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PubMed1978

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↗

PubMed1989

[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↗

PubMed2000

Intussusception. A cause of postoperative intestinal obstruction in children.

Intestinal obstruction is a common postoperative complication and usually related to intra-abdominal adhesions. Postoperative intussusception, however, is a rare cause and may be confused with postoperative ileus. With more children undergoing abdominal operations, the incidence of postoperative intussusception should rise but reports indicate that this complication may be either not suspected or overlooked. We report 2 children who developed postoperative intussusception following repair of ruptured urinary bladder in one and appendicectomy in the other. Both had successful manual reduction at laparotomy.

Appendectomy↗

PubMed1997

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↗

PubMed1987

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↗

PubMed1989

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↗

PubMed1994

The gynecologic contribution to intestinal obstruction in females.

This study was done to identify the cause of intestinal obstruction with particular emphasis on the gynecologic and perioperative related causes. All medical records from females with the discharge diagnosis "intestinal obstruction" from 1988 to 1991 at Columbia Presbyterian Medical Center were requested. The patient series consisted of the first 100 completed charts received. Forty-eight percent of those patients with intestinal obstruction had experienced a previous gynecologic or obstetric event that could account for the obstruction. Primarily, the gynecologist managed more than 20 percent of all female patients with intestinal obstruction. The most common causative factors contributing to intestinal obstruction were postoperative adhesions (59 percent) and tumor (17 percent). Fifty-six percent of the patients with intestinal obstruction associated with postoperative adhesions had a history of previous gynecologic and obstetric operation. Hysterectomy was the most common previously performed operation. In this series, cesarean section was less likely and myomectomy was more likely to cause subsequent intestinal obstruction than expected. Of 59 female patients with postoperative adhesions associated with intestinal obstruction, 31 had the original operative reports available for analysis. Eleven of these patients were taken to the operating room for management of the obstruction. In the nine patients who had surgical peritoneal closure in the original operation, the adhesions causing the obstruction were always to the site of reperitonealization. In the two patients in whom the peritoneum was left open, the adhesions causing obstruction were remote from the site of spontaneous reperitonealization. In an unselected patient series of intestinal obstruction, a history of previous gynecologic pathology is a significant factor contributing to the total number of instances of intestinal obstruction in females. Also, surgical peritoneal closure may result in an increase in the incidence of intestinal obstruction.

Adolescent↗

PubMed1991

[Tactics in cholelithic intestinal obstruction].

Tactical manipulations in cholelithic intestinal obstruction are analysed. The authors had 4 cases with cholelithic intestinal obstruction, in one of them obstruction with a gallstone occurred again on the 23rd postoperative day. Relaparotomy, correction of the obstruction, and cholecystectomy with one-stage removal of a biliodigestive fistula had to be conducted. It is pointed out that in obstruction of the intestine with a gallstone correction of the obstruction is a more sparing operation than one-stage cholecystectomy and removal of a biliodigestive fistula. With the use of this tactics there were no fatal outcomes.

Adult↗

PubMed1993

[Physiopathology and principles of intensive care in intestinal obstructions].

The physiopathology of intestinal obstruction consists of increased intestinal peristaltis, distension by gas and fluids, contraction of the extracellular fluid volumes (plasma and interstitial sectors) and bacterial proliferation. To this must be added, in obstruction by strangulation, the passage of bacteria and bacterial products into the general circulation and the peritoneal cavity through an ischaemic or necrotic intestinal wall. Metabolic disorders consist of water, sodium and potassium deficits and acid-base disturbances. Water and electrolyte replacement should take into account the deficits that existed at the beginning of treatment, the additional losses expected during treatment and the needs for daily maintenance of water and electrolyte balance. The therapeutic procedure is simple provided it is systematized.

Critical Care↗

PubMed1990

[Etiology of intestinal obstruction--4 years' experience].

In order to find out the etiological patterns of intestinal obstruction, we reviewed 1205 cases diagnosed as intestinal obstruction at our hospital. The operative findings, locations of obstruction and pathological results were analyzed among 707 cases who were operated on. The most common cause of colon obstruction was tumor (78.7%). The etiologies of small intestinal obstruction were: adhesions, 47.4%; hernia, 22.1%; tumor, 11.8%; intussusception, 8.8%; foreign bodies, 3.7%; and miscellaneous causes, 6.2%. In the patients older than 40 years, the most common causes of intestinal obstruction were adhesion and malignancy, in contrast to hernia and intussusception that were commonly found in children. The mean age of the patients with colon obstruction was older than those with small bowel obstruction, 55.7 +/- 21. vs 39.4 +/- 17.3 (P less than 0.001). Of the patients with previous abdominal surgery, adhesions caused the obstruction in up to 60.5%. Among the 102 cases who had been operated for abdominal malignancy, the cause of intestinal obstruction was due to recurrent tumor in 78 patients (76.4%). Of patients without previous abdominal surgery, the etiologies of intestinal obstruction were: incarcerated hernia, 36.7%; tumor, 21.1%; intussusception, 15.6%; and adhesion, 13.8%. The incidence of strangulation obstruction was 25.7%, of which the major causes were adhesions, 51.7%; and hernia. 43.0%. We concluded that the most common cause of colon obstruction was tumor. The two most common causes of small intestinal obstruction were adhesions and hernia. Age and past history of abdominal surgery can much help for the differential diagnosis.

Adolescent↗

PubMed1997

Intestinal obstruction due to ascariasis.

BACKGROUND: Intestinal obstruction due to ascariasis results from heavy worm infestation. This study is a review of 92 patients with intestinal obstruction from Ascaris lumbricoides. METHODS: Sixty-eight patients without peritonism were treated conservatively with resuscitation, antibiotics and anthelminthics. The remaining 24 patients presented with abdominal signs suggesting strangulation. Plain abdominal radiography was done in all patients. Abdominal ultrasonography was performed in the last 22 patients. RESULTS: There were no deaths in the first group and duration of hospital stay ranged from 4 to 7 days. Five of 24 patients in the second group died during resuscitation. After successful resuscitation, 19 had a laparotomy. Six patients needed resection of gangrenous bowel with primary anastomosis, in 11 an enterotomy was used to remove obstructing worms and in two it was possible to milk obstructing worms into the colon. Seven patients died after operation, giving an overall mortality rate of 12 of 24 patients in the second group. The characteristic sonographic features of 'railway track' sign and 'bull's eye' appearance helped make the diagnosis of ascariasis, and ultrasonographic signs were also typical for strangulation in five patients. CONCLUSION: Early clinical diagnosis supported by ultrasonography, together with prompt surgery when necessary, might reduce the mortality rate in what is still a potentially dangerous condition.

Adolescent↗

PubMedDate not supplied

Effects of octreotide and a-tocopherol on bacterial translocation in experimental intestinal obstruction: a microbiological, light and electronmicroscopical study.

BACKGROUND/AIMS: Bacterial translocation induced by intestinal obstruction is suggested to be due to increased intestinal luminal volume, leading to intestinal overgrowth with certain enteric microorganisms and intestinal mucosal damage. If this suggestion is true, maintenance of intestinal mucosal integrity by a cytoprotective agent, a-tocopherol, and inhibition of gastrointestinal secretions by octreotide should decrease the incidence of bacterial translocation and extent of mucosal injury due to intestinal obstruction. METHODS: Complete intestinal obstruction was created in the distal ileum of male Wistar Albino rats by a single 3-0 silk suture. The animals received subcutaneous injections of 1 ml of physiologic saline (group 1) (PS 24) and 1 ml of saline containing octreotide acetate (100 micrograms/kg) (group 2) (OC 24), at 0, 12 and 24 hours of obstruction. In group 3 (PS 48) and group 4 (OC 48), the rats were treated with subcutaneous physiologic saline (1 ml) and octreotide acetate (100 micrograms/kg), respectively, beginning at the time of obstruction and every 12 hours for 48 hours. The rats in group 5 (Toc 24), were pretreated with intramuscular a-tocopherol 500 mg/kg on day 1 and 8, and underwent laparotomy on day 9. A third dose of a-tocopherol was injected at the time of obstruction on day 9 and no treatment was given thereafter. We tested the incidence of bacterial translocation in systemic organs and circulation and evaluated the histopathological changes in all groups. RESULTS: Treatment with octreotide acetate was found to be ineffective in reducing the incidence of translocation, with no histopathological improvement. Mucosal damage scores, on the other hand, in the a-tocopherol group were statistically less than those in the octreotide and control groups (p < 0.05). Additionally, a-tocopherol treatment decreased the incidence of organ invasion with translocating bacteria, although this difference did not reach statistical significance. CONCLUSION: Octreotide acetate treatment in complete intestinal obstruction has no effect on the incidence of bacterial translocation. a-Tocopherol, on the other hand, has a cytoprotective effect on intestinal mucosa in intestinal obstruction which, in turn, is thought to decrease bacterial translocation when used in physiological doses and prophylactically.

Animals↗

PubMed1998

[A strangulated perineal hernia. A rare case of intestinal obstruction].

A rare case of intestinal obstruction due to strangulated perineal hernia, observed among 533 small bowel obstructions operated since January 1982 until December 1994 (0.2%) is described. Less than 100 cases are reported in literature. The etiologic, anatomical and clinical aspects of perineal hernia are examined. The reported case is of the primitive, congenital type caused by defect of the rectovaginal fascia fusion, in correspondence of the Douglas. Preoperative diagnosis is very difficult. Strangulation of this type of hernia is rare, the hernial sac surrounding tissue being elastic. In case of strangulation, symptoms of intestinal obstruction appear. In the reported case the preoperative diagnosis was "acute abdomen", because there was defence in hypogastrium and in the right iliac fossa. A straight abdominal radiography has not been performed. In the reported case the patient, a 22-year-old woman, was promptly operated and the incarcerated intestinal loop released. A regular postoperative period followed. The importance of a complete clinical examination, of a straight abdominal radiography and of a promptly performed operation is underlined.

Abdomen, Acute↗

PubMed1981

Effects of intestinal obstruction of plasma water and extracellular fluid volumes in the rat.

Total and regional plasma water and extracellular fluid volumes were measured in rats after obstruction of the small intestine. The rats lost 12.6 per cent of their initial weight. The volume of the sequestrated fluid in the obstructed intestine corresponded to 91 per cent of the plasma water volume. Intestinal obstruction caused a 19 per cent reduction of the total plasma water volume, while the total extracellular fluid volume was unchanged. Regional extracellular fluid volumes were diminished in the lung, liver and gastric antrum and increased in omental fat. The results indicate regional differences in fluid space responses to obstruction of the small intestine.

Animals↗

PubMed1986

Treatment of distal intestinal obstruction syndrome in cystic fibrosis with a balanced intestinal lavage solution.

Conventional treatment of distal intestinal obstruction syndrome (DIOS) with high doses of pancreatic enzymes, mucolytic agents, and enemas is neither predictably effective nor rapid in action. In 6 cystic fibrosis patients with DIOS a balanced, non-absorbable intestinal lavage solution produced clinical and radiological improvement and striking improvement in DIOS scores. It is suggested that a balanced intestinal lavage solution should be considered as an alternative treatment for DIOS in patients with cystic fibrosis.

Adolescent↗

PubMed1981

Small bowel obstruction: the role of nonoperative treatment in simple intestinal obstruction and predictive criteria for strangulation obstruction.

The clinical presentation, treatment, and results of 405 patients with mechanical small intestinal obstruction admitted to the Montefiore Hospital and North Central Bronx Hospitals were reviewed. The etiology of obstruction was adhesions 74%, malignancy 8.6%, hernia 8.1%, inflammatory bowel disease 5.2%, and miscellaneous causes 4.1%. The overall mortality rate for the series was 6.7%, and the incidence of bowel strangulation was 10.1%. Strangulation occurred in 33.3% of the hernia group, 9.0% of the adhesions group, and 2.8% of the malignancy group. The largest single cause of death was related to malignant disease--12 cases (44.4%). Six deaths (22.2%) were caused by bowel strangulation. Of the patients who received more than 24 hours of nonoperative therapy, 46% had relief of obstruction. There was no statistically significant difference in successful results between patients managed with long tubes compared to patients managed with nasogastric tubes. Conservative therapy for malignant obstruction was not successful in 85% of cases. The presence of bowel strangulation shows a positive correlation with age (greater than 70 years), feculant vomiting, peristaltic sounds, and a white blood cell count higher than 18,000/mm3. It shows no correlation with onset, localization or type of pain, duration of symptoms, temperature, tachycardia, or x-ray findings. The results of the study indicate that accurate criteria for small bowel obstruction therapy have not been clearly defined except in patients with incarcerated hernias. Nonoperative management is successful in a significnt percentage of patients.

Adolescent↗

PubMed1976

[Diagnosis and treatment of intestinal obstruction caused by cholelithiasis].

Cholelithic intestinal obstruction was observed in 7 (4.7%) of 150 patients operated upon for intestinal obstruction of non-tumor origin. The patients' age ranged from 56 to 82 years. The patients were admitted within the terms from 1 to 21 days since the onset of the disease. All patients were subjected to surgical therapy. In one case a duodenal concretion was removed, and cholecystectomy was performed. In the remainder a bile stone was removed from the small intestine. In one of these patients the intestinal segment changed pathologically being resected with an end-to end anastomosis. Three patients died: two--from peritonitis and one--from pulmonary artery embolism.

Age Factors↗

PubMed1992

[The effects of dachengqi decoction, shaogan decoction, emodin and sennoside on the histamine level of intestinal mucosa in intestinally obstructed rats].

The experimental intestinal obstruction model was made by partly ligating the ileum in rat. The histamine levels of obstruction groups (8.14 +/- 2.28 micrograms/g) were obviously lower than those of control groups (P < 0.01). After administration of Dachengqi decoction, Shaogan decoction, emodin and sennoside, the levels of histamine were significantly higher than those of obstruction groups, but there were no significant differences as compared with control groups.

Animals↗