The most common causes of small bowel obstruction (SBO) are adhesions, Crohn’s disease, neoplasms, and hernias. Internal hernias are rare, and they occur when the small bowel herniates through a defect in the abdominal cavity. The occurrence of internal hernias due to a broad ligament defect is very rare and accounts for 4%-7% of cases of internal hernia. We present a case of a 71-year-old female who was previously healthy with no significant past medical or surgical history and who presented with symptoms of small bowel obstruction. Imaging with X-ray and computed tomography (CT) confirmed the diagnosis, but not the etiology. A decision was made to perform a laparoscopy to manage the obstruction, which revealed a healthy small bowel loop that herniated through a defect in the right broad ligament. Acute abdominal pain due to intestinal obstruction is a relatively common surgical emergency. Internal hernias are the consequence of the herniation of a bowel loop, most commonly the small bowel, through a peritoneal or mesenteric defect into a compartment in the abdominal and pelvic cavity, and they have a high mortality rate than can be higher than 50%. CT imaging is very useful in the diagnosis of internal hernias, although it may not always reveal the etiology. To facilitate wider recognition, broad ligament hernia should be in the differential diagnosis of internal hernias evident in the pelvis on CT imaging. Early recognition of small bowel obstruction caused by broad ligament internal hernia allows for prompt surgical management and vastly facilitates postoperative recovery. Although most surgeons opt for a laparotomy approach to manage such cases, a laparoscopic approach is feasible.
Introduction:Oxytocin (OT), a known hormone and neurotransmitter, has been lately known to be involved in the drug addiction cycle especially during developing tolerance, in relation to craving and during withdrawal. Objectives:The aim was to assess serum OT level in patients with active opiate dependency in comparison with abstinent patients and healthy controls, and its relation with craving among patients and abstinent patients. Materials and Methods:A consecutive sample of 30 opiate-dependent patients who fully meet the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for opiate dependence, in addition to 30 patients fulfilling DSM-5 criteria of opiate dependence with at least 6 months of abstinence were assessed regarding serum OT levels, craving levels using immunoassay kit and brief substance craving scale, respectively. They were compared with each other and with a sample of 30 healthy controls matching both groups. Results:There was a statistically significant difference between the patient and the control groups in serum OT levels (P<0.05) but not between the other 2 groups, that is, patient versus abstinent and abstinent versus controls. Craving levels showed a statistically significant difference between the patient and the abstinent groups (P<0.001). A negative correlation was found between OT level and craving in the abstinent group (P<0.05). Conclusions:The interaction between serum OT levels and craving should be considered when dealing with opiate-dependent patients as they affect and are affected by opiate dependence. Further studies regarding how to implement this during patients treatment should be considered.
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