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This paper reports two case studies of adhesive ileus after gynecologic surgery in patients who presented with abdominal pain and constipation but without air-fluid levels on abdominal X-ray. In both cases, double-balloon enteroscopy was used for diagnostic assessment that identified small-bowel adhesions, followed by laparoscopic adhesiolysis, revealing extensive adhesion to prior surgical scars (including one with abnormal peristalsis suggesting both mechanical and functional ileus). The authors note a key limitation that conclusions are based on only two cases, and they do not provide broader comparative evidence for the approach. This paper is centrally about endometriosis and/or adenomyosis; it focuses on adhesive ileus after gynecologic surgery, and it does not explicitly discuss endometriosis or adenomyosis.
Abstract
[Objective] An air-fluid level (niveau) on abdominal X-ray is usually an important sign of ileus. We experienced two cases of ileus without air-fluid level following gynecologic surgery. Both patients underwent double-balloon enteroscopy for diagnosis, followed by laparoscopic adhesiolysis.[Case 1] The patient underwent total abdominal hysterectomy and right salpingo-oophrectomy for myoma uteri and right ovarian tumor. Five months later, she was readmitted with abdominal pain and constipation, but there was no air-fluid level on abdominal x-ray. Adhesion of the small bowel was diagnosed by enteroscopy. Laparoscopic adhesiolysis was performed. There was a 20 cm adhesion of the small bowel to the scar from the previous operation, but there was no stenosis or obstruction. Usually, a post-operative ileus is a mechanical ileus, but this case it was not only a mechanical ileus, but also a functional ileus because there was peristalsis abnormality.[Case 2] A patient who was being treated for depression underwent right adnexectomy for torsion of a right ovarian tumor. 16 months later, she was readmitted with lower abdominal pain and constipation without air-fluid levels. We initially suspected functional ileus because the patient was on antidepressants, but conservative therapy was not effective. Diagnostic enteroscopy revealed adhesion of the small bowel. Because of the enteroscopy results, laparoscopic surgery was selected and laparoscopic adhesiolysis between the ileum and retroperitoneum was performed.[Conclusion] When abdominal pain and constipation without air-fluid level are persistent, we must consider the possibility of ileus. Enteroscopy and laparoscopic adhesiolysis may be options in these cases.
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Case report
Enteroscopy and laparoscopic adhesiolysis for two cases of adhesive ileus after gynecologic surgery
2011 Volume 27 Issue 1 Pages 251-254
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Abstract
[Objective] An air-fluid level (niveau) on abdominal X-ray is usually an important sign of ileus. We experienced two cases of ileus without air-fluid level following gynecologic surgery. Both patients underwent double-balloon enteroscopy for diagnosis, followed by laparoscopic adhesiolysis.
[Case 1] The patient underwent total abdominal hysterectomy and right salpingo-oophrectomy for myoma uteri and right ovarian tumor. Five months later, she was readmitted with abdominal pain and constipation, but there was no air-fluid level on abdominal x-ray. Adhesion of the small bowel was diagnosed by enteroscopy. Laparoscopic adhesiolysis was performed. There was a 20 cm adhesion of the small bowel to the scar from the previous operation, but there was no stenosis or obstruction. Usually, a post-operative ileus is a mechanical ileus, but this case it was not only a mechanical ileus, but also a functional ileus because there was peristalsis abnormality.
[Case 2] A patient who was being treated for depression underwent right adnexectomy for torsion of a right ovarian tumor. 16 months later, she was readmitted with lower abdominal pain and constipation without air-fluid levels. We initially suspected functional ileus because the patient was on antidepressants, but conservative therapy was not effective. Diagnostic enteroscopy revealed adhesion of the small bowel. Because of the enteroscopy results, laparoscopic surgery was selected and laparoscopic adhesiolysis between the ileum and retroperitoneum was performed.
[Conclusion] When abdominal pain and constipation without air-fluid level are persistent, we must consider the possibility of ileus. Enteroscopy and laparoscopic adhesiolysis may be options in these cases.
[Case 1] The patient underwent total abdominal hysterectomy and right salpingo-oophrectomy for myoma uteri and right ovarian tumor. Five months later, she was readmitted with abdominal pain and constipation, but there was no air-fluid level on abdominal x-ray. Adhesion of the small bowel was diagnosed by enteroscopy. Laparoscopic adhesiolysis was performed. There was a 20 cm adhesion of the small bowel to the scar from the previous operation, but there was no stenosis or obstruction. Usually, a post-operative ileus is a mechanical ileus, but this case it was not only a mechanical ileus, but also a functional ileus because there was peristalsis abnormality.
[Case 2] A patient who was being treated for depression underwent right adnexectomy for torsion of a right ovarian tumor. 16 months later, she was readmitted with lower abdominal pain and constipation without air-fluid levels. We initially suspected functional ileus because the patient was on antidepressants, but conservative therapy was not effective. Diagnostic enteroscopy revealed adhesion of the small bowel. Because of the enteroscopy results, laparoscopic surgery was selected and laparoscopic adhesiolysis between the ileum and retroperitoneum was performed.
[Conclusion] When abdominal pain and constipation without air-fluid level are persistent, we must consider the possibility of ileus. Enteroscopy and laparoscopic adhesiolysis may be options in these cases.
© 2011 Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy
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