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PubMed1980

[Intestinal obstruction: technical and tactical aspects (author's transl)].

A tactical and technical vista of a differentiated surgical approach to intestinal obstruction is presented based on personal experience and literature: 1. For the treatment of early postoperative intestinal obstruction--of paralytic as well as of primarily mechanical origin--intestinal decompression using the long intestinal tube inserted endoscopically is a worthwhile procedure with a high rate of success.--2. Following operations for intestinal obstruction including cases of peritonitis, decompression gastrostomy using the Stamm-Kader or Dragstedt procedure is an important adjunct to therapy aimed at the reduction of morbidity and lethality within a well defined group of patients.--3. For prophylaxis against recurrence of late adhesive obstruction, gastro-entero-cecal intraluminary splinting combined with temporary gastrostomy can be recommended. Clinical results indicate, that standardized application of these procedures will definitely serve to reduce lethality of intestinal obstruction.

Endoscopes↗
PubMed1990

[The medical treatment of intestinal obstruction due to adhesions and adherences].

Adhesions are the most common cause of intestinal obstruction. Medical treatment for those patients with no signs of vascular involvement has been successful in many cases. We reviewed the clinical records of 87 patients with intestinal obstruction due to adhesions, having a total of 122 episodes. Satisfactory follow up was obtained in 76% of patients for a mean of 29.6 months. 47% of episodes resolved without need for surgical intervention. Volume entrapment during the first hours was correlated with need for surgical treatment (p < 0.01). Recurrences were not different between medical and surgical patients (p = 0.28). Thus, medical treatment of this type of intestinal obstruction may be attempted in most patients, not only those who are poor surgical risks.

Adult↗
PubMed1990

Clinical application of spectral analysis of bowel sounds in intestinal obstruction.

The bowel sounds of 21 patients with mechanical obstruction of the intestine were studied. A computer analysis of bowel sounds was performed using a signal processor. Bowel sounds of patients were classified into 3 types (Types I, II, and III) based on the histograms, although these were not distinguishable on auscultation. The lower, peak, and upper frequencies were 173 +/- 25 Hz, 273 +/- 64 Hz, and 667 +/- 58 Hz, respectively, in Type I; 309 +/- 121 Hz, 632 +/- 94 Hz, and 878 +/- 116 Hz, respectively, in Type II; and 330 +/- 120 Hz, 612 +/- 86 Hz, and 766 +/- 82 Hz, respectively, in Type III. High frequency sounds above 900 Hz were recorded in Types I and II but not in Type III. The ratio of the operated patients was 0, 23, and 100 percent in Types I, II, and III, respectively. The intervals between the times of admission and operation were 4.3 days and 1.2 days in Types II and III, respectively. Thus, it appears that the methods described by the authors could provide a very objective assessment of the severity and help determine the treatment (conservative or operative) of each patient.

Adult↗
PubMed1994

[Intestinal obstruction with invagination caused by an inflammatory fibroid polyp of the small intestine].

We observed the rare case of a 50-year-old man with intestinal obstruction due to an inflammatory fibroid polyp (IFP) of the jejunum. Here, we report its clinical and pathological characteristics, and its histologic appearance. Limited small bowel resection led to complete recovery of the patient. In a short review of the literature, possible pathogenetic mechanisms as well as diagnostic and therapeutic means are discussed. Although rare, IFP should be considered in the differential diagnosis of small bowel obstruction.

Anastomosis, Surgical↗
PubMed2002

The effects of pentoxifylline on bacterial translocation after intestinal obstruction.

Bacterial translocation (BT) occurs mainly in preseptic conditions such as intestinal obstruction, trauma, and burn, and the underlying mechanisms are still unclear. Pentoxifylline (PTX) is a derivative of methyl xanthine and has several beneficial effects in sepsis. We investigated the effects of PTX on a rat BT model. Simple intestinal obstruction (IO) was choosen to create high BT rates. Rats were divided in to five groups of 10 rats. Either 50 mg/kg PTX or placebo (3 mg/100 g saline) was administered subcutaneously following IO, either by single injection or twice with a 12-h interval. All rats were sacrificed 12 or 24 h after the procedure, and mesenteric lymph nodes (MLN), liver, and blood samples were obtained under aseptic conditions for bacterial cultures. The samples were obtained 12 h following IO in the first two groups, and the same samples were obtained 24 h after IO in last three groups. Groups IV and V were the PTX treatment groups. PTX was re-injected 12 h after IO only in group IV. As a result, BT rates in MLNs and liver were found to be significantly low, blood specimens remained sterile in PTX-pretreated and -treated rats, and BT rates were high in control groups and group V (once treatment late specimen group). We conclude that simple intestinal obstruction causes BT, and PTX reduces BT in rats with IO during the first 12-h period if PTX is given once immediately following IO. PTX reduces BT during the first 24-h after IO provided that is injected twice with a 12-h interval. More experimental studies are need to explain the exact mechanism of this beneficial effect.

Analysis of Variance↗
PubMed1988

Intestinal obstruction in patients with ovarian cancer. Variables associated with surgical complications and survival.

Intestinal obstruction is frequently encountered in patients with ovarian cancer. Surgical correction of intestinal obstruction may allow the prolonged survival of some patients. We identified prognostic factors associated with operative complications and postoperative survival. Multiple preoperative, intraoperative, and postoperative variables were considered. In addition, a previously published prognostic index was evaluated. Statistical assessment developed a model that demonstrated that the clinical assessment of tumor status, the serum albumin level, and the nutrition score were variables significantly associated with postoperative survival. The amount of residual ovarian cancer at the completion of bowel obstruction surgery was also significantly associated with postoperative survival. This information may aid in the preoperative selection of patients who might benefit from surgical correction of intestinal obstruction.

Aged↗
PubMed2000

Neonatal intestinal obstruction.

We reviewed 36 cases of neonatal intestinal obstruction admitted to our surgical unit over a 10-year period, 1986-1996, for surgical intervention following the failure of conservative treatment. There were more males than females and the age range was 12 hours-26 days. Imperforate anus was the main cause of the obstruction (27.8%) followed by duodenal atresia (13.9%) and colonic atresia and meconium ileus (11.1% each). There were 8 deaths following surgery (22% mortality rate), the main causes being aspiration pneumonia, septicaemia and hypothermia.

Age Distribution↗
PubMed1994

Intestinal obstruction caused by solitary bands: aetiology, presentation, diagnosis, management, results.

PURPOSE: Solitary band intestinal obstruction is receiving renewed interest based on the emerging possibility of laparoscopic intervention restricted to this type of small intestinal obstruction. Therefore, pertinent observations focussing on this patient population undergoing conventional "open" surgery could be of interest. METHOD: Prospectively collected chart data of all patients operated for solitary band obstruction (SBO) from January 1979 until December 1993 were reviewed and the further course followed for 1-15 (median 8) years. RESULTS: The incidence of SBO was 15.4% of a total of 123 patients operated for late adhesive obstruction. In previously operated patients (approximately 70%) appendectomy and gynecological procedures dominated, whereas in previously nonoperated patients inflammatory entities such as adnexitis or appendicitis were common precursers. In approximately 52%, SBO occurred without prodromal symptoms. Nonstrangulating SBO was characterized by vague clinical symptoms and screening sonography rendered an immediate diagnosis. In approximately 31%, SBO was complicated by strangulation or torsion. Early postoperative morbidity was approximately 28% including 2 cases of early postoperative intestinal obstruction, the further course complicated by 3 episodes of late recurrent obstruction in 2 patients. Approximately 21% developed proven and another approximately 21% suspected recurrent intestinal adhesions. CONCLUSIONS: 1. History and clinical presentation of SBO can be uncharacteristic including previously nonoperated patients with vague symptoms. 2. Sonography is highly sensitive. 3. Postoperative morbidity is mainly associated with enterotomy and omitted resection. 4. The incidence of late recurrent obstruction is substantial but within the range of obstructions following enterolysis and gut repair for obstructing extensive adhesions without intestinal tube splinting.

Adolescent↗
PubMed1980

[Laparoscopy in children with intestinal obstruction].

The authors have performed laparoscopy in 30 children suspected in acute intestinal obstruction. At the present time laparoscopy is believed to be the method enabling the disease to be diagnosed at early stages sufficiently exactly and for a short time. In a number of cases the authors succeeded in liquidating acute intestinal obstruction by menas of a laparoscope and a manipulator without a repeated laparotomy. The authors recommend to use laparoscopy more frequently in acute intestinal obstruction both with diagnostic and curative aims.

Acute Disease↗
PubMed1990

Nationwide investigations of intestinal obstruction in Japan.

Two nationwide questionnaire surveys of intestinal obstruction in Japan were undertaken, covering two two-year periods, from January, 1975 to December, 1976 and from January, 1985 to December, 1986, respectively. The findings of a comparative review of these two surveys indicated that although the overall mortality of intestinal obstruction had not changed between 1975/76 and 1985/86, being 6.8 per cent and 6.5 per cent, respectively, simple adhesive obstruction had decreased from 3.2 per cent in 1975/76 to 2.0 per cent in 1985/86. The main cause of adhesion was laparotomy and in cases of both simple adhesive obstruction and strangulation adhesive obstruction, the rate of adhesion secondary to laparotomy of the upper gastrointestinal tract and colon and rectum had increased between 1975/76 and 1985/76. Obstructions caused by neoplasms had increased from 8.2 per cent in 1975/76 to 10.0 per cent in 1985/86, while those caused by adhesions had increased further still, from 42.5 per cent in 1975/76 to 60.8 per cent in 1985/86. Among the latter group, non-operatively treated cases had increased, which may be accounted for by the fact that facilities which adopt non-operative treatment using intestinal decompression as the first choice for simple adhesive obstruction cases have increased. In both surveys, the mortality of cases receiving nonoperative treatment was lower than that of operative cases.

Health Surveys↗
PubMedDate not supplied

Idiopathic focal eosinophilic enteritis associated with small intestinal obstruction in 6 horses.

OBJECTIVE: To report the history, clinical findings, and outcome of horses with idiopathic focal eosinophilic enteritis associated with acute small intestinal obstruction. STUDY DESIGN: Retrospective study. ANIMALS: Six horses with idiopathic focal eosinophilic enteritis. METHODS: Retrospective review of medical records of horses with idiopathic focal eosinophilic enteritis, with acute abdominal pain and small intestinal obstruction, associated with a focal region of eosinophilic enteritis of unknown cause. Information retrieved from the medical records included signalment, physical examination, laboratory findings, surgical procedure, histologic diagnosis, and postoperative management. Outcome was determined by telephone communication with owners. RESULTS: Six horses met the selection criteria. Horses had persistent pain, distended small intestine, and nasogastric reflux. Idiopathic focal eosinophilic enteritis lesions associated with a small intestinal obstruction were treated surgically by intestinal resection and anastomosis or wedge resection. There were no observed complications associated with extension of the disease from the lesion site. Five horses were alive at follow-up 5 to 60 months after surgery. CONCLUSIONS: Although the cause of these focal eosinophilic enteritis lesions is unknown, the long-term outcome after lesion resection was favorable. CLINICAL RELEVANCE: Small intestinal obstruction associated with a focal eosinophilic enteritis lesion may be a cause of acute abdominal pain in horses. Horses apparently have a good prognosis after lesion resection.

Animals↗
PubMed2004

[Bezoars as a cause for acute small intestinal obstruction].

Results of treatment of 12 patients with acute small intestinal obstruction due to bezoars were analyzed. Mean age of the patients was 67,5+/-3,7 years. In 9 of them bezoars were localized in the ileum, in 3 -- in the jejunum. Mechanisms of bezoars formation are analyzed. Clinical symptoms of intestinal obstruction due to bezoars are regarded. Necessity of surgical treatment of these patients is noted. Bezoars were removed with enterotomy in 10 patients, in 2 -- with fragmentation and transposition in the cecum. Recommendations on surgical techniques are presented. All operated patients have recovered. There were no complications.

Acute Disease↗
PubMed1995

[Leiomyoma-dependent ileal invagination as a cause of intermittent intestinal obstruction].

We report the case of a 35-years-old-woman with history of abdominal surgery who presented several episodes of intermittent intestinal obstruction. Postoperative adhesions were suspected; laparoscopy surgery was made and uterine and anexial inflammation was observed. She was discharge with the diagnosis of inflammatory pelvic disease. Posteriorly, she was admitted with a new episode of intestinal obstruction. At laparotomy, intestinal intussusception was founded due to the presence of intestinal leiomyoma. We stress the relevance of two possible etiologies of intestinal obstruction; the coexistence of them difficult the diagnosis. Epidemiology, clinical presentation and diagnosis of leiomyomas of small intestine were reviewed.

Adult↗
PubMedDate not supplied

[Factors involved in bacterial translocation in an experimental model of intestinal obstruction].

We designed a model of intestinal obstruction (IO) to study the histological alterations in the intestinal wall and the mesenteric lymph nodes (MLN). Therefore we used 32 Sprague-Dawley rats and under anesthesia a laparotomy was performed and the distal ileum was ligated with 3-0 silk, producing a complete occlusion. At different interval (24, 48, 72 and 96 hours) the animals were sacrificed by cervical dislocation and were histologically analyzed. At 24 hours post IO, congestion, edema and a inflammatory infiltrate were observed at the level of the lamina propia and the MLN were reactive. At 48 hours the congestion and edema increased and the intestinal mucosa began to fragment, allowing the bacteria to translocate and getting to the lymph nodes in the intestinal wall. The reactivity at the MLN increased. The observation of bacterial translocation in IO widen the scope of the alterations in this pathology, were not only absorption of toxic products and endotoxin occurs in the compromise segment and this phenomenon could explain the incidence of bacteremia and sepsis in the IO patients.

Animals↗
PubMed1976

[Chyloperitoneum causing intestinal obstruction].

The two cases reported here show intestinal obstruction may occur by coagulation of lymph around the loops. They permit us to better understand the physiopathology of blockage of the lymph vessels whether congenital as in the first case or traumatic as in the second case. Traumatic rupture of the cisterns chyli is exceptional. The histological lesions observed on clamped biopsies show clearly the pathology of protein-losing enteropathy.

Adult↗
PubMed1978

Degree of bowel distension on plain-radiographs--a surgical-radiological study of new criteria in mechanical intestinal obstruction.

Three hundred sixty clinical cases which presented with or without mechanical intestinal obstruction were evaluated in order to discover reliable quantitative and qualitative criteria for pre-surgical x-ray diagnoses. It was discovered that small bowel distension of above 1.0 (ratio) together with obvious gas fluid level is usually indicative of small bowel obstruction, while large bowel distension of above 1.5 (ratio) together with obvious gas fluid level is usually indicative of large bowel obstruction. Subsequent surgery confirmed that there exists a correlation between the degree of small bowel distension seen on radiographs prior to surgery and the actual small bowel distension secondary to small bowel obstruction measured during surgery. The present results may be diagnostically useful in the radiological differentiation of mechanical intestinal obstructions from other abdominal conditions.

Humans↗