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PubMedDate not supplied

Changing pattern of acute intestinal obstruction in Accra.

Five hundred and fifty-two cases of intestinal obstruction were seen over a two year period, January 1987 to December 1988. Strangulated external hernias and adhesions still remain the most common causes of intestinal obstruction in Accra, but there has been a change in their relative incidence with external hernias falling to 59.8 per cent and adhesive obstruction increasing to 21.0 per cent. There has been no change in the overall mortality and mortality from inguinal hernia which are still 9.4 per cent and 4.9 per cent respectively. However, there has been a significant improvement in mortality rate from volvulus and a slight improvement in mortality from adhesive obstruction even though the overall resection rate has increased from 12.7 per cent to 17.6 per cent.

Abdominal Neoplasms↗
PubMed2000

Operative versus conservative management of adhesional intestinal obstruction

AIMS: This prospective controlled trial was undertaken to resolve the controversy over whether intestinal obstruction due to postoperative adhesions should be managed by immediate operation or by conservative care. METHODS: A randomized prospective controlled study was undertaken of all private and public sector patients admitted under the care of one surgeon with intestinal obstruction due to postoperative adhesions over a 15-year period. The patients were randomly allocated either to immediate operation or conservative care with nasogastric aspiration and intravenous fluids. Patients managed conservatively who had not settled after 5 days were operated on. The data were analysed by Student's t test and Fisher's exact test. RESULTS: There were 127 patients. The two groups were statistically identical regarding age, number of previous operations and time since last operation, and heart rate, blood pressure, haemoglobin concentration, white count and urea level on admission. Sixty-three patients were treated conservatively; 22 failed to settle and were operated on, of whom 11 required a bowel resection. There were two postoperative deaths. In 64 patients treated immediately by operation, the incidence of bowel resection was not significantly reduced (22 per cent; P > 0.05) but there were four postoperative deaths. There was no significant difference in the length of stay. CONCLUSIONS: Conservative management of postoperative adhesional intestinal obstruction is safe and 65 per cent settle. In those who fail to settle there is no significantly increased risk of bowel strangulation. There is no way of identifying those who will not settle from the history or initial investigations on admission.

Journal Article↗
PubMed1976

Post-traumatic intestinal obstruction.

The roentgenographic and pathologic findings in three patients with delayed post-traumatic intestinal obstruction are described. The pertinent literature also is reviewed to delineate the variable pathophysiology of the clinical phenomenon. As a result of the increasing incidence of blunt trauma in our society, the problem of occult intra-abdominal injury resulting in subsequent clinical disease always should be considered in the differential diagnosis of patients presenting later with intestinal complaints. Once considered, routine roentgenologic evaluation usually is diagnostic, and arteriographic evaluation should be considered if the diagnosis is strongly suspected in the face of normal contrast studies. If intestinal obstruction is diagnosed, operative treatment is indicated, simple, and effective.

Abdominal Injuries↗
PubMed1957

Intestinal obstruction due to gallstones.

The possibility of intestinal obstruction caused by a gallstone should be considered in any older person who has vomiting, abdominal distention, abdominal pain and absence of abdominal scars from previous operation.

Abdominal Pain↗
PubMed1999

Effects of Dai-kenchu-to on intestinal obstruction following laparotomy.

To confirm the usefulness of Dai-kenchu-to for intestinal obstruction, investigation of the effects of Dai-kenchu-to on postoperative intestinal adhesion was conducted. Repeated administrations of Dai-kenchu-to (100 or 300 mg/kg) significantly inhibited the formation of intestinal obstruction. Motor disturbance and inflammation are thought to be involved in the etiology of intestinal adhesion. A single treatment of Dai-kenchu-to (300 mg/kg) significantly reduce intestinal transit time in postoperative ileus and chemically induced ileus. Dai-kenchu-to (10(-4) g/ml) significantly inhibited COX-2 activity. These results suggest that Dai-kenchu-to prevents postoperative intestinal adhesion by gastroprokinetic and anti inflammatic effects. Dai-kenchu-to thus demonstrates positive effect on postoperative ileus.

Animals↗
PubMed1985

Intestinal obstruction of infancy and childhood in Benin City, Nigeria.

The pattern of intestinal obstruction observed on 168 Nigerian infants and children is presented. The commonest causes of intestinal obstruction were intussusception (21%), anorectal anomalies (20%) and Hirschsprung's disease (14%). Strangulated hernia and adhesions occurring in 3.5% and 1.7% of cases respectively were notably uncommon in this age group. The role of radiology in the management of some cases is highlighted.

Child, Preschool↗
PubMed1990

Intestinal obstruction. Its serious nature and numerous pitfalls.

Clinical findings and radiographic studies are the most valuable tools in differential diagnosis of intestinal obstruction. Treatment depends on the type of obstruction. Functional ileus does not require surgery, but mechanical obstruction usually does. Ischemic obstruction demands urgent surgery to prevent or remove gangrene. Even when intestinal obstruction seems to be nonmechanical and uncomplicated, repeated follow-up observation is necessary. Functional ileus may transform to mechanical obstruction.

Humans↗
PubMed1991

False diagnosis of intestinal obstruction in a fetus with congenital chloride diarrhea.

Intestinal obstruction is often diagnosed prenatally by ultrasound, providing an opportunity for prenatal counseling, genetic investigation, and planned delivery at a perinatal center. We describe a patient with typical features of fetal bowel obstruction, who was found at birth to have congenital chloride diarrhea. A 25-year-old white woman had marked polyhydramnios; multiple dilated, fluid-filled loops of intestine were seen in the fetal abdomen on prenatal ultrasound. However, postnatally, there was no evidence of bowel obstruction. The infant girl passed large amounts of watery stools, but tolerated feeds well. A rectal biopsy showed normal ganglion cells. On the fourth day of life her serum sodium and chloride were markedly decreased, and stool chloride levels were diagnostic of congenital chloride diarrhea. She was placed on sodium chloride and potassium chloride supplements, and her serum electrolytes normalized. Congenital chloride diarrhea is a rare, inherited condition caused by an abnormality of intestinal electrolyte transport. This case illustrates that it may present prenatally with a picture similar to that seen with intestinal obstruction.

Adult↗
PubMed2005

Adhesive intestinal obstruction following blunt abdominal trauma.

Advances in diagnosis and management of multiple trauma patients have lead to adopting a conservative approach for most patients with blunt abdominal trauma. Intestinal obstruction is a rare complication for this approach. Herein, we report a 37-year-old male, who did not have an abdominal operation, and who developed adhesive intestinal obstruction 7 weeks following blunt abdominal trauma. We detected no signs of peritonitis or intra-abdominal bleeding clinically or radiologically on admission. We initially treated the intestinal obstruction conservatively, but the obstruction did not resolve. Finally, we performed laparotomy, which showed that the small bowel was matted together by thick fibrous layers of adhesions. We performed adhesiolysis, and the patient was discharged home 3 weeks later. Histopathological findings of the fibrous layer were consistent with repair due to previous trauma and hemorrhage. We review the literature of this rare condition.

Abdominal Injuries↗
PubMed1995

Intestinal obstruction promotes gut translocation of bacteria.

PURPOSE: Translocation of enteric organisms has been implicated as a possible source of sepsis in susceptible patients. Animals studies have suggested that intestinal obstruction promotes bacterial translocation from the gut lumen. The aim of this study was to study the prevalence of bacterial translocation in patients with and without intestinal obstruction. METHODS: Serosal scrapings, mesenteric lymph nodes, and peripheral blood cultures were obtained from 254 patients. Scrapings and nodes were homogenized and incubated aerobically and anaerobically. Full-thickness biopsies underwent villous height analysis. The clinical course was followed for at least six weeks. RESULTS: Bacterial translocation to mesenteric nodes occurred more frequently in patients with large bowel obstruction than in patients without obstruction (14 of 36 patients vs. 16 of 218 patients; P < 0.001). Both aerobic and anaerobic bacteria were found to translocate. The more distal the obstruction, the more likely anaerobic bacteria were to be identified. Translocation of bacteria predisposed to postoperative septic complications (P < 0.05). Villous height was not related to bacterial translocation. CONCLUSIONS: Gut translocation of bacteria is more common in patients with intestinal obstruction, and its association with septic complications appears to be of clinical significance.

Adult↗
PubMed1984

Gastrografin treatment of intestinal obstruction due to Ascaris lumbricoides.

Gastrografin was used to relieve subacute intestinal obstruction due to Ascaris lumbricoides in children. This hyperosmolar and wetting agent proved to be highly efficient to achieve this goal. Statistical evaluation of the hospital stay and first bowel action showed a significant difference between the treated "gastrografin group' and the untreated by gastrografin "control group,' in favor of the "gastrografin group.' Our data strongly suggest the use of Gastrografin in subacute intestinal obstruction due to Ascaris lumbricoides. This treatment should be instituted provided the patient has been adequately hydrated prior to administration.

Ascariasis↗