DOI: http://dx.doi.org/10.18203/2349-2902.isj20190378

Jejunal obstruction due to ischemic stricture: an unusual presentation

Tanweerul Huda, Bharati Pandya

Abstract


Background: The most common causes of mechanical small bowel obstruction are postoperative adhesions and hernias. Other etiologies of small bowel obstruction include, diseases intrinsic to the wall of the small intestine, like tumors, strictures, intramural hematoma and processes that cause intraluminal obstruction like intussusception, gallstones, foreign bodies etc. Ischaemic enteritis is a rare etiology, reported only in about 0.1% of cases. Ischaemic strictures of the small bowel are a result of decreased blood supply to the small intestine. They require surgical intervention for their management.

Methods: Author presented a 40 year-old diabetic female who presented with upper GI obstruction of 2month duration. Her history of illnesses included stroke, myocardial infarction and a transient episode of intestinal obstruction occurring simultaneously 3years ago. On investigations, she was found to have an occlusive distal jejunal stricture. Author studied the literature for the various management options and selected the most appropriate one for her.

Results: Exploratory laparotomy with resection and end to end anastomosis of the jejunal segment was done. The histopathology of the segment revealed ischaemic enteritis with large vessel blockade causing stricture. The patient had an uneventful post op recovery and is asymptomatic two months since.

Conclusions: Ischaemic enteritis results in small intestinal obstruction due to intestinal stenosis in its chronic phase. Diagnostic delay is due to the differential diagnoses and missing out on the transient phase of early ischemia.


Keywords


Jejunal stricture, Ischaemic enteritis, Small bowel obstruction

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References


Bordeianou L, Yeh DD, Soybel DI, Hockberger RS, Collins KA. Epidemiology, clinical features, and diagnosis of mechanical small bowel obstruction in adults, 2017. Available at: https://www.uptodate.com/contents/epidemiology-clinical-features-and-diagnosis-of-mechanical-small-bowel-obstruction-in-adults.

Chuttani HK, Sarin SK. Intestinal tuberculosis. Ind J Tub. 1985;32(3):117-25.

Bapat RD, Aiyer PM, Relekar RG, Nazareth HM, Vora IM, Ramakantan R. Ischemic bowel disease. Ind J Gastroenterol: Off J Ind Soc Gastroenterol. 1990;9(1):19-22.

Mansard MJ, Rao U, Pradeep R, Sekaran A, Rao GV, Reddy DN. Vascular anatomy of strictured small bowel. Tropical Gastroenterol. 2011;32(2):103-6.

Räf LE. Ischaemic stenosis of the small intestine. Acta Chir Scand. 1969;135:253-9.

Takeuchi N, Naba K. Small intestinal obstruction resulting from ischemic enteritis: a case report. Clin J Gastroenterol. 2013;6(4):281-6.

Friedman G, Sloan WC. Ischemic enteropathy. Surg Clin North Am. 1972;52(4):1001-12.

Sada M. Ischemic enteritis. Stomach Intestine. 2008;43(4):617.

Nakayama H, Kashiwagi Y, Nishizawa M, Ogawa K, Okui K. A case of ischemic stenosis of small intestine. Nippon Daicho Komonbyo Gakkai Zasshi. 1997; 50 (4): 249-53.

Saito T, Suzuki T, Watanabe K, et al. A case of ischemic stenosis of the small intestine revealed by double balloon endoscopy. Prog Dig Endosc. 2010;77:104-5.

Koshikawa Y, Nakase H, Matsuura M, Yoshino T, Honzawa Y, Minami N, et al. Ischemic enteritis with intestinal stenosis. Intestinal Res. 2016;14(1):89-95.

Boley SJ, Schwartz S, Lash J, Sternhill V. Reversible vascular occlusion of the colon. Surg Gynecol Obstet. 1963; 116: 53–60.

Rueda Guzmán A, Wehkamp J, Kirschniak A, Naumann A, Malek NP, Goetz M. Endoscopic balloon dilatation of Crohn’s-associated intestinal strictures: high patient satisfaction and long-term efficacy. United Euro Gastroenterol J. 2016;4(6):794-9.

Paine E, Shen B. Endoscopic therapy in inflammatory bowel diseases (with videos). Gastrointestinal Endosc. 2013;78(6):819-35.

Williams, N., O'Connell, P., McCaskie, A. Bailey & Love's Short Practice of Surgery, 27th ed. Boca Raton: CRC: 2018.