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At least 397 records · Page 22Linked to original sources

Surgical management of intestinal obstruction after treatment for cancer. Case reports.

Eighty-five consecutive patients operated on for malignant intestinal obstruction after earlier treatment of cancer were studied retrospectively. The overall postoperative mortality was 22% (19/85) and morbidity 42% (36/85). Intra-abdominal sepsis (N = 5) and intestinal fistula (N = 3) were the most common complications, and seven deaths were attributed primarily to the underlying malignant disease. Emergency procedures (p less than 0.003) and age greater than 70 years (p less than 0.025) were significantly associated with fatal outcome. Just over half of the patients were relieved of their symptoms. The median survival was 8 months for the 25 patients who underwent resection and 2 months for the 60 patients for whom no resection was made. The cumulative 5-year survival was significantly better for patients who underwent resection than for those who did not (p less than 0.01) and in patients with regional cancers compared with those with distant growths (p less than 0.001). We conclude that operative treatment for malignant intestinal obstruction is indicated if widespread carcinomatosis and extensive tumour growth are excluded and that this surgery should be done urgently while there is still time to resuscitate the patient.

Abdominal Neoplasms↗

Carcinoid tumor of the ileum with intestinal obstruction.

An 83 year-old female presenting with intestinal obstruction due to a carcinoid tumor of the small intestine is herein reported. The intra-operative findings revealed a stenotic lesion and ischemic changes of the ileum. A segmental jejunotomy was performed and a submucosal tumor was recognized as a causal lesion. Histopathological investigation demonstrated the features of carcinoid tumor.

Aged↗

Intestinal obstruction and peritonitis resulting from gastrointestinal histoplasmosis in an AIDS patient.

Gastrointestinal histoplasmosis complicated by intestinal obstruction and peritonitis has not been reported. We report a case of gastrointestinal histoplasmosis in a 27-year-old patient with acquired immunodeficiency syndrome (AIDS). The patient was a Chinese man from Thailand with a history of intravenous drug use and unprotected sex with female prostitutes. He was admitted for prolonged fever, abdominal pain, and diarrhea. Colonoscopy revealed volcano-like ulcers and tumors, while computed tomography of the abdomen showed a colon tumor and hypoattenuated lymphadenopathy of the retroperitoneum. Histopathologic examination as well as cultures of colon biopsy specimens and an aspirate from the retroperitoneal lymphadenopathy revealed Histoplasma capsulatum. Intestinal obstruction and peritonitis requiring surgical intervention developed, despite amphotericin B therapy. Histoplasmosis should be included in the differential diagnosis in AIDS patients who present with colon tumors, retroperitoneal lymphadenopathy, and peritonitis.

Acquired Immunodeficiency Syndrome↗

Surgical correction of an intestinal obstruction in a turtle.

Ingested scutes caused an intestinal obstruction in an 18-year-old turtle. An enterotomy, performed through a flank approach to the celiac cavity, successfully relieved the obstruction. The scutes were ingested during a period of neglect by the owner.

Animals↗

Extranodal lymphoplasmacytoid lymphoma (immunocytoma) presenting as small intestinal obstruction.

A 57-year-old woman presented with intermittent symptoms of intestinal obstruction. Workup provided nondiagnostic radiologic studies. An exploratory laparotomy revealed a segmental dilatation in the proximal ileum, which showed diffuse thickening of the intestinal wall. Microscopic examination of the affected area disclosed a diffuse transmural infiltrate composed of small lymphocytes, mature plasma cells, and lymphoplasmacytoid cells in different stages of maturation associated with extracellular periodic acid-Schiff-positive material. In addition, serum protein electrophoresis showed a monoclonal immunoglobulin M kappa paraprotein. Postoperative workup did not demonstrate evidence of systemic involvement. The morphologic features and immunohistochemical and molecular analyses were consistent with lymphoplasmacytoid lymphoma (immunocytoma). We report an unusual case of primary extranodal immunocytoma involving the small intestine and discuss its clinicopathologic features.

Female↗

Acute small intestinal obstruction associated with Parascaris equorum infection in young horses: 25 cases (1985-2004).

AIMS: To retrospectively evaluate the medical and surgical records of horses with acute small intestinal obstructions associated with Parascaris equorum infection; to describe the gastrointestinal lesions; and to determine the outcome of cases with such lesions. METHODS: Records of 25 horses with acute small intestinal obstruction associated with P. equorum between 1985 and 2004 were reviewed to determine signalment, history, physical examination, surgical or post-mortem findings, and outcome. RESULTS: All horses except one were less than 12 months old. Standardbreds were over-represented in the population studied. Sixteen horses (72%) had been administered anthelmintics, including pyrantel (n=8), ivermectin (n=7), and trichlorphon (n=1), within 24 h prior to the onset of colic. Of the 25 cases reviewed, 16 had simple obstructive ascarid impactions (SOAIs), and nine had complicated obstructive ascarid impaction (COAI) including volvulus (n=6) or intussusception (n=3), both concurrent with ascarid impaction of the small intestine. Short-term survival (discharge from hospital) occurred in 79% of horses treated for SOAI, and was 64% for all horses. Long-term survival (>1 year) occurred in 33% of horses with SOAI, and the overall long-term survival was 27% for all horses. Formation of adhesions was the most frequent finding associated with death for horses that did not survive long-term. CONCLUSIONS AND CLINICAL RELEVANCE: The incidence of anthelmintic treatment within 24 h of the onset of colic in this study population (72%) was higher than that previously reported. Resistance of P. equorum to ivermectin recently reported in Ontario may be associated with increased ascarid burdens, predisposing horses to ascarid impaction. The long-term survival of these horses was better than that reported previously.

Animals↗

Acute small bowel volvulus in adults. A sporadic form of strangulating intestinal obstruction.

Small bowel volvulus is an uncommon but important cause of small intestinal obstruction. It often results in ischemia or even infarction. Delay in diagnosis and surgical intervention increases morbidity and mortality rates. Based on cause, small bowel volvulus can be divided into primary and secondary type. Goals for treatment of small bowel volvulus should include physician awareness of this uncommon diagnosis, accurate workup, and advanced surgical intervention. The presentation and subsequent management of 35 patients with small bowel volvulus confirmed by laparotomy are reviewed and discussed. The incidence of small bowel volvulus in the adult European and North American is low. The resultant mortality rate, however, makes diagnosis critically important. The cardinal presenting symptom is abdominal pain. There is no single specific diagnostic clinical sign or abnormality in laboratory or radiologic finding. In practice, the diagnosis can only be made by laparotomy. The failure to perform an exploratory laparotomy cannot be justified. Early diagnosis and early surgery are the keys for successful management of strangulation obstruction of the small bowel.

Abdomen, Acute↗

Incidence of distal intestinal obstruction syndrome in cystic fibrosis.

A variety of intestinal complications, including constipation, abdominal pain, palpable cecal masses, intestinal obstruction, intussusception, and volvulus, have been observed beyond the neonatal period in patients with cystic fibrosis (CF). In a retrospective chart review of 63 patients with CF, we found evidence of one or more of these complications in 26 patients (41.3%). The incidence of intestinal complications was not related to overall disease severity, pulmonary exacerbations, history of meconium ileus at birth, or dose or type of pancreatic enzyme replacement. There was no change in the incidence of intestinal complications after patients switched to a pH-sensitive enteric-coated microsphere enzyme preparation.

Adolescent↗

Acute intestinal obstruction: an electromyographic study in dogs.

We have investigated the motility effects of acute experimental canine intestinal obstruction. A 30-min midjejunal obstruction was produced by clamping a Biebl loop or by inflating an intraluminal balloon. Spike bursts from serosal electrodes proximal to the site of obstruction increased markedly, while those from distal electrodes decreased. When the obstruction from an intraluminal Foley catheter was continued for 5.5 h, the inhibition persisted distally but the proximal contractile activity gradually fell to control levels. The reduced proximal activity after prolonged obstruction was largely due to clusters of regular intense spike bursts preceded and followed by lengthening periods of absent motor activity. Similar clustered contractions obliterated the lumen when the passage of barium through a Thiry-Vella loop was monitored fluoroscopically. Significant motility changes occur in intestinal obstruction, but an increased understanding of the mechanisms involved awaits future studies.

Animals↗

Segmental jejunal lipomatosis--a rare cause of intestinal obstruction.

A rare case of a segmental small intestinal (jejunal) lipomatosis is described. A 33-year-old male was admitted with a clinical diagnosis of an acute intestinal obstruction. A plain erect abdominal x-ray showed multiple air-fluid levels. On an exploratory laparotomy, a jejunojejunal intussusception was found secondary to a segmental submucosal lipomatosis. This was treated by a segmental resection and anastomosis, which resulted in a complete cure. Here we present this case with a review of the relevant literature.

Adult↗

Prenatal diagnosis of intestinal obstruction due to ileal atresia.

A case of intestinal obstruction due to ileal atresia where the diagnosis was made prenatally by ultrasound is presented. Close monitoring of the fetus was done ultrasonographically to look for any evidence of meconium peritonitis. The baby was delivered preterm but weighed 3.3 kg. Laparotomy and enterostomy was done and the baby is currently well.

Female↗

Prenatal ultrasound diagnosis of intestinal obstruction: a case report.

A case of intrauterine intestinal obstruction diagnosed at 31 weeks' gestation by sonographic examination is presented. Unlike other reported cases, the diagnosis was made early in the third trimester and before the development of polyhydramnios. The patient was managed conservatively until delivery at 33.5 weeks. At exploratory laparotomy, immediately after birth, ileal atresia was found and resected. The infant recovered uneventfully.

Adolescent↗

[Solitary intestinal fibromatosis: an unusual cause of neonatal intestinal obstruction].

We report a new case of solitary intestinal fibromatosis (SIF) in a neonate with intestinal obstruction in the first day of life. At the laparotomy was found to be due to a solid mass in the jejunum. A segmental jejunal resection with anastomosis was performed. Histologic examination showed a SIF. The postoperative course was excellent in contrast to cases of congenital fibromatosis with multiples lesions, which carries a poor prognosis.

Female↗

Surgical treatment or gastric drainage only for intestinal obstruction in patients with carcinoma of the ovary or peritoneal carcinomatosis of other origin.

The records of 38 patients with advanced carcinoma of the ovary and 21 patients with peritoneal carcinomatosis of other origin who were treated for relief of intestinal obstruction were retrospectively analyzed. An explorative laparotomy was performed upon 40 instances, whereas in 25 instances, a large bore draining tube gastrostomy was done primarily. Retrospectively, the 40 explorative laparotomies were performed in two separate groups of patients. The first group consisted of 15 patients without palpable masses or ascites and five patients with intestinal obstruction as the first sign of ovarian disease. Another group of 20 patients presented with clinically manifest ascites or palpable masses, or both. The patients in group 1 survived for a median time of 154 days (range of 29 to 1,086 days) without recurrent intervention for obstruction. The patients in group 2 died after a median time of 36 days (three to 151 days). The explorative laparotomy was successful in only one patient in group 2. A third group of 25 patients was deemed inoperable and primarily received a tube gastrostomy. Twenty-three patients presented with ascites or palpable masses, or both. They died after a median time of 33 days (eight to 163 days). Surgical therapy for relief of intestinal obstruction should only be considered in patients who do not present with manifest ascites or palpable masses and in patients with carcinoma of the ovary for whom effective chemotherapy is available. Percutaneous gastrostomy should be the method of choice for other patients.

Ascites↗