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PubMed1991

[Tactics in cholelithic intestinal obstruction].

Tactical manipulations in cholelithic intestinal obstruction are analysed. The authors had 4 cases with cholelithic intestinal obstruction, in one of them obstruction with a gallstone occurred again on the 23rd postoperative day. Relaparotomy, correction of the obstruction, and cholecystectomy with one-stage removal of a biliodigestive fistula had to be conducted. It is pointed out that in obstruction of the intestine with a gallstone correction of the obstruction is a more sparing operation than one-stage cholecystectomy and removal of a biliodigestive fistula. With the use of this tactics there were no fatal outcomes.

Adult↗
PubMed1993

Epidural block for treatment of intestinal obstruction--clinical and experimental studies.

Seventy patients with intestinal obstruction were managed with usual conservative treatments and epidural anesthesia to block splanchnic and somatic nervous systems, for nine years from 1981 to 1990. Improvement of clinical symptoms and general conditions was accomplished in 48 patients (68.6%). In these 48 patients, 41 patients (58.6%) had complete remission of intestinal obstruction, showing flatus in 8.3 hours on an average, but seven (10.0%) had incomplete remission. For these seven, after improvements of their clinical symptoms, elective radical operations were performed within three weeks. In 22 (31.4%) patients whose symptoms were not improved at all with the epidural block, emergency exploratory celiotomies were performed, 15.4 hours on an average after the initial epidural block. Indications for surgical intervention of intestinal obstruction were decided by the absent movement of gas in the bowel in a series of plain X-rays. The effectiveness of the epidural block on the motility of the obstructed intestinal loop was experimentally confirmed in monkeys. We suggested that the epidural block, accompanied with usual conservative treatments, be recommended as the initial treatment for intestinal obstruction.

Journal Article↗
PubMed1993

[Physiopathology and principles of intensive care in intestinal obstructions].

The physiopathology of intestinal obstruction consists of increased intestinal peristaltis, distension by gas and fluids, contraction of the extracellular fluid volumes (plasma and interstitial sectors) and bacterial proliferation. To this must be added, in obstruction by strangulation, the passage of bacteria and bacterial products into the general circulation and the peritoneal cavity through an ischaemic or necrotic intestinal wall. Metabolic disorders consist of water, sodium and potassium deficits and acid-base disturbances. Water and electrolyte replacement should take into account the deficits that existed at the beginning of treatment, the additional losses expected during treatment and the needs for daily maintenance of water and electrolyte balance. The therapeutic procedure is simple provided it is systematized.

Critical Care↗
PubMed1990

[Etiology of intestinal obstruction--4 years' experience].

In order to find out the etiological patterns of intestinal obstruction, we reviewed 1205 cases diagnosed as intestinal obstruction at our hospital. The operative findings, locations of obstruction and pathological results were analyzed among 707 cases who were operated on. The most common cause of colon obstruction was tumor (78.7%). The etiologies of small intestinal obstruction were: adhesions, 47.4%; hernia, 22.1%; tumor, 11.8%; intussusception, 8.8%; foreign bodies, 3.7%; and miscellaneous causes, 6.2%. In the patients older than 40 years, the most common causes of intestinal obstruction were adhesion and malignancy, in contrast to hernia and intussusception that were commonly found in children. The mean age of the patients with colon obstruction was older than those with small bowel obstruction, 55.7 +/- 21. vs 39.4 +/- 17.3 (P less than 0.001). Of the patients with previous abdominal surgery, adhesions caused the obstruction in up to 60.5%. Among the 102 cases who had been operated for abdominal malignancy, the cause of intestinal obstruction was due to recurrent tumor in 78 patients (76.4%). Of patients without previous abdominal surgery, the etiologies of intestinal obstruction were: incarcerated hernia, 36.7%; tumor, 21.1%; intussusception, 15.6%; and adhesion, 13.8%. The incidence of strangulation obstruction was 25.7%, of which the major causes were adhesions, 51.7%; and hernia. 43.0%. We concluded that the most common cause of colon obstruction was tumor. The two most common causes of small intestinal obstruction were adhesions and hernia. Age and past history of abdominal surgery can much help for the differential diagnosis.

Adolescent↗
PubMed1997

Intestinal obstruction due to ascariasis.

BACKGROUND: Intestinal obstruction due to ascariasis results from heavy worm infestation. This study is a review of 92 patients with intestinal obstruction from Ascaris lumbricoides. METHODS: Sixty-eight patients without peritonism were treated conservatively with resuscitation, antibiotics and anthelminthics. The remaining 24 patients presented with abdominal signs suggesting strangulation. Plain abdominal radiography was done in all patients. Abdominal ultrasonography was performed in the last 22 patients. RESULTS: There were no deaths in the first group and duration of hospital stay ranged from 4 to 7 days. Five of 24 patients in the second group died during resuscitation. After successful resuscitation, 19 had a laparotomy. Six patients needed resection of gangrenous bowel with primary anastomosis, in 11 an enterotomy was used to remove obstructing worms and in two it was possible to milk obstructing worms into the colon. Seven patients died after operation, giving an overall mortality rate of 12 of 24 patients in the second group. The characteristic sonographic features of 'railway track' sign and 'bull's eye' appearance helped make the diagnosis of ascariasis, and ultrasonographic signs were also typical for strangulation in five patients. CONCLUSION: Early clinical diagnosis supported by ultrasonography, together with prompt surgery when necessary, might reduce the mortality rate in what is still a potentially dangerous condition.

Adolescent↗
PubMedDate not supplied

Effects of octreotide and a-tocopherol on bacterial translocation in experimental intestinal obstruction: a microbiological, light and electronmicroscopical study.

BACKGROUND/AIMS: Bacterial translocation induced by intestinal obstruction is suggested to be due to increased intestinal luminal volume, leading to intestinal overgrowth with certain enteric microorganisms and intestinal mucosal damage. If this suggestion is true, maintenance of intestinal mucosal integrity by a cytoprotective agent, a-tocopherol, and inhibition of gastrointestinal secretions by octreotide should decrease the incidence of bacterial translocation and extent of mucosal injury due to intestinal obstruction. METHODS: Complete intestinal obstruction was created in the distal ileum of male Wistar Albino rats by a single 3-0 silk suture. The animals received subcutaneous injections of 1 ml of physiologic saline (group 1) (PS 24) and 1 ml of saline containing octreotide acetate (100 micrograms/kg) (group 2) (OC 24), at 0, 12 and 24 hours of obstruction. In group 3 (PS 48) and group 4 (OC 48), the rats were treated with subcutaneous physiologic saline (1 ml) and octreotide acetate (100 micrograms/kg), respectively, beginning at the time of obstruction and every 12 hours for 48 hours. The rats in group 5 (Toc 24), were pretreated with intramuscular a-tocopherol 500 mg/kg on day 1 and 8, and underwent laparotomy on day 9. A third dose of a-tocopherol was injected at the time of obstruction on day 9 and no treatment was given thereafter. We tested the incidence of bacterial translocation in systemic organs and circulation and evaluated the histopathological changes in all groups. RESULTS: Treatment with octreotide acetate was found to be ineffective in reducing the incidence of translocation, with no histopathological improvement. Mucosal damage scores, on the other hand, in the a-tocopherol group were statistically less than those in the octreotide and control groups (p < 0.05). Additionally, a-tocopherol treatment decreased the incidence of organ invasion with translocating bacteria, although this difference did not reach statistical significance. CONCLUSION: Octreotide acetate treatment in complete intestinal obstruction has no effect on the incidence of bacterial translocation. a-Tocopherol, on the other hand, has a cytoprotective effect on intestinal mucosa in intestinal obstruction which, in turn, is thought to decrease bacterial translocation when used in physiological doses and prophylactically.

Animals↗
PubMed2005

Anomalous congenital band: a rare cause of intestinal obstruction and failure to thrive.

Intestinal obstruction caused by an anomalous congenital band is very rare in adults and children. A 7-year-old boy was admitted with acute intestinal obstruction. His parents mentioned that the child always had mild abdominal distention and failure to thrive from his infancy. On his medical history, there were not any attacks of abdominal pain, fever and hospitalization. Laparotomy showed an ileal loop compressed by an anomalous band, which extended from the ileum to the sigmoid mesentery resembling a mesenteric remnant. The band was resected. Histologically, it was composed of loose connective tissue containing mature vessels.

Child↗
PubMed2005

[Pathogenetic mechanisms of peritonitis in acute small intestinal obstruction].

Microscopic changes in the walls of strangulated small intestine, morphology of their vascular and resorption elements, adaptive mechanisms were studied in experimental acute small intestinal obstruction. It is demonstrated that the main factor of pathogenesis of peritonitis in strangulate and obstructive small intestinal obstruction is morphofunctional changes of intraorganic microcirculation of the small intestine.

Acute Disease↗
PubMed1998

[A strangulated perineal hernia. A rare case of intestinal obstruction].

A rare case of intestinal obstruction due to strangulated perineal hernia, observed among 533 small bowel obstructions operated since January 1982 until December 1994 (0.2%) is described. Less than 100 cases are reported in literature. The etiologic, anatomical and clinical aspects of perineal hernia are examined. The reported case is of the primitive, congenital type caused by defect of the rectovaginal fascia fusion, in correspondence of the Douglas. Preoperative diagnosis is very difficult. Strangulation of this type of hernia is rare, the hernial sac surrounding tissue being elastic. In case of strangulation, symptoms of intestinal obstruction appear. In the reported case the preoperative diagnosis was "acute abdomen", because there was defence in hypogastrium and in the right iliac fossa. A straight abdominal radiography has not been performed. In the reported case the patient, a 22-year-old woman, was promptly operated and the incarcerated intestinal loop released. A regular postoperative period followed. The importance of a complete clinical examination, of a straight abdominal radiography and of a promptly performed operation is underlined.

Abdomen, Acute↗
PubMed1981

Effects of intestinal obstruction of plasma water and extracellular fluid volumes in the rat.

Total and regional plasma water and extracellular fluid volumes were measured in rats after obstruction of the small intestine. The rats lost 12.6 per cent of their initial weight. The volume of the sequestrated fluid in the obstructed intestine corresponded to 91 per cent of the plasma water volume. Intestinal obstruction caused a 19 per cent reduction of the total plasma water volume, while the total extracellular fluid volume was unchanged. Regional extracellular fluid volumes were diminished in the lung, liver and gastric antrum and increased in omental fat. The results indicate regional differences in fluid space responses to obstruction of the small intestine.

Animals↗
PubMed1986

Treatment of distal intestinal obstruction syndrome in cystic fibrosis with a balanced intestinal lavage solution.

Conventional treatment of distal intestinal obstruction syndrome (DIOS) with high doses of pancreatic enzymes, mucolytic agents, and enemas is neither predictably effective nor rapid in action. In 6 cystic fibrosis patients with DIOS a balanced, non-absorbable intestinal lavage solution produced clinical and radiological improvement and striking improvement in DIOS scores. It is suggested that a balanced intestinal lavage solution should be considered as an alternative treatment for DIOS in patients with cystic fibrosis.

Adolescent↗
PubMed1981

Small bowel obstruction: the role of nonoperative treatment in simple intestinal obstruction and predictive criteria for strangulation obstruction.

The clinical presentation, treatment, and results of 405 patients with mechanical small intestinal obstruction admitted to the Montefiore Hospital and North Central Bronx Hospitals were reviewed. The etiology of obstruction was adhesions 74%, malignancy 8.6%, hernia 8.1%, inflammatory bowel disease 5.2%, and miscellaneous causes 4.1%. The overall mortality rate for the series was 6.7%, and the incidence of bowel strangulation was 10.1%. Strangulation occurred in 33.3% of the hernia group, 9.0% of the adhesions group, and 2.8% of the malignancy group. The largest single cause of death was related to malignant disease--12 cases (44.4%). Six deaths (22.2%) were caused by bowel strangulation. Of the patients who received more than 24 hours of nonoperative therapy, 46% had relief of obstruction. There was no statistically significant difference in successful results between patients managed with long tubes compared to patients managed with nasogastric tubes. Conservative therapy for malignant obstruction was not successful in 85% of cases. The presence of bowel strangulation shows a positive correlation with age (greater than 70 years), feculant vomiting, peristaltic sounds, and a white blood cell count higher than 18,000/mm3. It shows no correlation with onset, localization or type of pain, duration of symptoms, temperature, tachycardia, or x-ray findings. The results of the study indicate that accurate criteria for small bowel obstruction therapy have not been clearly defined except in patients with incarcerated hernias. Nonoperative management is successful in a significnt percentage of patients.

Adolescent↗
PubMed2004

Surgical workload and cost of postoperative adhesion-related intestinal obstruction: importance of previous surgery.

Postoperative intraabdominal adhesions cause morbidity of varying degree. Intestinal obstruction is the most severe complication of adhesions. This study examined the importance of previous surgery on clinical and economic workloads caused by intestinal obstruction due to postoperative intraabdominal adhesions. All emergency hospitalizations due to adhesion-related intestinal obstruction from January 1, 1999 to December 31, 1999 in a hospital district serving roughly 450,000 inhabitants was reviewed retrospectively. The patient population was divided into six groups according to the site of previous surgery, and the total as well as group-related surgical workload and direct costs of inpatient care were analyzed. There were 123 hospitalizations due to postoperative adhesion-related intestinal obstruction during the study period. A total of 101 patients had experienced 176 operations. The most prevalent operations were colorectal (with or without other operations), upper abdominal, and female reproductive system procedures. Colorectal surgery preceded 40% and 38% of inpatient episodes and inpatient days, respectively. Altogether, 40 operations were performed because of adhesion-related intestinal obstruction. No differences between groups were seen in terms of the mean operating or theater time. Total annual inpatient costs due to emergency hospitalizations for intestinal adhesion-related obstruction related to colorectal surgery in a hospital district serving roughly 450,000 inhabitants was 72,520.60 (U.S. dollars) which accounted for 35.3% of all annual costs caused by postoperative adhesion-related intestinal obstructions. There were no significant differences between groups regarding the total mean inpatient episode costs. Intestinal obstruction due to postoperative adhesions poses substantial costs for the society. Colorectal operations are the most important procedures preceding adhesion-related intestinal obstruction, accounting for 35.3% to 46.8% of the total clinical workload or costs attributable to postoperative adhesion-related obstruction.

Adult↗
PubMed2003

[Surgical treatment of large intestines obstruction caused by colorectal cancer].

Large intestinal obstruction like a life-threatening steatement is a subject of investigation in the present study. In such prospection are included 65 patients undergone surgery for large intestinal obstruction of cancer in period of seven years. Analyzed are after undertaken surgical procedures. It is clear that tendency of more security after surgery is concerned with the principles of radicalization after lower morbidity and mortality.

Colorectal Neoplasms↗
PubMed1976

[Diagnosis and treatment of intestinal obstruction caused by cholelithiasis].

Cholelithic intestinal obstruction was observed in 7 (4.7%) of 150 patients operated upon for intestinal obstruction of non-tumor origin. The patients' age ranged from 56 to 82 years. The patients were admitted within the terms from 1 to 21 days since the onset of the disease. All patients were subjected to surgical therapy. In one case a duodenal concretion was removed, and cholecystectomy was performed. In the remainder a bile stone was removed from the small intestine. In one of these patients the intestinal segment changed pathologically being resected with an end-to end anastomosis. Three patients died: two--from peritonitis and one--from pulmonary artery embolism.

Age Factors↗
PubMed2006

Adhesive intestinal obstruction.

BACKGROUND: Adhesions after abdominal and pelvic surgery are a major cause of intestinal obstruction in the western world and the pathology is steadily gaining prominence in our practice. OBJECTIVE: To determine the magnitude of adhesive intestinal obstruction; to determine the types of previous operations in patients who presented with adhesive intestinal obstruction; to determine the outcome of treatment; and to determine the factors affecting the overall management of adhesion-related intestinal obstruction. DESIGN: Retrospective descriptive study. SETTING: The Moi Teaching and Referral Hospital (MTRH) - Eldoret, Kenya. RESULTS: Ninety three patients were managed for adhesive intestinal obstruction. Of these, 57 were male and 36 were female. Abdominal distension, bilious vomiting, absolute constipation and abdominal pain were the main symptoms. Forty two (45%) patients were operated on, twenty five (59%) of them being operated on more than 72 hours after the start of the symptoms. Eight (9%) patients had ischaemic gut injury by the time of operation. Fluid therapy was inadequately administered in 86 (92%) patients, and their charts were not completely filled. CONCLUSION: Adhesion-related intestinal obstruction is a common problem encountered in the surgical service at the Moi Teaching and Referral Hospital-Eldoret. It is the major cause of intestinal obstruction. Fluid therapy and delayed surgical intervention were the major challenges in the management of these patients.

Adolescent↗
PubMed1992

[The effects of dachengqi decoction, shaogan decoction, emodin and sennoside on the histamine level of intestinal mucosa in intestinally obstructed rats].

The experimental intestinal obstruction model was made by partly ligating the ileum in rat. The histamine levels of obstruction groups (8.14 +/- 2.28 micrograms/g) were obviously lower than those of control groups (P < 0.01). After administration of Dachengqi decoction, Shaogan decoction, emodin and sennoside, the levels of histamine were significantly higher than those of obstruction groups, but there were no significant differences as compared with control groups.

Animals↗
PubMed1975

Effect of acute intestinal obstruction on the leakage of albumin from blood into the small intestine.

The effect of a simple, low intestinal obstruction has been investigated in dogs on the leakage of 131I-serum albumin from the circulation into the intestine. An increase leakage has been demonstrated. In the distended segment of the intestine above that ligation a significant increase in protein-bound radioactivity, from the normal value of 0.082 plus or minus 0.012 ml/10 cm intestine/hour to 0.276 plus or minus 0.068 ml/10 cm intestine/hour, was obseved which means a more than 3fold increase. The values for albumin leakage did not change in the more proximal segments of the intestine less involved in the distension namely in the duodenum and the jejunum, furthermore in the ileal segment below the ligation. The increase in albumin liadage observed during intestinal obstruction resulted in 33% rise of total catabolism.

Acute Disease↗