Transrectal ultrasonography (TRUS)‐guided prostate biopsy is the most commonly used method of sampling prostate tissue for the diagnosis of prostate cancer. The technique is well recognised to potentially cause severe pain and discomfort for patients and this has led to numerous attempts to devise ways to minimise these problems. This systematic review summarises the techniques that have been described to date, with special reference to studies using either a visual analogue or numerical analogue scale to report outcomes. Commonly used approaches that are effective to minimise pain or discomfort include intravenous sedoanalgesia, inhalational agents and periprostatic infiltration of local anaesthetic. Whilst diclofenac suppositories are more effective than placebo, intra‐rectal local anaesthetic gels appear to be of no benefit. Performing TRUS‐guided prostate biopsy without any form analgesia is not appropriate.
The Penthrox inhaler appears to be a safe and effective method of analgesia for TRUSPB. Patients who had experienced both PILA and Penthrox reported pain scores that significantly favoured PILA over the Penthrox inhaler.
BACKGROUND
Small bowel diverticulosis is an uncommon condition which is usually asymptomatic and is discovered incidentally. One rare complication is enteroliths forming in the diverticula causing bowel obstruction. Only a few cases of such have been described in literature, and recurrence from this aetiology has not been reported previously. This case report outlines the management of a 68-year-old male who presented with recurrent small bowel obstruction secondary to jejunal diverticular enterolith impaction, seven months following a previous episode.
CASE SUMMARY
A 68-year-old male presented with symptoms of small bowel obstruction. Computed tomography (CT) of the abdomen demonstrated small bowel obstruction from an enterolith formed in one of his extensive jejunal diverticula. He required a laparotomy, an enterotomy proximal to the enterolith, removal of the enterolith, closure of the enterotomy, and resection of a segment of perforated ileum with stapled side-to-side anastomosis. Seven months later, he represented to emergency department with similar symptoms. Another CT scan of his abdomen revealed a recurrent small bowel obstruction secondary to enterolith impaction. He underwent another laparotomy in which it was evident that a large enterolith was impacted at the afferent limb of the previous small bowel anastomosis. A part of the anastomosis was excised to allow removal of the enterolith and the defect was closed with cutting linear stapler. In the following two years, the patient did not have a recurrent episode of enterolith-related bowel obstruction.
CONCLUSION
The pathophysiology underlying enterolith formation is unclear, so it is difficult to predict if or when enteroliths may form and cause bowel obstruction. More research could provide advice to prevent recurrent enterolith formation and its sequelae.
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