[Ileostomy in persistent paresis and paralysis of the intestines].
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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.
64 patients have been studied by means of an original abdominal epicutaneous electric recording technique. Cases of intestinal paralysis did not show up waves of particular importance while cases of intestinal occlusion showed waves of three basic types. A close relationship was found between types of waves and occlusion localization. The physiopathological and clinical implications of this diagnostic approach are discussed.
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An unusual late complication of side-to-side intestinal anastomosis, chronic small-bowel obstruction with massive proximal ileal dilation despite a widely patent anastomosis, occurred in a patient. The classic blind loop syndrome was not present. Several potential mechanisms are suggested, including regional absence of normal peristalsis on a mechanical basis and bacterial overgrowth. This report adds support to the concept that side-to-side intestinal anastomosis should be avoided whenever possible.
A double-blind crossover study using placebo and antibiotics effective against either aerobic or anaerobic organisms has been performed to elucidate the role of intestinal microflora in the pathogenesis of colonic pseudo-obstruction, which is now established as an important complication of jejunoileal bypass. Using strict Virginia Polytechnic Institute (VPI) technique, quantitative bacterial studies of the intestinal flora in the region of bypassed bowel have been correlated with symptoms of abdominal pain and distension. It has been shown that antibiotics effective against obligate anaerobes rapidly relieve the symptoms of pseudo-obstruction and this coincides with the disappearance of these organisms from this region of bowel. Symptoms rapidly recur when anaerobic organisms repopulate the bowel. It is concluded that obligate anaerobes may play a role in the pathogenesis of this complication.
Two patients with intestinal obstruction in pregnancy are presented and discussed. In neither case was there any obvious cause for the intestianl obstruction. Pseudo-obstruction of the bowel has not previously been described as a complication of pregnancy.
We have encountered two patients with volvulus of the small intestine at the ileocolic anastomosis, occurring after jejunoileal bypass. This uncommon complication is generally seen many months after bypass and may be difficult to diagnose. Barium enema examination was helpful in one patient. If there are acute, severe abdominal symptoms, mechanical obstruction and early operation should be considered. Attention has been called to other intestinal syndromes with obstructive features developing after jejunoileal bypass, and these have been compared.
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