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[Bacterial translocation in a model of intestinal obstruction. II. Bacteriological study and role of cellular immunity].

Bacterial translocation (Bt) from the gastrointestinal (GI) tract to systemic organs creates the possibility of Infection and sepsis in a great number of pathologic entities. In a mouse model of Intestinal Obstruction (IO), we evaluated the type of micro-organisms and the organs that bacteria frequent translocated. At 24 hours post-10, positive cultures where obtained at the MLN, portal, systemic circulation and peritoneal cavity, establishing that the translocation is bi-directional. The more frequent bacteria isolated were the Streptococcus group D, Proteus mirabilis, Escherichia coli, Pseudomonas sp., an clostridium. BT occurs at 24 hour post-OI and was due to increased intestinal permeability, at 48 hrs BT increased and related to the physical disruption of the mucosal barrier in the intestinal mucosa. Cell mediated immunity (CMI) response in this model was not altered, although a progressive decrease was observed at 48 hrs it was not significant, suggesting that the CMI play no role in the pathogenesis of BT. In the Control-Laparotomy group, CMI response was increased significantly at 48 hours, suggesting that a simple laparotomy boost the immune defense response.

Animals↗

[Intestinal obstruction caused by postoperative adhesion. 79 cases].

The intestinal post-operative bridle represents the third most important etiology of obstructions at the clinic of the University Hospital of Dakar, behind hernia strangulations and the volvulus of the digestive tube. Between 1970 and 1989, a retrospective study has led to a sample of 79 patients with post-operative bridle obstructions. The group was made of 47 women and 32 men between 17 and 84 years of age. Stomach ache was by far the most common functional symptomatology, followed by the stoppage of the transit and vomiting. In most cases palpation revealed the presence of tympanism. For almost all the patients, the abdomen without preparation revealed either a hydroaeric level or a diffuse grey area. The initial intervention concerned mainly gynecological affections or pathologies of appendicular type. The resection of the bridles was carried out in most cases. There were 10 deaths. The intestinal obstructions by post-operative bridles continue to be a surgical emergency still characterized by a high mortality rate. The late consultation of the patients, often received when presenting considerable visceral deficiency, is one of the main causes of the high rate of fatalities.

Adolescent↗

Intestinal obstruction by distension of a Foley jejunostomy catheter.

Jejunostomies can be effective in permitting postoperative nutritional support, particularly in the patient with complicated gastrointestinal disease. In the case presented, however, distension of the Foley balloon catheter, used as the jejunostomy tube, led to intestinal obstruction which was not initially detected. Following radiographic identification of the problem, removal of the air from the Foley balloon allowed the patient to complete his convalescence from surgery. The possibility of obstruction from the Foley jejunostomy catheter should be recognized as a potential problem in the postoperative period.

Catheterization↗

[Acute intestinal obstruction. General review apropos of 100 cases].

The authors report 100 cases of mechanic acute intestinal occlusion. 62% of them are men and 38% are women. The average age of the patients is 40 years (6 to 74 years). It is relatively young. The small intestine occlusion predominance has been noticed. These have been more dominated by bridle and adhesions (56%) from which (42%) post operative. The aetiology of colonic occlusion (31%) is dominated by volvulus (20%). The colonic occlusion is rarely caused by cancer (9%). All the patients are operated and 7 died. The mortality depend of the frequent delay of the diagnosis and the mediocre field.

Acute Disease↗

[Intestinal obstruction caused by peritoneal carcinomatosis due to signet ring cell carcinoma of the breast].

The signet ring variant of lobular mammary carcinoma is aggressive and metastasis to serosal surfaces. We report a 46 years old woman presenting with an intestinal obstruction due to a peritoneal carcinomatosis secondary to a signet ring cell carcinoma of the breast. After surgery, the patient received chemotherapy (5-fluorouracil, adriamycin, cyclophosphamide and tamoxifen). A satisfactory response, with regression of peritoneal carcinomatosis and a good quality of life, was achieved. The patient is alive after 2 years of diagnosis.

Breast Neoplasms↗

Retroperitoneal jejunal diverticulum: cause of intestinal obstruction.

A 3-week-old boy presented with repeated episodes of vomiting and constipation. At laparotomy a jejunal diverticulum arising from its antimesenteric border and extending retroperitoneally was found. The narrow neck of diverticulum caused a situation similar to a Richter's hernia. The fundus of diverticulum was attached to the upper pole of left kidney. A retroperitoneal jejunal diverticulum is a new addition to the cause of neonatal intestinal obstruction.

Diverticulum↗

[Paraduodenal hernia: an unusual cause of intestinal obstruction].

Paraduodenal hernia. The paraduodenal hernia is the most common type of intraabdominal hernia. There exists a right and left variety, both of them with their own specific pathogenesis. The clinical manifestations range from intermittent and mild digestive problems to acute intestinal obstruction. An exact preoperative diagnosis is seldom made. The knowledge of their pathogenesis and the anatomical characteristics is very important for a successful surgical treatment.

Adult↗

Indications for internal stenting in intestinal obstruction.

Internal stenting (sutureless plication) for intestinal adhesions was performed operatively in 16 patients. Subsequent recurrent obstruction occurred in four patients. Other complications occurred in three patients and included retained tube, jejunostomy-site abscess, and intestinal fistulization. Four patients died for an in-hospital mortality of 25%. Internal stenting for adhesions should be used cautiously. Its use should probably be restricted to the setting of severe adhesive small bowel obstruction particularly when numerous enterotomies are incurred during the course of adhesiolysis.

Humans↗

[Intestinal obstruction caused by ischemic colitis: description of 3 surgically treated cases].

The diagnosis of ischemic colitis is challenging and still based upon a high index of suspicion. We report here, three patients affected by ischemic colitis causing stenosis and intestinal obstruction who required surgical treatment. Results of surgery in the three cases were not fair reflecting the high mortality and morbidity rate of ischemic colitis. However, the three cases showed peculiar features allowing us to make a few speculative considerations. Better results in the treatment of ischemic colitis might be achieved by means of a prompt recognition of the initial picture and through a better control of the many associated diseases, that represent the main risk factor for the development of ischemic colitis itself and for the bad prognosis of surgical treatment.

Aged↗

Segmental dilatation of the ileum: an uncommon cause of neonatal intestinal obstruction.

Two cases of congenital segmental dilatation of the ileum are reported. In both cases additional abnormal segments of bowel were not diagnosed during the initial laparotomy, and further surgical exploration was required. Consideration of this entity in the differential diagnosis of neonatal intestinal obstruction may enable definition of the optimal site for bowel resection and anastomosis.

Diagnosis, Differential↗