from the hospital after 30 days. An anatomical pathology examination revealed a lipoma of his ileum.</p> <p>Conclusions</p> <p>Intussusception in adults requires early surgical resection regardless of the nature of the initial cause. Delayed treatment can cause very serious complications.</p

Adenomyoma of the Ileum Leading to Intussusception

Adenomyoma of the ileum is a rare condition. A 68-year-old Japanese man presented with nausea and distension of the abdomen. Enhanced computed tomography of his abdomen revealed wall thickening in the ileum and dilation of the proximal small intestine. Open laparotomy was performed to find the cause of the patient's small bowel obstruction, and a tumor was found in the ileum, which had resulted in intussusception. The tumor and 20 cm of the adjacent ileum were resected. The resected specimen displayed a macroscopic appearance suggestive of a submucosal tumor. Histopathological evaluation showed duct cell proliferation and bundles of smooth muscle cells from the mucosa to the serosa, leading to a diagnosis of adenomyoma. Immunohistochemical examination found that cytokeratin 7 and carbohydrate antigen 19-9 were expressed in the duct epithelia. We report a rare case of ileal adenomyoma leading to intussusception in an adult and present the immunohistochemical evaluation of the adenomyoma

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Adult intussusception: case reports and review of literature

Adult intussusception occurs infrequently and differs from childhood intussusception in its presentation, aetiology, and treatment. Diagnosis can be delayed because of its longstanding, intermittent, and non-specific symptoms and most cases are diagnosed at emergency laparotomy. With more frequent use of computed tomography in the evaluation of patients with abdominal pain, the condition can be diagnosed more reliably. Treatment entails simple bowel resection in most cases. Reduction of the intussusception before resection is controversial, but there is a shift against this, especially in colonic cases. Surgical treatment can be difficult in gastroduodenal and coloanal intussusceptions, sometimes requiring innovative techniques. This paper presents the diagnosis and management of four cases of adult intussusception, followed by review of the literature

Core surgical training: 12 tips for securing a post

Applying for core surgical training in the United Kingdom can be competitive and stressful. Wen Ling Choong and colleagues give tips for securing a pos