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Disruption of the intestinal barrier and bacterial translocation in an experimental model of intestinal obstruction.

Clinical evidence and the use of experimental models in laboratory animals indicate that the intestine is a reservoir of microorganisms that can cause systemic infection in the human. The purpose of this work was to study the possible effect of intestinal obstruction (IO) on the mechanical and chemical barriers that bring protection against microorganisms crossing from the intestinal lumen towards the systemic tissues. We demonstrated that 24 hours after IO, histological and ultrastructural alterations do occur, seriously compromising the structure of the intestinal barrier in 100% of the studied animals. Likewise, it was observed that during the same period, microorganisms translocation from intestine to the peritoneal cavity and liver (100 and 80% respectively) occurred. The lungs were spared. Changes observed in the intestinal epithelium are related to a process similar to that produced by intestinal ischemia: mitochondrial destruction, with subsequent decrease of its capacity to supply energy and to preserve the equilibrium and structure of the intestinal epithelium. We propose that translocation of enteric bacteria may be the cause of the infection that brings about the death a significant group of animals at 48 hours (27%) and 72 hours (33%) post-IO.

Animals↗

Experimental studies on fluid pathophysiology in small intestinal obstruction in the rat. II. Effects of intraluminal hyperosmolality and simultaneous intravenous infusions.

Using an experimental model in rats a hyperosmolal glucose solution was introduced into the intestinal lumen to simulate and magnify the accumulation of fluid seen in simple small intestinal obstruction. Efforts to modify the extent and rate of this fluid flux by administering parenteral solutions of varying osmolality produced no result. When hypoosmolal or iso-osmolal infusion solutions were used, the intraluminal dilution process displayed mathematical characteristics in agreement with those of a simple dilution process, while at the same time normal blood volume was maintained. On the other hand, when a hyperosmolal glucose solution was infused, very great demands were made on the extravascular compartment, because a severe diuresis equal in volume to the fluid given parenterally took place, while at the same time there was marked hemodilution. Despite this the organism delivered as much fluid to the intestine as when hypo-osmolal or iso-osmolal infusions were given. Thus in principle the flow of fluid into the intestinal lumen could not be modified by giving parenteral solutions of any osmolality.

Animals↗

[Diagnosis and treatment of acute intestinal obstruction due to gall-stone].

Results of treatment of 43 patients with acute intestinal obstruction due to gall-stones are analyzed. Forty patients were operated, 3 patients were not because of extremely severe state. Enterolythotomy was performed in 27 cases, incision of intestinal wall was carried out directly above the stones (14 cases, group 1), above or below it (13 cases, group 2). Insufficiency of enteral suture was seen in 4 patients of group 1 that required repeated surgery. Lethality in group 1 was 21.4%, in group 2-7.1%. Intestinal resection was performed in 12 patients of group 3, there were no cases of suture insufficiency, and lethality was 8.3%. It is concluded that enterotomy should be performed above or below strangulated stone. Intestinal resection should be performed when concrement is immovable or in cases of intestinal necrosis.

Acute Disease↗

[Intestinal obstruction caused by Ascaris].

A worm-conglomerate in cases of ascariasis may cause an intestinal obstruction. The worms can be demonstrated as irregular oblong shadows or nodular thickenings. Level formation in the intestine must not be found because of filling intestinal loops with worms.

Adolescent↗

Observations on the colic motor complex in a pony with a small intestinal obstruction.

Characteristic motility patterns were seen throughout the gastrointestinal tract in a pony prepared chronically with electromechanical recording devices after developing a simple obstruction of the small intestine. Gross distension of the stomach with fluid produced loss of gastric contractile activity and a chaotic electrogram. These changes were reversed instantaneously when the stomach was decompressed. In the jejunum, proximal to the obstruction, the unique 'colic motor complex' was observed with contractions of longer duration arranged in characteristic pulses of activity. The left dorsal colon showed continuous hyperactivity and the small colon remained active. Abnormal motility patterns occurring secondary to a small intestinal obstruction could play a role in the aetiology of small and large intestinal disorders.

Animals↗

[A case of nodular lymphoid hyperplasia of the small bowel in a patient with intestinal obstruction].

Nodular lymphoid hyperplasia (NLH) represents an uncommon lesion usually related to humoral immunodeficiency conditions. A case of NLH of the small bowel discovered by chance during an emergency laparotomy for an intestinal obstruction is herein reported. Discussion is focused on the main features of NLH which as in the reported case, is likely to be the initial manifestation of an intestinal disease not yet clinically defined.

Adult↗

[Cystic neoplasm of the pancreas as a cause of intestinal obstruction].

Cystic neoplasms of the pancreas are unusual varieties of pancreatic tumors. We herein report a new case presenting with atypical features, such as mental and electrolytic disturbances secondary to upper intestinal obstruction. We reviewed the literature, and discuss the differential diagnosis, the histopathological characteristics of prognostic value, and the therapeutic strategy. We conclude that these tumors should be included in the differential diagnosis of the upper intestinal obstructions, and emphasize the need to remove the lesion in all cases because of the difficulties of predicting the benign or malignant behaviour of these tumors before and during the surgical procedure.

Cystadenocarcinoma↗

A strategy for intestinal obstruction of peritoneal carcinomatosis.

Obstruction of the small intestine caused by peritoneal carcinomatosis is properly palliated by resection, bypass, and stoma formation. If none of these procedures is applicable, palliation may be achieved by the permanent placement of a long intraluminal decompressive (Baker) tube. Twelve patients have been treated in this manner, nine of them living long enough to exhibit the capacity to eat and drink without repetitive vomiting. The Baker tube was passed across the abdominal wall, inserted into the proximal jejunum, and then passed as far as practical down to the surgically nontreatable obstruction. Venting of the small intestine distally allows continuing decompression, which thereby permits mucosal functions proximally. This technique allows the surgeon to do something beneficial for these unfortunate patients when the established maneuvers of bypass, resection, or stoma formation are pointless.

Female↗

Solitary intestinal fibromatosis in the newborn. Rare cause of neonatal intestinal obstruction.

We describe a case of solitary fibromatosis of the ileum in an infant. Intestinal fibromatosis is a rare cause of intestinal obstruction in the newborn. The disease is poorly characterized and has been rarely reported under this name. The differential diagnosis is discussed with particular attention to inflammatory fibroid polyps, neurofibromatosis, and sarcoma. Reasons of a theoretical and practical nature are outlined that recommend the term "solitary intestinal fibromatosis" as the most appropriate name for this disease.

Diagnosis, Differential↗

[Small intestine intubation for treatment of patients with peritonitis and intestinal obstruction].

The analysis of 36 case records of patients with peritonitis (n = 12) and intestinal obstruction (n = 24) is presented. Nasogastrointestinal intubation of the small bowel was used in combined treatment. The aims, indications and contraindications for the intubation are formulated. Bacteriologic and biochemical parameters of bowel content were studied. It was established that the quantity of enterobacteria and unfermenting gram-negative bacteria was increased in intestinal paresis, the alkaline phosphatase, amylase, bilirubin, transaminase, a potassium content were increased as well. For the tube to function from the first hours after its introduction it should be periodically properly washed with sodium hypochlorite in concentration 300 mg/l.

Female↗

A case of anisakiasis causing intestinal obstruction.

A 31-year old salesman living in Seoul developed suddenly abdominal pain due to intestinal obstruction. Exploratory laparotomy exhibited segmental jejunal cellulitis caused by penetrating Anisakis larva. The patient had eaten raw fish. The typical history of intestinal anisakiasis was presented with a short review of Korean patients of anisakiasis.

Adult↗

Detection of clustered gastrointestinal contractions in partial intestinal obstruction by surface vibration analysis.

Gastrointestinal contraction "clusters" with alternating quiescence occur in partial intestinal obstruction and are conventionally detected by intraluminal manometry. Surface Vibration Analysis (SVA), which is a noninvasive test, was evaluated in this study in experimental and clinical situations. In the experimental situation, former SVA was assessed against simultaneous manometry in two volunteers, in whom partial obstruction had been induced by intrajejunal balloon distension. Manometry showed typical contraction "clusters" with alternating quiescence, each of two to four minutes duration, in obstructed jejunum proximal to the balloon. The distal jejunum was inhibited. SVA showed a pattern of hyperactivity and quiescence corresponding to proximal jejunal activity. In the clinical situation, SVA recordings taken after a standard meal in nine patients with suspected chronic obstruction adhesive obstruction, (subsequently proven in seven patients and disproved in two), and 36 volunteers were compared. All patients with proved obstruction showed an SVA pattern of alternating hyperactivity and quiescence. This pattern was not observed in volunteers or nonobstructed patients.

Abdomen↗

Intestinal obstruction caused by a strangulated Morgagni hernia in an adult patient.

A Morgagni hernia is a congenital herniation of abdominal contents into the thoracic cavity through a retrosternal diaphragmatic defect. The reported incidence of congenital diaphragmatic hernias is estimated to be 1 in between 2000 to 5000 births. Morgagni hernias comprise 2% of diaphragmatic hernias. Most Morgagni hernias are found and repaired in children, but 5% are found in adults. They are usually asymptomatic and often found incidentally on chest radiography. Symptoms of these hernias are attributable to the herniated viscera. Morgagni hernias containing bowel may require repair on presentation because of the risk of incarceration. We present a case of an incarcerated and strangulated Morgagni hernia in a 71-year-old woman admitted to our clinic for abdominal pain and symptoms of intestinal obstruction. The diagnosis was made preoperatively by chest radiography, sonography, and computed tomography. Emergent laparotomy was performed, with the herniated transverse colon and omentum reduced into the abdomen. The diaphragmatic defect was repaired, followed by resection of the strangulated omentum. In conclusion, a Morgagni hernia may cause intestinal obstruction. Routine radiographic studies are usually sufficient to arrive at the diagnosis, but a CT scan and sonography may be necessary. Laparotomy is appropriate for the management of symptomatic adult patients with Morgagni hernias, particularly those with findings of intestinal strangulation, with laparoscopic treatment an alternative approach in selected cases.

Aged↗