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Three cases of intestinal obstruction are described in which the diagnosis was delayed because of the absence of gas in the bowel. The obstructed bowel was entirely fluid-filled and so abdominal distension was not marked, peristaltic sounds were not accentuated and the abdominal X-rays did not show air-fluid levels.
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Intestinal obstruction in pregnancy is rare and difficult to diagnose. Common causes of gestational intestinal obstruction include adhesions, volvulus, intussuscetion, carcinoma, hernia and appendicitis [3]. Abdominal pain is a common feature, but the displacement of abdominal organs as pregnancy progresses results in atypical location of the pain and hence delay in diagnosis. We report a case of intestinal obstruction at 33 weeks gestation in a woman with previous appendicectomy. Clinical suspicion of the presence of obstruction is required for prompt diagnosis and aggressive intervention, to minimise the morbidity and mortality of this rare complication of pregnancy.
During a 20-year period among 513 patients, subjected to surgery for acute intestinal obstruction, the intestinal obstruction with bile stones was noted in 10 cases. The clinical picture of cholelithic intestinal obstruction is characterized by an intermittent course, that would result in late hospitalization and a delayed surgical therapy. Among 10 patients under treatment there were 5 lethal issues. Despite a comparatively not infrequent spontaneous cure in this lesion, it is felt that active surgical measures should be employed. An initiated operative intervention should be as minimum as possible, i. e. be limited by a liquidation of the obstruction by means of removing a cholelith from the intestinal lumen.
Despite improvements in knowledge of the pathologic physiology of intestinal obstruction, the introduction of gastrointestinal decompression, and more effective antibiotics, obstruction remains a serious disease with a high mortality rate. Although the diagnosis is often obscure, it can usually be made with a fair degree of accuracy by the history alone; pain is fairly constant and characteristically is of a cramping type simulated by very few other lesions. Distention is present in low lesions but absent in high lesions; on the contrary, vomiting is minimal in low lesions but prominent in high lesions. Visible peristaltic waves are almost pathognomonic of intestinal obstruction. Increased peristaltic sounds, as noted by auscultation, are extremely helpful in diagnosis; they are absent in paralytic ileus. Although intestinal obstruction is a surgical lesion, it must be remembered that in the type produced by adhesions the obstruction can be relieved by gastrointestinal decompression in 80 to 90 per cent of cases. Operation is usually indicated a short time after relief because of the probability of recurrence. In practically all other types of obstruction decompression is indicated only while the patient is being prepared for operation. Obviously any type of strangulation demands early operation. Strangulation can usually be diagnosed, particularly if it develops while the patient is under observation. Increase in pain, muscle spasm and pulse rate are important indications of development of strangulation. Dehydration and electrolytic imbalance are produced almost universally in high obstruction. Usually, it is unwise to wait until these two deficiencies are corrected before operation is undertaken, but correction must be well under way at the time of operation. Resections should be avoided in the presence of intestinal obstruction, but obviously will be necessary in strangulation. Operative technique must be expert and carried out with minimal trauma. Postoperative care is very important; important features are decompression, for two to three days, accurate fluid and electrolytic replacement, and transfusions.
Mechanical intestinal obstructions form important part of pathologies those necessitates emergent surgical intervention. Length of time between symptoms and surgery, preference of surgical procedure and prevention of recurrence are still under discussion. While the most frequent etiological factor is postoperative adhesions in developed countries, strangulated hernias are more common in developing countries. In this study, among 147 cases operated on with the diagnosis of mechanical intestinal obstruction between 1993-1999, 80 strangulated were 50 males (%62.5) and 30 females (%37.5). Mean age was 59 years (range 4-94). The most frequent type of hernia was inguinal hernia and observed in 49 cases. Small intestine was detected most frequently in hernia sac. In 14 cases (%17.5), beside hernia repair, additional surgical interventions were performed. Total morbidity was %22.5 and mortality was %7.5. Patients with mechanical intestinal obstruction should be evaluated for abdominal wall hernias because of high incidence of mech surgical intervention have high morbidity and mortality rates, elective surgery should be recommended when abdominal wall hernia is diagnosed.
A method for an intestinal bypass operation is presented. The procedure has been valuable in patients with post-cystectomy intestinal obstruction who did not respond to non-operative measures. A discussion on the possible means to prevent further obstruction is included.
Five autopsy cases of sudden death caused by intestinal obstruction are reported. The causes of death of the cases were duodenal obstruction of impacted food stuff, ileocaecal obstruction caused by Crohn's disease, incarceration of inguinal hernia, intestinal obstruction caused by heterotopic pancreas and paralytic ileus. In three cases, the patient was in cardiopulmonary arrest on arrival at hospital, and in the remaining cases the patient died within 12 hours from the beginning of treatment; therefore, a correct clinical diagnosis was not made before the death in all cases. All the patients had from one to three days history of nausea and abdominal pain, major complications of intestinal obstruction. Among all cases, the duration from the onset to death was the shortest in the case of a patient complicated with schizophrenia. It is characteristic that the patients of all cases died suddenly and resuscitation was not successful. Regarding the laboratory data of a hospitalized patient, marked hemoconcentration and an increased level of BUN/Cr ratio and blood sugar were shown. The patient who died from duodenal obstruction caused by impacted food-stuff had suffered from depression for six years, and the patient who died from paralytic ileus had suffered from schizophrenia for about 23 years. In both cases, it is characteristic that the complaints of the patient were poorer than what would be expected. Furthermore, these patients had been taking medication of psychotic, anti-depressant and anti-parkinsonism drugs; therefore the combination of these drugs was thought to be reflected in the bowel movement.
SUMMARY: The use of laparoscopy for the management of acute intestinal obstruction is increasing. It has potential advantages over classic laparotomy. The objective of the current study was to evaluate the feasibility and outcome of laparoscopic management of small intestinal obstruction. A retrospective review of 30 children admitted for attempt of laparoscopic management of acute intestinal obstruction was performed. Their mean age was 6.7 +/- 1.73 years. Of the 30 laparoscopic attempts, 20 (66.7%) were performed successfully, whereas 10 patients (33.3%) needed a conversion to laparotomy because of inadequate laparoscopic visualization in 6 cases, gangrenous bowel in 2 cases, and inability to relieve the obstruction laparoscopically in 2 cases. There were no intra-or postoperative complications in the laparoscopic group. The mean operative time for the laparoscopic release of intestinal obstruction was 68 +/- 12.32 minutes and 102 +/- 9.67 minutes for the converted cases. The mean time of return of bowel function and mean hospital stay in the laparoscopic release of intestinal obstruction were significantly shorter. The study showed that laparoscopic release of intestinal obstruction in children is worthy of attempting initially. It is a feasible, effective, and safe alternative to laparotomy for most patients with acute intestinal obstruction.
BACKGROUND/AIMS: Acute intestinal obstruction is an urgent disease to be diagnosed and treated promptly. In elderly, fecal impaction may be an important and preventable cause of colonic obstruction. We investigated the clinical features of patients presenting with identical features of intestinal obstruction transiently due to fecal impaction. METHODS: From February 2001 to March 2004, nineteen patients were diagnosed as transient intestinal obstruction due to fecal impaction. We evaluated clinical characteristics, radiologic findings, sigmoidoscopic or colonoscopic findings and managements. RESULTS: Male and female ratio was 1:1.1. Mean age was 79.3 years. All 19 patients had abdominal pain and distension. On digital rectal examination, the hard feces was palpable in only 8 patients (42%) while others showed empty rectum. The abnormal laboratory findings included leukocytosis in 5 patients (26%), anemia in 10 patients (53%) and electrolyte abnormalities in 7 patients (37%). Simple abdominal X-rays showed diffuse small and/or large bowel dilatations. In only 3 patients (16%) air-fluid levels were definite, but most patients showed abundant feces in the rectum and colon. During emergency sigmoidoscopy, abdominal pain and distension were relieved and there were Bristol type 1 hard stool in the recto-sigmoid junction in 7 patients (37%) and multiple rectal ulcers in 1 patient. On colonoscopy, there were no mass or pathologic obstruction in all patients. Patients were discharged after the adequate medication and toilet training. CONCLUSIONS: In elderly patients, fecal impaction is odd and preventable cause of intestinal obstruction. It is often significant to differentiate fecal impaction from other pathologic conditions in patients with chronic constipation.
HYPOTHESIS: The prevalence and mechanisms of intestinal obstruction following laparoscopic abdominal surgery have not been studied extensively. DESIGN: Retrospective review of cases of intestinal obstruction after laparoscopic surgery. SETTING: Sixteen surgical units performing laparoscopy in France. PATIENTS: Twenty-four patients with intestinal obstruction. MAIN OUTCOME MEASURES: Prevalence values and descriptive data. RESULTS: The 3 most frequent primary procedures responsible for intestinal obstruction were cholecystectomy (10 cases), transperitoneal hernia repair (5 cases), and appendectomy (4 cases). Prevalences of early postoperative intestinal obstruction after these procedures were 0.11%, 2.5%, and 0.16%, respectively. Intestinal obstruction was due to adhesions or fibrotic bands in 12 cases and to intestinal incarceration in 11 cases. Obstruction was located at the trocar site in 13 cases (9 incarcerations and 4 adhesions), mainly at the umbilicus, and in the operative field in 10 cases (2 incarcerations in a wall defect after transperitoneal inguinal hernia repair, 4 adhesions, and 4 fibrotic bands). The small intestine was involved in 23 of 24 cases; the other was due to cecal volvulus following unrecognized intestinal malrotation. Intestinal obstruction was treated by laparoscopic adhesiolysis in 6 patients and by laparotomy in 18 patients, 6 of whom required small intestine resection. Three postoperative complications but no deaths occurred. CONCLUSION: Intestinal obstruction following laparoscopic abdominal surgery can occur irrespective of the type of operation; the prevalence is as high as (cholecystectomy and appendectomy) or even higher than (transperitoneal hernia repair) that seen in open procedures.
We report a case of bowel infection by Pneumocystis carinii (PC) that presented as an acute obstruction accompanied by intestinal hemorrhage (melena) in a HIV seropositive hemophilic patient. Laparotomy followed by resection of two plaque-like jejunal tumors was performed, and intravenous therapy with pentamidine was initiated. No other organ was found to be affected by PC (not even the lung), with the exception of the thyroid gland. To our knowledge, this is the first reported case in which acute intestinal obstruction was the presenting symptom of extrapulmonary pneumocystosis.
Intestinal obstruction in the early post-operative period may be difficult to diagnose clinically and on plain abdominal radiographs with failure to distinguish obstruction from ileus. During the last 11 years we have examined 14 patients with the enteroclysis technique (small bowel barium enema) for suspected early postoperative small intestinal obstruction. Evidence of obstruction was demonstrated in all cases, the site of obstruction was clearly shown in most patients, and the cause identified in 5.
BACKGROUND: Intestinal endometriosis is not commonly reported in Nigeria and Africa. This paper presents a case of chronic intestinal endometriosis in a young Nigerian woman presenting with features of chronic intestinal obstruction. METHOD: The case records of a 29-year old Nigerian female, who presented with chronic intestinal obstruction secondary to endometriosis at the Olabisi Onabanjo University Teaching Hospital (OOUTH) Sagamu, Nigeria and literature review on the subject using medline and manual library search is presented. RESULT: A young woman presented with a three- month history of progressive abdominal distension and worsening constipation. Examination revealed a grossly distended abdomen, slightly tense but no area of tenderness. Bowel sounds were slightly exaggerated. A plain radiograph of the abdomen showed features of small and large bowel obstruction. A diagnosis of chronic large bowel obstruction was made. She was found to have a stricture in the rectosigmoid at laparotomy. Hartmann's resection was done. Histologically, the stricture was due to endometriosis. Subsequent closure of colostomy and re-establishment of intestinal continuity gave excellent results. CONCLUSION: A young Nigerian female diagnosed with chronic intestinal obstruction due to rectosigmoid endometriosis was successfully treated. Though this condition is believed to be relatively uncommon in Nigeria, there is a need for a high index of suspicion, to ensure early diagnosis.