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PubMed1985

Intestinal obstruction caused by ingestion of a Heidelberg capsule: report of a case.

A case is reported in which a Heidelberg pH capsule was administered to a patient with the stenosing form of Crohn disease. The capsule impacted in the stricture resulting in small bowel obstruction ultimately requiring surgical intervention. The authors wish to emphasize that a careful history of preexisting intestinal disease should be taken before the administration of any nonabsorbable diagnostic device.

Crohn Disease↗
PubMed1980

[Results and conclusions based on our experience with the surgical treatment of mechanical intestinal obstruction].

Over the period 1963 to July 30, 1978 a total of 312 patients with clinical picture of acute or subacute mechanical ileus were admitted to the surgical department of the district hospital in Targovishte, and 227 of them were operated on as emergency cases. During the first period covering 1963-1970, the number of operated patients amounted to 78 of which eighteen - a 23.07 per cent lethality. During the second out of 149 patients operated on twenty-three died which makes a 15.63 per cent lethality. A detailed analysis is made of the factors influencing the treatment results, and the conclusion is reached that the age of patients, cause of obstruction and level of ileus have an essential practical bearing. It is assumed that in small intestinal ileus the 11.95 per cent lethality recorded among the 92 operated patients, against 26.3 per cent in the first period, is due first and foremost to the radical operative interventions applied, aimed not only to tackle the ileus problem but also to remove the prime cause of ileus, as well as to the measures undertaken - mesenteriplication after Childs-Philips and its modification - to prevent early and late recurrence of the ileus. The tactics adopted in the various forms of small intestinal ileus are analyzed in detail. The operative methods used and lethality recorded in colonic ileus are also analyzed. Here the condition presents volvulus of the sigma and carcinoma of the colon. The immediate results of the applied radical and palliative operations are evaluated. Radical surgery of the right half of the colon is more justified. Ileus of the left half of the colon demands meticulous assessment of the local status prior to take the decision about undertaking radical intervention on passage indications. The indications for resection of the colon and its completion with anastomosis or provisory preternatural anus are discussed. The lethality rate recorded in 57 patients operated for colonic ileus during the second period amounts to 21 per cent.

Acute Disease↗
PubMed1981

Intestinal obstruction in germ-free dogs.

Mechanical occlusions were created in the intestines of four germ-free dogs. At the time of the operation, a control loop of mid-intestine was perfused in vivo and then excised for examinations in vitro, which included the determination of the equilibrium uptake of phenylalanine and of beta-methyl-glucoside, the influx kinetics of phenylalanine and morphometric analysis of the mucosa by microdissection and stereological techniques. Seven days after establishment of the occlusion the abdomen was reopened, and loops above and below the occlusion were perfused, and then excised for the same tests in vitro. Unlike occluded loops of conventional dogs, the intestine of the germ-free animal above the occlusion does not secrete water and electrolytes into the lumen. Its transport properties in vitro do not differ from those of the control loop, and the morphometric analyses reveal only slight changes in villus structure. The loop below the obstruction undergoes marked atrophy, as has been observed in conventional dogs. The results suggest that the copious secretion that occurs above an intestinal obstruction in normal animals is due to the presence of an abundant bacterial population in the obstruction fluid.

Animals↗
PubMed1975

Studies on small intestinal obstruction. III. Circulatory effects of artificial small bowel distension.

Feline small-bowel circulation was studied during in vitro homologous perfusion of denervated intestine, following artificial and successive elevation of the intraluminal pressure. The specimens were inflated with nitrogen in 20 mmHg increments to the 100 mmHg level. Each pressure level was maintained for a 10-minute period. After deflation the specimens were studied for a further 60 minutes. Blood flow, vascular resistance, capillary filtration, and oxygen consumption were significantly affected by the distension. In the post-distension period flow rate and vascular resistance remained on levels differing significantly from the control values, whereas capillary filtration and oxygen consumption reverted immediately to levels not differing from the control values. It is concluded that, in isolated and denervated small intestine of the cat, an elevated intra-intestinal pressure affects the consecutive vascular sections in a similar manner, probably by simple mechanical compression. Flow rate is reduced less than capillary filtration, suggesting an opening of short-circuiting shunts in the bowel wall. In the post-distension phase vascular resistance remains elevated, while the exchange circulation is rapidly and completely restored, suggesting an extensive closure of the short-circuiting shunts.

Animals↗
PubMed1975

Studies on small intestinal obstruction. V. Blood circulation in moderately distended small bowel.

Feline small-bowel circulation was studied during in vitro homologous perfusion of denervated intestine upon artificial distension to 20 mmHg for a 60-minute period. Delayed compliance was observed, and distension evoked contractile bowel activity; each bowel contraction was accompanied by a decrease in blood-flow rate, whereas bowel relaxations coincided with augmentations of flow. Artificial distension diminished blood flow, denoting a 50-60% increase of regional vascular resistance, and elicited variable capillary filtration coefficient (CFC) responses, on the average a 45-50% reduction of the perfused capillary surface area, but did not affect the oxygen consumption rate. After release of the distension, the enhancement of vascular resistence persisted and even increased, whereas CFC returned to control level. Control experiments involving homologous perfusion but no artificial distension also featured some resistence augmentation and CFC reduction. The effects of homologous perfusion on bowel haemodynamics and viability are discussed; though the experimental procedure may occasion some degree of haemodynamic impariment, present observations and previous reports suggest that bowel viability is not significantly affected. It is concluded from the present study that a sustained and moderate distension of nonobstructed feline small bowel, perfused in vitro, involves no threat to the microcirculation or the viability of the bowel.

Animals↗