[Use of small intestine intubation for the treatment and prevention of paretic ileus after operations for peritonitis and ileus in childhood].
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Adolescent↗
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[Ileus and ileus-like conditions in internal pediatrics].
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Age Factors↗
[Our experience of the Vest-Margulis test in the differential diagnosis of mechanical and paralytic ileus (author's transl)].
In order to evaluate the Vest-Margulis test in the differential diagnosis between mechanical and paralytic ileus a retrospective study was undertaken on 51 such tests performed before and after operation. Transit of gastrografin (Sodium amidotrizoate) through the caecum 4 hours after ingestion was controlled through roentgenograms. The diagnostic value of a positive test in pure paralytic ileus can be confirmed. Indeed 23 positive cases proved to have paralytic rather than mechanical ileus. On the contrary a negative test has no diagnostic value. Twenty-eight patients in which the contrast medium had not reached the caecum within 4 hours had either form of intestinal obstruction. The attention is drawn on the interesting therapeutic action of gastrografin in patients with a paralytic ileus and the simplicity of the investigation.
Cecum↗
[Paralytic ileus in pheochromocytoma. Possible correlation with an attempt at adrenal phlebography].
Following adrenal phlebography, obstruction of the large bowel associated with adrenergic crisis was observed in a 60 year old patient with pheochromocytoma. As in other published cases of ileus associated with pheochromocytoma, high urinary catecholamine concentrations were found in our patient and the tumor resected at surgery was large. As phlebography immediately preceded the onset of ileus and hypertensive crisis, it is postulated that angiography led to massive secretion of catecholamines, which caused the hypertensive crisis as well as the ileus. The possible mechanisms by which phlebography may lead to adrenergic crisis are discussed. It is concluded that in suspected pheochromocytoma all angiographic examinations should be carried out under simultaneous treatment with alpha-blocking agents.
Adrenal Glands↗
[Intestinal obstruction with feces (meconium ileus equivalent) in the course of mucoviscidosis. Radiographic diagnosis (author's transl].
Meconium ileus equivalent is a late intestinal occlusion occurring in patients suffering from mucoviscidosis. Three cases are reported in children aged, respectively, 3 years, 6 years and 10 years. In one of the observations (three year old girl), the intestinal obstruction with feces was first manifestation of a mucoviscidosis that was previously undetected. The radiological signs are identical to those found in cases of neonatal meconium ileus: intestinal obstruction and accumulation of closely spaced matter in a distended ileum (terminal part). As in cases of meconium ileus without complications, treatment consisted of enemas with water-soluble products. The high osmotic pressure of these products made it possible to remove the obstruction.
Child↗
The value of Gastrografin in the differential diagnosis of paralytic ileus versus mechanical intestinal obstruction: a critical review and report of two cases.
Two cases in which serious intra-abdominal complications were masked by results of the contrast examination using Gastrografin were encountered. This caused the authors to review critically the use of Gastrografin in the differential diagnosis of paralytic ileus versus mechanical intestinal obstruction. In a series of 41 cases in which the diagnostic problem was not solved initially by means of physical examination and plain abdominal roentgenograms, the Gastrografin examination proved reliable in 28 (68 per cent). The reliability of the examination was defined as the relative number of cases in which a correct decision could be made for or against surgical operation. It is concluded that Gastrografin is a valuable diagnostic aid in controversial cases of ileus. A "negative" result of the examination, however, would never be allowed to damp the surgeon's awareness of possible serious intra-abdominal conditions, which the contrast examination has failed to disclose and which require immediate surgical intervention.
Adult↗
Dissolution of Barium-impaction ileus by Gastrografin.
Ileus caused by impaction of hardened residual barium stagnated in the colon-a rare complication of barium-meal examination-constitutes a particularly serious problem when it occurs following abdominal operations, leading to postoperative ileus. The administration of Gastrografin in such cases has proven efficacy in the dissolution of inspissated barium, refractory to routine means of evacuation. Four case reports provide an illustration of this problem. The satisfactory results obtained, and the hitherto reported lack of side effects of this compound, justify recommendation of Gastrografin as a safe, simple method for use in the management of these cases.
Aged↗
Meconium ileus: laparotomy without resection, anastomosis, or enterostomy.
During the 14 yr from 1965 through 1978, 49 infants presented shortly after birth with intestinal obstruction due to impacted meconium. Three of these patients did not have fibrocystic disease. Eight patients were cured by a Gastrografin enema. There were 18 patients who had complications that included associated atresia, volvulus, and/or peritonitis. Various operations were done including resection with either primary anastomosis or enterostomy or varieties of the foregoing. Twenty-three babies had the simple uncomplicated form of meconium ileus. Eleven of these underwent resection and six patients died. Twelve patients were treated by laparotomy, ileotomy through a purse-string suture and prolonged irrigations using acetylcysteine. Of this group only one succumbed. This latter course of management is recommended for patients with simple uncomplicated meconium ileus as it involves no resection, no enterostomy, nor any primary anastomosis.
Cystic Fibrosis↗
The effects of metoclopramide on postoperative ileus. A randomized double-blind study.
Metoclopramide or placebo was administered postoperatively in a randomized, double-blind fashion to 115 patients undergoing laparotomy. The effect of metoclopramide on postoperative adynamic ileus (PAI) was evaluated. The patients were stratified into two groups: Group A--those with laparotomy without a gastrointestinal anastomosis or ostomy procedure, and group B--those with laparotomy undergoing an anastomosis or ostomy procedure. Metoclopramide reduced nausea and emesis postoperatively. However, the only significant effect on postoperative adynamic ileus was an earlier return to tolerance of solid foods in the patients in Group A.
Adult↗
Gallstone ileus masquerading as a gastric outlet obstruction.
We have described a patient with gallstone ileus who was initially believed to have a gastric outlet obstruction. Roentgenogram of the abdomen revealed a markedly distended stomach. None of the classic roentgenographic signs of gallstone ileus were present. Old age and diabetes mellitus probably contributed to her severe gastric retention.
Aged↗
Air in gallbladder: a frequent finding in gallstone ileus.
A retrospective assessment of the presence of air in the biliary tract is presented, based on plain film findings in 16 proven cases of gallstone ileus. In addition to five cases that demonstrated air in the biliary radicles, four cases exhibited air exclusively in the gallbladder and duodenal bulb. A clearly identifiable radiographic appearance composed of two adjacent small air-fluid levels in the right upper quadrant is described. This radiographic feature represents the air- and fluid-filled duodenal cap adjacent to the visualized shrunken gallbladder. Recognition of this combination of findings helps in establishing a prompt preoperative diagnosis in cases of gallstone ileus.
Aged↗
[Utilization of the small intestine fistula technique in paralytic ileus. Report on clinical experience].
Seventy-three patients with paralytic ileus hospitalized at the Surgical Clinic of the Hospital in Herford during the years 1971-1975 are reviewed. All the patients were treated with a small bowel fistula according to a modified technique of Witzel-Heidenhain. The special indication, the technical details, and the results are discussed. The overall mortality of a total of 73 patients with paralytic ileus undergoing a small bowel fistula operation was 19%. The temporary small bowel fistula according to the modified technique of Witzel-Heidenhain is proposed as a simple, safe, and with accurate indication an effective method for accomplishing total decompression of distended bowel.
Adolescent↗
[Imitation of acute adnexa processes through a small intestine ileus].
Under the picture of acute inflammatory events of adnexa there may be sometimes be hidden diseases of the intestines. Out of them acute state of ileus is of utmost importance. State post appendectomy, atypical anamnesis and antiinflammatory treatment without effect is suspect of an ileus. An early laparotomy presents a low risk in such cases.
Adnexa Uteri↗
Ileus of the colon with cecal dilatation and perforation.
Segmental dilatation of the colon without obstruction is an unusual but recognizable entity, distinct from mechanical obstruction and paralytic ileus. Cases of ileus of the colon with cecal dilatation following delivery and gynecologic surgery are collected from the literature, and 3 recent cases are presented: 1 following cesarean section and 2 following abdominal hysterectomy. The etiology of this condition is still obscure and the clinical features are deceptive. The occurrence of this entity in obstetric and gynecologic patients is by no means a rarity and warrants a familiarity with and early recognition of this entity on the part of the physician in order to avoid serious sequelae.
Adult↗
[Prevention of paralytic ileus after colonic surgery by continuous peridural sympathetic block. Preliminary report].
Gastrointestinal atony must be considered as a reflex response to surgical intervention, due to activation of sympathetic nerves. Following colonic surgery, the duration of this response may be notably extended and the ensuing intestinal distension becomes the paramount factor of a persisting ileus. Blocking the sympathetic fibers prevents intestinal distension. Introducing appropriate catheter into the peridural space up to the level of the 10th--11th thoracic vertebra makes it possible to realize a segmental continuous block between T6--L2, where gastrointestinal sympathetic innervation actually originates. Using bupivacaine at low concentration (0.125% with epinephrine 1/400,000) reduces untoward effect on circulation and may even prove beneficial if volaemia is effective. In addition, it produces a selective block on the visceromotor fibers which allows a differential diagnosis of the ileus, without risking to pass over a perforation of the gut whenever a coexisting mechanical factor is suspected.
Autonomic Nerve Block↗
[Conservative treatment of severe paralytic ileus. Clinical experiences with Ceruletid].
After the failure of other medicamentous treatment attempts for paralytic ileus, Ceruletid (Takus) was used in 20 surgical patients. Ceruletid was applied as an infusion of 40 microgram in 250 ml or 500 ml physiological saline solution over a period of 2-3 hours. During this time the occurrence of bowel sounds, flatulence and defecation was observed. The most important clinical and serological parameters were measured before and after treatment. Treatment was successful in 17 cases, in 3 cases no success was achieved. Severe side effects did not occur. The use of Ceruletid in the described form of administration can be recommended for the treatment of paralytic ileus.
Ceruletide↗
Management of meconium ileus by resection and end-to-end anastomosis.
Six patients with meconium ileus, in whom bowel resection and end-to-end anastomosis were performed, are presented. Meconium ileus may be simple or complicated. The simple form may be treated by Gastrografin enema. Surgery is indicated if conservative treatment fails and for patients with a complicated obstruction. Provided the bowel is disobstructed and carefully resected, end-to-end anastomosis is preferable. Confirmation of the diagnosis by careful histological examination of the resected bowel is urged.
Cystic Fibrosis↗
[Colon dynamics in ileus].
All forms of ileus have one thing in common, namely a disorder of the intestinal motility, which, with increasing distension of the intestinal wall, finally leads to paralysis of the intestine. With the increase in distension mechanical and functional colon changes take place which are discussed in this study. During peristalsis the strain on the wall is directed against the intra-luminal course of pressure. In spite of the increase of the internal pressure from 5 cm H2O to 100 cm H2O, the tension of the wall remains low or even decreases (roughly 500 dyn/mm2). In ileus patients, however, the strain on the intestinal wall increases enormously (about 100000 dyn/mm2). The maximum contraction capacity of the large intestine's muscle system (50,000 dyn/mm2) is high and similar to that of the skeletal muscles.
Colon↗