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PubMed2001

Metformin retention independent of renal failure in intestinal occlusion.

Metformin is eliminated by the kidneys, and metformin accumulation has always been noticed in oligo-anuric patients. We have reported an exception to the rule with the case of a metformin-treated patient having metformin accumulation contrasting with a mild increase in serum creatinine in the context of a volvulus of the sigmoid colon. This case prompted us to examine the association between intestinal occlusion and plasma metformin concentrations. For this purpose, we developed an experimental animal model of mechanical obstruction of the intestine. Rats were pre-treated during 3 weeks via drinking solution at a dose of approximately 100 mg/kg/day of metformin. They underwent at day 0 either sham-operation (n=7) or operation (n=8) to place a plastic tube around the ileum near the ileocaecal valve. Metformin administration was pursued on days 1, 2, and 3 giving a single dose of 100 mg/kg by intragastric gavage. Four days after the surgery, i.e. 24 h after the last metformin administration, the surviving intestinal obstructed rats (n=8) developed overt intestinal dilation but no biochemical abnormality compared to sham-operated animals (n=7; arterial lactate concentrations respectively 4.87 +/- 0.63 mmol/l and 3.97 +/- 0.30 mmol/l, NS, and serum creatinine concentrations 69.0 +/- 1.7 micromol/l and 68.7 +/- 1.9 micromol/l, NS). By contrast, there was a striking difference with regard to metformin concentrations, decreasing from 2.95 +/- 0.94 mg/l at day 0 to 0.12 +/- 0.03 mg/l at day 4 (p<0.001) in the sham-operated group but remaining unchanged (1.65 +/- 0.76 mg/l and 1.61 +/- 0.51 mg/l) in the operation group. In conclusion, this is the first experiment showing that intestinal occlusion may be responsible for metformin retention in the absence of renal failure. Whether this observation may be relevant to other drugs remains to be established.

Acute Kidney Injury↗

PubMedDate not supplied

Onchocerca volvulus: expression and immunolocalization of a nematode cathepsin D-like lysosomal aspartic protease.

The N-terminal region of the cathepsin D-like aspartic protease from the human filarial parasite Onchocerca volvulus was expressed as His-tag fusion protein. Light and electron microscopic immunohistology using antibodies against the recombinant protein showed labeling of lysosomes in the hypodermis and epithelia of the intestine and the reproductive organs of Onchocerca. While developing oocytes were negative, mature oocytes and early morulae showed strong labeling. In older embryos and mature microfilariae, stained lysosomes were only found in a few cells. Cell death in degenerating microfilariae of patients untreated and treated with microfilaricidal drugs was associated with strong expression of aspartic protease. IgG1, IgG4, and IgE antibodies reactive with the recombinant protein were demonstrated in sera from onchocerciasis patients indicating exposure and recognition of the enzyme by the host's defence system. The aspartic protease of O. volvulus appears to function in intestinal digestion and tissue degradation of the filaria.

Animals↗

PubMed1981

Giant Meckel's diverticulum. A cause of intestinal obstruction.

Giant Meckel's diverticula are more likely to cause obstruction than bleeding. In neonates, this is commonly due to volvulus; in adults, it is usually due to adhesions and a mass effect. A lateral view of the abdomen following barium studies can be helpful. This entity should be included in the differential diagnosis of intestinal obstruction, especially incomplete, intermittent, and chronic forms.

Colonic Diseases↗

PubMedDate not supplied

Small bowel volvulus resulting in infarction due to an anterior gastropexy band.

Volvulus of the small bowel, although rare, carries a high risk of strangulation and ischemic necrosis. It is usually caused by the rotation of a loop of small intestine around an adhesion band or stoma. We present a case of an anterior gastropexy band, giving rise to a small bowel volvulus, necessitating resection due to infarction. This band resulted from separation of the most distal anterior gastropexy suture from the anterior abdominal wall. The distensible nature of the stomach and its resultant postprandial gain in weight produced tremendous shearing forces on the gastropexy sutures, and, as our case demonstrates, a greater number of gastropexy sutures does not protect against this complication.

Acute Disease↗

PubMedDate not supplied

The pattern of acute intestinal obstruction in a peripheral district of eastern India.

This is a review of 146 patients operated upon over a period of five years, for 150 episodes of mechanical intestinal obstruction, in a developing country in the tropics. The pattern of intestinal obstructions reveals that external hernia accounts for the largest number of cases followed by volvulus which today still forms the second largest group. Operative mortality was 28%. The major adverse factors were gangrenous bowel and large bowel obstruction. The highest mortality rate (about 41.3%) was found in volvulus.

Adolescent↗

PubMed1985

Malrotation in children with symptoms of gastrointestinal allergy and psychosomatic abdominal pain.

Three children with malrotation 4.5, 5 and 9 years old at operation are presented. Their preliminary diagnoses were gastrointestinal (GI) allergy, GI allergy with colon irritable and psychosomatic abdominal pain. They were treated on an outpatient basis under these diagnoses for more than two years before their malrotations were discovered. In two children radiology did not demonstrate any signs of intestinal obstruction and in one of these children repeated radiological examinations were necessary for the diagnosis of malrotation. Operative findings were chronic volvulus with compromised blood flow and obstructive duodenal bands. The third child suffered acute strangulation ileus with gangrene of the intestines before diagnosis was made. We conclude that special consideration must be given to the possibility of malrotation when treating and radiologically investigating children with GI disturbances.

Abdomen↗

PubMedDate not supplied

Angiographic patterns in experimental obstruction of the small bowel.

Mechanical obstruction of the small intestine was induced in 79 rabbits. Ligation and/or fixation of an intestinal loop with sutures was performed in order to produce simple obstruction, strangulation, intussusception and volvulus. The obstructed loop and the adjacent segments of the bowel were examined with microscopic, microangiographic and angiographic methods at fixed time intervals of 6, 12, 24 and 48 hours. Dynamics of arterial changes in the intestinal wall and mesentery were investigated. Angiographic patterns of obstruction in the exteriorized loop of a living animal are described. These findings may be of value in evaluating clinical cases.

Angiography↗

PubMed1976

Volvulus of the small bowel.

Over two years in a major hospital in northern Uganda 12 cases of primary volvulus of the small bowel were seen out of a total of 65 cases of intestinal obstruction which did not include external hernias. This relatively high incidence was associated with drinking large amounts of local "kongo" beer. General systemic symptoms of circulatory collapse were conspicuous by their absence. The kongo beer was found to have a high concentration of serotonin, and this substance may have caused the volvulus of the small bowel in three quarters of the cases.

Adolescent↗

PubMed1991

Short-bowel syndrome in children. Quality of life in an era of improved survival.

A number of disorders in childhood can result in short-bowel syndrome (small bowel length, less than 100 cm). Improved care has increased survival in patients with short-bowel syndrome, but the quality-of-life factors associated with such improved survival have not been examined, to our knowledge. Sixteen consecutive pediatric patients with short-bowel syndrome (bowel length range, 22 to 98 cm) were followed up for 2 to 10 years. The original diagnoses were as follows: necrotizing enterocolitis (n = 6), multiple intestinal atresias (n = 4), extensive aganglionosis (n = 2), meconium peritonitis (n = 2), and midgut volvulus (n = 2). The range of initial hospitalization was from 62 to 395 days, and 13 of 16 patients have required readmission (two to 14 times). All patients required multiple operations (range, two to 14 operations), including combinations of venous access, adhesiolysis, tapering enteroplasty, reversed intestinal segments, and pull-through procedure. Nine of 16 patients received home total parenteral nutrition, and 12 of 16 patients required home elemental diets, usually via pump feedings. Fifteen patients (94%) survived. Two survivors are deaf, and one of these has mild developmental delay. Seven survivors (age range, 6 to 10 years) attend a regular school, four while receiving total parenteral nutrition or an elemental diet. Ten of 15 survivors are off all nutritional support (including the child with a 22-cm small bowel), with four others weaning. The presence or absence of an ileocecal valve did not affect outcome. Modern nutritional support methods provide excellent survival and quality of life for children with short-bowel syndrome.

Child↗

PubMed1991

The clinical features of children with malrotation of the intestine.

A review was performed of the 37 cases of malrotation of the intestine which occurred in previously healthy children during a 12-year period. There were 33 patients (89%) younger than eight weeks of age, with 17 patients (46%) aged less than one week. Symptoms included bilious vomiting in 36 patients (97%) and constipation in 33 patients (89%). On initial examination, 35 patients (95%) appeared to be well (including 23/25 patients [92%] with volvulus of the midgut), and 28 patients (76%) exhibited no abnormal physical findings on abdominal examination (including 15/25 patients [60%] with volvulus of the midgut). In all, 25 cases (68%) of malrotation were accompanied by volvulus of the midgut; in 21 of these cases, torsion of the bowel was greater than or equal to 360 degrees. There were four patients (11%) with gangrenous bowel requiring surgical resection. The mortality rate associated with this disorder was 5%; both patients who died were neonates with volvulus who presented in shock and had extensively gangrenous bowel. Malrotation of the intestine usually presents in the young infant, is almost always associated with bilious vomiting, and is commonly accompanied by few if any abnormal physical findings suggestive of a serious underlying intraabdominal disease process. An emergent radiographic contrast study of the upper gastrointestinal tract should be performed to delineate the anatomy of the proximal bowel in all young infants with bilious vomiting.

Child↗

PubMed1990

Role of ascariasis in surgical abdominal emergencies in the Rangoon Children's Hospital, Burma.

Patients aged 1 month to 12 years admitted with an acute abdominal surgical condition comprising 226 cases with and 206 cases without ascariasis, recorded in the operation theatre registers and in-patients clinical sheets, were studied in relation to morbidity, duration of operation and hospital stay and mortality. Annually, 7.5% of laparotomies were due to complications of ascariasis. Operations for ascariasis accounted for 10.6% of all hospital admissions for an acute abdominal emergency. Also, ascariasis accounted for 26.3% of emergency operations. All operated biliary obstruction cases were due to ascariasis. Moreover, 20.4% of all cases of ascariasis with abdominal complications required operation. The mean ages at operation were higher in Ascaris-induced than in non-Ascaris-induced intestinal obstruction (5.1 vs 3 yr), intussusception (3.5 vs 1.2 yr) and volvulus (4.8 vs 1.7 yr). The durations of operation and hospital stay were longer and case fatality rates higher in Ascaris-induced than in non-Ascaris-induced cases. The importance of this study in relation to the socio-economic benefits of controlling ascariasis is discussed.

Abdomen, Acute↗

PubMed1977