Unusual causes of acute intestinal obstruction in adults.

This paper refers to 50 unusual cases of 542 consecutive adult patients who underwent surgery because of acute intestinal obstruction. Of the 38 small bowel cases, 5 were caused by hernias in anomalous recesses (1 prevesical, 2 left paraduodenal, and 2 paracecal hernias), 6 by a gallstone ileus, 14 to the presence of a bezoar or foreign body, 8 to extended postradiation perivisceritis, 3 to Meckel diverticulum volvulus, 1 to transepiploic hernia, and 1 to ileus-Meckel hematoma during anticoagulation treatment. The 12 large bowel cases included 3 diaphragmatic hernias (1 late post-trauma), 3 cases of colo-colic intussusception, 1 case of obstructive cholecystitis, and 5 cases of Ogilvie's syndrome. Major technical problems have to be immediately solved in the case of left paraduodenal, prevesical, or diaphragmatic hernias; however, during laparotomy, there may also be some difficult and unpredictable problems caused by widespread postradiation perivisceritis.