Ogilvie’s syndrome following cesarean delivery: a case report

Ogilvie’s syndrome (OS) or acute pseudo-obstruction of the large bowel, is a rare condition and the true incidence is unknown. We present a case of acute colonic pseudo-obstruction (OS) post cesarean section in a 35-year-old patient with fetal distress, following cesarean delivery at term under general anesthesia. On the second postoperative day, she complained of abdominal distension, pain, nausea, vomiting, bloating and no passage of stool. As the patient's condition did not improve, she continued to have persistent abdominal distention. A plain abdominal film was taken and abdominal ultrasound was done, which showed massive gaseous distention of the bowels without fluid level. At laparotomy, a huge distended gut, pussy flakes on intestine, and massive dilatation of the whole colon were found. Postoperatively, the patient was managed with fluids, antibiotics, nutritional support, etc., along with the standard guidelines for management of peritonitis. The patient recovered and was discharged after 1 day of intensive care unit management to the ward. The need for awareness about the syndrome and early diagnosis is emphasized.

Reversed Intestinal Rotation Presented as Bowel Obstruction in a Pregnant Woman

A rare case of complete large bowel obstruction in a pregnant woman, without previous surgical history, due to previously undiagnosed reversed intestinal rotation is presented. The young woman was admitted with progressive nausea and vomiting which did not respond to conventional therapy. Her plain abdominal film revealed signs of small bowel obstruction. On laparotomy, her transverse colon was found to be located beneath the root of small bowel mesentery and completely obstructed by congenital fibrous bands. Postoperative recovery was unremarkable. Surgery for this unusual developmental anomaly is discussed.

A Giant Ureteral Stone without Underlying Anatomic or Metabolic Abnormalities: A Case Report

A 28-year old man presented with left flank pain and dysuria. Plain abdominal film and computed tomography showed a left giant ureteral stone measuring 11.5 cm causing ureteral obstruction and other stones 2.5 cm in size in the lower pole of ipsilateral kidney and 7 mm in size in distal part of right ureter. A left ureterolithotomy was performed and then a double J stent was inserted into the ureter. The patient was discharged from the hospital 4 days postoperatively with no complications. Stone analysis was consistent with magnesium ammonium phosphate and calcium oxalate. Underlying anatomic or metabolic abnormalities were not detected. One month after surgery, right ureteral stone passed spontaneously, left renal stone moved to distal ureter, and it was removed by ureterolithotomy. Control intravenous urography and cystography demonstrated unobstructed bilateral ureter and the absence of vesicoureteral reflux.

THE EFFECTIVENESS OF RENALOF® COMPARED TO KALKURENAL® AND PLACEBO

Objective: To compare the effectiveness after administration of Renalof to Kalkurenal and placebo in patient with renal calculus. Material & Method: We analyzed 30 patient with renal calculi less than or equal to 20 mm (2 cm) between January 2011 and March 2011. Patients were divided into 3 groups. Nine patients were treated with placebo, 8 patients were treated with Kalkurenal and the last 13 patients were treated with Renalof. After 30 days, we analyzed calcium and uric acid excretion for 24 hours and measured the stone with plain abdominal film and renal ultrasound. Results: There were decreased in excretion of calcium and uric acid all of patients but not significant statistically (p > 0,05) and there were significant decreased on stone measurement in patient treated with Renalof. Conclusion: Renalof  can be given as adjunct therapy for patient with renal calculi. Keywords: Calcium and uric acid excretion in urine 24 hours, stone measurement and stone surface area.

Long-term indwelling double-J stents: Bulky kidney and urinary bladder calculosis, spontaneous intraperitoneal perforation of the kidney and peritonitis as a result of 'forgotten' double-J stent

Background. The first double-J (DJ) stents were manufactured in 1978. Their J-shaped tips efficiently prevent their migration from kidneys and from the urinary bladder. Nowadays, DJ stents are in common use because they provide efficient and relatively safe urinary derivation between the kidney and the urinary bladder. We report this case with the aim to point out possible serious complications with long-term indwelling stents. Case report. The patient was admitted to hospital five years after the placement of DJ in a bad general condition, with symptoms of peritonitis. Radiological examination (plain abdominal film, computerized tomography, excretory urogram and cystography) showed bulky calculosis at each tip of the stent, affunctional right kidney, vesicoureteral reflux through the DJ stent and ureter all the way to the right kidney, as well as a large amount of turbid liquid in the abdomen. In the course of the operation, the bulky stone with the DJ stent was removed form the urinary bladder, followed by a large amount of turbid liquid extracted from the abdomen. During adhesiolysis, a small intraperitoneal perforation through which a tip of the stent prolapsed, was found on the upper pole of the kidney. After that, nefrectomy was performed. The patient was discharged 18 days after the surgery. Conclusion. There are usually no complications with shortterm DJ stent urinary drainage. However, indwelling DJ stents can cause serious complications, such as migration, incrustration and fragmentation. DJ indwelling should be as short as possible. If indwelling stenting is necessary, the DJ stent should be replaced with a new one in due time, or another kind of derivation should be performed. Careful monitoring of patients could exclude any possibility of a stent being forgotten at all.