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Based on a series of 100 cases, the paper reviews the causes, diagnosis and treatment of apparent bowel obstruction in cattle with particular emphasis on non-obstructive tympanitic disorders of the intestine.
An algorithm for the evaluation of a newborn with an intestinal obstruction was formulated. It is hoped that this will aid the practicing surgeon in rapidly and safely arriving at the proper diagnosis so that appropriate therapy can be promptly instituted.
The number of neonates with functional intestinal obstruction being admitted to this surgical unit is increasing. The obstruction may be transient and curable within a few days, or weeks or, more rarely, may be prolonged and intransigent, usually resulting in death despite parenteral nutrition. In the former group, the infants are often the result of an abnormal pregnancy or delivery. Recently, a small number of infants has been identified in whom prolonged jaundice is a notable feature, but the aetiology of this syndrome is not apparent. All of these infants must be screened to exclude mucoviscidosis, septicaemia, meningitis, and Hirschsprung's disease. Ideally, neonates suspected of having Hirschsprung's disease should not be submitted to surgery until after histological proof of the diagnosis. Infants with the rarer forms of intransigent ileus should be referred to special centres for intensive investigations, much of which would be somewhat experimental, in order to discover more about the aetiology of the various syndromes. For the adequate investigation and treatment of any these infants, an experienced team of clinicians, radiologists and pathologists is essential, and these infants should not be treated where the necessary facilities are unavailable.
BACKGROUND: Bezoars usually present as a mass in the stomach. The patient often has a preceding history of some psychiatric predisposition. Presentation could be in the form of trichophagy followed by trichobezoar (swallowing of hair leading to formation of bezoar), orphytobezoar (swallowing of vegetable fibres). Rapunzel syndrome is a condition where the parent bezoar is in the stomach and a tail of the fibres or hair extends in to the jejunum. Presentation as intestinal obstruction due to a bezoar in the intestine without a parent bezoar in the stomach is rare, therefore we report it here. CASE REPORT: A 35 year old lady tailor with a previous history of receiving treatment for depression on account of being infertile- years after her marriage, presented to the surgical emergency department with features of acute intestinal obstruction. Exploratory laparotomy and enterotomy revealed a cotton bezoar in the terminal ileum without a parent bezoar in the stomach. She was managed by resection of the affected segment of the ileum and end-to-end anastomosis of the bowel. In the postoperative period the patient gave a history of ingesting cotton threads whenever she was depressed. CONCLUSION: Presence of cotton bezoar is rare and an intestinal bezoar in the absence of parent bezoar in the stomach is still rarer.
In 173 patients (study group), undergoing appendicectomy because of suspected acute appendicitis, normal saline solution, in the amount of 10 ml per 1000 g of patient weight, was injected into the peritoneal cavity before closing the incision. A control group of patients undergoing appendicectomy was selected, matched for age and sex. The mean observation period was five years for both groups. One of the patients in the study group and two patients in the control group developed small intestinal obstruction due to adhesions which led to relaparotomy. The difference was not statistically significant. Because of the rarity of this complication after appendicectomy (1-2%) and the long elapse of time reported from the appendicectomy to the development of the small intestinal obstruction due to adhesions, the group of 173 patients in too small and the observation period of five years too short to enable a conclusion to be made so far. Further follow-up of the patients in this study and a further investigation is necessary.
PURPOSE: The aim of this study was to demonstrate bacterial translocation after experimentally induced intestinal obstruction as well as investigate the preventive effects of hyperbaric oxygen on obstruction-induced bacterial translocation in rats. METHODS: Forty Wistar-albino male and female rats were used. Although no procedure was done in the control group (n = 8), hyperbaric oxygen treatment under 2.5 atm absolute for 90 minutes daily was applied for two days in the hyperbaric oxygen group (n = 8). In the sham group (n = 8), after laparotomy the small bowel was only handled gently, and tissue sampling was done 48 hours later. In the obstruction group (n = 8) the ileum was ligated by 5-0 polypropylene just 5 cm proximal to the ileocecal valve. In the obstruction and hyperbaric oxygen group (n = 8), after obstruction hyperbaric oxygen treatment was applied. Forty-eight hours after the procedures, tissue samples from small bowel, mesenteric lymph nodes, spleen, and liver were taken and 1 ml of blood from the portal vein was withdrawn. All samples were cultured for microbiologic examination. RESULTS: Hyperbaric oxygen treatment significantly reduced the endogenous bacterial overgrowth in the small intestine of normal rats. Endogenous bacteria in the small intestine were significantly increased in the obstruction group, and the presence of bacterial overgrowth was proven by bacterial presence on mesenteric lymph nodes, spleen, liver, and blood. Hyperbaric oxygen treatment significantly reduced the endogenous bacterial overgrowth in the small intestine and prevented the bacterial translocation almost completely in obstruction-induced rats. CONCLUSIONS: Intestinal obstruction causes bacterial overgrowth and translocation. Hyperbaric oxygen treatment prevents the bacterial translocation effectively.
PURPOSE: The aim of this study was to report on a rare cause of small-intestinal obstruction caused by small-intestinal enteroliths. METHODS: We present three different cases of enterolith formation in the small intestine. One occurred after nontropical sprue, one patient had multiple jejunal diverticula, and another patient had enterolith formation in a blind loop after a small-bowel side-to-side anastomosis. RESULTS: After initial conservative therapeutic approach all patients underwent surgery. In two patients the enteroliths were removed by ileotomy or jejunostomy. In the third patient the bowel anastomosis had to be revised after removal of the enterolith. CONCLUSION: Small-intestinal enteroliths may cause small-bowel obstruction. The first therapeutic approach is nonsurgical; however, if obstruction proceeds, surgical removal with or without revision of underlying pathology is necessary. We discuss the causes and therapeutic management of enteroliths and give a review of related literature.
Intraluminal stenting of the small bowel has been advocated as a method of reducing the risk of recurrent adhesional obstruction in patients requiring adhesolysis. We reviewed the complications and efficacy of this technique in 25 patients undergoing surgery for relief of intestinal obstruction due to complex, extensive and dense adhesions. Five patients developed minor and three patients major complications. Three (13%) of 23 patients alive after mean follow-up of 4 years had had episodes of recurrent intestinal obstruction, but none had required reoperation. Intraluminal stenting remains of unproven efficacy. It may find a place as an adjunct to adhesolysis in patients requiring repeated operations for the relief of obstruction due to extensive and dense adhesions; but, in view of the high rate of complications, careful case selection will be necessary.
Abdominal cocoon, which is characterised by encasement of bowel by a fibrous membrane, is a rare cause of intestinal obstruction. It occurs primarily in females with only three cases reported earlier in males. We report a male patient presenting with small bowel obstruction and detected to have abdominal cocoon at surgery. Incision of thick membrane and lysis of adhesions led to relief of obstruction without any recurrence.
PURPOSE: The aim of this study is to present patients, to discuss causes of morbidity and mortality, and to ascertain prognostic indexes and therapeutic options influencing outcome of patients with intestinal obstruction caused by Ascaris lumbricoides. MATERIALS AND METHODS: During the past 20 years, between 1975 and 1995, a total of 17 patients with intestinal obstruction attributable to A. lumbricoides underwent surgery. Five were adults, and 12 were children. The most frequent symptoms and physical findings were abdominal pain, distention, nausea, vomiting, and constipation. Enterotomy was performed in ten patients and resection in two patients. Manual exposition and advancement of the parasitic bundle toward the colon was attempted in five patients. Morbidity and mortality rates were 29 and 17 percent, respectively, and septic shock was the major cause of death. RESULTS: This study suggests that simple bowel obstruction is the fatal complication of A. lumbricoides infestation, which is seen particularly in pre-school and young school-aged children living in unhygienic conditions, and illustrates the need for heightened awareness of A. lumbricoides by the emergency physician in the differential diagnosis. CONCLUSIONS: Early diagnosis and surgical intervention are essential to minimize high morbidity and mortality.
Content of cytochromes P-450 and b5 as well as activities of amidopyrine demethylase, aniline hydroxylase and NADPH cytochrome c reductase were studied in liver tissue of rats with occlusive and strangulational ileus. Distinct inhibition of main microsomal enzymes activity and decrease of cytochromes content in hepatocytes occurred independently on the type of acute intestinal obstruction. Within early periods after surgical operation of the acute intestinal obstruction all the alterations observed were maintained especially distinctly in the strangulational type of the disease.
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