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PubMed1989

[Effect of acute intestinal obstruction on erythrocyte membrane function].

The amino acid composition of red blood cell membrane proteins had been studied in different stages of acute intestinal obstruction. Hydrophobic amino acids were revealed to increase and glutamate was found to decrease during the early period of acute intestinal obstruction. Later neutral amino acids and some of the main amino acids were stated to decrease. Shifts in the ratio of protein fractions seen in red blood cell membrane of rats with acute intestinal obstruction could be explained by changes followed in the amino acid composition. The data accumulated had demonstrated that such a significant modification of protein component of the red blood cell membrane could be one of the reasons of the erythrocyte membrane penetrability violation and could play the pathogenetic role in the occurrence of irreversibility changes in cases of the intestinal obstruction. All that was mentioned above had shown the necessity to use membrane protectors and antienzyme drugs in the postoperative period.

Amino Acids↗
PubMed1992

Gangrenous cholecystitis: five patients with intestinal obstruction.

Gangrenous cholecystitis, a disease more common in older patients and diabetics, may be complicated by perforation, pericholecystic abscess, and fistula. Intestinal obstruction has rarely been reported as a complication and only in cases involving perforation or acute, nongangrenous cholecystitis. A retrospective review of hospital records between 1961 and 1989 identified 126 patients with gangrenous cholecystitis, five of whom came to the hospital with intestinal obstruction. Three were cases of paralytic ileus and two of simple mechanical obstruction without perforation. The latter group may represent the first such cases reported. Gallbladder perforation occurred in two patients and cholelithiasis was found in three. The mean age of the total patient cohort was 70.6 years; patients were predominantly male and black. Hypertension and diabetes were common concomitant diseases. Patients commonly came to the hospital with nausea and vomiting, increasing abdominal girth, and obstipation. A leukocytosis on admission was more common than fever or hyperbilirubinemia. The clinical presentation of intestinal obstruction and the lack of objective data specific for gangrenous cholecystitis made a preoperative diagnosis impossible. Thus, a high index of suspicion should increase diagnostic accuracy. The incidence of intestinal obstruction (at presentation) in cases of gangrenous gallbladders was 4 per cent. Morbidity and mortality are reduced with early operation.

Aged↗
PubMed2002

Acute intestinal obstruction: diagnosis and management.

In acute intestinal obstruction, the clinician must distinguish between acute small bowel obstruction (ASBO) and acute colonic obstruction (ACO). In cases of ASBO, management depends on whether the patient has had previous abdominal surgery. Most cases of ACO require surgery, although mechanical causes must be distinguished from pseudo-obstruction for different management techniques.

Acute Disease↗
PubMedDate not supplied

The "Ibadan intussusception"; now a myth? A 10 year review of adult intestinal obstruction in Ibadan, Nigeria.

Caecocolic intussusception was a significant cause of adult intestinal obstruction in Ibadan where it earned itself the appellation "Ibadan Intussusception". Recently, it has been noticed that there is a significant drop in the cases of adult intussusception. A retrospective review of the intra-operative diagnoses of adult patients who presented to the University College Hospital, Ibadan with intestinal obstruction between June 1990 and June 2000 was carried out. The most common cause of adult intestinal obstruction was obstructed groin hernias followed by adhesions. There was a significant paucity of cases of intussusception, hence the paper queries the veracity of the appellation "Ibadan intussusception" in the present day.

Adolescent↗
PubMed1996

[The effect of the duration of dynamic intestinal obstruction on the occurrence of suppurative complications in acute pancreatitis].

Longer periods of the dynamic intestinal obstruction in acute pancreatitis are responsible for more frequent purulent complications. Laparotomy in acute pancreatitis is responsible for a longer duration and greater degree of the dynamic intestinal obstruction and more frequent purulent complications. Early administration of cooled electrolytic solutions into the jejunum, according to the authors' data, reduced the periods of the dynamic intestinal obstruction and decreased lethality.

Acute Disease↗
PubMedDate not supplied

An unusual cause of intestinal obstruction--computed tomographic findings.

Computed tomographic findings in a case of acute intestinal obstruction due to ingested heroin packages are described. Ingestion of drug packages for the purpose of contraband transportation is a well-known method employed by drug-traffickers and intestinal obstruction may be seen as a complication. Plain radiographs and history are usually adequate for diagnosis when required for medico-legal purposes.

Adult↗
PubMed2003

The utility of gastrojejunostomy in secondary cytoreduction and palliation of proximal intestinal obstruction in recurrent ovarian cancer.

BACKGROUND: Gastrointestinal obstruction is a common complication of recurrent ovarian cancer. Proximal intestinal obstruction, at the level of the duodenum or proximal jejunum, can result from bulky intraperitoneal or retroperitoneal disease. Classic management has been palliation of symptoms with a gastrostomy or jejunostomy tube. CASE: We describe a series of four patients with recurrent ovarian carcinoma and proximal intestinal obstructions treated with a bypass stapled side-to-side gastrojejunostomy at the time of secondary cytoreduction or surgical palliation. The clinical history, preoperative evaluation, surgical technique, and outcomes of each patient are reviewed. CONCLUSIONS: Gastrojejunostomy may offer patients with ovarian cancer and a proximal intestinal obstruction symptomatic relief and an opportunity for resumption of enteral feedings.

Aged↗
PubMed1978

[Conservative treatment of intestinal obstruction: prospects and limits. Experiences with 27 cases treated by Miller-Abbott-tubes inserted endoscopically (author's transl)].

27 cases of intestinal obstruction primarily treated conservatively by means of Miller-Abbott-tubes are presented, technical details, clinical results, indications and risks of the procedure discussed. The controlled placement of the tube using a gastroscope rules out technical failures. Fifteen patients were cured, 2 patients removed the tube; in 8 cases the procedure turned out to be ineffective; they were cured by laparotomy. The separate monitoring of gastric and intestinal secretion permits early prognosis in respect to efficacy. Two patients died. Strict limitation of indication is of decisive importance. The method is highly effective in early postoperative intestinal obstruction--apparently of mechanical as well as of paralytic origin. In our experience, the possible mistaking of anastomotic leakage for postoperative ileus is practically negligible. For acute admissions with intestinal obstruction of unclear origin, however, the procedure should only be aimed at the resotration of general condition before surgery. In spite of the fact, that some cases of late postoperative intestinal obstruction could be cured conservatively, the risk of delaying operations of utmost necessity in cases of strangulation, incarceration and perforation is too high.

Adolescent↗
PubMed1989

[Surgical treatment and observation of the therapeutic results in 11 cases of tuberculous adherent intestinal obstruction].

11 cases with tuberculous adherent intestinal obstruction treated by means of exfoliating and resecting of fibrous plate and tuberculous focus curettage were reported. All were females with an age range of 22 to 44 years. The diagnosis was confirmed by operation and biopsy. 8 of them were complete obstruction and incomplete in 3.5 cases were strangulated by fibrous band. Bowel necrosis occurred in 3. A thorough exfoliating and resecting of fibrous plate were carried out in all cases, associated with enterectomy in 2 cases and ileocecectomy on one. No mortality and fistula formation in this series. Follow-up from 1.5 to 7 years in 8 cases. No obstructive signs of recurrence were noticed. Weight gained about 10-15 kg. postoperatively.

Adult↗
PubMed1976

The pattern of intestinal obstruction in Malaysia.

This is a review of 261 patients operated for 271 instances of mechanical intestinal obstruction over a 5-year period in a developing country in the tropics. The pattern of intestinal obstruction in Chinese is similar to that in Caucasians, where adhesions account for the largest number of cases. The occurrence in Malays, Indians, Pakistanis and Ceylonese is similar to that in other developing communities where external hernia is commonest while adhesive or tumour obstruction is rare; however, these racial groups do not exhibit the high incidence of intussusception and volvulus found in Africa and India. The operative mortality was 13-9 per cent, which is comparable to that in Western series. The major adverse factors in intestinal obstruction, i.e. extremes of age, associated disease, gangrenous bowel, large bowel obstruction and malignancy, were confirmed. Fluid and electrolyte imbalance was frequent, as in other tropical series, but with intensive preoperative correction it was not an important adverse factor.

Adolescent↗
PubMed1994

Management of intestinal obstruction in patients with advanced cancer.

Intestinal obstruction is a common and distressing complication for patients with advanced abdominal or pelvic cancer. Palliative surgery has an inevitable high mortality and morbidity rate in these patients who are often very ill. Conservative treatment, using intravenous fluids and nasogastric suction, has not been shown to cause resolution of the obstruction and it involves hospitalisation, immobility and discomfort. Pharmacological treatment, using drugs to control the symptoms of colic, continuous abdominal pain and vomiting, is effective in the majority of patients. They can therefore be cared for at home or in a hospice. A small group of patients, mainly with high obstruction, will benefit from a nasogastric tube or venting gastrostomy and fluids can be given, if needed, by intravenous or subcutaneous infusion.

Abdominal Neoplasms↗
PubMedDate not supplied

Acute gastro-intestinal obstruction as a late presentation of congenital diaphragmatic hernia. A report of three cases.

Three cases of acute gastro-intestinal obstruction due to incarceration of congenital diaphragmatic hernia (Bochdalek hernia) in infants are reported. The level of incarceration was stomach, small and large intestine. All of the presented posterolateral diaphragmatic defects were small and without a sac. History of trauma was absent in all patients. Two girls recovered well while a boy died of intracerebral bleeding one month after surgery. Acute gastro-intestinal obstruction as a late, post neonatal, presentation of congenital diaphragmatic hernia is a rare, life-threatening emergency. The combination of gastro-intestinal obstruction, circulatory and respiratory distress requires urgent gastro-intestinal decompression, fluid resuscitation and ventilatory support. Surgery can be performed safely only after pre-operative stabilization.

Cerebral Hemorrhage↗
PubMed1998

Usefulness of CT in patients with intestinal obstruction who have undergone abdominal surgery for malignancy.

OBJECTIVE: The purpose of this study was to evaluate the usefulness of CT in determining the causes of intestinal obstruction in patients who have undergone abdominal surgery for malignancy. MATERIALS AND METHODS: We analyzed the CT scans of 55 patients with benign (n = 26) or malignant (n = 29) intestinal obstruction that developed after abdominal surgery for malignancy. After calculating the diagnostic accuracy of interpretations by three radiologists, we compared CT findings for benign and malignant intestinal obstructions with respect to peritoneal involvement patterns and other ancillary findings. Multivariate logistic regression analysis was used to determine the diagnostic performance of CT in revealing causes of obstruction. RESULTS: Diagnostic accuracies of the three radiologists were 67%, 75%, and 78%. CT findings indicating malignant obstruction were a mass at the site of obstruction or prior surgery, lymphadenopathy, or an abrupt transition zone and irregular bowel wall thickening at obstructed sites (p < .05). Conversely, the chance for benign obstruction increased when CT revealed mesenteric vascular changes, a large amount of ascites, or a smooth transition zone and smooth bowel wall thickening at the obstructed site (p < .05). With multivariate logistic regression analysis using two variables (a mass at the site of obstruction or prior surgery and lymphadenopathy), we calculated the overall accuracy of CT as 84% (46/55 patients). CONCLUSION: CT is useful in differentiating benign from malignant intestinal obstructions in patients who have undergone abdominal surgery for malignancy. However, CT has limitations in patients not having a demonstrable peritoneal mass.

Abdomen↗
PubMed2004

Intestinal obstruction after inguinal and femoral hernia repair: a study of 33,275 operations during 1992-2000 in Sweden.

The risk of intra-abdominal intestinal obstruction after open or laparoscopic hernioplasty is, to our knowledge, not known. The transabdominal laparoscopic (TAPP) route brings a potential risk of abdominal adhesions, which may increase the risk of postoperative intestinal obstruction. The pre-peritoneal route laparoscopically, totally extraperitoneal laparoscopic hernioplasty (TEP), should not increase this risk since the abdominal cavity is not entered. The Swedish Hernia Register, with 33,275 patients operated on for single primary unilateral groin hernia during the period 1992-2000, was linked to the Swedish Inpatient register and the Swedish Death register for the period 1987-2000. The risk of postoperative intestinal obstruction was low, 1.02 per 1,000 personyears. The highest adjusted relative risks (RR) were found in patients with previous admissions for abdominal inflammations or operations. The risk increased with the number of admissions. After an acute operation, and in patients older than 60 years, there was also a significantly increased risk. The RR was 2.79 (95% CI 1.01-7.42) after TAPP and 0.57 (95% CI 0.07-4.33) following TEP compared to patients operated on by the Lichtenstein method. None of the patients undergoing open hernia operations had a significantly increased risk. TAPP increased the risk of postoperative intestinal obstruction, but other risk factors, especially previous abdominal surgery or inflammation, have greater influence.

Adolescent↗
PubMed1990

[Toxemia syndrome in patients with acute intestinal obstruction].

The results of examination and treatment of 216 patients with acute intestinal obstruction of benign genesis are discussed. The values of blood plasma toxicity and the values of hemostasis determined before and after the operation were compared. Intoxication of patients was found to increase in the postoperative period. Its increase was appraised according to the duration of the disease. The causes of mortality were analysed and the risk factors of intoxication increase in the postoperative period were revealed. The authors suggest a classification of the phases of intoxication in patients with acute intestinal obstruction on the basis of the degree of intoxication and the condition of homeostasis.

Acute Disease↗
PubMed1998

Computed tomography compared with small bowel enema in clinically equivocal intestinal obstruction.

OBJECTIVE: To compare the findings in computed tomography (CT) and small bowel enema (SBE) in clinically equivocal small bowel obstruction in order to identify the reasons for the limitation of CT evaluation. SUBJECT AND METHOD: Over a period of 5 years, 49 patients who had both CT and SBE within a period of 1 week were analysed. The findings at SBE were categorized into partial low-grade, partial high-grade and complete obstruction and compared with the CT findings. A critical analysis of the CT false-negative cases was made. The predictive values for the determination of the presence of obstruction in CT were also obtained. RESULTS: Forty-three out of the 49 patients had proven intestinal obstruction. CT correctly identified 34 cases including 19 of 20 with partial high-grade obstruction, two with complete obstruction and 13 out of 21 cases of partial low-grade obstruction. Among those cases with low-grade obstruction cases with complex or long segment narrowing or with masses were correctly identified while six patients with short stenotic segment due to various causes were not. CT also had two false-positive findings of obstruction in patients with mesenteric infarction. SBE had neither false positive nor false negative. The sensitivity, specificity, positive predictive value and negative predictive values for CT were 83%, 67%, 94% and 36%, respectively. Abrupt transition from dilated to collapsed loops in CT were caused by various intraluminal lesions apart from adhesions. CT was superior to SBE in showing extraluminal masses, revealing abscesses, tuberculous lesions and malignancy anterior adhesions as well as features of strangulation. CONCLUSION: Apart from degree of obstruction and the presence of masses, the length of the stenotic part also affected CT detection. Abrupt change from dilated to collapsed segment could be due to various transmural and intraluminal lesions although adhesions was the commonest lesion. While SBE is more accurate in identifying the presence and location of obstruction, CT is superior for detection of the cause of small bowel obstruction and also for the presence of strangulation. In places where CT is more widely used for intestinal obstruction, SBE evaluation could be prudently considered in CT negative cases of clinically equivocal intestinal obstruction.

Adolescent↗
PubMed2003

[Endometriosis: a rare cause of acute intestinal obstruction].

In the differential diagnosis of intestinal obstruction, the endometriosis is an uncommon disease, rarely reported preoperatively. Surgical objective is a total resection of endometriomas, to guarantee symptom relief and ovoid recurrence. In elective cases, preoperative GH-RH analogue hormonal treatment makes easier the surgical procedures. Conservative surgery of the ovaries is mandatory in premenopausal patients.

Acute Disease↗
PubMed2002

[Long-term block of thoracic vegetative nerve trunks in combined treatment of acute intestinal obstruction].

Results of treatment of acute intestinal obstruction with long-term block of the left thoracic sympathetic trunk, paraaortal and paraesophageal vegetative plexuses, vagus and posterior bronchial plexuses are analyzed. Compared with long-term epidural block this method permits one to reduce 2 times the rate of postoperative complications and lethality, to shorten the hospital stay by 5 days. Long-term block of thoracic vegetative nervous trunks provide manipulations out of structures of the spinal column and permits to influence directly both parts of the vegetative nervous system.

Acute Disease↗