Saudi Journal of Gastroenterology
Home About us Instructions Ahead of print Submission Subscribe Advertise Contact Login    Print this page  Email this page Small font sizeDefault font sizeIncrease font size 
Users Online: 19 


 
CASE REPORT Table of Contents   
Year : 2008  |  Volume : 14  |  Issue : 1  |  Page : 36-37
Intestinal obstruction due to an anomalous congenital band


Department of Surgery, University Hospital of Ioannina, Greece

Click here for correspondence address and email

Date of Submission22-Jun-2007
Date of Acceptance15-Nov-2007
 

   Abstract 

We report a case of a 20-year-old male who presented with symptoms and signs of intestinal obstruction. The patient reported no previous history of abdominal surgery or trauma while clinical and radiographic examinations were not diagnostic. An open laparotomy was subsequently performed and the intraoperative findings were consistent with a congenital band extending from the antimesenteric wall of the jejunum to the root of mesentery. The band was ligated and divided with an uneventful postoperative course. Congenital bands are extremely rare. Their exact incidence is still unknown and usually observed in childhood. This case, therefore, represents an unusual surgical problem in an older individual in which the diagnosis was clinically unexpected.

Keywords: Congenital band, intestinal obstruction, remnant

How to cite this article:
Dimitrios C, George AA, Dimosthenis Z, Nikolaos X. Intestinal obstruction due to an anomalous congenital band. Saudi J Gastroenterol 2008;14:36-7

How to cite this URL:
Dimitrios C, George AA, Dimosthenis Z, Nikolaos X. Intestinal obstruction due to an anomalous congenital band. Saudi J Gastroenterol [serial online] 2008 [cited 2014 Nov 22];14:36-7. Available from: http://www.saudijgastro.com/text.asp?2008/14/1/36/37806


Small bowel obstruction is the most common surgical disorder of the small intestine. Adhesions are by far the most frequent causes followed by hernias, tumors, intussusception, foreign bodies, gallstones, and inflammatory bowel disease.

Obstruction by a congenital band is extremely rare and usually observed in childhood.

This report presents a 20-year-old male with symptoms of intestinal obstruction, subsequently treated by ligation and division of a congenital band. This is the first report of a band running from the root of the mesentery to the jejunum.


   Case Report Top


A 20-year-old male presented to the Emergency Department complaining of epigastric pain of 6-h duration. He also reported an episode of vomiting. There was no history of abdominal surgery or trauma. Abdominal palpation revealed moderate tenderness over the epigastric area without rebound tenderness or a palpable mass. On auscultation, there were active bowel sounds. Rectal examination was normal. At the time of arrival, he had a temperature of 37.0°C, a blood pressure of 130/80 mm Hg, and a pulse rate of 85 beats/min. Laboratory data showed an elevated lactate dehydrogenase of 241 IU/l and creatinophosphokinase of 507 IU/l, but no leukocytosis.

Abdominal plain X-ray showed intestinal loops with air-fluid levels on the left side of the abdomen, which remained unaltered in a subsequent X-ray after 2 h [Figure - 1]. Due to the patient's clinical deterioration, an exploratory laparotomy was performed and revealed a congenital vascular band that formed a closed loop through which a part of small bowel was entrapped. The band was vascularized by one of the branches of the superior mesenteric artery, and the start of the band was located at the end of the jejunum, and the termination was at the root of the mesentery at the level of the second lumbar vertebrae; no sign of ischemic bowel was noted [Figure - 2]. The band was ligated and divided. Histopathological examination revealed a fibrotic band containing blood vessels. Postoperative outcome was uneventful and the patient was discharged on the fourth postoperative day.


   Discussion Top


Congenital bands are a rare cause of intestinal obstruction in infancy and childhood. Their occurrence in adults is an extremely rare condition. [1],[2] Obstruction is caused by entrapment of the intestine between the band and mesentery or by compression of the bowel. Akgur et al. have recently reported in a series of eight patients that bands principally were located between ascending colon and terminal ileum followed by ligament of Treitz and terminal ileum; between the right lobe of liver and terminal ileum; and between the right lobe of liver and ascending colon. [1] Lin et al. have reported a band extending from the iliac fossa to the sigmoid mesocolon, [3] while Itagaki et al. reported the presence of a jejuno-jejuno congenital band. [4] As far as we know, there are no reports of a band running from the root of mesentery to the jejunum. In addition, its location excluded known embryogenic remnants such as mesourachus or vitelline arteries, veins or omphalomesenteric ducts. [5],[6] In all the reported cases, the band was well vascularized as was the case in the present study.

Patients usually present with symptoms of intestinal obstruction, and despite the availability and wide use of modern imaging techniques, preoperative diagnosis is very difficult to establish. Plain films are nonspecific. Ultrasound scan might provide details of localized distended intestinal loops or indirect signs of peritonitis, but it is not specific while barium-contrast gastrointestinal series may provide clues to narrow the differential diagnosis. In the present case, plain abdominal X-ray revealed air-fluid levels located on the left side of the abdomen, which remained unaltered in a subsequent image after 2 hours.

Concerning the management of a congenital band, surgical treatment is the cornerstone. Traditionally, laparotomy is indicated, whereas with the advent of minimally invasive surgery, laparoscopy has been proposed as an alternative. Wu et al . have recently reported that laparoscopy may be safe and feasible in the diagnosis and treatment of a congenital band. [7]

In conclusion, the possibility of a congenital band must be included in the differential diagnosis of young patients with symptoms and signs of bowel obstruction and no history of abdominal surgery, trauma or clinical hernia, although this entity is very uncommon. This clinical situation requires early surgical intervention that will be diagnostic and therapeutic.

 
   References Top

1.Akgur FM, Tanyel FC, Buyukpamukcu N, Hicsonmez A. Anomalous congenital bands causing intestinal obstruction in children. J Pediatr Surg 1992;27:471-3.  Back to cited text no. 1    
2.Habib E, Elhadad A. Small bowel obstruction by a congenital band in 16 adults. Ann Chir 2003;128:94-7.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Lin DS, Wang NL, Huang FY, Shih SL. Sigmoid adhesion caused by a congenital mesocolic band. J Gastroenterol 1999;34:626-8.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Itagaki MW, Lema R, Gregory JS. Small bowel obstruction caused by a congenital jejuno-jejuno band in a child. Pediatr Emerg Care 2005;21:673-4.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Dammert W, Curraino G. Mesourachus and colon obstruction. J Pediatr Surg 1983;18:308-10.  Back to cited text no. 5    
6.Kleinhaus S, Cohen MI, Boley SJ. Vitelline artery and vein remnants as a cause of intestinal obstruction. J Pediatr Surg 1974;9:295-9.  Back to cited text no. 6  [PUBMED]  
7.Wu JM, Lin HF, Chen KH, Tseng LM, Huang SH. Laparoscopic diagnosis and treatment of acute small bowel obstruction resulting from a congenital band. Surg Laparosc Endosc Percutan Tech 2005;15:294-6.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]

Top
Correspondence Address:
Alexiou A George
P.O. Box 103, Neohoropoulo, Ioannina, 455 00
Greece
Login to access the Email id


DOI: 10.4103/1319-3767.37806

PMID: 19568494

Get Permissions



    Figures

  [Figure - 1], [Figure - 2]

This article has been cited by
1 Intestinal Obstruction in Children
Ana Kostic,Marijana Krstic,Andjelka Slavkovic,Nikola Vacic
Pediatric Emergency Care. 2013; 29(4): 500
[Pubmed]
2 Congenital Membrane Causing Duodenal Obstruction and Malpositioning of the Descending Colon
Chee-Chee Koh,Sheng-Hong Tseng,Chia-Chi Weng,Yun Chen
Pediatrics & Neonatology. 2013; 54(4): 275
[Pubmed]
3 Anomalous congenital band and intestinal obstruction: report of a fatal case in a child
Aniello Maiese,Luigi Bonaccorso,Massimiliano Dell’Aquila,Lorenzo Gitto,Giorgio Bolino
Forensic Science, Medicine, and Pathology. 2013; 9(4): 588
[Pubmed]
4 Congenital membrane causing duodenal obstruction and malpositioning of the descending colon
Koh, C.-C. and Tseng, S.-H. and Weng, C.-C. and Chen, Y.
Pediatrics and Neonatology. 2013; 54(4): 275-277
[Pubmed]
5 Intestinal obstruction in children: Could it be congenital abdominal bands?
Kostic, A. and Krstic, M. and Slavkovic, A. and Vacic, N.
Pediatric Emergency Care. 2013; 29(4): 500-501
[Pubmed]
6 Extrinsic colonic obstruction by congenital fibrous band in an infant
Catania, V.D. and Olivieri, C. and Nanni, L. and Pintus, C.
BMJ Case Reports. 2013; (007897)
[Pubmed]
7 Small bowel obstruction due to anomalous congenital peritoneal bands-case series in adults
Sozen, S. and Emir, S. and Yazar, F.M. and Altinsoy, H.B. and Topuz, O. and Vurdem, U.E. and Tukenmez, M. and Keceli, M. and Uzun, A.S. and Cetinkunar, S. and Ozkan, Z. and Guzel, K.
Bratislava Medical Journal. 2012; 113(3): 186-189
[Pubmed]
8 Constipation in a 7-year-old boy: Congenital band causing a strangulated small bowel and pulseless electrical activity
Fang, A.C. and Carnell, J. and Stein, J.C.
Journal of Emergency Medicine. 2012; 42(3): 283-287
[Pubmed]
9 Internal hernia through the descending mesocolon following left radical nephrectomy-a rare complication: Case report and review of the literature
Kumar, A. and Trehan, V. and Ramakrishnan, T.S. and Maheshwari, V.
Hernia. 2012; 16(1): 103-106
[Pubmed]
10 Constipation in a 7-year-old Boy: Congenital Band Causing a Strangulated Small Bowel and Pulseless Electrical Activity
Andrea C. Fang,Jennifer Carnell,John C. Stein
The Journal of Emergency Medicine. 2012; 42(3): 283
[Pubmed]
11 Canine congenital intestinal obstruction due to a band of small bowel in the pubic bone [Obstrução intestinal congĂȘnita em cĂŁo por aderĂȘncia de alça em osso pĂșbico]
Pereira, E.Z. and Fam, A.L.P.D. and de Farias, M.R. and Sarraff-Lopes, A.P.
Ciencia Rural. 2011; 41(10): 1797-1799
[Pubmed]
12 Intestinal obstruction due to anomalous congenital band
Sozen, S. and Keceli, M. and Topuz, O. and Vurdem, U.E.
Pakistan Journal of Medical Sciences. 2011; 27(4): 909-910
[Pubmed]
13 Internal hernia through the descending mesocolon following left radical nephrectomy—a rare complication: case report and review of the literature
A. Kumar, V. Trehan, T. S. Ramakrishnan, V. Maheshwari
Hernia. 2010;
[VIEW]



 

Top
 
  Search
 
  
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
    Case Report
    Discussion
    References
    Article Figures

 Article Access Statistics
    Viewed7179    
    Printed108    
    Emailed2    
    PDF Downloaded413    
    Comments [Add]    
    Cited by others 13    

Recommend this journal