Background Acute intestinal obstruction is a commonly encountered surgical emergency that is prevalent worldwide and has substantial morbidity and fatality rates. Therefore, swift and precise diagnosis is essential. While mortality rates in urban areas have declined due to timely medical intervention following early detection, the situation contrasts starkly in rural areas. Delays in presentations often lead to complications because of hesitancy toward surgery, economic challenges, and limited access to healthcare information. Therefore, this study aimed to evaluate how well multidetector computed tomography (MDCT) can help determine the site, cause, and level of intestinal obstruction compared to what the surgeons confirmed intraoperatively. Methodology A prospective study involving 101 patients was conducted at a tertiary care center in western Maharashtra from July 2022 to July 2024. The emergency department referred patients with clinical symptoms such as nausea and vomiting, abdominal distension, abdominal pain, inability to pass flatus, constipation, or diarrhea, which are commonly seen with intestinal obstruction. The study involved all patients who underwent a contrast-enhanced MDCT scan using both intravenous and oral contrast agents. We selected patients from both genders, regardless of their age; however, considerations were taken to include characteristics convenient and relevant to the study. Patients with abnormal serum creatinine levels or allergies to contrast were excluded from the study. We conducted CT examinations, noting findings such as the transition point between the dilated and collapsed loops, mesenteric fat stranding, and intestinal dilatation. An experienced radiologist made the final report, and the operating surgeons\' notes on laparoscopy or open surgery for the same patient were reviewed to understand the operative findings. Results MDCT scans had high diagnostic accuracy for small and large bowel obstruction. Of the 101 patients, the mean age was 43.7 years. There were 70 (69.30%) males and 31 (30.69%) females. Sensitivity was 100%, specificity was 98.1%, positive predictive value was 83.7%, and negative predictive value was 100%. Conclusions MDCT demonstrated high sensitivity and specificity for diagnosing and determining the underlying cause of intestinal obstruction. It identified the location of the obstruction and discerned whether it originated from intrinsic, extrinsic, or intraluminal factors.

Peutz-Jeghers syndrome (PJS) is an autosomal dominant disorder characterized by hamartomatous polyposis of the gastrointestinal tract, melanin pigmentation of the skin and mucous membranes, and an increased risk for cancer. Radiological imaging, contrast studies, and scopy-directed biopsies confirm the diagnosis and help in surveillance. Hamartomatous mucosal polyps, which are characterized by a central core of branching smooth muscle connected to a mucosa unique to the site of origin, are pathognomonic for PJS. We present the case of a young male with a history of pain in the abdomen and vomiting. The patient had mucocutaneous pigmentations on the buccal mucosa. CT scan revealed jejuno-jejunal intussusception with multiple small and large bowel polyps causing acute intestinal obstruction. Intraoperatively, jejunal polyps were found to be the cause of jejuno-jejunal intussusception. Histopathology revealed hamartomatous polyps of PJS. Our interest in this case is due to the uncommon case of intussusception in an adult where radiological imaging played an important role in diagnosis.

Paraduodenal hernias are a rare but important clinical entity, as their presentation can be life-threatening if not properly diagnosed and managed appropriately. Additionally, this entity is defined by a unique and complex congenital anatomical abnormality which dictates a specific treatment algorithm. Here we present the cases of three patients from our clinical experience who all presented with either acute or chronic small bowel obstructions secondary to paraduodenal hernias. Two were left-sided paraduoenal hernias and one was right-sided. All three patients were successfully managed with surgical intervention. An appreciation of paraduodenal hernias, including the defining anatomy and methods of surgical management, is important for the general surgeon.

Small bowel obstruction is one of the most common urgent surgical conditions, caused by a variety of factors, with adhesions, malignancies, and hernias, internal and external, being the most common. Many types of internal hernias have been described in the literature; however, internal hernia caused by the ureter as a secondary complication of ureteroplasty is rare and only a few cases have been reported worldwide. This presentation discusses an interesting case of small bowel obstruction accompanied by obstruction of the urinary tract due to an internal hernia caused by the ureter. A 58-year-old female presented to the emergency department (ED) with acute pain in the abdominal and right lumbar region. Her surgical history includes hysterectomy, right ureter injury, and ureteroplasty performed 10 years ago. Clinical examination showed tenderness in the lower abdomen, positive Giordano\'s sign on the right, and metallic bowel sounds. A computer tomography scan revealed right-sided hydronephrosis, absence of excretion in the right urinary tract, and dilated loops of the small intestine. An exploratory laparoscopy revealed a small bowel loop strangulated by the ureter, followed by laparotomy, resection of a segment of the ileum, oblique anastomosis, and reimplantation of the right ureter. The patient was discharged eight days postoperatively without any complications. This case underscores the significance of surgical history in order to recognize even rarer causes of small bowel obstruction.

UNASSIGNED: Intussusception in adults is rare, constituting a miniscule number of bowel obstruction pathologies. Clinical practice often considers it a last-resort diagnosis, as other causes of mechanical small bowel obstruction are more common. The diagnosis is a challenging one to make, as the \"telescoping\" motion of the intestines fluctuates in a waxing-and-waning nature. In adults, the etiology is predominantly a pathological lead point being either benign or malignant. When encountering an obscure cause of abdominal pain, intussusception caused by a small bowel lipoma may be the culprit.
METHODS: In this unique case, we present the journey of a 55-year-old Emirati male who presented with severe abdominal pain, nausea and vomiting. The patient underwent various imaging modalities, initially an \"incidental\" lipoma finding in the terminal ileum until a diagnosis of ileo-ileal intussusception emerged in later imaging, given its unusual and fluctuating nature. Ultimately, a resection of the bowel segment with side-to-side anastomosis was done.
UNASSIGNED: This case report aims to illuminate the diverse clues and incidental findings encountered during our patient\'s path to a diagnosis. By exploring the elements of this patient\'s journey to a diagnosis, we aspire to aid future clinicians in navigating the challenges of identifying obstructive pathologies and considering intussusception as a rare yet crucial differential diagnosis.
CONCLUSIONS: This case highlights the importance of a comprehensive approach to diagnosis and management of patients presenting with obstructive symptoms, incorporating both clinical insight and imaging modalities such as CT to ensure optimal patient outcomes. When confronting such an obscure cause of abdominal pain, intussusception caused by a small bowel lipoma may be the culprit.

UNASSIGNED: Small bowel obstruction (SBO) is a common surgical emergency with various causes. However, SBO resulting from appendicitis is uncommon and often overlooked. Appendico-ileal knotting, a rare and dangerous form of SBO, occurs when the appendix becomes twisted around the small intestine, leading to strangulation. Despite being reported since 1901, there have been very few documented cases of this condition. Diagnosing appendico-ileal knotting preoperatively is challenging, and even imaging techniques like computed tomography scans may not provide definitive diagnostic findings. Our current case report is a valuable addition to the limited literature and enhances understanding of this infrequent cause of SBO from a resource limited setting.
METHODS: We present the case of a 28-year-old female who presented with symptoms of dynamic SBO, including abdominal pain, vomiting, and constipation. Preoperative evaluation couldn\'t determine the exact cause.
UNASSIGNED: Diagnosis of a strangulated ileum was discovered, with the appendix identified as the source intraoperatively, leading to an open retrograde appendectomy. Postoperatively, the patient received IV ceftriaxone (1 g daily), metronidazole (500 mg tds), paracetamol (1 g tds), and IV crystalloids. Oral intake resumed gradually, and discharge occurred on day 4. Follow-up on 10th day was uneventful.
CONCLUSIONS: Appendico ileal knotting is a rare cause of mechanical SBO. Knowledge of its pathophysiology, diagnosis, and management is very crucial to reduce its associated morbidity and mortality.

BACKGROUND: Early small bowel obstruction (eSBO) (within 30-days) is a rare but important complication that is associated with high rates of morbidity, including readmission, reintervention, and reoperation.
OBJECTIVE: To identify patient-specific and operation-specific characteristics that predispose patients to eSBO and to identify at-risk individuals preoperatively.
METHODS: 2015-2021 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP).
METHODS: Utilizing the 2015-2021 MBSAQIP PUF, 1,016,484 records were analyzed. Pediatric, revisional, open-conversion, and cases with incomplete data in sex, body mass index, operative-time, 30-day-follow-up variables were excluded. Case details were compared using Fisher\'s exact & Wilcoxon -Mann -Whitney tests to identify at-risk patients. The likelihood of eSBO was modeled with rare event logistic regression.
RESULTS: Incidence of eSBO was .40%. Of the 4103 occurrences of eSBO, RYGB (Roux-en-Y gastric bypass), SG (sleeve gastrectomy), and DS (duodenal switch) accounted for 79.4%, 19.3%, and 1.3%, respectively. Many patient-specific characteristics were significantly associated with eSBO. History of prior foregut surgery, a non-metabolic surgery trained operator, and longer operative times were all associated with increased eSBO (P < .0001). While simultaneously controlling for these factors, eSBO remained higher in DS (OR 9.55, P < .0001) and RYGB (OR 5.18, P < .0001) compared to SG. Increased length of operation (OR 1.03, P < .0001) and non -MS-trained operators (OR 1.33, P < .0001) remained highly significant. Male-sex (OR .70, P < .0001) and diabetes (OR .78, P < .0001) were both protective.
CONCLUSIONS: In the largest analysis to date, eSBO remains a rare event. RYGB accounts for the largest proportion of eSBO, however, DS has a higher risk adjusted rate of eSBO.

Encapsulating peritoneal sclerosis (EPS) is a serious complication of chronic peritoneal dialysis (PD) that results in encapsulation of the bowel in a thick, fibrocollagenous membrane. Given its rare and complex nature, diagnosis of EPS often arises late in the disease process or intraoperatively. We report the case of an 86-year-old male with a history of renal failure managed with PD who presented with multiple hospital admissions for recurrent abdominal pain and symptoms of small bowel obstruction. Open laparotomy revealed encasement of the entire abdominal cavity in a cocoon-like membrane, consistent with EPS, which was successfully managed with extensive excision and adhesiolysis. This discussion, enriched by unique radiographic insights and delineation of a surgical strategy, seeks to enhance the understanding of this underreported disease characterized by a lack of definitive treatment and an enigmatic pathophysiology.

UNASSIGNED: Ileus, mechanical bowel obstruction, and acute colonic pseudo-obstruction are characterized by distension of the intestines with accumulated bowel gas. Current treatments are not completely satisfactory.
UNASSIGNED: By manipulating the partial pressures of oxygen and nitrogen in the trapped air with a novel 6-hour treatment with 100% oxygen via nonrebreather mask, the bowel can be successfully decompressed, facilitating resolution of the underlying condition.
UNASSIGNED: A positive clinical response was seen in 7/8 [87.5%] patients after therapeutic oxygen for gastrointestinal atony. Maximal lumen diameter decreased by an average of 1.14 ± 0.87 cm [16%].
UNASSIGNED: In this first clinical report of therapeutic oxygen for gastrointestinal atony, the provision of 100% oxygen via nonrebreather mask is a useful therapy. It decreased the diameter of the intestinal lumen and enhanced resolution of ileus, acute colonic pseudo-obstruction, and bowel obstruction. This is a low-morbidity, low-cost treatment of gastrointestinal luminal distension.ClinicalTrials.gov Identifier NCT03386136.st.

Ileo-ileal intussusception, an infrequent cause of small bowel obstruction in adults, can be initiated by inflammatory fibroid polyps. These are uncommon, benign submucosal lesions of the gastrointestinal tract. This case report explores an adult patient with inflammatory fibroid polyps-induced ileo-ileal intussusception.