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A case of an internal cholecystogastric fistula that closed spontaneously and combined with low large-intestinal obstruction due to a gallstone is described. Other, similar cases reported in the literature are reviewed.
The overall approach to blunt abdominal trauma resulting in hematoma and intestinal obstruction has been variable and controversial. Recent reports recommend conservative nonoperative management. We reviewed six cases of duodenal and jejunal hematomas resulting from blunt trauma of which five resolved with nasogastric decompression and parenteral nutrition. The average hospital stay was 16 days (10-23 days), and total parenteral nutrition days were 9 days (4-16 days). Upper gastrointestinal series (UGI) demonstrated partial bowel obstruction in all five cases. In contrast, the sixth case was a restrained passenger who had evidence of complete bowel obstruction on UGI series, which failed to resolve after 18 days of conservative management. Laparotomy revealed jejunal and colonic strictures with fibrosis, which were successfully resected. We recommend that based on radiologic documentation of persistent high-grade obstruction, as well as the clinical course, patients whose obstructions do not resolve by 10 to 14 days ought to be further investigated and operative intervention considered. This approach may facilitate an earlier diagnosis of complications, reduce length of hospitalization and days on parenteral nutrition, as well as to expedite the proper management.
This article aims to increase your understanding of issues associated with intestinal obstruction, including the different causes of small bowel and large bowel obstruction, the treatments available and the best nursing management of patients with this condition.
Two fatalities due to an occlusive ileus following the ingestion of foreign bodies in patients with psychiatric disorders are described. A severely mentally handicapped young man developed a temperature and died 1 h after admission to a surgical ward. At autopsy, approximately 2000 cm3 of foreign material, including broken glass and porcelain, branches, buttons, parts of clothing and other material were found in the gastrointestinal tract, leading to a complete obstruction of the distal intestine and colon with resulting faecal vomiting. The other case was even more unusual as hair fetishist had swallowed a thick strand of his own hair, 50 cm long, also resulting in mechanical obstruction of the distal intestine.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
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The purpose of this study was to determine the utility of jejunal manometry in evaluating patients having partial small intestinal obstruction or the pseudoobstruction syndrome. We studied 10 healthy volunteers, 9 patients with documented mechanical obstruction, and 3 patients with chronic intestinal pseudoobstruction during fasting and for 2 h after a 650-kcal meal. Contractile activity, especially during phase 2, was extremely variable in all individuals studied. After the meal, the most striking finding in mechanical obstruction was the regular occurrence of clustered contractions. These were defined as 3-10 regular contractions, occurring 1 per 5 s, preceded and followed by at least 1 min of absent motor activity. The associated periods of quiescent motor activity may account for the unexpectedly reduced frequency and motility index in obstructed patients compared with normal subjects after the meal. Two different contractile patterns occurred in patients with pseudoobstruction. Before and after the meal, infrequent and low-amplitude contractions occurred in 2 patients, and multiple, aborally migrating, clustered contractions occurred in the other patient with pseudoobstruction. Manometric abnormalities occur in both mechanical obstruction and pseudoobstruction. However, the technique is probably not more sensitive than radiologic procedures, and the abnormalities that are detected by manometry are not specific. Some of the same motility changes occurred in both disorders.
A clinical and pathological study was made of 40 patients with intestinal obstruction due to far-advanced abdominal and/or pelvic malignant disease. Surgical intervention was feasible in only 2 cases. The remaining 38 patients were managed medically without intravenous fluids and nasogastric suction. Obstructive symptoms such as intestinal colic, vomiting, and diarrhoea were effectively controlled by drugs.
Comparative analysis of the results of treatment of patients with acute intestinal obstruction was carried out. Plasmapheresis was used in postoperative period in 38 patients. 32 operated patients were treated with conventional methods of detoxication. It was established that after the earliest performance of plasmapheresis in postoperative period, manifestations of toxemia revived more rapidly and significantly and intestinal motility restored more rapidly.
A case of a hernia traversing the lesser sac with a primary defect in the greater omentum and a secondary defect in the lesser omentum is reported herein. This type of internal hernia is extremely rare and we have found only three other reported cases apart from our case. All four cases in whom this type of hernia occurred were young people. The general manifestation resembles acute intestinal obstruction and a plain radiograph shows obstruction of the upper small intestine. An erect lateral view of the abdomen often shows the anatomical location more clearly. Bowel resection was performed in two cases and all of the four reported cases recovered uneventfully.
Cecal volvulus is a rare cause of intestinal obstruction after major abdominal surgery. A case of cecal volvulus occurring in the early postoperative period after left colon resection for malignancy is presented. Clinical evaluation and plain abdominal radiographs suggesting cecal volvulus prompted laparotomy and correction. Delay in diagnosis results in high mortality, and treatment depends largely on the viability of the involved intestine. This report describes the second case of cecal volvulus complicating a left colectomy. It was treated by detorsion and reperitonealization cecopexy.
496 case reports of patients operated upon for various kinds of intestinal obstruction were analysed. Complications were studied in 202 (40.6%) patients. 93 patients died (19.7%). Peritonitis remains to be the main cause of death postoperatively (49.5 per cent to all lethal issues).
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Prolonged decompression of the small intestine was used in the complex surgical treatment of 85 patients with acute ileus (67) and peritonitis (18). The main stage of the operation included liquidation of ileus and elimination of a source of peritonitis. Antegrade nasogastric intubation of the intestine was performed in 54 patients, via gastrostomy--in 3, retrograde intubation via cecostomy--in 15, via appendicostomy--in 4, via ileostomy--in 9. Performance of active transtubal sanation of the intestine by means of antiseptic solutions (53 cases) in combination with enterosorption (17) contributed to essential increase in the effectiveness of treatment.
OBJECTIVE: To obtain 'intestinal atresia-like' conditions in the fetal lamb model to subsequently allow in utero surgical repair. METHODS: Six time-dated pregnant sheep underwent general anesthesia at 75 days of gestation (term 145 +/- 5 days). After maternal laparotomy and hysterotomy, the fetal abdomen was opened. Once the jejunoileal intestinal loop was identified, the mesenteric vessels were isolated, ligated, and sectioned in 2 fetuses, and in the remaining 5 fetuses the bowel loop was ligated. Two further fetuses were used as controls and underwent sole laparotomy. Of the group of 7 fetuses 2 were reoperated at 100-105 days of gestational age and underwent intestinal recanalization. Eight fetuses were delivered at term by cesarean section and the remaining 1 by spontaneous delivery. One newborn underwent neonatal entero-enteric anastomosis. RESULTS: 4 out of 6 fetuses survived, in utero intestinal or vascular ligation having provoked an 'intestinal atresia-like' picture. The animal operated at birth died. The 2 control fetuses and the 2 fetuses with in utero intestinal recanalization survived until term. CONCLUSION: The present study shows that in utero treatment of intestinal obstruction is possible in an experimental model.
We have designed the newly devised endoscopic procedure for inserting and placing the intestinal tube into the duodenum in order to reduce the distress of patients with intestinal obstruction.