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PubMed1977

[Utilization of the small intestine fistula technique in paralytic ileus. Report on clinical experience].

Seventy-three patients with paralytic ileus hospitalized at the Surgical Clinic of the Hospital in Herford during the years 1971-1975 are reviewed. All the patients were treated with a small bowel fistula according to a modified technique of Witzel-Heidenhain. The special indication, the technical details, and the results are discussed. The overall mortality of a total of 73 patients with paralytic ileus undergoing a small bowel fistula operation was 19%. The temporary small bowel fistula according to the modified technique of Witzel-Heidenhain is proposed as a simple, safe, and with accurate indication an effective method for accomplishing total decompression of distended bowel.

Adolescent↗
PubMed1979

[Imitation of acute adnexa processes through a small intestine ileus].

Under the picture of acute inflammatory events of adnexa there may be sometimes be hidden diseases of the intestines. Out of them acute state of ileus is of utmost importance. State post appendectomy, atypical anamnesis and antiinflammatory treatment without effect is suspect of an ileus. An early laparotomy presents a low risk in such cases.

Adnexa Uteri↗
PubMed1979

Ileus of the colon with cecal dilatation and perforation.

Segmental dilatation of the colon without obstruction is an unusual but recognizable entity, distinct from mechanical obstruction and paralytic ileus. Cases of ileus of the colon with cecal dilatation following delivery and gynecologic surgery are collected from the literature, and 3 recent cases are presented: 1 following cesarean section and 2 following abdominal hysterectomy. The etiology of this condition is still obscure and the clinical features are deceptive. The occurrence of this entity in obstetric and gynecologic patients is by no means a rarity and warrants a familiarity with and early recognition of this entity on the part of the physician in order to avoid serious sequelae.

Adult↗
PubMed1979

[Prevention of paralytic ileus after colonic surgery by continuous peridural sympathetic block. Preliminary report].

Gastrointestinal atony must be considered as a reflex response to surgical intervention, due to activation of sympathetic nerves. Following colonic surgery, the duration of this response may be notably extended and the ensuing intestinal distension becomes the paramount factor of a persisting ileus. Blocking the sympathetic fibers prevents intestinal distension. Introducing appropriate catheter into the peridural space up to the level of the 10th--11th thoracic vertebra makes it possible to realize a segmental continuous block between T6--L2, where gastrointestinal sympathetic innervation actually originates. Using bupivacaine at low concentration (0.125% with epinephrine 1/400,000) reduces untoward effect on circulation and may even prove beneficial if volaemia is effective. In addition, it produces a selective block on the visceromotor fibers which allows a differential diagnosis of the ileus, without risking to pass over a perforation of the gut whenever a coexisting mechanical factor is suspected.

Autonomic Nerve Block↗
PubMed1979

[Conservative treatment of severe paralytic ileus. Clinical experiences with Ceruletid].

After the failure of other medicamentous treatment attempts for paralytic ileus, Ceruletid (Takus) was used in 20 surgical patients. Ceruletid was applied as an infusion of 40 microgram in 250 ml or 500 ml physiological saline solution over a period of 2-3 hours. During this time the occurrence of bowel sounds, flatulence and defecation was observed. The most important clinical and serological parameters were measured before and after treatment. Treatment was successful in 17 cases, in 3 cases no success was achieved. Severe side effects did not occur. The use of Ceruletid in the described form of administration can be recommended for the treatment of paralytic ileus.

Ceruletide↗
PubMed1977

Management of meconium ileus by resection and end-to-end anastomosis.

Six patients with meconium ileus, in whom bowel resection and end-to-end anastomosis were performed, are presented. Meconium ileus may be simple or complicated. The simple form may be treated by Gastrografin enema. Surgery is indicated if conservative treatment fails and for patients with a complicated obstruction. Provided the bowel is disobstructed and carefully resected, end-to-end anastomosis is preferable. Confirmation of the diagnosis by careful histological examination of the resected bowel is urged.

Cystic Fibrosis↗
PubMed1978

[Colon dynamics in ileus].

All forms of ileus have one thing in common, namely a disorder of the intestinal motility, which, with increasing distension of the intestinal wall, finally leads to paralysis of the intestine. With the increase in distension mechanical and functional colon changes take place which are discussed in this study. During peristalsis the strain on the wall is directed against the intra-luminal course of pressure. In spite of the increase of the internal pressure from 5 cm H2O to 100 cm H2O, the tension of the wall remains low or even decreases (roughly 500 dyn/mm2). In ileus patients, however, the strain on the intestinal wall increases enormously (about 100000 dyn/mm2). The maximum contraction capacity of the large intestine's muscle system (50,000 dyn/mm2) is high and similar to that of the skeletal muscles.

Colon↗
PubMed1978

[Treatment of meconium ileus equivalent].

A 12-year old boy with mucoviscidosis developed a mechanical obstruction of the small intestine. The diagnosis of a meconium ileus equivalent was made and a conservative treatment was started. After this treatment failed, a laparotomy was performed which verified the diagnosis of a meconium ileus equivalent. It was possible to move the inspissated feces inside the terminal ileum into the ascending colon. The postoperative course was uneventful. The etiology, differential diagnosis, and both conservative and operative treatment of this complication of the mucoviscidosis are discussed.

Acetylcysteine↗
PubMed1977

Adynamic ileus in the rat induced by chloral hydrate.

During neurophysiologic studies in the rat [Crl:COBS CD(SD)BR], chloral hydrate was given intraperitoneally to produce anesthesia for brain electrode implantation. The incidental occurrence of adynamic ileus in six of these rats, 5-16 days after surgery, prompted further investigation. Pathological evaluations and transmission experiments using ingesta and viscera from affected rats failed to reveal an infectious agent. Subsequently chloral hydrate-induced adynamic ileus leading to morbidity or death was experimentally produced in 14 of 27 rats, 3--36 days after intraperitoneal administration of the anesthetic at a dose of 400 mg/kg body weight and concentrations of 125--275 mg/ml. The experimentally produced condition was characterized by lethargy, anorexia, abdominal distension, ruffled hair coat, inactivity, drowsy expression, constipation, and death. Gross pathologic findings included gaseous distension and atony of the cecum and segments of the small intestine. Small intestine contents varied from liquid to solid. The colon and rectum contained only a few dry hard fecal pellets. A few animals showed excess abdominal fluid. Microscopic findings were limited to focal chronic serositis and serosal fibrosis affecting the visceral peritoneum. On the basis of the experimental studies, it was concluded that the condition described was not an infectious disease but was an abnormal physiologic condition produced by the irritating or pharmacologic action of chloral hydrate given at high concentrations in the abdominal cavity.

Anesthesia, General↗
PubMed2026

Glial Connexin-43 Is a Pathogenic Mechanism Promoting Gut Inflammation in Postoperative Ileus Induced by Gut Surgical Manipulation With Potential Relevance to Humans.

BACKGROUND & AIMS: Abdominal surgery often precipitates postoperative ileus (POI), a frequent and severe gastrointestinal (GI) motility disorder, through mechanisms that involve intestinal inflammation. Emerging data show that enteric glia acquire a reactive phenotype that aggravates POI, but how glia exert this effect remains unclear. Enteric glia express connexin-43 hemichannels (gCx43), which are implicated in neurological and inflammatory disorders. Thus, we aimed to decipher contributions of glial connexin-43 (Cx43) in the pathophysiology of POI. METHODS: We induced POI in mice using in vivo intestinal manipulation and used glial Cx43cKO (Sox10CreERT2;Cx43fl/fl) or RiboTag (Sox10CreERT2/Rpl22HA/+) mice to evaluate Cx43-dependent signaling. Human enteric glial cultures (hEGC) and muscularis externa obtained during intestinal surgery translated findings to patients. Transcriptome analysis, immunofluorescence co-labeling, Western blots, and Cx43 hemichannel activation were used for quantitative analysis. RESULTS: Cx43 is the highest expressed connexin in enteric glia in mice and humans. Up-regulation of Cx43 occurs in various disease models linked to POI, GI surgical trauma, inflammation, immune cell activation, and enteric gliosis. In the mouse POI model, glial Cx43-deletion reduces glial reactivity, pro-inflammatory signals, upregulates host protection genes, regulates immune cell activation, and prevents enteric neuropathy. In hEGCs, interleukin (IL)-1β induction opens Cx43 and stimulates release of IL-6 and C-C motif ligand 2 (CCL2). The Cx43 peptide inhibitor, 43Gap26, inhibits glial Cx43 activation, reduces IL-6 release, and blocks upregulation of macrophage activation factors and immune cell regulation factors. Surgical intestinal trauma in patients upregulates Cx43 during inflammation and enteric gliosis in mouse POI. CONCLUSIONS: Glial Cx43 signaling promotes enteric gliosis, immune cell activation, inflammation, and enteric neuropathy in mice with potential translatability to humans after intestinal surgical trauma and mechanical stress in POI. Interventions that block glial Cx43 activation may be protective against POI development.

Animals↗
PubMed1979

Colonic ileus. Indication for prompt decompression.

Eleven cases of colonic ileus were associated with a variety of clinical conditions. The dominant roentgenographic finding was severe cecal dilation. Its recognition and prompt management are required to prevent possible disastrous perforation.

Cecum↗
PubMed1977

Herpes zoster and paralytic ileus: a case report.

A case of herpes zoster presenting as intestinal obstruction is described. Clinical and radiological evidence of intestinal obstruction was obtained. The mechanisms by which herpes zoster may cause an ileus are discussed.

Herpes Zoster↗
PubMed1978

Meconium ileus equivalent an adult: a case report.

A case is described of meconium ileus equivalent presenting as a small bowel obstruction in an adult patient with cystic fibrosis. The importance of conservative management with acetylcysteine and intravenous fluids is emphasized.

Acetylcysteine↗
PubMed1978

[Use of stoma for decompression of the paralytic ileus (author's transl)].

Indications for the construction of a stoma in the handling of paralytic ileus caused by peritonitis should be ascertained early and completely, since this method is probably the safest and fastest way to relieve advanced intestinal paralysis. There is no need for a secondary laparotomy in order to close the stoma when a catheter-entero- or colostomy is performed. Replacement of lost fluid and electrolytes through the stoma should no longer present serious problems because of the possibilities offered by modern intensive care treatment.

Catheterization↗
PubMed1977

Colonic ileus.

Nine cases of colonic ileus, characterized by selective or disproportionate distention of the large intestine without organic obstruction, are detailed. Massive cecal dilatation often dominates the radiographic presentation and may portend perforation. While management is generally conservative, cecostomy may be necessary to prevent peritonitis.

Adult↗
PubMed1979

Study of the oligosaccharide units from mucus glycoproteins of meconium from normal infants and from cases of cystic fibrosis with meconium ileus.

1. The mucus glycoproteins in meconium from normal infants and from infants having cystic fibrosis with meconium ileus have been studied. 2. Whereas normal meconium contained about 50% protein-bound carbohydrate, the meconium from cystic fibrosis contained only about 10%. 3. Glycopolypeptides were prepared from the mucus of glycoproteins. The oligosaccharide units from this material were released and fractionated. The fractions ranged widely in size and composition. 4. The fractions from cystic fibrosis specimens had a significantly higher content of fucose than those from normal specimens.

Carbohydrate Metabolism↗
PubMed1975

Fatal paralytic ileus complicating phenothiazine therapy.

The occurrence of fatal paralytic ileus with peritonitis in a patient receiving phenothiazines and an antiparkinsonian agent is described. Although sporadic reports of this complication have appeared, it has not been emphasized in the literature. Only by being alert to this problem can one hope to achieve earlier diagnosis and begin prompt and appropriate treatment.

Adult↗