Changes in blood serotonin concentration in mechanical obstruction of the small intestine. II. Findings in patients with intestinal obstruction.
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Blood↗
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Results for “Intestinal Obstruction”
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Changes in blood serotonin concentration and urinary 5-hydroxyindoleacetic acid excretion in mechanical obstruction of the small intestine. I. Experimental intestinal obstruction in the dog.
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Animals↗
Acute distal intestinal obstruction in gnotobiotic rats. Intestinal morphology and cell renewal.
1. Complete mechanical obstruction of the distal small intestine was produced in gnotobiotic rats. 72 h after the operation small intestinal morphology and epithelial cell renewal were investigated proximal and distal to the site of obstruction. 2. Proximal to the site of obstruction there were minor changes in villus height, base length and in villus cell number, a large increase in depth and diameter of the crypts and an approximately threefold increase in cell renewal. 3. Distal to the site of obstruction there were no differences between the intestines of rats with obstruction and controls. 4. The apparent lack of secretion by the goblet cells and the reduced number of intraepithelial leucocytes suggest that the barrier function of the small intestine is impaired in obstruction.
Animals↗
Palliative surgery for intestinal obstruction in advanced ovarian cancer.
Intestinal obstruction in ovarian cancer patients is a major complication which frequently affects survival and quality of life. After a reasonable trial of conservative management fails, surgery is the only hope for relief of obstruction. In an effort to evaluate the success of such surgery we have reviewed the outcome of 54 operations (52 patients) for relief of intestinal obstruction performed over the 3-year period 1983-1985. Possible predictive factors for success and survival following surgery were analyzed. The sites of intestinal obstruction in the 54 procedures were as follows: small intestine 24 (44%); large intestine 18 (33%); combined small and large intestine 12 (22%). In 11 operations no surgical correction of the obstruction was possible. In 43, major intestinal procedures were performed, including 14 bypasses, 13 resections, and 20 colostomies. Of the 43 instances in which intestinal procedures were performed, 4 patients expired without leaving the hospital. At the time of discharge from the hospital the remaining 34 of these 43 patients were eating a regular or low-residue diet. Successful palliation of intestinal obstruction was thus achieved in 79% of the 43 instances in which a definitive procedure could be performed, and in 63% of the total of 54 operations. Mean survival following surgery was 6.8 months for the group undergoing a definitive procedure, and 1.8 months for the group undergoing exploration only. There was no significant difference between the two groups with regard to age, time from diagnosis, prior radiotherapy, number of prior laparotomies, site of obstruction, or use of total parenteral nutrition. None of the multiple clinical variables analyzed correlated with survival following definitive surgery. Most patients explored for intestinal obstruction due to advanced ovarian cancer can have their obstruction relieved and be discharged from the hospital. We were not able to define criteria that would allow selection of patients unlikely to benefit from surgery.
Adult↗
Paraovarian-omental bands as a cause of small intestinal obstruction in cows.
Small intestinal obstruction caused by a fibrous band extending from the free edge of the greater omentum to the ovary or the tip of uterine horn was found in 4 cows. The band and distended small intestine were palpable per rectum in each cow. In 3 cows, severance of the fibrous band relieved the small intestinal obstruction and the cows recovered without complication. In the fourth cow, the compromised portion of intestine ruptured during manipulation and the animal was euthanatized.
Animals↗
[Serum enzyme activities in intestinal obstruction].
In patients with intestinal obstruction, nine of the enzymes usually studied in liver diagnostics were determined before and after operation. Intestinal obstruction causes reversible changes in the liver and in hepatic metabolism; they normalize after relief of the obstruction.
Clinical Enzyme Tests↗
Gallstone ileus as a cause of upper intestinal obstruction.
Gallstone ileus, a mechanical intestinal obstruction caused by the passage of a gallstone into the intestinal lumen through a fistula, although not common, deserves to more carefully studied due to its morbidity and mortality. Its incidence among older-age groups explains its association with chronic and degenerative diseases, which increase the complexity of the treatment choice. The need and appropriateness of a surgical approach to a cholecystenteric fistula to solve the obstructive emergency, in a one or two stage procedure, has been discussed in the literature. It has also been reported that gallstone ileus is an uncommon cause of upper intestinal obstruction. Intestinal obstruction is seen more frequently after a gallstone impacts at the ileocecal valve. The authors report a case of gallstone ileus as a cause of upper intestinal obstruction and discuss its diagnosis and treatment.
Aged↗
Intestinal obstruction in Khartoum.
The pattern of intestinal obstruction at Khartoum Teaching Hospital was reviewed in this study which included 239 patients. 170 of them were males and 68 were females. Their ages ranged from two days to 95 years (mean 31.4 +/- 5.3 years). The commonest causes of intestinal obstruction were strangulated external hernias (27.7%), intestinal adhesions (21%), intussusception (12%) and sigmoid volvulus (11%). Less frequent causes were paralytic ileus, large bowel tumours, peritoneal bands and Hirschsprung's disease. Of the strangulated hernias, inguinal hernia (70%) was the most frequent type of hernia seen, followed by paraumbilical hernia (20%). Previous appendicectomy (40%) and laparotomy for abdominal trauma (20%) were the commonest causes of adhesive intestinal obstruction. The mortality rate of intestinal obstruction was 19.7%. This high mortality is attributed to delayed presentation, fluid and electrolyte imbalance, intestinal ischaemia and gangrene. This could be minimised by health education, adequate preoperative preparation, meticulous surgical technique and good postoperative care.
Adolescent↗
Neonatal intestinal obstruction due to absence of intestinal musculature: a new entity.
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Congenital Abnormalities↗
Histological phenotypes of enteric smooth muscle disease causing functional intestinal obstruction in childhood.
AIMS: Functional intestinal obstruction or chronic idiopathic intestinal pseudo-obstruction is due to defects either in the enteric innervation or in intestinal smooth muscle. We have studied full-thickness intestinal biopsies from 27 patients with functional intestinal obstruction due to enteric smooth muscle disease by routine histology and electron microscopy together with histochemical and immunohistochemical techniques to detect changes in the intestinal smooth muscle. METHODS AND RESULTS: Two patients appeared to have an acquired intestinal myopathy as a result of an autoimmune process. In 25 the disorders were congenital, of these seven had segmental abnormalities limited to the rectum and distal colon and 18 had a diffuse disease affecting both the small and large bowel. We identified five apparent histological phenotypes of enteric muscle disease, three of which represent abnormalities in morphogenesis resulting in alterations in intestinal muscle layering and two exemplify intrinsic myocyte defects and/or changes in the extracellular matrix. CONCLUSIONS: Careful phenotyping of these patients is important in devising optimal treatment and in understanding the underlying defect as well as the possible genetic mechanisms resulting in these abnormalities. Recognition of autoimmune smooth muscle disease is helpful, since making the diagnosis influences the patient's management.
Child, Preschool↗
Intestinal obstruction after appendectomy.
BACKGROUND: The frequency of intestinal obstruction varies in the literature (0.2-10.7%) and requires evaluation in a proper design. METHODS: From 1978 to 1985, 1951 patients underwent appendectomy; 58 patients were excluded because of appendectomy per occasionem, 156 because of previous laparotomy, and 190 because of simultaneous major surgery. Three foreigners were lost to follow-up. The cohort was linked to the Danish National Inpatient Register for identification of cases, defined by intestinal obstruction requiring surgical intervention. RESULTS: The follow-up period was long (median, 3563 days; range, 2-5113). Twenty-one patients developed intestinal obstruction. The cumulated incidence was 0.33% after 30 days, 0.79% after 1 year, and 1.51% after 14 years. Female sex as compared with male sex (RR = 3.91; 95% confidence limits (CL), 1.25-12.0) and removal of a removal of a normal appendix as compared with an inflamed appendix (RR = 4.0; 95% CL, 1.28-12.5) carried a significantly higher risk of intestinal obstruction. CONCLUSION: Intestinal obstruction after open appendectomy is rare.
Adolescent↗
Prognostic factors in neonatal intestinal obstruction: a prospective study of Nigerian newborns with bowel obstruction.
The management of neonatal intestinal obstruction in developing countries remains challenging, but the results are relatively less rewarding compared with results of treatment of this condition in industrialized countries. This study is an attempt to evaluate, using acceptable scientific methods, some of the factors that are believed to influence survival in neonatal intestinal obstruction, including those that are not peculiar to developing countries alone. Sixty-five babies treated for intestinal obstruction at the Lagos University Teaching Hospital, Lagos, Nigeria, formed the subjects for the study. The levels of obstruction, which were congenital in all cases, spanned the entire intestinal tract from the duodenum to the anus. Forty-one babies survived and 24 died, a survival rate of 63%. Employing Student's t test, there were no significant differences in the gestational age and birth weight between survivors and nonsurvivors, whereas significant differences do exist with respect to the age at operation and admission serum bicarbonate levels, P less than .05 and P less than .001, respectively. Analysis of the levels of obstruction and nature of operative procedure using the chi-square test shows no significant differences between the two groups. However, there is significant difference in the percentage of major associated congenital problems, P less than .01, which was higher in nonsurvivors.
Abnormalities, Multiple↗
[Imaging of intestinal obstructions].
The diagnosis of intestinal obstruction still rests on radiography of the abdomen without preparation. Three X-ray films must systematically be taken: a general film and a film centred on the diaphragmatic domes with the subject standing; another general film with the subject lying on his back. It is relatively easy to identify the obstructed segment, but the cause of obstruction remains difficult to determine. For small bowel obstruction, emergency surgery is often necessary. If the patient's condition permits, it may be useful to opacify the dilated segment in order to study the nature of the obstacle. Colonic obstruction is opacified through the anus, this route being more informative. There are two types of acute obstruction: by occlusion and by strangulation. The various causes are considered, but there are also incomplete obstructions and dilatations without obstruction.
Colonic Diseases↗
Experimental studies on fluid pathophysiology in small intestinal obstruction in the rat. V. Effects of intraluminal hyperosmolality and simultaneous intravenous infusions on the experimentally obstructed and decompressed small intestine.
An influx of fluid into the lumen of the intestine similar to that seen in simple obstructional ileus may be provoked by introducing a hyperosmolal glucose solution into the bowel. In the otherwise intact small intestine the effect of this influx of fluid will be in accordance with a simple dilution curve. The intestinal mucosa thus functions in the manner of a semipermeable membrane permitting only hypo-osmolal fluids to enter the intestinal lumen and in amounts independent of parenteral fluid infusions, regardless of osmolality. This relationship persists even after the intestine has been totally obstructed for 3 days. The influx of fluid has the same principal characteristics, and the only limiting factor on the magnitude of this fluid shift to the intestine is the lack of fluids resulting from the marked dehydration of the organism due to ileus. Prerequisites for this are normal epithelial function and normal mucosal circulation. Thus it is clear that the organism in general and the small intestine in particular, even when exposed to prolonged obstruction, are still able to counteract intraluminal hyperosmolality by dilution with hypo-osmolal fluid.
Animals↗
[Experimental substantiation of a precision technic of creating an interintestinal anastomosis in acute intestinal obstruction].
Two kinds of intestinal sutures performed with the use of a precision technique were investigated on models of acute intestinal obstruction. One-row (serous-muscular-submucosal) and two-row (serous-musculo-submucosal and submucosal-mucosal) sutures provide an exact layer-after-layer connection of the intestinal wall layers and a sufficient mechanical firmness of the anastomosis with little traumatization. The dynamics of microcirculation changes in the anastomosis zone was followed with the help of contact intraoperative biomicroscopy. Symptoms of the traumatic inflammation were cupped off within 5 days and changed by reparative processes.
Acute Disease↗
Congenital intestinal malrotation causing gestational intestinal obstruction. A case report.
BACKGROUND: Intestinal obstruction in pregnancy is rare. The mortality rate is higher during pregnancy than in the general population and applies to fetal as well as maternal survival. Major causes of intestinal obstruction in the pregnant women include adhesions, volvulus and intussusception. CASE: A 27-year-old woman, gravida 2, para 1, estimated gestational age approximately 26 weeks, with a high-level, complete small bowel obstruction. The patient failed a trial of conservative management and required laparotomy, at which time a congenital malrotation was found. She was treated successfully with a modified Ladd's procedure. There was no maternal or fetal morbidity. CONCLUSION: This case represents an extremely rare cause of bowel obstruction in pregnancy; a paucity of such cases have been reported.
Adult↗
Segmental intestinal muscular thinning: a possible cause of intestinal obstruction in the newborn.
Intestinal obstruction proximal to a transition zone without an interposed physical barrier usually indicates Hirschsprung disease. The authors report one case of focal small bowel muscular thinning just distal to a transition zone that produced clinical and radiographic findings that simulated long-segment Hirschsprung disease in a 2-day-old infant.
Diagnosis, Differential↗
Acute intestinal obstruction.
Nine hundred and four children with intestinal obstruction were studied. Necrotising enteritis was the commonest cause of intestinal obstruction in children. Acute intussusception was the second commonest cause in the whole group and the commonest cause in children under 1 year of age. Less common causes included band obstruction, sub acute intestinal obstruction and remnants of vitello-intestinal duct. A steady and significant improvement in the results of treatment was noted in children suffering from necrotising enteritis in the study period.
Child↗