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Intestinal obstruction from a forgotten artery forceps: a case report
1Doset Specialist Hospital, P. O. Box 7720, Secretariat, Ibadan.
Abstract:
68-year-old male patient who had had two previous gall bladder operations presented with an acute abdomen. Upon investigation an Artery Forceps was seen on plain abdominal X-ray, and subsequent laparotomy showed that it entrapped a segment of the small intestine, which was gangrenous. The gangrenous loop was delivered from the forceps followed by resection and end-to-end anastomosis. The patient had an uneventful post-operative period and remained well on follow up twenty four months later.
Insights
A retained surgical instrument, specifically artery forceps, caused small bowel obstruction and gangrene in a patient with a history of gallbladder surgery. Surgical intervention, including resection and anastomosis, led to a successful outcome and recovery.
Area of Science:
- Gastroenterology
- Surgical Pathology
- Abdominal Surgery
Background:
- Previous abdominal surgeries, particularly cholecystectomy, can increase the risk of intra-abdominal complications.
- Retained surgical instruments are a rare but serious complication following operative procedures.
- Acute abdomen presentation necessitates prompt diagnosis and management to prevent morbidity.
Observation:
- A 68-year-old male with a history of two cholecystectomies presented with acute abdominal pain.
- Plain abdominal X-ray revealed a radiopaque foreign body consistent with artery forceps.
- Laparotomy confirmed the artery forceps entrapping and causing gangrene in a segment of the small intestine.
Findings:
- Surgical removal of the entrapped gangrenous small bowel segment.
- Successful small bowel resection and end-to-end anastomosis performed.
- Histopathological examination confirmed ischemic injury secondary to external compression by the surgical instrument.
Implications:
- This case highlights the importance of meticulous surgical counts and intraoperative imaging to prevent retained surgical items.
- Delayed diagnosis of retained instruments can lead to severe complications such as bowel obstruction and ischemia.
- Effective surgical management, including bowel resection and reconstruction, can achieve favorable outcomes even in complex cases.