BACKGROUND: This case report reports an unusual occurrence of gossypiboma, which refers to the accidental retention of surgical materials like sponges in the peritoneal cavity. The term is derived from \"gossypium\" (cotton) and \"boma\" (place of concealment). Its incidence varies with surgical type, posing diagnostic challenges due to nonspecific symptoms and equivocal imaging. Despite its rarity, gossypiboma poses significant risks, including intestinal obstruction and abscess formation.
METHODS: A 37-year-old woman with ten previous pregnancies and an emergent caesarean section presented with abdominal pain. Examination and ultrasound suggested an ovarian cyst. During surgery, a 10 × 10 cm gauze-filled mass adherent to the ovary and jejunum was found. Postoperatively, she recovered well with no complications. The patient was treated with intravenous fluids and antibiotics for five days post-surgery and recovered without any complications. She was discharged from the hospital five days after the procedure.
CONCLUSIONS: To the best of our knowledge, this is the first reported case of gossypiboma in Sudan in 2024, highlighting diagnostic challenges and the need for preventive protocols. Root cause analysis of accidents, enhanced training, application of advanced technologies and a collaborative culture in the operating room can prevent the occurrence of such incidents. This case underscores the importance of meticulous surgical protocols and continuous improvement in safety measures to prevent retained surgical items, ensuring patient safety and optimal outcomes.

Internal hernias, in particular, hernia of the foramen of Winslow, are rare and occur in typical sites. Laparotomy is common in these cases while laparoscopic surgery is rarely used in such urgent cases. However, modern diagnosis and treatment including computed tomography and laparoscopy allowing minimally invasive interventions are not an exception for patients with hernia of the foramen of Winslow. This approach is effective for this problem and prevents adverse outcomes of disease.
Внутренние грыжи, одной из которых является грыжа Винслова отверстия, считаются редкими хирургическими заболеваниями, которые имеют типичные места формирования. В большинстве случаев проблему разрешают с помощью лапаротомии, в свою очередь, лапароскопическая хирургия в подобных ургентных случаях используется редко. Однако стоит учесть, что современные методы диагностики и лечения, такие как компьютерная томография и лапароскопия, дающие возможность проводить малоинвазивные вмешательства, не являются исключением и для пациентов с грыжей Винслова отверстия с целью радикального лечения и предотвращения неблагоприятных исходов заболевания.

Despite available armored personal protection in troops, the incidence of abdominal wounds in modern wars is 6.6-9.0%. Of these, penetrating abdominal injuries comprise 75-80%. Thoracoabdominal injuries occupy a special place with incidence up to 88%. We present the first case of the \"Koblenz algorithm\" in the treatment of a patient with mine explosion wound, combined injury of the head, limbs, thoracoabdominal trauma, widespread peritonitis, small intestinal obstruction and septic shock in a military hospital. This algorithm was implemented under import substitution considering the peculiarities of abdominal adhesive process in a patient with thoracoabdominal wound. This case demonstrates the advantage of this algorithm for patients with severe combined wounds of the chest and abdomen complicated by diffuse purulent peritonitis. Clinical status of these patients does not allow not only open laparostomy, but also \"classical\" redo laparotomies.
Несмотря на использование в войсках броневой индивидуальной защиты, частота ранений живота в современных войнах составляет 6,6—9,0%, 75—80% из них — проникающие в брюшную полость. Особое место занимают торакоабдоминальные ранения, частота которых достигает 88%. В статье представлено клиническое наблюдение первого случая применения «кобленцского алгоритма» в лечении пациента с минно-взрывным ранением, сочетанным ранением головы, конечностей, торакоабдоминальным ранением, с развившимся распространенным перитонитом, тонкокишечной непроходимостью и септическим шоком в условиях военного госпиталя. «Кобленцский алгоритм» был реализован в условиях импортозамещения и с учетом особенностей течения спаечного процесса в брюшной полости у пациента с торакоабдоминальным ранением. Этот случай демонстрирует преимущество «кобленцского алгоритма» ведения пациентов с тяжелыми сочетанными ранениями груди, живота, осложнившимися развитием разлитого гнойного перитонита, когда общее состояние пациента не позволяет не только вести лапаростому открыто, но и выполнять «классические» релапаротомии.

Superior mesenteric artery syndrome is an acquired vascular compression disorder resulting from the compression of the third portion of the duodenum, which is the first part of the small intestine, leading to a reduction in the space between the aorta and the superior mesenteric artery. Although rare, superior mesenteric artery syndrome-induced pancreatitis has been documented in the literature. This article presents the case of a 20-year-old female patient with a history of colectomy for acute severe colitis, resulting in significant weight loss. She was admitted to the hospital with symptoms of upper bowel obstruction, and the diagnosis of superior mesenteric artery syndrome complicated by acute pancreatitis was made. The patient underwent a nutritional assistance program along with intravenous fluid therapy, resulting in positive outcomes. Superior mesenteric artery syndrome -induced pancreatitis is rarely reported and can be attributed to an occlusive post-papillary syndrome, which causes retrograde reflux of bile into the pancreatic duct, activating inflammation responsible for pancreatitis.

BACKGROUND: Gallstone ileus is a rare condition resulting from cholelithiasis, associated with the formation of a fistula between the gallbladder and the intestinal tract. It is responsible for less than 0.1 % of cases of mechanical bowel obstruction.
METHODS: A 54-year-old male with hypertension presented with symptoms of intestinal obstruction, including inability to pass stool, anorexia, abdominal pain, vomiting, and oliguria. Physical examination revealed epigastric tenderness and a distended abdomen without jaundice. Laboratory tests indicated mild anemia. The patient initially refused any surgical interventions, so he was placed on conservative treatment for 24 h. Subsequently, an emergency exploratory open laparotomy was performed, revealing a gallstone causing small bowel obstruction. A constricted ileal loop, 15 cm in length, with stone impaction was resected, and an end-to-end anastomosis was performed. A cholecystogastric fistula was identified and repaired, and a retrograde cholecystectomy was performed. The patient recovered without complications.
CONCLUSIONS: Gallstone ileus occurs when a fistula develops between the gallbladder and the intestinal tract. Notably, the presence of a fistula connecting the gallbladder and stomach ranges from 0 % to 13.3 %. Cholecystoenteric fistulas (CEFs) typically occur in elderly women in their seventh or eighth decade of life. Diagnosis often relies on CT scanning, and surgical intervention remains the primary treatment. Interestingly, despite improved awareness and imaging techniques, some cases are still discovered incidentally during surgery.
CONCLUSIONS: This case highlights the diagnostic and therapeutic challenges posed by gallstone ileus, and emphasizes the importance of considering gallstone-related disorders in differential diagnoses for acute abdominal obstruction.

暂无摘要。

BACKGROUND: A volvulus refers to the torsion or rotational twisting of a portion of the gastrointestinal tract, with a predilection for impacting the caecum and sigmoid colon, often resulting in the development of bowel obstruction. The risk factors associated are old age, chronic fecal impaction, psychiatric disorders, colonic dysmotility, prior abdominal surgical procedures, diabetes, and Hirschsprung\'s disease. Elderly are most commonly affected with sigmoid volvulus but there are few cases among young adults that culminate in grave complications. Although it is rare, but young individuals presenting with acute abdomen secondary to sigmoid volvulus need urgent attention. To prevent more invasive surgical procedures, endoscopic detorsion is preferred nowadays with complete recovery of patients. We present a case of young female who was successfully managed with endoscopic detorsion.
METHODS: 27 years old Asian Pakistani female presented with worsening abdominal distention, constipation and vomiting since 2 days. On examination she was afebrile, vitally stable. Abdomen was distended, tympanic percussion with generalized tenderness. Abdominal radiograph was obtained which showed dilated bowel loops followed by Computed tomography of abdomen which was suggestive of Sigmoid volvulus causing intestinal obstruction. Patient was immediately moved to endoscopy unit and endoscopic detorsion of volvulus was done. For individuals who present with sigmoid volvulus and do not exhibit signs of peritonitis or colonic gangrene, the recommended course of action involves acute endoscopic detorsion, followed by scheduled surgical intervention.
CONCLUSIONS: This case report emphasizes the significance of clinicians considering sigmoid volvulus as a rare but important cause when evaluating abdominal pain in young and otherwise healthy patients. A delay in diagnosis and treatment extending beyond 48 hours leads to colonic necrosis, amplifying the associated morbidity and mortality. Swift intervention is imperative to mitigate these complications and attain a conclusive remedy.

BACKGROUND: Acute intestinal obstruction is a blockage of the intestine which causes a range of clinical symptoms such as acute and severe abdominal pain, nausea, and obstipation. Intestinal obstruction is a medical emergency and can be life-threatening when left untreated. In cases where treatment involves emergency abdominal surgery, a multimodal perioperative care pathway (enhanced recovery after surgery ERAS) has shown to accelerate patient recovery after surgery, reduce hospital length of stay, and improve overall outcomes. The objective of this scoping review was to identify and synthesize the existing evidence regarding the implementation of ERAS components with a focus on postoperative components in patients undergoing surgery for acute intestinal obstruction.
METHODS: This scoping review followed the preferred reporting items for systematic reviews and meta-analysis extension for scoping reviews framework. PubMed-Medline and Embase database were searched.
RESULTS: The search identified 1860 studies of which 16 were included in the final analysis. All the studies were quantitative. Eleven studies used 10 or more ERAS interventions (range 10-28). The most common interventions were multimodal systemic analgesia, and the least common were the management of blood glucose and screening tools.
CONCLUSIONS: This scoping review found that 56% (n = 9/16) of the identified studies used 10 or more ERAS interventions out of a possible 35. This review highlighted the need for studies on the ERAS emergency laparotomy guidelines.

We report a highly unusual case of small bowel obstruction in an 86-year-old man from ingestion of a citrus fruit, known as kumquats, which led to intestinal perforation and peritonitis. He initially presented with a one-day history of diffuse abdominal pain associated with nausea and feculent emesis after eating whole pieces of unpeeled kumquats. When symptoms of peritonitis evolved with a blood lactate of 5.1 mg/dL, he was urgently taken to the operating room for exploration. Multiple areas with fibrous exudates and full-thickness ulceration were encountered along the distal jejunum and proximal ileum, with a partially obstructing intraluminal mass in the distal ileum. Treatment involved resection of 70 cm of non-viable bowel, removal of the intraluminal mass, and surgical re-establishment of intestinal continuity. Unpeeled kumquats were confirmed to have caused these intestinal findings. The patient did well following the operation and has had no further problems referred to by this management.

UNASSIGNED: Meckel\'s diverticulum is a rare congenital intestinal anomaly that can sometimes cause serious complications. The authors\' aim is to review the literature on this condition by reporting the clinical case of a young adult with Meckel\'s diverticulum complicated by acute intestinal obstruction.
UNASSIGNED: This was a 24-year-old young man, operated on for open bladder stones received for occlusive syndrome. Abdominal computed tomography (CT) suggested a flange occlusion. Surgical exploration found a Meckel\'s diverticulum creating a flange around the last one. An intestinal resection was performed with direct anastomosis with simple consequences.
UNASSIGNED: Meckel\'s diverticulum is a rare congenital intestinal anomaly. It is discovered incidentally or in the face of serious complications such as intestinal obstruction. Intestinal resection with one-stage anastomosis emerges as a standard and safe management approach.
UNASSIGNED: A Meckel\'s diverticulum can be complicated by acute intestinal obstruction mimicking a postoperative flange that can err the diagnosis.