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PubMed1983

Elevated levels of peripheral serum creatine phosphokinase with strangulated small bowel obstruction.

Experimental arterial bowel infarction can cause elevations in levels of peripheral serum creatine phosphokinase (CPK), lactic dehydrogenase (LDH), and their isoenzymes. To test whether these changes would occur in strangulated small bowel infarctions, 18 dogs were placed under general anesthesia and randomized to one of three categories: laparotomy alone, simple mechanical small bowel obstruction, or strangulated small bowel infarction induced by incarcerating bowel in a surgically created ventral hernia. Serum samples were drawn for 48 hours postoperatively. Total CPK and LDH activity were determined by automated spectrophotometry; isoenzyme levels were determined by agarose gel electrophoresis. Levels of peripheral serum CPK and each of its isoenzymes became significantly elevated in the dogs with strangulated infarction. Such elevations did not occur with LDH. The findings suggest that changes in peripheral serum CPK could prove helpful in evaluating bowel viability in cases of intestinal obstruction.

Animals↗
PubMed1978

Strangulating adhesive small bowel obstruction with normal radiographs.

A review of patients having laparotomy for adhesive small bowel obstruction has revealed that many patients have normal radiographs on admission and that this group of patients, who are predominantly women, have delayed laparotomies and are at a significantly increased risk of developing strangulating obstruction while in hospital. The clinical and laboratory data which may distinguish strangulating from non-strangulating obstruction were examined and found to be non-discriminatory in this series.

Adolescent↗
PubMed1987

Catecholamine effects on pulmonary blood vessels in strangulation.

Guinea pigs were killed by strangulation to investigate the vasomotor of pulmonary congestion by asphyxia. The noradrenaline uptake by the endothelial cells of the pulmonary arteries and capillaries was observed by fluorescence histochemistry, peroxidase-anti-peroxidase (PAP) immunocytochemistry, and autoradiography. By radioassay, the volumes of noradrenaline uptake by the pulmonary arteries and capillaries in the strangulation group were at a significantly higher level than in the control groups. Many myoendothelial junctions were observed at the sites of constricted arteries, and the invasive noradrenaline was clearly observed in the myoendothelial junction. The mechanism of the pulmonary vasoconstriction in strangulation is due to the fact that the plasma noradrenaline, increased by asphyxia, invades the endothelial cells of pulmonary arteries and capillaries and causes the vasoconstriction.

Animals↗
PubMed1981

[Histomorphological alterations of lung after strangulation. A comparative experimental study (author's transl)].

It was investigated by animal experiments (50 rats, 15 rabbits) if histomorphological vital reactions can be found in the lung after strangulation and how far these findings differ from other violent causes of death with comparatively short survival period. Besides strangulation by ligature the animals were killed by overdose of ether, chloroform, pentobarbitone, and ketaminehydrochloride; gasing with propane and nitrogen; suffocation in a small closed box; thoracic compression; injection of KCN i.p.; decapitation, blunt force; electric current; cardiac injection of KCL. In comparison with the controls the striking findings after strangulation consisted of a qualitatively and quantitatively considerable hemorrhagic syndrome and an edema of all compartments of the lung which was frequently hemorrhagic, too. The authors award specific significance to the alveolar-septal edema which was found in semithin sections (and electron-microscopically)--which never occurred in the controls.

Animals↗
PubMed1998

The effect of Ginkgo biloba on the activity of catalase and lipid peroxidation in experimental strangulation ileus.

This study was designed to assess the therapeutic effect of Ginkgo biloba extract (EGb 761) in experimental strangulation ileus. Rats were divided into control (n = 7), placebo (n = 11), and EGb-treated (n = 11) groups. No surgical procedure was carried out on the control group. Strangulation ileus was produced in the placebo and EGb groups for 2.5 h. At the end of this period, 100 mg/kg EGb in 1 ml of saline was injected intraperitoneally to the EGb-treated group. In the placebo group, animals received an equivalent amount of saline intraperitoneally; 24 h later, repeat laparotomies were performed to take blood and intestinal tissue samples. The EGb treatment decreased tissue malondialdehyde levels and increased catalase activities compared with the placebo group (P < 0.05 for both). Serum creatine kinase and phosphorus levels were also determined in all groups. In the placebo group these were significantly higher than in the control group (P < 0.01 and P < 0.05, respectively). In the EGb group these were not different from controls and the increase in creatine kinase activity in the EGb group was not as high as in the placebo group (P < 0.05). Our results suggest that EGb could be preventive against the effects of strangulation ileus in a rat model.

Animals↗
PubMed2006

Is D-dimer a predictor of strangulated intestinal hernia?

BACKGROUND: The goal of this study was to assess the relevance of serum D-dimer measurement as a possible reliable marker for the diagnosis of strangulated intestinal hernia. METHODS: Consecutive patients admitted with nontraumatic acute abdominal gastrointestinal disorders were recruited prospectively in a tertiary referral hospital. The study was conducted in 159 patients between August 2002 and April 2004. D-dimer, lactate dehydrogenase, serum amylase, and international normalized ratio (INR) levels were tested in the emergency room prior to surgical intervention. For each patient, 15 variables, including D-dimer, were available for analysis. RESULTS: Thirty-three (20.7%) of the 159 patients had intestinal ischemia, and 28 (85%) of these 33 patients had D-dimer level > 300 ng/ml. Plasma levels of D-dimer in patients with intestinal ischemia were significantly higher than in patients without ischemia (P < 0.05). There were 29 (18.2%) patients in the hernia group with incarceration (n = 22) or strangulation requiring resection (n = 7). D-dimer levels in patients requiring intestinal resection were insignificantly higher than in patients without resection (P > 0.05). Six (85%) of the 7 hernia patients requiring resection had D-dimer levels > 360 ng/ml. The D-dimer variable correlated best with the leukocyte count in patients with hernia requiring resection. Levels of lactate dehydrogenase, serum amylase, and INR did not show any correlation with D-dimer levels. CONCLUSIONS: To help predict ischemic events, the increasing use of the D-dimer assay in clinical practice could be extended to patients presenting with intestinal emergencies. An elevated D-dimer level on admission had a high sensitivity for identifying patients with intestinal ischemia, although it had a low specificity. Whether it is predictive or preventive for resection in strangulated intestinal hernia patients still remains a question.

Adult↗
PubMed2006

Strangulated umbilical hernias in children.

Umbilical hernia is a frequent pathology of the anterior abdominal wall in children. The hernia ring closes usually before 4 years, but a strangulation can occur. It is an exceptional complication according to the literature data. Since this complication is rare, we undertook a retrospective study of these strangulations in a 5-year period from January 1997 to December 2001 at Aristide Le Dantec hospital. We collected 41 cases that underwent emergency surgery operations for strangulated umbilical hernias, which represent about 15% of umbilical hernias operated during the same period. The age range was 8 months to 10 years and the average age was 14 months. All the children were examined within 24 h after the onset of the disease and the surgery was immediately performed. In five cases the bowel was necrosed and perforated and we performed a resection followed immediately by an anastomosis. In the follow up, two children presented wound infections and a hernia recurred in one child. There was no mortality. This study conducts us to question western reports which recommend conservative therapy for umbilical hernia in children.

Child↗
PubMed2000

Treatment of acute strangulated internal hemorrhoids by topical application of isosorbide dinitrate ointment.

Exogenous nitric oxide has been shown useful in decreasing the internal anal sphincter tone. This study investigated the role of isosorbide dinitrate in the treatment of patients with acute strangulated internal hemorrhoids, thereby avoiding the risk of continence disturbances following conventional surgical treatment. Four male patients (median age 35 years, range 30-42) with acute strangulated hemorrhoids were treated with 1% isosorbide dinitrate. The ointment was applied to the anoderm. This application was repeated every 3 h during daytime for 2 weeks. Significant pain relief was achieved within 1 day, while transient mild headache was experienced during the first 2 days. Within 1 week the hemorrhoids became reducible. Thereafter the hemorrhoids could be treated adequately by rubber band ligation. The alternative treatment of patients with acute strangulation of prolapsed internal hemorrhoids is effective. This nonsurgical, i.e., reversible reduction of sphincter tone is an attractive alternative.

Acute Disease↗
PubMed2001

Strangulated umbilical hernia in a child: report of a case.

Most umbilical hernias in children close spontaneously. Complications associated with umbilical hernias are rarely observed during follow-up. We report herein a 5-month-old girl with a strangulated umbilical hernia. Her umbilicus was hard, reddish, and irreducible. Plain radiography of the abdomen showed signs of mechanical ileus. The patient was thus diagnosed to have a strangulated umbilical hernia. A 5-cm section of the ascending colon and a 5-cm section of the terminal ileum, as well as the cecum and appendix, were congested, edematous, and erythematous, and together were enclosed by a firm hernial ring. A closure of the fascial defect and umbilicoplasty were performed. The postoperative course was uneventful. In patients with infantile umbilical hernias, strangulation may occur as the fascial defect decreases in size.

Constriction, Pathologic↗
PubMed2004

Gallbladder strangulation within an incisional hernia.

We describe here the first case in the literature of gallbladder strangulation within an incisional hernia. A patient with a history of rectal cancer operation presented with a "surgical abdomen" and a palpable right upper quadrant mass at the site of the previous colostomy. At surgery, a strangulated gallbladder was found in the subcutaneous tissue. Cholecystectomy was performed, and patient recovery was uneventful. If gallbladder strangulation is suspected, the surgeon should avoid forceful attempts at hernia reduction, as this may cause rupture of the gallbladder and subsequent contamination.

Aged↗
PubMed1989

Increased peritoneal fluid lactic acid values and progressive bowel strangulation in dogs.

In the present study, we determined values for peritoneal fluid and blood ammonia, amylase, and lactic acid content in 11 dogs after experimental bowel strangulation. In the nine survivors of this group, we demonstrated a near linear increase in peritoneal fluid lactic acid over a 24-hour period, during which the plasma lactic acid remained relatively constant. A significant increase in peritoneal fluid ammonia was also demonstrated, but this did not occur until more than 16 hours after strangulation. In a second group of two dogs in which simple obstruction was produced, no significant increase in peritoneal fluid lactic acid or ammonia occurred. We did not find significant changes in peritoneal fluid amylase in this study. These data suggest that the determination of peritoneal fluid lactic acid content, especially when compared with concomitant plasma lactic acid, may be useful in the accurate preoperative diagnosis of bowel strangulation.

Ammonia↗
PubMed1994

Hair coil strangulation of the penis.

Strangulation of the penis caused by a coil of hair is uncommon. It can produce varying grades of injury that may result in a urethral fistula or even gangrene of the glans. Therefore it is important to be aware of this condition so that the strangulating hair can be removed and treatment instituted. The authors describe 15 boys who presented with hair coil strangulation of the penis. Their age range was 5 to 11 years. All were previously circumcised. Three boys had a superficial injury, and 11 had a more severe injury that resulted in a urethral fistula. One boy presented with gangrene of his glans penis, which resulted in autoamputation. One-stage repair was performed in 10 boys. The first three had recurrence of the fistula, and hence the technique was modified for the remaining seven patients. The latter technique proved simple and satisfactory.

Child↗
PubMed1995

CT in the early detection of strangulation in intestinal obstruction.

The role of CT in evaluating the gastrointestinal tract has increased recently because CT demonstrates pathological conditions involving the bowels, mesenteric vessels, and peritoneal cavity well. In patients who have an intestinal obstruction, the observation of both bowel loop configuration and mesenteric vessels on CT is the key to identifying the site and cause of obstruction and determining the absence or presence of intestinal strangulation. Although many clinical and radiological findings reported in the literature are not seen in the early stages of intestinal strangulation, CT might assist in its early detection. This article reviews the clinical, pathophysiological, and radiological aspects of strangulating obstruction with emphasis on the role of CT in its early diagnosis.

Contrast Media↗
PubMed1995

Fracture of the hyoid bone in survivors of attempted manual strangulation.

Fractures of the hyoid bone are known to occur in 17-71% of fatalities following manual strangulation, but are infrequently recognised in survivors. Two cases are presented of attempted manual strangulation in young women (aged 30 and 35 years) in which lateral neck X-rays disclosed an isolated fracture of the greater horn of the hyoid bone. In both cases the X-rays were performed because the victim complained of symptoms: one victim complained of pain on swallowing and on neck movement. The other complained of pain on speaking and swallowing. Radiological demonstration of an isolated hyoid fracture is of great evidential value in criminal proceedings in cases of attempted manual strangulation, especially when presentation to the police authorities is delayed and external evidence of neck injury may be minimal. Consideration should be given to obtaining X-rays in those cases where symptoms persist.

Journal Article↗
PubMed2005

Homicide by ligature strangulation in Finland: offence and offender characteristics.

In Finland, homicide by ligature strangulation is a rare event. The purpose of this study was to investigate recent homicide cases by ligature strangulation and to analyse offence and offender characteristics. All forensic psychiatric evaluation statements of offenders accused of ligature strangulation homicides during the 7-year period 1996--2002 (n=19) were reviewed retrospectively. Thirty-five percent of the victims were females. In four cases, the victim was the offender's intimate partner; in one case, it was the stepson; in one case, a father and in the rest of the cases (n=13), an acquaintance. None of the cases involved planning, sadism or sexual elements. In 89% of the cases, the offender was either intoxicated or on drugs at the time of the offence and in 94% of the cases, the victim was found at the scene of the killing. Of the offenders, 63% had crime history, and approximately half of the offenders had experienced parental alcohol abuse, domestic violence or previous trauma. Most of the offenders were unemployed at the time of the offence. In all, 89% were diagnosed as having personality disorder and two were schizophrenic.

Adolescent↗
PubMed2004

Penile strangulation treated with the modified string method.

Penile strangulation by a nonmetallic or thin metallic ring is easily overcome by severing the object, but a heavy metal ring causing penile strangulation is very difficult to sever. Here we report 2 cases of penile strangulation by metal rings, involving a 38-year-old man and a 44-year-old man, both of whom were treated with the modified string method and glandular puncture.

Adult↗
PubMed1997

Preoperative diagnosis of strangulated obturator hernia using ultrasonography.

BACKGROUND: Obturator hernia is rarely recognized before surgical intervention, since it is relatively infrequent and its definitive diagnosis is difficult. To change this situation, we introduced ultrasound examination in 1993 for differential diagnosis of strangulated obturator hernia among patients with bowel obstruction of unknown cause. PATIENTS AND METHODS: Between 1993 and 1995, we encountered 15 patients with suspected obturator hernia based on the presence of bowel obstruction of unknown cause and so-called predisposing factors. These patients underwent ultrasound examinations. RESULTS: The 4 patients with bowel obstruction caused by strangulated obturator hernia were all correctly diagnosed preoperatively by ultrasonography and were successfully cured by surgery. The time required for diagnosis was shorter than reported previously (average 16.5 h). CONCLUSIONS: Ultrasonography is useful and reliable for the diagnosis of strangulated obturator hernia and can decrease the morbidity and mortality associated with delayed diagnosis.

Aged↗