Published online Sep 10, 2019. doi: 10.4291/wjgp.v10.i2.29
Peer-review started: July 16, 2019
First decision: August 2, 2019
Revised: August 16, 2019
Accepted: August 21, 2019
Article in press: August 21, 2019
Published online: September 10, 2019
Intraabdominal adhesions develop spontaneously or after an inflammatory process or surgical procedure in the abdomen. They are the most common cause of small bowel obstruction (SBO). SBO occasionally leads to intestinal ischemia (InIs) which can be a life-threatening condition that requires management as soon as possible. We herein report a case of SBO with InIs presented in our institution and treated without intestinal resection.
A 34-year-old man presented at the emergency department after a 12-h-onset diffuse abdominal pain, bloating and nausea. He had a history of traumatic right hepatectomy 11 years ago as well as adhesiolysis and resection of a long part of small bowel 2 years ago. An abdominal computed tomography (CT) showed dilated loops that led to the diagnosis of SBO. Due to deteriorating lactic acidosis, the patient was operated. Torsion of the small bowel around an adhesion led to 2.30 m of ischemic ileum. After the application of N/S 40 °C for 20 min, the intestine showed signs of improvement and it was decided to avoid resection and instead temporary close the abdomen with vacuum-pack technique. At the second-look laparotomy 48 h later, the intestine appeared normal. The patient was discharged on the 8th post-op day in excellent condition.
In case of SBO caused by adhesions, extreme caution is needed if InIs is present, as the clinical signs are mild and you should rely for diagnosis in CT findings and lactate levels. Conservative surgical approach could reverse the effects of InIs, if performed quickly, so that intestinal resection is avoided and should be used even when minimum signs of viability are present.
Core tip: Intraabdominal adhesions are the most common cause of small bowel obstruction which occasionally leads to intestinal ischemia (InIs). InIs can be a life-threatening condition that requires high index of suspicion because the clinical signs are mild and you should rely for diagnosis in computed tomography findings and lactate levels. Lactate, if present is a good indicator of the progress or regression of the disease. Diagnosis of InIs leads to immediate operation. Conservative surgical approach avoiding resection of ischemic bowel, could lead to reversal of InIs and should be used even when minimum signs of viability are present.