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PubMed1996

Intestinal obstruction caused by splenic volvulus: report of a case.

Torsion of a wandering spleen is rare, usually presenting as acute abdomen, and is commonly misdiagnosed. In special cases, ultrasonography, arteriography, and additional scintigraphy are extremely valuable in the preoperative diagnostic management. We herein present an unusual case of torsion of a wandering spleen in a 19-year-old female. The presenting symptom was acute gastrointestinal obstruction due to pressure of the enlarged and ptotic spleen in the pelvis. The intestinal obstruction with signs of peritonitis made a laparatomy with removal of the infarcted spleen imperative. After the operation, the patient made a complete recovery.

Adult↗
PubMed2005

Adrenal insufficiency in intestinal obstruction from carcinomatosis peritonei--a factor of potential importance in symptom palliation.

Corticosteroids are used in the management of intestinal obstruction (IO) in carcinomatosis peritonei. There is considerable overlap in the symptoms experienced in IO and functional adrenal insufficiency (AI). The success of symptom palliation in IO may be related to the presence of AI. The aim of this preliminary study was to evaluate the incidence of functional adrenal insufficiency in patients with IO and its relation to clinical outcome and symptom control. Twenty-nine consecutive patients with IO and carcinomatosis peritonei from gastrointestinal cancers admitted to our inpatient service between January and October 2002 were analyzed. They were screened for AI using the short corticotropin stimulation test. Thirteen patients (45%) had functional AI. Differences in characteristics of patients with normal adrenal function (Group 1) and adrenal insufficiency (Group 2) were not statistically significant. Time taken to control symptoms in Group 2 was longer. Mean duration of hospitalization per month of survival was two times longer in Group 2 relative to Group 1 (7.9 versus 4.0 days, P=0.011). Functional AI may be caused by cytokines produced in advanced cancer mediating direct adrenal suppression. Prompt corticosteroid therapy in the presence of AI may facilitate IO symptom palliation.

Adrenal Cortex Hormones↗
PubMed2002

Gdnf haploinsufficiency causes Hirschsprung-like intestinal obstruction and early-onset lethality in mice.

Hirschsprung disease (HSCR) is a common congenital disorder that results in intestinal obstruction and lethality, as a result of defective innervation of the gastrointestinal (GI) tract. Despite its congenital origin, the molecular etiology of HSCR remains elusive for >70% of patients. Although mutations in the c-RET receptor gene are frequently detected in patients with HSCR, mutations in the gene encoding its ligand (glial cell line-derived neurotrophic factor [GDNF]), are rarely found. In an effort to establish a possible link between human HSCR and mutations affecting the Gdnf locus, we studied a large population of mice heterozygous for a Gdnf null mutation. This Gdnf(+/-) mutant cohort recapitulates complex features characteristic of HSCR, including dominant inheritance, incomplete penetrance, and variable severity of symptoms. The lack of one functioning Gdnf allele causes a spectrum of defects in gastrointestinal motility and predisposes the mutant mice to HSCR-like phenotypes. As many as one in five Gdnf(+/-) mutant mice die shortly after birth. Using a transgenic marking strategy, we identified hypoganglionosis of the gastrointestinal tract as a developmental defect that renders the mutant mice susceptible to clinical symptoms of HSCR. Our findings offer a plausible way to link an array of seemingly disparate features characteristic of a complex disease to a much more narrowly defined genetic cause. These findings may have general implications for the genetic analysis of cause and effect in complex human diseases.

Age of Onset↗
PubMedDate not supplied

[A rare cause of intestinal obstruction revealed during pregnancy (Kamenge University Hospital Center, Bujumbura, Burundi)].

Acute intestinal occlusion is rare during pregnancy, and more exceptional is the source itself of the occlusion we are reporting embryonic. This is actually an embryonic remains: the omphalo-mesenteric (vitellin) duct that did not resorb and has developed into a fibrous cord. The latter, owing to physiological modifications, is responsible of the occlusion. The authors analyse the two facts which, when associated, represent an interesting clinical fact.

Adult↗
PubMed2003

Intestinal obstruction caused by omphalomesenteric duct remnant: usefulness of laparoscopy.

The anomalies related to omphalomesenteric duct remnant constitute an uncommon cause of intestinal obstruction, of which Meckel"s diverticulum and its variants represent the most important clinical presentation. In most cases they are asymptomatic and usually affect young patients. When symptomatic, they usually present episodes of gastrointestinal bleeding or acute abdomen syndromes caused by strangulation of intestinal loops as a result of fibrous intraabdominal remnants or inflammation produced by the diverticulum. In most cases, the unexpected presence of these alterations makes intraoperative diagnosis necessary. Treatment is surgical and consists in exeresis of the diverticulum or the fibrous band causing the clinical picture. We report two cases of persistence of the vitelline duct resolved by laparoscopic approach.

Adolescent↗
PubMed2000

Eosinophilic enteritis caused chronic partial small intestinal obstruction: a case report and review of the literature.

This is the case-report of a rare cause of chronic small intestinal obstruction by eosinophilic enteritis. A 53-year-old woman presented with an 8-month history of severe intermittent abdominal colick associated with malnutrition, weight loss, and bowel habit change. Several investigations were done but failed to demonstrate the cause. Exploratory laparotomy was therefore performed and the cause of partial small bowel obstruction was found to be eosinophilic enteritis.

Barium Sulfate↗
PubMed2000

The use of steroids in the management of inoperable intestinal obstruction in terminal cancer patients: do they remove the obstruction?

This multicentre, randomized double-blind study was undertaken to assess the efficacy of corticosteroids as a palliative treatment of intestinal obstruction due to advanced and incurable cancer. Thirty-one French palliative care units agreed to participate in the study and 12 actually recruited at least one patient. To be included, patients had to have an advanced cancer with a surgically inoperable bowel obstruction and to have received no specific anticancer therapy within the preceding 28 days. They had to fulfil at least three of the following criteria: vomiting at least twice a day; colicky abdominal pain; no flatus for 12 h or more; no stool for at least 4 days, faecal impaction being excluded; intestinal distension; air-fluid levels or absence of gas in the colon on an abdominal radiograph. Patients were randomized in three groups to receive either a placebo for 3 days (group A), or methylprednisolone 240 mg daily for 3 days (group B) or methylprednisolone 40 mg daily for 3 days (group C). Symptoms were assessed daily but success or failure of the treatment was assessed on day 4, according to the disappearance or persistence of symptoms. Fifty-eight patients were randomized, of whom 52 were able to be evaluated. Details of symptoms and associated treatments are described below. Of 40 patients without a nasogastric tube, symptoms were relieved in 68% of cases versus 33% among placebo-treated patients (P = 0.047). In 12 patients who had a nasogastric tube already in place, the results are less significant (60% versus 33% with P = 0.080). Because of the small sample size, no conclusions can be reached about the relative efficacy of low versus high-dose treatment regimes.

Adult↗
PubMed1975

Studies on small intestinal obstruction. I. Intraluminal pressure in experimental low small bowel obstruction in the cat.

Intra-intestinal pressure was recorded with open-tip catheters in experimental low small-bowel obstruction in the cat. At zero time the pressure was 2-4 mmHg. After 72 hours sustained intraluminal pressure ranged mainly between 5 and 10 mmHg. Long periods of inactivity alternated with short bouts of spontaneous bowel activity. During activity the pressure rose to about 20 mmHg. In motility responses elicited by cholecystokinin, momentary pressure waves amounting to 40-50 mmHg were recorded. The result of simple mechanical obstruction is predominantly a bowel distension, whereas the magnitude of sustained intraluminal pressure is rather modest. Possible effects of distension on intestinal microcirculation are discussed.

Animals↗