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[Obstructive intestinal occlusion in the 3d trimester of pregnancy].

Abdominal pain refractory to analgetics in a II-para of third trimester pregnancy who had been operated on raised suspicion of intestinal obstruction. Diagnosis could only be established by surgical exploration after emptying the uterus by cesarean section, counteracting the even today high mortality of mother and fetus. The value of laboratory, roentgenologic and physical measures especially considering time factor as well as obstetrical management are being discussed.

Adult

[Postischemic disorders in the surgery of acute intestinal obstruction].

Acute intestinal obstruction accompanied by disorders in the mesenterial blood circulation is one of the variations of the ischemic injury of the intestine. After recovery of blood circulation in the portion of the intestine subjected to ischemia, the products of autolysis of the intestinal wall come into the liver and general blood flow and bring about the development of intoxication and cardiopulmonary insufficiency. The therapeutic measures should be directed to stabilization of indices of hemodynamic microcirculation, to liquidation of metabolic acidosis and stimulation of urination.

Acute Disease

Histochemical studies of experimental fetal intestinal obstruction.

Experimental intestinal atresia can be produced by mesenteric disruption in fetal lambs. In previous reports, a detailed histochemical study of the bowel in this atresia model demonstrated: (1) hyperplasia of ganglion cells in the dilated proximal segment, (2) involutional changes in the area of maximal distension, (3) decreased to absent adenosine triphosphatase (ATP-ase) production in the area of the atresia, (4) gradual increase of ATP-ase production to normal proximally, and (5) greater reduction of ATP-ase production along the antimesenteric border compared to the mesenteric border. In the present study, a model of fetal intestinal obstruction by simple ligation of the bowel has been created to observe the effects of pure obstruction of the lumen of the fetal bowel without the possible ischemic effects of any vascular interruption. Studies with this model reveal: (1) hyperplasia of ganglion cells in the dilated proximal segment, and (2) decreased ATP-ase production proximal to the obstruction, but (3) no involutional changes in the area of maximal distension. These findings show a pattern of disturbance of bowel morphology and function caused by obstruction of the fetal bowel that is similar to but less severe than that seen with intestinal atresia.

Acetylcholinesterase

Intestinal obstruction complicating pregnancy.

Intestinal obstruction is a rare but serious complication of pregnancy with significant maternal and fetal mortality. The reported incidence of intestinal obstruction complicating pregnancy varies widely, from 1 in 66,431 to 1 in 1,500 deliveries. A retrospective review of 66 cases of intestinal obstruction complicating pregnancy and the puerperium, including 2 cases from our institution, revealed that the most common causes of mechanical obstruction were adhesions (58%), volvulus (24%), and intussusception (5%). Seventy-seven percent of the patients with obstruction due to adhesions had undergone previous abdominal or pelvic surgery. Presenting symptoms and signs were similar to those of the nonpregnant patient; abdominal pain was present in 98% of patients, vomiting in 82%, and tenderness to palpation in 71%. In 82% of patients, obstruction was evident on radiographic evaluation. Prompt management of obstruction is essential; the median length of time from admission to laparotomy in the 66 patients was 48 hours. Bowel strangulation requiring resection was present in 23% of patients. Thirty-eight percent of patients completed term pregnancies after operative resolution of obstruction; total maternal mortality was 6%, and total fetal mortality 26%. Thus, both mother and fetus are at risk when intestinal obstruction complicates pregnancy. Clinical suspicion of the presence of obstruction and aggressive intervention are required to decrease the morbidity and mortality of this rare complication of pregnancy.

Female

Altered gastric and duodenal motility in intestinal obstruction.

There are no strict clinical or radiographic criteria that consistently indicate imminent strangulation in cases of small bowel obstruction. An intestinal obstruction with vascular compromise produces a marked retention of food, fluid, or contrast material in the stomach and duodenum, while an obstruction without vascular problems may show no change or somewhat delayed gastric emptying with some duodenal hypotonia. The association of gastric atony and profound stomach dilatation with strangulating, usually closed-loop intestinal obstruction, has generally not been appreciated by radiologists. We illustrate this phenomenon in 4 patients and emphasize its usefulness in evaluating intestinal obstructions.

Adult

[A case of intestinal obstruction in pregnancy].

Intestinal obstruction during pregnancy is a rare and dangerous complication. The causes of its occurrence are previous operations ad inflammation and one of their results: adhesions. Symptoms of intestinal obstruction (nausea, vomiting, constipation) rarely occur simultaneously and often accompany normal pregnancy, hampering diagnosis. Abdominal X-ray often represents the only complementary investigation diriment for diagnosis. A case of intestinal obstruction at 36 weeks gestation is reported to emphasize diagnostic difficulties of this rare pregnancy complication.

Adult

Intraluminal Miller-Abbott tube stenting as treatment and prophylaxis of recurrent intestinal obstruction.

Chronic recurrent intestinal obstruction due to massive adhesions after abdominal surgery is a complication that is difficult to treat. The records were studied of 25 patients with acute intestinal obstruction due to massive adhesions. Since conservative measurements were unsuccessful, the patients were treated with internal intestinal splinting by means of a Miller-Abbott tube. These 25 patients underwent a total of 72 operations, 36 were performed for mechanical obstruction. Conservative treatment alone was effective during 25 admissions. The complaints of the patients lasted five years on an average. After lysis of adhesions the Miller-Abbott tube was introduced either via the nose, via a gastrostomy or via an enterostomy. The tube was left in situ for three weeks and then gradually withdrawn. There was no hospital mortality. There was one postoperative complication: a tube had to be removed under general anaesthesia. Long-term follow-up of the patients varied from 4.5 to 19 years with a mean of 11.3 years. One patient with recurrent intestinal obstruction due to adhesions, required surgical intervention after one year. A second patient with Peutz-Jeghers syndrome needed surgery because of an intestinal adenoma after six years. The mean symptom-free interval was 11.1 years in the cured patients.

Female

[The colonic atresia: an uncommon cause of neonatal intestinal obstruction].

The intestinal atresia is a common cause of neonatal bowel obstruction, but the colonic atresia is an uncommon cause of neonatal intestinal obstruction. We present a newborn with congenital colon atresia who underwent laparotomy, revealing a colonic atresia type III. We recommend resection of the dilated proximal colon with primary anastomosis end to end if the patient is not perforated or in bad general conditions.

Anastomosis, Surgical

Intestinal obstruction in pregnancy.

Intestinal obstruction is an unusual complication of pregnancy, but may be encountered more frequently in the future. Two patients with such a complication are described. Relief of the obstruction was achieved by surgical intervention in one patient and by delivery of a term baby in the other. The management of intestinal obstruction in late pregnancy is discussed.

Adult

[Acute intestinal obstruction caused by congenital intestinal abnormalities].

By means of two examples--one in pregnancy, the other one after an abdominal hysterectomy--we report on a rare cause of an acute mechanical ileus. In both cases an incomplete intestinal turn with distinct mobility of the colon caused a volvulus. It is pointed to the importance of an early diagnosis inspite of aggravating circumstances in late pregnancy, parturition and postoperatively after gynecologic operations. Effective operative treatment is based on careful exploration of the abdomen in order not to overlook rare causes of an ileus, among those also fetal developmental disturbances of the intestine and other abdominal viscera. Only by operative removing of the causes of an ileus in cooperation with surgeons--and that in good time--the results in gynecology can be improved especially during pregnancy but also postoperatively.

Acute Disease

[Diagnosis and treatment of acute intestinal obstruction in cancer of the large intestine].

A complex program of treatment of acute intestinal obstruction in carcinoma of the large bowel has been developed on the basis of an analysis of 71 patients. Urgent operations were performed in 70% of the patients with acute intestinal obstruction after a short preoperative preparing. Due to substantial metabolic and immunologic shifts the complex parenteral immunostimulating therapeutic measures are necessary in the postoperative period for all the patients.

Acute Disease

[Surgical treatment of intestinal obstruction].

The etiology of intestinal obstruction (I.O.) has changed markedly since the beginning of this century. In this series, the authors studied 121 cases of I.O. treated surgically; adhesions were the commonest cause of high intestinal obstruction, accounting for 43.03 percent in a total of 79 patients, with hernia being the obstruction lesion in 16.45 percent. Colo-rectal cancer were the commonest cause of low intestinal obstruction accounted for 73.81 percent, with volvulus of the sigmoid colon in 14.28 percent. Complications occurred in 15.7 percent of patients following operative intervention; wound infection was the most common postoperative complication. The overall operative mortality was 9.09 percent.

Adolescent