Search Results (6)

A 4.5-year-old female spayed, mixed-breed (Beagle X Cavalier King Charles Spaniel) presented with acute onset of vomiting and abdominal pain. The dog had undergone an exploratory celiotomy for comparable symptoms 9 months earlier, with no aetiology identified. Computed tomography (CT) was highly suggestive of mechanical obstruction of the small intestine. An exploratory celiotomy was performed and identified strangulation of the jejunum by a rent within the median ligament of the urinary bladder. It was hypothesised the rent formed secondary to previous surgical trauma. Complete excision of the median ligament resulted in resolution of clinical signs. This report emphasises the importance of minimising the formation of mesenteric rents when performing abdominal surgery. Full article

Background and Objectives: Every surgical procedure has the possible risk of complications, and caesarean sections (CSs) are no exception. As CS rates are increasing worldwide, being familiar with rare but possible complications has become extremely important. Case report: We present a case of 25-year-old nulliparous patient who came to our hospital with twin pregnancy for a scheduled induction of labour. An urgent CS was performed due to labour dystocia. On the second postoperative day, the patient started to complain about pain in the epigastrium, but initially showed no signs of bowel obstruction, passing gas, and stools, and could tolerate oral intake. After a thorough examination, an early postoperative complication—small-bowel strangulation at the incision site—was diagnosed. Small bowels protruded in between sutured rectus abdominis muscle causing a strangulation which led to re-laparotomy. During the surgery, there was no necrosis of intestines, bowel resection was not needed, and abdominal wall repair was performed. After re-laparotomy, the patient recovered with no further complications. Conclusions: Although there are discussions about CS techniques, most guidelines recommend leaving rectus muscle unsutured. This case demonstrates a complication which most likely could have been avoided if the rectus muscle had not been re-approximated. Full article

Enterolithiasis is a well-documented cause of colic in horses, especially in some geographic areas such as California and Florida. This retrospective case-control study aims at comparing the prevalence of gastric ulcers in horses affected by enterolithiasis to that in horses affected by other types of large intestinal obstruction. Two hundred and ninety-six horses were included in the study sample. Horses that had surgery for the removal of one or more enteroliths were included in the study as cases. Patients that had surgery for large intestinal simple obstructions other than enterolithiasis (large colon displacement, non-strangulating large colon torsion, and large and small colon impactions) were selected to match case horses for age, sex, and breed and included as controls. A total of 101/148 horses with enteroliths (68%) had gastric ulcers diagnosed during hospitalization, compared with 46/148 of matched controls (31%). There was a significant association between enterolithiasis and gastric ulceration (odds ratio 4.76, p < 0.0001), and a greater prevalence in Thoroughbreds as compared with other breeds (odds ratio 22.6, p < 0.0001). We concluded that enterolithiasis is significantly associated with gastric ulceration (p < 0.0001). The association is stronger in Thoroughbreds. Full article

Lower survival has been reported in foals than adults with small intestinal strangulating obstruction (SISO), but age-dependent outcomes have not been examined directly. Hospital records were collected from five US academic referral hospitals. It was hypothesized that foals would exhibit lower survival than case-matched adults. Foal cases 6-months-of-age or younger, and adult cases between 2- and 20-years-of-age were collected. Data revealed 24 of 25 (96.0%) foals and 66 of 75 (88.0%) adults that were recovered from surgery for SISO survived to hospital discharge. Sixteen of the total 41 (39.0%) foals studied were euthanized intraoperatively, whereas 30 of 105 (28.6%) adults were euthanized intraoperatively. Common lesions in foals that were recovered from surgery were volvulus (n = 13) and intussusception (n = 5), whereas common lesions in adults were volvulus (n = 25) and strangulating lipoma (n = 23). This study was limited by incomplete medical records, relatively small sample size, and lack of long-term follow-up. Unexpectedly, short-term survival tended to be higher in foals than adults and may have been partly driven by case selection prior to referral or surgery or decision-making intraoperatively. More optimism toward surgical treatment of foals with SISO may be warranted. Full article

Precision medicine may significantly contribute to rapid disease diagnosis and targeted therapy, but relies on the availability of detailed, subject specific, clinical information. Proton nuclear magnetic resonance (¹H–NMR) spectroscopy of body fluids can extract individual metabolic fingerprints. Herein, we studied 64 patients admitted to the Florence main hospital emergency room with severe abdominal pain. A blood sample was drawn from each patient at admission, and the corresponding sera underwent ¹H–NMR metabolomics fingerprinting. Unsupervised Principal Component Analysis (PCA) analysis showed a significant discrimination between a group of patients with symptoms of upper abdominal pain and a second group consisting of patients with diffuse abdominal/intestinal pain. Prompted by this observation, supervised statistical analysis (Orthogonal Partial Least Squares–Discriminant Analysis (OPLS-DA)) showed a very good discrimination (>90%) between the two groups of symptoms. This is a surprising finding, given that neither of the two symptoms points directly to a specific disease among those studied here. Actually herein, upper abdominal pain may result from either symptomatic gallstones, cholecystitis, or pancreatitis, while diffuse abdominal/intestinal pain may result from either intestinal ischemia, strangulated obstruction, or mechanical obstruction. Although limited by the small number of samples from each of these six conditions, discrimination of these diseases was attempted. In the first symptom group, >70% discrimination accuracy was obtained among symptomatic gallstones, pancreatitis, and cholecystitis, while for the second symptom group >85% classification accuracy was obtained for intestinal ischemia, strangulated obstruction, and mechanical obstruction. No single metabolite stands up as a possible biomarker for any of these diseases, while the contribution of the whole ¹H–NMR serum fingerprint seems to be a promising candidate, to be confirmed on larger cohorts, as a first-line discriminator for these diseases. Full article

Background. Various diagnostic utilities have been used in the diagnosis of strangulated obstruction. Despite this, there is no simple and reliable marker for it, and diagnosis in most cases is based on clinical, laboratory, and radiological investigations. The purpose of the present study was to assess D-dimer value in the diagnosis of strangulated obstruction.
Methods. A prospective study of 53 patients with small-bowel obstruction was conducted. Strangulated obstruction was present in 15 (28.3%) patients. Eight (53%) had intestinal necrosis, while 7 (47%) reversible ischemia. The blood samples were taken and analyzed with NycoCard Reader method with monoclonal antibodies specific for D-dimer neoantigens.
Results. In the presence of intestinal necrosis, there was a higher D-dimer level found than in the cases with reversible ischemia or simple small-bowel obstruction, although this difference did not reach statistically significant level. The D-dimer test had a sensitivity of 60%, specificity of 68%, positive predictive value of 43%, and negative predictive value of 81% in diagnosing strangulated obstruction.
Conclusion. In present series, D-dimer test was neither sensitive nor specific in diagnosing strangulation. Full article