Neonatal intestinal obstruction due to absence of intestinal musculature: a new entity.
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Congenital Abnormalities↗
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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↗
Cecal duplication cyst: a cause of intestinal obstruction in a newborn infant.
Intestinal obstruction is the most common surgical emergency in newborn infants. We report a case of cecal duplication cyst (CDC) as a cause of intestinal obstruction in a newborn infant. Prenatal ultrasonography (US) had shown an intra-abdominal cyst that was confirmed by the first postnatal US. Water-soluble contrast enema and a repeat US showed an intracecal cyst, however, the diagnosis of CDC was only established at laparotomy. CDC should be considered in the differential diagnosis of intestinal obstruction in an infant with an intra-abdominal cyst on US and a palpable right iliac fossa mass.
Cecum↗
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↗
Haematemesis resulting from ischaemic strangulating intestinal obstruction.
Although bleeding into the intestinal lumen may occur in strangulating intestinal obstruction, haematemesis is infrequently encountered. We report on a patient who presented with haematemesis and who had, in addition, clinical and radiological features of small bowel obstruction. Upper gastrointestinal endoscopy did not locate the source of bleeding. At laparotomy, which was performed because of clinical deterioration, gangrenous strangulated small bowel secondary to adhesive obstruction was found. In a patient with non-resolving intestinal obstruction, a deterioration in the condition is a clear indication for exploration. Haematemesis occurring concurrently may be a marker of intestinal strangulation, adds strength to the indication and highlights the urgency of the need for exploration.
Adult↗
[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↗
Intestinal obstruction due to tuberculosis.
OBJECTIVES: Intestinal obstruction due to tuberculosis is a rare form of mechanical bowel obstruction. The objectives of this study were to determine the clinical features, to evaluate the role of surgery and to choose procedures in management of this disease. METHODS: In this 7-year retrospective study (from 1992 to 1998), 23 patients (20 males, three females) were included, accounting for 4.5% of all mechanical intestinal obstructions. More than 80% of the patients had a clinical picture of lower small bowel obstruction, while 90.5% of patients had advanced pulmonary tuberculosis. RESULTS: In 54.6% of cases, obstruction occurred in the ileocaecal region. The main lesion causing obstruction was intestinal tuberculosis in the hypertrophic form (86.4%). Diagnosis of intestinal tuberculosis as a cause of obstruction was not easy because it has no specific symptoms and signs. CONCLUSION: In terms of management, ileocolostomy was often used (68.2%) but long-term results were not very good. Blind loop syndrome was one of its disadvantages. Resection may be the safe and effective procedure.
Adult↗
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↗
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↗
Intestinal obstruction due to volvulus of small intestine.
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Humans↗
[The physiopathology and treatment of intestinal obstruction].
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Intestinal Obstruction↗
Relative contribution of genetic and nongenetic modifiers to intestinal obstruction in cystic fibrosis.
BACKGROUND & AIMS: Neonatal intestinal obstruction (meconium ileus [MI]) occurs in 15% of patients with cystic fibrosis (CF). Our aim was to determine the relative contribution of genetic and nongenetic modifiers to the development of this major complication of CF. METHODS: A total of 65 monozygous twin pairs, 23 dizygous twin/triplet sets, and 349 sets of siblings with CF were analyzed for MI status, significant covariates, and genome-wide linkage. RESULTS: Specific mutations in the CF transmembrane conductance regulator (CFTR), the gene responsible for CF, correlated with MI, indicating a role for CFTR genotype. Monozygous twins showed substantially greater concordance for MI than dizygous twins and siblings (P = 1 x 10(-5)), showing that modifier genes independent of CFTR contribute substantially to this trait. Regression analysis revealed that MI was correlated with distal intestinal obstruction syndrome (P = 8 x 10(-4)). Unlike MI, concordance analysis indicated that the risk for development of distal intestinal obstruction syndrome in CF patients is caused primarily by nongenetic factors. Regions of suggestive linkage (logarithm of the odds of linkage >2.0) for modifier genes that cause MI (chromosomes 4q35.1, 8p23.1, and 11q25) or protect from MI (chromosomes 20p11.22 and 21q22.3) were identified by genome-wide analyses. These analyses did not support the existence of a major modifier gene on chromosome 19 in a region previously linked to MI. CONCLUSIONS: The CFTR gene along with 2 or more modifier genes are the major determinants of intestinal obstruction in newborn CF patients, whereas intestinal obstruction in older CF patients is caused primarily by nongenetic factors.
Chromosomes, Human, Pair 11↗
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↗
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↗