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PubMed2004

Systematic review of transpyloric versus gastric tube feeding for preterm infants.

AIM: To determine if enteral tube feeding by the transpyloric versus the gastric route improves feeding tolerance, and growth and development, without increasing adverse events, in preterm infants. METHODS: Systematic review of randomised controlled trials. A search was made of the Cochrane Controlled Trials Register (CCTR; 2003, issue 1), Medline (1966 to April 2003), and Embase (1980 to April 2003), and references in previous reviews. The data were extracted, analysed, and synthesised using the standard methods of the Cochrane Neonatal Collaborative Review Group. RESULTS: Data were found from eight trials. No evidence of an effect on growth or development was found, but transpyloric feeding was associated with a greater incidence of gastrointestinal disturbance: relative risk (RR) 1.45, 95% confidence interval (CI) 1.05 to 2.09. Transpyloric feeding was also associated with increased mortality: RR 2.46, 95% CI 1.36 to 4.46. However, the trial that contributed most to this finding may have been affected by allocation bias. No significant differences were detected in the incidence of other adverse events, including necrotising enterocolitis, intestinal perforation, and aspiration pneumonia. CONCLUSIONS: No evidence of benefit was found, but evidence of harm was found. Feeding by the transpyloric route cannot be recommended for preterm infants.

Enteral Nutrition↗
PubMed2003

Small bowel complication caused by magnetic foreign body ingestion of children: two case reports.

Accidental ingestion of foreign bodies is a common pediatric problem. The majority of such cases occur between 6 months and 3 years. When several magnets are ingested, they can be attracted to each other through the intestinal wall, causing necrosis and intestinal perforation or fistula, so they should be removed while they are still in the stomach. The authors experienced 2 cases of unusual small bowel complication caused by the ingestion of magnets. The first case was in a 10-month-old boy with ileal perforation caused by to 2 ingested magnetic beads, and the second case was in a 22-month-old boy with ileo-ileal fistula caused by to 7 ingested magnetic beads.

Foreign Bodies↗
PubMed2004

Intestinal obstruction by eosinophilic jejunitis.

Eosinophilic enteritis is an uncommon disease that rarely develops as a surgical emergency. Although it may be associated with infestation by Ancylostoma caninum, its etiology is unknown and often related to a personal or family history of atopy. A transmural involvement may cause intestinal obstruction--more frequently in the jejunum--or even acute abdomen, which may or may not be accompanied by intestinal perforation. The latter two conditions tend to be more commonly associated with ileum disease, causing pain in the lower right quadrant of the abdomen. Patient history, eosinophil count--which may be paradoxically reduced when the disease appears in this way--, ultrasonography, and/or CT lead to the suspicion of this condition before a surgical procedure is considered. A definitive diagnosis, however, must be reached by means of an anatomopathological study. Macroscopically, intestinal loops exhibit a thickened appearance with an elastic consistency. Laparoscopic intestinal biopsy may play a major role in the diagnosis of disease.

Enteritis↗
PubMed1999

Cadaveric small bowel/split liver transplantation in a child.

Scarcity of size-matched grafts continues to be a major limiting factor for liver and combined liver/intestinal transplants in the pediatric population. It is reported that 29% of pediatric patients listed for hepatic transplantation die while waiting for a donor. The reported mortality of pediatric patients awaiting intestinal transplantation is about 40%. We report on a technique of segmental liver and intestinal transplantation in a child. To our knowledge, this is the first report of a combined split liver-intestinal transplantation. We used a cadaveric donor, but the technique can also be performed with a live donor. The adult recipient of one segment of the liver was discharged home without complications. The child who received the combined liver intestinal graft developed intestinal perforation and severe rejection and died. If this technique is applied successfully, the adverse effects and mortality of a long pretransplant waiting period in pediatric patients may be avoided.

Adult↗
PubMed1984

Intestinal intramural haemorrhage after blunt abdominal trauma.

Intramural haemorrhage of the intestine following blunt trauma to the abdomen has been described in several clinical studies. Though such lesions may have an innocent appearance at primary laparotomy, they lead to delayed intestinal perforation in some cases. In previous experiments with similar lesions produced by penetrating abdominal missile, the histologic appearance and the clinical course were documented in pigs observed under long-term anaesthesia. In the present study anaesthetized pigs were submitted to blunt abdominal trauma in an impact machine, whereby the impact velocity could be regulated. The intra-abdominal pressure and the delivered impulse were recorded and the incidence and histologic appearance of intestinal injuries were observed at laparotomy immediately after the trauma. Intramural haemorrhage was found to occur when the impact velocity exceeded 5 m/s. At impact velocity 20 m/s, intestinal rupture occurred primarily. The observed intramural haemorrhages had the same histologic appearance as those seen after penetrating missile injury. The same clinical course, consequently, could be anticipated after blunt trauma.

Abdominal Injuries↗
PubMed2000

Small bowel injuries in children.

OBJECTIVE: To determine the common features of small bowel injury (SBI) in childhood and the consequences of delayed diagnosis. METHODOLOGY: A retrospective case review was performed of children with traumatic SBI between January 1988 and November 1999. RESULTS: Twenty-eight patients were identified with SBI. Road trauma accounted for 71% of them. Tachycardia was present on admission in 82% of patients with SBI including all but one of the intestinal perforations. SBI was associated with a Chance fracture of the lumbar spine in three patients (11%). An abdominal computed tomography scan with intravenous contrast was abnormal in all patients with a perforation or mesenteric tear. Diagnosis was delayed in six patients, one of whom died as a result of sepsis from a small bowel perforation. CONCLUSIONS: Persistent tachycardia with an appropriate mechanism of injury following blunt abdominal trauma requires active exclusion of SBI. Delayed diagnosis is associated with significant morbidity and mortality.

Adolescent↗
PubMed1977

Neonatal small left colon syndrome.

Neonatal small left colon syndrome is a functional disease of the lower colon which produces typical signs and symptoms of intestinal obstruction. It is manifest in the first 24-48 hours of life, particularly in infants of diabetic mothers and, if detected early, it can be fully cured by radiographic contrast enemas, not unlike meconium plug syndrome. Intestinal perforation and death may occur, however. The etiology of the disease is unknown but it may relate to neurohumoral imbalances between the autonomic nervous system and glucagon.

Colonic Diseases↗
PubMed1993

Obstructive intestinal herniation due to improper use of a seat belt: a case report.

The term "seat belt syndrome" has been used to describe injuries to the abdominal viscera caused by seat belts during car accidents. These injuries are usually sustained as a result of the rapid deceleration that occurs in front-end collisions, with the consequent compression of the abdominal viscera. The spectrum of injuries includes intestinal perforation or stenosis, mesenteric disruption, and lumbar fracture-dislocation. We present an uncommon case of obstructive herniation in a 2-year-old girl which we believe was due to improper use of a seat belt.

Child, Preschool↗
PubMed2004

Ileocaecal valve atresia: our surgical approach.

BACKGROUND: Atresia of ileocaecal valve is the rarest type of intestinal atresia; there are very few reports on it in the literature and all cases described to date were treated with ileocolic resection. METHODS: We present a rare case of ileocaecal valve atresia, the third in the literature, in which a "different" technical approach was employed as an alternative to the usual surgical technique (ileocolic resection). The described case came to our attention in a patient presenting with complicated intestinal perforation in whom we performed an ileal stoma after an unsuccessful conservative approach. Approximately four months later we operated her to close the stoma: during this procedure we discovered the colic valve atresia and treated it by creating a "new ileocaecal valve" and carrying out an appendectomy. After a 7-year follow-up no complications have occurred and the girl enjoys very good health. CONCLUSIONS: We conclude that performing a plasty of Bauhin's valve is a valid alternative to intestinal resection in such cases of atresia even if, according to some authors, the resection of the ileocaecal valve was not associated with increased morbidity and mortality (3).

Digestive System Surgical Procedures↗
PubMed1977

Nontraumatic perforations of the small intestine.

The etiology of nontraumatic small bowel perforations in 24 operated patients was as follows: strangulation in five, diverticulum in four, foreign bodies in four, idiopathic in three, Crogn's disease in two, malignant atrophic papulosis of Degos (MAP) in two, and tuberculosis, carcinoid tumor, radiotherapy, and iatrogenic in one. The high mortality rate in these patients appeared to be a funciton of the disease process rather than of the means of treatment. In favorable circumstances, as in strictly localized lesions with well known etiology and otherwise normal bowel, a simple closure of perforation is warranted. In more far advanced cases operated upon early enough, we still consider bowel resection and primary anastomosis as the best method of treatment, though it yielded poor results in procedures are advisable to protect the anastomosis.

Adolescent↗
PubMed1988

Acute graft-versus-host disease of the intestine. A surgical perspective.

The general surgeon may be involved in assessment and treatment of intestinal complications in patients who have undergone bone marrow transplantation. It is important to recognize the major causes of intestinal morbidity in these patients and to be aware of the cause and natural progression of the entity of acute graft-versus-host disease. Of 89 patients who underwent allogeneic bone marrow transplantation over a 6 year period, acute intestinal graft versus host disease developed in 29 (33 percent). Although surgical consultation for abdominal pain and peritonism was requested for 15 of these patients, intestinal perforation did not occur, and only two patients underwent laparotomy, both for obstruction (and hemorrhage in one case). Patients who require operation tend to be in the end stages of the disease, and the chance for salvage appears to be remote.

Bone Marrow Transplantation↗
PubMed2002

[Primary intestinal T lymphoma: a report of two cases and a review of the literature].

Lymphomas of the gastrointestinal tract are the most common type of primary extranodal lymphomas and about 15-20% of these are primary intestinal lymphomas. They may be or B or T- cell. Intestinal T-cell lymphomas are much less common and they can be enteropathy-associated. This disease occurs in adults with abdominal pain often associated with intestinal perforation. The course is aggressive. The major problem is to distinguish this disease from a benign ulcer. Two cases with differents clinical and pathologic features are reported with a review in the literature of this uncommon entity.

Adult↗
PubMed2005

[Intestinal ischemia represents serious surgical problem].

Surgeon rarely meets intestinal ischemia; it occurs in about 1 to 4% of abdominal operations. At our clinic about 170 patients per year are operated with the mortality 55 to 85%. It appears to be due to the advanced age of the treated patients, co morbidity and the late diagnosis. Intestinal ischemia can be caused by mesenteric arterial embolism (40%), thrombosis developing upon an atherosclerotic plaque (30%), nonocclusive form after the pharmacological treatment (20%), post operation changes, circulatory failure during cardiac arrhythmias, reperfusion act. If the case is not diagnosed in time on the basis of the patient's history and after the blood vessel examination, timely treatment cannot be done and the disorder can develop into the sepsis caused by intestinal perforation or in the more favourable circumstances by an extensive resection with the necessity to cooperate with an immunologist and nutritionist. Statistical data from the last years remain stable. To change the situation would require not only a development of invasive angiography but namely education of the medical doctors of the first and second line.

Humans↗
PubMed1996

Toothpick perforation of the intestine diagnosed by a small bowel series.

We report the case of a 50-yr-old man who unknowingly swallowed a double-pointed toothpick that ultimately perforated the distal small bowel over a period of several weeks. Appendicitis and ileitis were sequentially considered as diagnosis. A foreign body was diagnosed on a second small bowel series and removed. It has been noted that, because toothpicks are not radiopaque, radiographic studies are not useful in the diagnostic workup. In the case reported, the toothpick was seen on the contrast radiograph of the small bowel and the correct diagnosis ultimately made.

Appendicitis↗
PubMed1981

Ichthyosis and marrow involvement in malignant histiocytosis of the intestine.

It has recently been suggested that a number of small bowel lymphomas arise from histiocytic cells in the intestine. This has been referred to as malignant histiocytosis of the intestine (MHI) (Isaacson et al, 1979). Three such patients with small bowel malabsorption had the following features: subtotal villous atrophy of the jejunum, generalized ichthyosis, fever and lymphopenia are described. In all three, the bone marrow appearances were similar to those seen in histiocytic medullary reticulosis (HMR) (Scott & Robb-Smith, 1939). A tumour was present in the small bowel and/or mesentery of all patients and the histological lesion was similar to that described as MHI. Two patients had a response to combination chemotherapy. One patient had a complete remission of his disease but this relapsed after 1 year and proved refractory to chemotherapy. A second patient died following chemotherapy with gastro-intestinal perforation and septicaemia and the third patient died shortly after diagnosis and before chemotherapy could be commenced. It is suggested that the combination of signs, symptoms and pathological features described may reflect a specific clinical entity which has not previously been described.

Adult↗
PubMed1980

[Studies on relaparotomy in childhood (author's transl)].

20.8% of 2185 laparotomies were repeat procedures. Of these 159 were planned and a further 295 were not planned procedures. The most usual reason for an unplanned repeat laparotomy was intestinal obstruction due to adhesions. This was followed by abscess formation or peritonitis, fistula formation, intestinal perforation, or leakage at the suture line. Procedures are more often necessary in the first year of life. The average mortality was 11.7%, and increased with the number of repeat laparotomies. The most usual causes of death were septicaemia, pneumonia. Early repeat laparotomy and intensive post-operative treatment are advocated.

Abscess↗