INTESTINAL OBSTRUCTION DUE TO A FORGOTTEN MISSING LIPPES LOOP- A CASE REPORT WITH REVIEW OF LITERATURE
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 21
Abstract
PRESENTATION OF CASE A 45-year-old female patient presented with intermittent pain in abdomen and recurrent episodes of vomiting since 6 months. She also reported intermittent constipation. On examination, patient had tachycardia of 120/min and blood pressure of 110/70 mmHg. Rest of general examination was normal. Per abdomen exam revealed mildly distended abdomen with mild tenderness in periumbilical region. Auscultation revealed hyperperistalsis of the bowel. Plain radiographs revealed dilated small bowel loops with air fluid levels. Abdominal ultrasound was equivocal. CT scan revealed transition zone in mid-ileal region with delayed to no passage of oral contrast beyond it. Conservative management was initiated with proximal decompression with a nasogastric tube. Patient continued to have tachycardia and abdominal pain. Endoscopy was done. Decision was taken to perform exploratory laparotomy. Intra-abdominal findings were dilated jejunal and proximal ileal loops. Distal ileal loops were clumped and rotated around a foreign body. On further dissection, an entangled Lippes loop (a double S shaped intrauterine device) was identified forming a foreign body granuloma. Lippes loop was extracted and bowel was reposited. Postoperative recovery was unremarkable. Patient reported of relief of symptoms. This is a rare case of a forgotten Lippes loop, which caused silent perforation of the uterine wall and migrated intraperitoneally to cause intestinal obstruction. On thorough review of literature, there are instances documented of a forgotten missing Lippes loop causing complications and ours appears to be only one of the few to report a case of intestinal obstruction
Authors and Affiliations
Mohan Joshi, Ashwini Paranjpe, Vishwajeet Pawar, Monika Pohekar, Devbrata Adhikari
Keywords
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- EP ID EP431648
- DOI 10.14260/jemds/2018/595
- Views 56
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