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Rare cause of complicated Meckel's with Schistosoma infection: An unusual cause of acute intestinal obstruction in adults.
Int J Surg Case Rep. 2020; 66:257-259.IJ

Abstract

INTRODUCTION

Small bowel obstruction (SBO) is a common surgical condition, while Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal (GI) tract, for which differential diagnosis is considered among children. Intestinal parasitosis refers to a group of disease caused by one or more species of protozoa, cestodes, trematodes, and nematodes. Intestinal parasitic infections (IPIs) caused by pathogenic helminths and protozoan species are endemic throughout the world. The intestine is frequently involved during Schistosoma infection, especially with Schistosoma mansoni.

PRESENTATION OF CASE

A 41 years old Egyptian male with an unremarkable past medical or surgical history presented to the emergency department with two days history of abdominal pain associated with nausea, vomiting, and abdominal distention. The pain was colicky and started gradually without any bowel motion or flatus for two days. Patient had tachycardia with other vitals within the normal limit. The abdomen was found to be distended and tender all over with an empty rectum by digital rectal examination (DRE). Upright chest and abdominal X-rays showed multiple air fluid levels. CT abdomen showed dilated proximal small bowel loop and a picture of SBO at distal ileal loops. The patient was resuscitated with IV fluids and shifted to the operating room. Laparoscopic exploration showed dilated small bowel loops with collapsed distal ileum, and an inflammatory band was found 20 cm from ileocecal junction, originating from a small bowel diverticulum. The inflammatory band was released, and the diverticulum was resected at the base by gastrointestinal anastomosis (GIA). Postoperatively, the patient significantly improved, passed bowel motion and was discharged for home. The histopathology report showed MD with Schistosoma infection. The patient was then referred to the infectious disease department and praziquantel, a drug of choice for schistosomiasis, effective against all Schistosoma species was initiated.

DISCUSSION

Schistosomiasis is a parasitic disease that is transmitted through contact with contaminated water sources. Our patient had complete SBO with significant symptoms. He was treated with the surgical approach with diverticulum resection. Intestinal schistosomiasis was found on histopathology testing. In summary, we report a rare presentation of acute small bowel obstruction with an inflammatory band around MD harboring parasitic infection.

CONCLUSION

Diagnostic laparoscopy should be considered for all patients having virgin abdomen presenting with complete bowel obstruction. To the best of our knowledge from the literature review, this is the first case to be reported as acute SBO secondary to MD harbouring Schistosoma mansoni infection.

Authors+Show Affiliations

Department of Surgery, King Saud Medical City, Riyadh, Saudi Arabia.Department of Surgery, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-kharj, Saudi Arabia. Electronic address: dr.aljohani@hotmail.com.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

31877547

Citation

Almadi, Fahad, and Emad Aljohani. "Rare Cause of Complicated Meckel's With Schistosoma Infection: an Unusual Cause of Acute Intestinal Obstruction in Adults." International Journal of Surgery Case Reports, vol. 66, 2020, pp. 257-259.
Almadi F, Aljohani E. Rare cause of complicated Meckel's with Schistosoma infection: An unusual cause of acute intestinal obstruction in adults. Int J Surg Case Rep. 2020;66:257-259.
Almadi, F., & Aljohani, E. (2020). Rare cause of complicated Meckel's with Schistosoma infection: An unusual cause of acute intestinal obstruction in adults. International Journal of Surgery Case Reports, 66, 257-259. https://doi.org/10.1016/j.ijscr.2019.11.039
Almadi F, Aljohani E. Rare Cause of Complicated Meckel's With Schistosoma Infection: an Unusual Cause of Acute Intestinal Obstruction in Adults. Int J Surg Case Rep. 2020;66:257-259. PubMed PMID: 31877547.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Rare cause of complicated Meckel's with Schistosoma infection: An unusual cause of acute intestinal obstruction in adults. AU - Almadi,Fahad, AU - Aljohani,Emad, Y1 - 2019/12/19/ PY - 2019/09/24/received PY - 2019/11/08/revised PY - 2019/11/16/accepted PY - 2019/12/27/pubmed PY - 2019/12/27/medline PY - 2019/12/27/entrez KW - Acute bowel obstruction KW - Meckel’s diverticulum KW - Schistosoma SP - 257 EP - 259 JF - International journal of surgery case reports JO - Int J Surg Case Rep VL - 66 N2 - INTRODUCTION: Small bowel obstruction (SBO) is a common surgical condition, while Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal (GI) tract, for which differential diagnosis is considered among children. Intestinal parasitosis refers to a group of disease caused by one or more species of protozoa, cestodes, trematodes, and nematodes. Intestinal parasitic infections (IPIs) caused by pathogenic helminths and protozoan species are endemic throughout the world. The intestine is frequently involved during Schistosoma infection, especially with Schistosoma mansoni. PRESENTATION OF CASE: A 41 years old Egyptian male with an unremarkable past medical or surgical history presented to the emergency department with two days history of abdominal pain associated with nausea, vomiting, and abdominal distention. The pain was colicky and started gradually without any bowel motion or flatus for two days. Patient had tachycardia with other vitals within the normal limit. The abdomen was found to be distended and tender all over with an empty rectum by digital rectal examination (DRE). Upright chest and abdominal X-rays showed multiple air fluid levels. CT abdomen showed dilated proximal small bowel loop and a picture of SBO at distal ileal loops. The patient was resuscitated with IV fluids and shifted to the operating room. Laparoscopic exploration showed dilated small bowel loops with collapsed distal ileum, and an inflammatory band was found 20 cm from ileocecal junction, originating from a small bowel diverticulum. The inflammatory band was released, and the diverticulum was resected at the base by gastrointestinal anastomosis (GIA). Postoperatively, the patient significantly improved, passed bowel motion and was discharged for home. The histopathology report showed MD with Schistosoma infection. The patient was then referred to the infectious disease department and praziquantel, a drug of choice for schistosomiasis, effective against all Schistosoma species was initiated. DISCUSSION: Schistosomiasis is a parasitic disease that is transmitted through contact with contaminated water sources. Our patient had complete SBO with significant symptoms. He was treated with the surgical approach with diverticulum resection. Intestinal schistosomiasis was found on histopathology testing. In summary, we report a rare presentation of acute small bowel obstruction with an inflammatory band around MD harboring parasitic infection. CONCLUSION: Diagnostic laparoscopy should be considered for all patients having virgin abdomen presenting with complete bowel obstruction. To the best of our knowledge from the literature review, this is the first case to be reported as acute SBO secondary to MD harbouring Schistosoma mansoni infection. SN - 2210-2612 UR - https://www.unboundmedicine.com/medline/citation/31877547/Rare_cause_of_complicated_Meckel's_with_Schistosoma_infection:_An_unusual_cause_of_acute_intestinal_obstruction_in_adults_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2210-2612(19)30673-X DB - PRIME DP - Unbound Medicine ER -
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