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LAPAROSCOPIC MANAGEMENT OF CLOSE LOOP BOWEL OBSTRUCTION

Andres E Giovannetti, MD1, Jamie O’Rear, MD1, Brian Welch, MD1, Rami Lutfi, MD, FACS2, Francisco Quinteros, MD2. 1UIC-MGH General Surgery Residency, 2Mercy Hospital Chicago

INTRODUCTION: Small bowel obstruction has been known as one of the contraindications for laparoscopic surgery. In 1991 Bastug et al. described the first adhesiolysis using laparoscopy. Since then, multiple groups have worked to analyze and find the specific criteria for the use of this technique. There is still no consensus but is clear that it is based on patient characteristics and complexity of the intervention planned. This video shows a case of closed loop bowel obstruction managed with laparoscopic surgery alone with excellent results.

METHODS: We present an 81 y.o. female with a history of hypertension, laparoscopic cholecystectomy and laparoscopic hysterectomy. She presented to the Emergency Department with a 2-days history of diffuse abdominal pain associated with nausea and vomiting. No similar episodes in the past. On exam, vital signs were normal, her abdomen was soft non-distended, non-tender, bilateral large non-complicated, easily reducible inguinal hernias were present. CT was performed and showed high-grade close loop bowel obstruction in the mid abdomen. Informed consent was obtained and she was scheduled for surgery. The abdomen was approached using a 12mm trocar in the umbilical area and three 5mm trocars. The abdomen was inspected, inguinal hernias reduced. A loop of small intestine in the mid-abdomen was dilated and showed signs of ischemia. The ischemic loop was completely exposed and inspected from both sides. An internal hernia was discovered as the cause of the obstruction, formed by a redundant loop of sigmoid colon that formed adhesions with the abdominal wall just below the left inguinal hernia, creating a tunnel between the descending colon and the sigmoid colon where the loop of small intestine was passing through. Sharp and blunt dissection of those adhesions was performed with the successful release of the obstructed segment. Immediately after, significant improvement of the ischemia was observed. Further irrigation with warm saline allowed us to observe adequate peristalsis of the most affected segment.  No other intervention was required. The patient tolerated the intervention well and was discharged home on postoperative day 3.

CONCLUSION: Despite the controversy in the management of bowel obstruction patient using laparoscopic techniques, it can be used safely in selected cases obtaining the same results compared to open surgery with the advantage of the minimally invasive approach.  Laparoscopic surgery represents a valuable tool in the evaluation of patients presenting with unclear signs and symptoms of bowel obstruction.  


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 87487

Program Number: V216

Presentation Session: Thursday Video Loop (Non CME)

Presentation Type: VideoLoop

160

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