Skip to main content

Advertisement

SpringerLink
Log in

Mandatory Resection of Strangulation Marks in Small Bowel Obstruction?

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

No evidence is available on how to treat intraoperatively detected band-shaped strangulation marks of the bowel wall originating from an adhesive band or hernia ring. The authors prefer to resect these hazardous strangulation marks to avoid secondary small bowel perforation. This retrospective study investigated the prevalence of intraoperatively unrecognized ulceration and transmural necrosis at the site of the strangulation marks.

Methods

From July 2003 to July 2011, a total of 31 of 461 patients with acute bowel obstruction underwent small bowel resection due to strangulation marks, exclusively. Seven patients had two strangulation marks, resulting in 38 strangulation marks to be analyzed.

Results

From 38 examined strangulation marks, 14 (36.8 %) exhibited deep ulceration or transmural necrosis. Four (10.5 %) necrotic lesions had already been recognized intraoperatively, while 7 (18.4 %) unsuspicious strangulation marks showed deep ulceration and 3 (7.9 %) showed transmural necrosis exclusively at final histopathologic examination. The number of strangulation marks that needed to be resected for prevention of one missed deep ulceration and/or transmural necrosis of the small bowel was 3.4. The presence of deep ulceration or transmural necrosis is associated with an obvious decrease in bowel diameter caudad to the strangulation mark. No anastomotic leak occurred.

Conclusion

The severity of small bowel damage at the site of band-shaped strangulation marks may be underestimated by surgeons. The present series showed favorable results with a resection-per-principle policy for these strangulation marks. If an obvious decrease of bowel diameter aborally to the strangulation mark is present, resection or seromuscular invagination of the later is particularly recommended.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Duron JJ, du Montcel ST, Berger A et al (2008) Prevalence and risk factors of mortality and morbidity after operation for adhesive postoperative small bowel obstruction. Am J Surg 195(6):726–734

    Article  PubMed  Google Scholar 

  2. Fevang BT, Fevang J, Stangeland L et al (2000) Complications and death after surgical treatment of small bowel obstruction: a 35-year institutional experience. Ann Surg 231(4):529–537

    Article  CAS  PubMed  Google Scholar 

  3. Margenthaler JA, Longo WE, Virgo KS et al (2006) Risk factors for adverse outcomes following surgery for small bowel obstruction. Ann Surg 243(4):456–464

    Article  PubMed  Google Scholar 

  4. Cox MR, Gunn IF, Eastman MC et al (1993) The operative aetiology and types of adhesions causing small bowel obstruction. Aust N Z J Surg 63(11):848–852

    Article  CAS  PubMed  Google Scholar 

  5. Karliczek A, Harlaar NJ, Zeebregts CJ et al (2009) Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery. Int J Colorectal Dis 24:569–576

    Article  CAS  PubMed  Google Scholar 

  6. Horgan PG, Gorey TF (1992) Operative assessment of intestinal viability. Surg Clin North Am 72(1):143–155

    CAS  PubMed  Google Scholar 

  7. Hofmann M (1907) Das Verhalten des Darmes bei Incarceration, insbesondere an den Schnürfurchen. Beitr Klin Chir 54:85–160

    Google Scholar 

  8. Van Beuren FT (1920) The relation between intestinal damage and delayed operation in acute mechanical ileus. Ann Surg 72:610–615

    Article  PubMed  Google Scholar 

  9. Lehr L, Siewert JR (1992) Ileus. In: Kremer K, Lierse W, Platzer W, Schreiber HW, Weller S (eds) Chirurgische Operationslehre, vol 6, 1st edn. Thieme, Stuttgart, p 332

    Google Scholar 

  10. Meng X, Liu L, Jiang H (2010) Indications and procedures for second-look surgery in acute mesenteric ischemia. Surg Today 40:700–705

    Article  PubMed  Google Scholar 

  11. Robertson I, Leung E, Hughes D et al (2005) Prospective analysis of stoma-related complications. Colorectal Dis 7(3):279–285

    Article  CAS  PubMed  Google Scholar 

  12. Wilmore DW, Robinson MK (2000) Short bowel syndrome. World J Surg 24(12):1486–1492. doi:10.1007/s002680010266

    Article  CAS  PubMed  Google Scholar 

  13. Chow A, Tilney HS, Paraskeva P et al (2009) The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases. Int J Colorectal Dis 24:711–723

    Article  PubMed  Google Scholar 

  14. Bougard V, Avisse C, Patey M et al (2008) Double ischemic ileal stenosis secondary to mesenteric injury after blunt abdominal trauma. World J Gastroenterol 14:143–145

    Article  PubMed  Google Scholar 

  15. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed  Google Scholar 

  16. Ruf W, Suehiro GT, Suehiro A, Pressler V, McNamara JJ (1980) Intestinal blood flow at various intraluminal pressures in the piglet with closed abdomen. Ann Surg 191(2):157–163

    Article  CAS  PubMed  Google Scholar 

  17. Robinson JW, Mirkovitch V, Winistörfer B, Saegesser F (1981) Response of the intestinal mucosa to ischaemia. Gut 22(6):512–527

    Article  CAS  PubMed  Google Scholar 

  18. Brown RA, Chiu CJ, Scott HJ, Gurd FN (1970) Ultrastructural changes in the canine ileal mucosal cell after mesenteric arterial occlusion. Arch Surg 101(2):290–297

    Article  CAS  PubMed  Google Scholar 

  19. Vákonyi T, Wittmann T, Varró V (1977) Effect of local circulatory arrest on the structure of the enterocytes of the isolated intestinal loop. Digestion 15(4):295–302

    Article  PubMed  Google Scholar 

  20. Chiu CJ, McArdle AH, Brown R, Scott HJ, Gurd FN (1970) Intestinal mucosal lesion in low-flow states. I. A morphological, hemodynamic, and metabolic reappraisal. Arch Surg 101(4):478–483

    Article  CAS  PubMed  Google Scholar 

  21. Menge H, Robinson JW (1979) Early phase of jejunal regeneration after short term ischemia in the rat. Lab Invest 40(1):25–30

    CAS  PubMed  Google Scholar 

  22. Wagner R, Gabbert H, Höhn P (1979) The mechanism of epithelial shedding after ischemic damage to the small intestinal mucosa. A light and electron microscopic investigation. Virchows Arch B 30(1):25–31

    CAS  PubMed  Google Scholar 

  23. Robinson JW, Mirkovitch V (1972) The recovery of function and microcirculation in small intestinal loops following ischaemia. Gut 13(10):784–789

    Article  CAS  PubMed  Google Scholar 

  24. Cameron GR, Khanna SD (1959) Regeneration of the intestinal villi after extensive mucosal infarction. J Pathol Bacteriol 77(2):505–510

    Article  CAS  PubMed  Google Scholar 

  25. Pitha J (1971) The fine structure of regenerating epithelium in the small intestine. Virchows Arch B 7(4):314–341

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General, Visceral, Vascular, and Thoracic Surgery, Hospital of Liestal, Affiliated to the University of Basel, Liestal, Switzerland

    Samuel Andreas Käser & Christoph Andreas Maurer

  2. Institute of Pathology, Liestal, Switzerland

    Niels Willi

Authors
  1. Samuel Andreas Käser
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Niels Willi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christoph Andreas Maurer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Samuel Andreas Käser.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Käser, S.A., Willi, N. & Maurer, C.A. Mandatory Resection of Strangulation Marks in Small Bowel Obstruction?. World J Surg 38, 11–15 (2014). https://doi.org/10.1007/s00268-013-2248-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-013-2248-6

Keywords

Search

Navigation