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PubMedDate not supplied

Changing pattern of intestinal obstruction in Accra, Ghana.

BACKGROUND/AIMS: Over the past 50 years acute intestinal obstruction has remained among the commonest causes of the acute abdomen, along with peritonitis, appendicitis and gastrointestinal perforations. However several observers have noticed over the past 2 decades a shift in the etiological spectrum. The study aims at ascertaining the precise nature of the change. METHODOLOGY: Published data on intestinal obstruction from the Korle Bu Teaching Hospital over the past 50 years were reviewed, as the consistent report format permitted ready comparison of the series. Emphasis was placed on clinical features, established cause and resulting complications. RESULTS: The case load of intestinal obstruction has dwindled over the past 3 decades, accounting for 0.7% of all hospital admissions compared with 1.4% 30 years earlier. External hernias together with adhesive bands still constitute the bulk of presenting cases, but the proportions have changed with strangulated hernias accounting for 59.8% instead of 77.6%. The change has paralleled a rise in elective hernia day case surgery. The incidence of intussusception has almost doubled (7.4% from 4.0%) and it still afflicts the very young. Colonic neoplasms have been commoner over the past 2 decades although the incidence (3.3%) falls short of Western figures. Overall mortality has remained unchanged at 9.4% and this has been associated with a rise in resection rates to 18.3%. CONCLUSIONS: The patterns of intestinal obstruction have been much influenced by changing attitudes regarding elective hernia surgery and evolving financial policies.

Acute Disease↗

PubMedDate not supplied

Intestinal obstruction in Crohn's disease in childhood.

Out of 540 children and adolescents from the Multicenter Pediatric Crohn's Disease Study Group, 42 patients presented with decompensated intestinal obstruction. In 26 patients only one intestinal obstruction occurred, and in 16 children up to five intestinal obstructions occurred. Conservative measures were successful in 37 of 72 episodes of intestinal obstruction (51.4%), while 19 of 42 patients underwent emergency surgery (45.2%) and 16 of 42 (38.1%) were operated on following conservative treatment. From analysis of clinical, intraoperative, and histological findings in surgically treated patients, criteria for emergency surgery and elective surgery of intestinal obstruction in Crohn's disease are derived. One patient with adenocarcinoma of the large bowel, presenting with recurrent obstruction, signals caution in delaying proper diagnosis.

Adolescent↗

PubMed1999

Comparative evaluation of plain films, ultrasound and CT in the diagnosis of intestinal obstruction.

BACKGROUND: There are limited studies in the literature comparing plain radiography, US and CT in the evaluation of intestinal obstruction. We carried out this prospective study to compare the relative efficacies of these three imaging techniques in patients with intestinal obstruction. MATERIAL AND METHODS: Thirty-two patients presenting with clinical suspicion of intestinal obstruction were subjected to plain radiography, US and CT and the findings were compared with reference to the presence or absence of obstruction, the level of obstruction and the cause of obstruction. The final diagnosis was obtained by surgery (n=25), or by contrast studies and/or clinical follow-up in those who were treated conservatively (n=7). RESULTS: Out of 32 patients, 30 had mechanical intestinal obstruction (22 had small bowel obstruction and 8 had large bowel obstruction). Of the remaining 2 patients, 1 had adynamic ileus and the other had a mesenteric cyst. CT had high sensitivity (93%), specificity (100%) and accuracy (94%) in diagnosing the presence of obstruction. The comparable sensitivity, specificity and accuracy were, respectively. 83%, 100% and 84% for US and 77%, 50% and 75% for plain radiography. The level of obstruction was correctly predicted in 93% on CT, in 70% on US and in 60% on plain films. CT was superior (87%) to both US (23%) and plain radiography (7%) in determining the aetiology of obstruction. CONCLUSION: CT is a highly accurate method in the evaluation of intestinal obstruction especially for determining the level and cause of obstruction and should be the technique of choice when clinical or plain radiographic findings are equivocal.

Adolescent↗

PubMed1989

Neonatal intestinal obstruction.

Our experience in the management of 138 infants with various causes of intestinal obstruction has provided us with important principles of diagnosis and treatments that we adhere to in the course of our practice. 1. The overall mortality of neonates suffering from intestinal obstruction should be fewer than 5 per cent. The high survival rate is accounted for by improved care these patients receive in specialized units. 2. Prematurity did not appear to play a significant factor in the outcome of these infants with intestinal obstruction. Our experience shows that premature infants tolerate operative procedures well, even in those instances in which an associated surgically correctable lesion is simultaneously repaired. 3. The major risk factor in any neonate with intestinal obstruction is the delay in diagnosis and operative intervention, especially in infants diagnosed to have midgut volvulus. The additional second risk factor is the association of chromosome abnormality. 4. Traditional diagnostic studies such as plain films of the abdomen supplemented by either an upper GI or lower GI contrast study for specific indications have been very effective in obtaining an accurate diagnosis of intestinal bowel obstruction. 5. Hirschsprung's disease can be diagnosed in the neonatal period if the index of suspicion for this is high. 6. Special surgical techniques as described should be used whenever indicated to minimize morbidity. 7. The traditional Wangensteen-Rice evaluation of a patient with imperforate anus is accurate, and specialized studies should be deferred for the postoperative period. Collaborative care provided by the neonatologist, pediatric anesthesiologist, and pediatric surgeon for these patients is the key to a favorable outcome.

Abnormalities, Multiple↗

PubMed1990

[Diagnosis and treatment of adhesive intestinal obstruction in children].

The work analyses 455 patients with acute adhesive intestinal obstruction (194 children with the early and 261 with the advanced stage of the disease). The most common causes of the obstruction were acute appendicitis, developmental anomalies of the intestine, and intestinal intussusception. Complete viscerolysis and horizontal intestinoplication by means of medical glue without application of sutures were performed in a total adhesion process, even in the acute period (34 cases). Severe paresis or paralysis of the gastrointestinal tract is an indication for its decompression. Laparoscopy was conducted in 90 children (from 3 months to 14 years of age) in suspected acute adhesive intestinal obstruction. The diagnosis was confirmed or defined more exactly in 64 patients. As the result of endoscopic operations intestinal obstruction was corrected and laparotomy was avoided in almost half of the patients. The total mortality was 1.3%.

Acute Disease↗

PubMed1987

Comparison of duodenitis/proximal jejunitis and small intestinal obstruction in horses: 68 cases (1977-1985).

Sixty-eight horses with colic caused by small intestinal disease were allotted into 2 groups of 34 on the basis of recorded findings during exploratory celiotomy, necropsy, or response to medical treatment alone. Signalment, history, physical examination findings, and laboratory findings were compared between the group of horses with small intestinal obstruction and the group with duodenitis/proximal jejunitis. A significantly greater proportion of horses with duodenitis/proximal jejunitis were older than 2 years old (P less than 0.05). Differences in sex or breed distribution, or in seasonality of the 2 disease syndromes were not observed. Horses with duodenitis/proximal jejunitis had significantly greater signs of depression than those with small intestinal obstruction (P less than 0.01), and horses with small intestinal obstruction had significantly greater signs of abdominal pain (P less than 0.05). The mean heart and respiratory rates were significantly lower (P less than 0.01) and the volume of nasogastric reflux was significantly greater (P less than 0.05) in the group of horses with duodenitis/proximal jejunitis. Sections of small intestine that were palpable per rectum were less distended and there were more auscultable borborygmi in horses with duodenitis/proximal jejunitis, compared with those with small intestinal obstruction (P less than 0.05 and P less than 0.01). The group of horses with duodenitis/proximal jejunitis had lower mean plasma potassium and higher mean plasma bicarbonate concentrations (P less than 0.05) than the group with small intestinal obstruction. The mean nucleated cell count and total protein concentration of peritoneal fluid specimens were significantly less in the group with duodenitis/proximal jejunitis (P less than 0.01); however, these values were greater than normal.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1994

Palliation of malignant intestinal obstruction using octreotide.

Vomiting due to malignant intestinal obstruction is an unpleasant terminal event in many cancer patients, which responds poorly to conventional therapies. Somatostatin and its long-acting analogues reduce intestinal secretion. For this reason, octreotide was used in a phase I/II study of patients with intractable vomiting secondary to intestinal obstruction due to malignant disease. Vomiting was controlled or the volume of nasogastric aspirate was markedly reduced in 18 of 24 (75%) patients receiving a subcutaneous infusion of octreotide (median initial dose 300, range 100-600 micrograms/day) for a median of 9.4 (range 1-38) days. A further 2 patients had partial relief of their symptoms. Octreotide is an effective treatment of nausea and vomiting due to malignant bowel obstruction.

Adult↗

PubMed1993

[Intestinal obstruction caused by milk curds in newborns].

Intestinal obstruction due to milk curds syndrome may present with a clinical picture and radiological findings which suggest the correct diagnosis. This type of intestinal obstruction usually affects neonates, previously healthy, with concentrated formula feeding. Surgical treatment may be avoided in some cases by the administration of Gastrografin enemas. Two patients with milk curd obstruction treatment in our Hospital, are presented.

Humans↗

PubMed1995

Intestinal obstruction in an infant due to magnet ingestion.

A case of intestinal obstruction in an infant due to magnet ingestion is reported. The 17-month-old female swallowed seven small magnets, and developed an acute intestinal obstruction. At laparotomy, a fistula between the jejunum and the ileum which contained the seven magnets was found and resected. The patient's postoperative recovery was uneventful. Accidental magnet ingestion mandates careful observation for the development of intestinal obstruction.

Acute Disease↗

PubMed1990

[Endocrine cells of the small intestine in experimental strangulated intestinal obstruction].

In experiment on 25 cats reproducing small intestinal obstruction it has been established that the number of endocrine cells (EC) and the degree of their saturation with secretory granules increase in 3 and 6 h after the experiment. These indices decrease by 12 and 25 h after the experiment. The results obtained enable to reveal the EC participation in acute intestinal obstruction pathogenesis and to suppose the influence of released serotonin by paracrine way on mucous membrane as well as distant action on peristalsis and blood flow through intramural nerve plexus.

APUD Cells↗

PubMed1955