SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Rheohepatographic examinations of 48 patients operated upon for strangulative intestine obstruction and experiments in 62 dogs have shown substantial disturbance of the hepatic blood circulation with the reduced volume blood flow. Measures promoting normalization of homeostatic, porto-hepatic blood circulation protecting the liver from harmful factors are recommended for the treatment of acute intestinal obstruction.
A very rare case of intestinal obstruction due to segmental agenesis of musculature of the small intestine is presented. In reviewing the literature, only nine cases of this entity has been published. Generally, the clinical evolution make necessary to perform several laparotomies, but the diagnosis is made by pathological findings. The prognosis is very poor.
A 10-yr review of acute intestinal obstruction in 280 Nigerian children reveals that the condition is the major cause of surgical emergencies in Nigerian children, as in children of other developing countries. These are significant differences of pediatric intestinal obstruction in developing countries, as compared with the pattern in other parts of the world. Intussuscaption was the leading cause followed by incarcerated or strangulated hernia. Lateness in presentation was common, with a resulting high morbidity and prolonged hospital stay. The overall mortality was 16%, but mortality of 33% was recorded in the neonatal group.
Considerable drops in liver glycogen contents of guinea pigs suffering from gangrenous intestinal obstruction were recorded in regard to control values (P less than 0.001). An additional experiment was conducted by using carbontetrachloride (CT) to determine whether or not the shortening of survival related to liver glycogen content in animals with strangulation obstruction. The mean tissue glycogen content in the sham-operated group was 816.2 +/- 13.3 micrograms/g, w. wt., whereas in the CT-treated group it was 73.5 +/- 11.0 micrograms/g w. wt. This difference is highly significant (P less than 0.001). The mean survival was 54.4 +/- 5.8 h and 21.9 +/- 5.5 h in animals with gangrenous intestinal obstruction before and after CT treatment, respectively. These results suggested that the liver glycogen depletion was a significant factor in decreasing the survival time of guinea pigs with strangulation obstruction.
To review the management of intestinal obstruction associated with gynecologic disease, the authors studied the records of 368 patients with acute intestinal obstruction. Most patients (83%) had gynecologic malignancies. Obstruction of the small intestines was more common than obstruction of the large intestines (77% versus 23%). Major causes of mechanical small bowel obstruction included extrinsic neoplasms (62%, mostly ovarian carcinomas), radiation therapy-associated strictures and adhesions (17%), postoperative adhesions (14%), and inflammatory strictures and adhesions (3%). Obstruction of the colon was caused mainly by extrinsic neoplasms (45%), strictures and adhesions associated with radiation therapy (26%), fecal impaction (9%), and intrinsic neoplasms (8%). Gastrointestinal intubation successfully relieved 81% of small bowel obstructions caused by postoperative adhesions. Tube suction alone was rarely successful when the obstruction was caused by malignant neoplasms. The prognosis was dependent on the cause of the underlying disease. The cases studied in this report were compared with a large number of cases of bowel obstruction in general surgery. It is concluded that bowel obstruction associated with gynecologic disease has unique features deserving wider recognition.
Explore the source record for details and available documents.
Relations between blood flow and oxygen consumption were studied in denervated and homologously perfused small intestine of the cat. Under "resting" conditions, oxygen uptake was independent of blood flow within rather wide limits, whereas fractional oxygen extraction displayed a highly significant correlation to flow. Upon artificial distension of the bowel, oxygen uptake became a function of blood flow. It is suggested that there may exist an "autoregulation" of oxygen uptake, striving to satisfy theoxygen need of the bowel irrespective of the current blood-flow rate. It is also suggested that this "autoregulation" is abolished upon distension of the bowel. With respect to intestinal obstruction, the continuing distension of simple obstruction causes an inability of the bowell-wall vasculature to extract and consume the oxygen currently needed, probably a result of disturbed "autoregulation" of oxygen uptake. An intervening decompression seems to re-establish "autoregulation" in the obstructed bowel. The present results afford evidence for "autoregulation" of intestinal oxygen uptake. They further suggest deterioration of "autoregulation" in intestinal obstruction and corroborate the previous suggestion that intra-operative decompression of obstructed bowel restores the ability of its capillary circulation to withstand with retained function, renewed increments of strain and distension.
INTRODUCTION: Internal hernia is a very rare cause of intestinal obstruction (0.2-0.9% of cases), associated with 45% mortality. A review of the literature revealed just eight reported cases of double omental hernia since 1950 of which our patient is the first case successfully treated laparoscopically. CASE PRESENTATION: We report on a 29-year-old man who presented with signs and symptoms of intestinal obstruction. The patient underwent emergent exploratory laparoscopy. This revealed herniation of a 20-cm jejunal loop through the gastrocolic ligament and reemergence through a defect in the gastrohepatic ligament. The strangulated loop was reduced with slight traction, and the defect was repaired. The patient was discharged from hospital in just 5 days' time, and after 6 months of follow-up, the general condition of the patient was normal. CONCLUSIONS: Laparoscopy is a good technique with minimal complications compared with laparotomy. As many cases are missed due to nonspecific signs and symptoms, an urgent laparoscopy or laparotomy is highly recommended in such a situation.
A study of one hundred and forty-two patients with acute intestinal obstruction over a period of ten years (January 1985-December 1994) at Wesley Guild Hospital was undertaken to determine the pattern and outcome of this problem in a tropical African population. There was a preponderance of males over females; ratio 1.7:1. Mean age was 33 years and over half of the patients were aged between two and 30 years. There was a second peak age incidence among elderly patients between 50-80 years. Abdominal pain, vomiting and constipation were common symptoms, while abdominal distension and tenderness were common clinical findings. Intraperitoneal adhesions were responsible in 41.5%; there was associated intestinal volvulus in 25.4% of the cases of intraperitoneal adhesions. In 16.9%, strangulated external hernia was responsible for acute intestinal obstruction. Small intestinal volvulus was encountered in 20 cases (14.1%) and associated with adhesion in 75% of the cases. Intussusception occurred in 14.1% of cases of which 70% of the patients were below the age of 15 years. In 15 (10.6%) patients, there were volvulus of the sigmoid colon, with 80% (12 patients) having gangrenous bowel segments. Ascaris were responsible in 3.5% of the patients and large bowel tumour in 2.8%. Other rare causes were internal hernia and ileal pseudo obstruction. Adhesiolysis and intestinal resection were the commonest operative procedures. Common complications were wound infection in 16.2%, postoperative fever in 10.6% and chest infection in 9.1%. A mortality rate of 8.4% was recorded.
The experience with 211 cases of neonatal intestinal obstruction in Lagos, Nigeria, is described in an attempt to define the pattern in a developing country. Some of the major differences from the established pattern in the West include absence of meconium ileus and the relatively low prevalence of duodenal atresia which accounted for 8 per cent of bowel obstruction. Jejuno-ileal atresia and Hirschprung's disease constituted 21 and 14 per cent, respectively. Imperforate anus, as in the West, was the commonest, occurring in 38 per cent. Although neonatal intestinal obstruction was seen throughout the year a peak involving all the major types appeared in the second quarter. This may indicate an aetiological relationship with malaria. Delay in presentation, shortage of personnel, and inadequate facilities were the major problems associated with management of neonatal intestinal obstruction. The overall surgical mortality was 35 per cent; respiratory failure, metabolic disturbances, and malabsorption being the major causes of death.
An experimental model is described which is intended to simulate and accentuate the movement of fluids across the intestinal mucosa resulting from simple small intestinal obstruction as well as to provide a means for measuring these fluid shifts. Working on the hypothesis that the increase in fluid in the obstructed small intestine is a consequence of increased osmolality resulting from enzymatic breakdown of the intestinal contents, a solution of high osmolality was introduced into an intestinal segment of known size and position. Under these conditions the intestinal mucosa functioned in the manner of a semipermeable membrane and permitted only fluids of low osmolality to enter the intestinal lumen, thus tending to normalize its hyperosmolal contents. The process of dilution followed a simple dilution curve. At the same time hemoconcentration and increased serum osmolality reflected the mobilization of fluids from the extravascular and vascular compartments. The transfer of fluids into the intestinal lumen continued throughout the test period, despite the fact that there was a linear increase in intraluminal pressure to a relatively high level, indicating increased smooth muscle tone probably due to the hyperosmolal provocation. The observed accumulation of fluid was well reproducible and associated with predictable effects on the vascular and extra-vascular compartments.
Since it has been suggested that colonic obstruction due to carcinoma may play a role in elevations of circulating carcinoembryonic antigen, serial plasma carcinoembryonic antigen levels were studies in 19 patients with intestinal obstruction due to tumor and nontumor causes. Regardless of cause, eight of ten patients with colonic obstruction did not show decreased carcinoembryonic antigen levels after decompression. Two patients with postoperative carcinoembryonic antigen reductions of greater than 40 per cent had ascite removed at operation. Removal of a large volume of carcinoembryonic antigen-rich ascites was thought to contribute to the fall in circulating carcinoembryonic antigen. Six patients with small intestinal obstruction and one patient with large and small intestinal obstruction did not show a reduction in postdecompression carcinoembryonic antigen levels. One patient with Crohn's disease who underwent ileal resection and one with intestinal obstruction due to carcinoma of the ovary who underwent resection at the time of decompression had a greater than 40 per cent reduction in postoperative carcinoembryonic antigen levels. Inflamed intestinal and carcinoma of the ovary are known sources of carcinoembryonic antigen and their removal could explain the decrease in carcinoembryonic antigen. Rehydration, as monitored by plasma osmolality and protein concentration, did not explain changes in plasma carcinoembryonic antigen. Thus, it appears that carcinoembryonic antigen production may play a more significant role in the regulation of circulating carcinoembryonic antigen than the physiopathologic processes associated with obstruction.
A retrospective analysis of 70 consecutive patients with a clinical diagnosis of intestinal obstruction from January 1983 to September 1985 was reviewed. Mean age was 62 years. Etiological factors included adhesions 50 percent, malignancy 24 percent, volvulus 12 percent, diverticulitis 7 percent, hernias 4 percent, and radiation enteritis, mesenteric infarction, and perforation of the cecum in the remaining 3 percent. Complications included wound infection 9 percent (n = 6), intra-abdominal sepsis 7 percent (n = 5), and recurrent small bowel obstruction 4 percent (n = 3). Overall mortality was 24 percent (n = 7).Results of the univariant analysis showed no association between the clinical signs of intestinal obstruction, that is, fever, tachycardia, leukocytosis, and local tenderness, and gangrenous bowel. A multiple regression analysis showed, however, that only 14 percent of the variance was able to predict the gangrenous bowel based on clinical signs. In conclusion, the classical signs of intestinal obstruction are poor indicators for compromised bowel, and early surgical intervention will reduce the incidence of ischemic bowel and mortality.
The correct diagnosis of an acute abdomen in the aged is difficult, because of its varying presentation. Intestinal obstruction as a cause of acute abdomen is five times more common in the elderly as compared to younger patients. Acute intestinal obstruction in elderly patients may be due to intestinal or gynaecologic malignancies, or more frequently to incancerated hernias, peritoneal adhesions or faecal impaction. This case report describes a 90-year old female patient with intestinal obstruction, due to a bilateral torsion of benign ovarian cysts. Urgent surgery was life-saving. This case demonstrates that early decision for adequate therapy can reduce morbidity and mortality, also in very old patients.
Feline small-bowel circulation was studied during in vitro homologous perfusion of denervated intestine shortly after release of an in vivo small-bowel obstruction. Blood flow, vascular resistance, capillary filtration, and oxygen consumption were determined. A previous study demonstrated that any microcirculatory impairment accompanying obstruction was rapidly ameliorated after decompression of the bowel. In the present study the specimens were distended in 20 mmHg increments to the 100 mmHg level. Each pressure level was maintained for a 10 minute period. After deflation the specimens were studied for a further 60 minutes. The results indicate that the microcirculation of the previously obstructed intestine reacts to a considerable distension in essentially the same way as does that of non-obstructed intestine. Certain findings suggest, however, that, by way of enhanced distensibility, an obstruction may render the capillary bed more susceptible to a moderate in crease in intra-intestinal pressure, an increase that in itself does not reduce the capillary filtration rate in non-obstucted intestine.
OBJECTIVE: To determine the presentation, aetiological pattern, management and outcome of intestinal obstruction at the Central Provincial General Hospital, Nyeri, Kenya. DESIGN: A descriptive retrospective study. SETTING: Surgical Department, Central Provincial General Hospital, Nyeri, Kenya. SUBJECTS: All patients who were admitted and operated on for intestinal obstruction in the surgical department of the above hospital between January 1992 and May 1999. RESULTS: A total of 139 patients were studied. There were 102 males and 37 females giving a male:female ratio of 2.8:1. The age range was two days to 85 years with the majority (43.2%) of the patients being in the age group 0-10 years. Vomiting and abdominal pain were the commonest symptoms while abdominal distension and abdominal tenderness were the leading signs. Abount seventy of the patients had any form of investigation with plain abdominal x-ray being the leading investigation. Sigmoid volvulus, external herniae, adhesions and bands and ileo-colic intussusception were the commonest causes of bowel obstruction. About a third (32.4%) of the patients were found to have gangrenous gut. Sixty three complications were recorded in 47 patients, with the leading complication being death (17.3%) followed by wound infection (14.4%). CONCLUSION: Five leading causes of intestinal obstruction in Nyeri, Kenya, are: sigmoid volvulus, external herniae, adhesions and bands, ileocolic intussusception and small bowel volvulus.
UNLABELLED: A mesenteric hernia is one type of intraperitoneal hernia. There is no hernia sac in this situation but only a mesenteric defect, which is present at birth. Strangulated mesenteric hernia is a rare cause of intestinal obstruction especially in the pediatric population. Between January 1996 and January 2006, four patients with intestinal obstruction were determined to have congenital mesenteric hernia at Chang Gung Children's Hospital. Patients consisted of three boys and one girl, ranging in age from 2 years 5 months to 5 years 4 months. All patients presented with symptoms and signs indicative of intestinal obstruction. On physical examination, all patients appeared to be severely ill. A shock-like state was associated with necrosis of the strangulated bowel in two patients. A palpable abdominal mass was present in one patient with volvulus of small bowel. The plain abdominal radiography and the ultrasound scan also showed dilatation of the small bowel and excluded intussusception. All the patients underwent laparotomy after initial resuscitation. During laparotomy, three patients had incarceration of small bowel through the small mesenteric defect, and another one had volvulus with gangrenous bowel entrapped within a large mesenteric defect. The defects ranged in size are from 2 to 7 centimeters in diameter. Simple reduction of the incarcerated bowel with repair of the defect was performed in two patients, resection of gangrenous bowel and primary anastomosis was required in one patient, and resection with end ileostomy was needed in another one patient. There was no postoperative mortality in our patients. CONCLUSION: A mesenteric hernia is a rare cause of intestinal obstruction, especially in children. Open exploration is the only way to establish a clear anatomic diagnosis.
Intestinal obstruction is an uncommon complication of Yersinia enterocolitica infection. We report a case of enterocolitis in an 11-month-old infant, complicated by intestinal obstruction. Y. entercolitica serotype O:21, previously reported to cause severe disease, was isolated from the patient's stool. Unusual or complicated presentations of yersiniosis may be associated with more pathogenic strains of Y. enterocolitica.