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Intestinal obstruction is diagnosed as one of two kinds--small intestine and large intestine obstruction. They differ in etiology of the obstacle, pathogenesis and degree of clinical picture. The cause of the small intestine obstruction in patients having laparotomy in medical history is the formation of commissures. In patients with intact abdomen the cause of low obstruction was torsion and intussusception, the cause of high obstruction was the obturation with a bile calculus and a foreign body. Causes of the large intestine obstruction were obturation with a tumor and torsion. Napalkov's test is expedient but when suspecting the small intestine obstruction. Conservative treatment is possible in commissural small intestine obstruction (12-24 h) and in large intestine obturation obstruction (not longer than 2h).
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Intestinal smooth myosin B was prepared from muscle layers around the lesion in dogs with experimental colonic stenosis and in patients with congenital intestinal obstruction. Mg2+-ATPase activity of the myosin B was compared between the proximal dilated segment and distal segment to obstruction. Experimental colonic stenosis: In early period after surgery, proximal colons showed higher activity of myosin B ATPase than distal colons, decreasing to less than distal colon as time passed. Congenital intestinal obstruction: In three cases, whose atresia might have occurred at earlier period of gestation, proximal bowels showed less activity of myosin B ATPase than distal bowels. However, in two cases, whose atresia might have occurred at later period of gestation, and two cases with intestinal stenosis, proximal bowels indicated higher activity of myosin B ATPase than distal bowels. These data suggested that the contractibility of the proximal intestine was depending on the duration of obstruction, and it was depressed in the former patients and was accelerated in the latter patients. These results suggested that the extensive resection of dilated proximal bowel in the congenital atresia is not always necessary to obtain good postoperative intestinal dynamics at the operation of the atresial lesions which may be induced at later period of gestation. They also suggested that surgery for intestinal obstruction should be performed before the depression of intestinal contractibility to get good bowel function.
Intestinal obstruction developed in a 4-month-old child in association with an ileal lymphangioma. Intestinal lymphangiomas have only rarely been reported in the literature. This case report documents an additional case and also points out an association with intestinal obstruction. The clinical and pathologic details of lymphangiomas are also reviewed.
Intestinal obstruction is a relatively common clinical problem in patients with advanced cancer, particularly those with colorectal and ovarian tumours. A proportion of patients have a non-malignant cause for their obstruction, but in the remaining patients obstruction will be caused by advanced malignancy itself. In the past, most patients were either managed surgically or by nasogastric intestinal decompression and intravenous hydration. Surgery in patients with advanced cancer is associated with high mortality and morbidity. Effective surgical decompression is difficult. We have managed 24 patients with advanced abdominal malignancy and previous operative or radiological evidence of intestinal obstruction without operation. The technique is only appropriate for patients in whom a solitary or correctable obstructing lesion can be excluded. The patient is encouraged to take free fluid and a diet low in fibre. Intestinal colic is managed with morphine, the dose required being titrated for each individual patient against background pain and colic. Vomiting is controlled by the parenteral administration of antiemetic drugs. To simplify drug administration, morphine and metoclopramide are mixed in the same syringe and infused subcutaneously simultaneously. In our 24 patients the mean survival rate after the onset of complete obstruction was 29.2 days. The mean dose of morphine infused was 9.2 mg/h, and the mean dose of metoclopramide was 6.9 mg/h. The case of an 82-year-old male patient is presented. We commend the technique to surgeons contemplating surgery in these very difficult patients. It is simple, relatively non-invasive and saves the patients the pain, discomfort and complications of unproductive surgery.
Intestinal circulation was studied during in vitro perfusion of denervated small intestine of the cat shortly after release of an in vivo small-bowel obstruction. Blood flow, vascular resistance, capillary filtration, and oxygen consumption were determined. No significant differences were demonstrated between obstructed and non-obstructed intestines. The presently studied facets of small-bowel microcirculation thus exhibit a virtually normal function 30 minutes after decompression of a bowel obstruction. The pertinent literature affords evidence that a distension impairs bowel viability; it would seem that this impairment is rapidly ameliorated following decompression of the bowel.
Intestinal obstruction is a common and distressing complication for patients with advanced abdominal or pelvic cancer. Many of these patients are unfit for surgery due to extensive local disease or poor general condition. There are now many drug regimens available that will relieve obstructive symptoms in most patients, although a few, mainly with high obstruction, will require a venting procedure.
Intestinal obstruction, a disorder that afflicts both children and adults, is associated with significant morbidity. Early recognition and appropriate management can prevent life-threatening complications; however, considerable controversies exist regarding the ideal method of diagnosis and treatment. This article provides a comprehensive overview of risk factors for small and large bowel obstruction. The pathophysiologic process is related to the clinical findings. A summary of diagnostic methods with an evaluation of their relative merit is presented. Preventive, and medical, surgical, and palliative therapies are described, with an emphasis on the actions that an advanced practice nurse can implement.
Although dilatation of the jejunum is a well-recognized feature of Crohn's disease there has been no systematic inquiry as to whether this is related simply to distal intestinal obstruction or to other factors such as hypoalbuminemia and mucosal disease. Barium follow-up examinations of 21 patients with Crohn's disease who had serum albumin concentrations of 2.1-4.4 g/dl were reviewed. Fourteen of these patients (67%) had increased mean jejunal width. All patients with direct radiologic evidence of a stricture (six patients) had increased jejunal caliber, but this only accounted for 43% of patients with this abnormality. Of the remaining eight patients, six had hypoalbuminemia, three of whom had serum albumin concentrations less than or around 2.7 g/dl, the previously determined "albumin threshold" for jejunal dilatation. We conclude that increased jejunal caliber in Crohn's disease not only occurs in association with distal intestinal stenosis but also with severe hypoalbuminemia in the absence of obstruction. We were unable to define a cause of jejunal dilatation in 36% of these patients, but propose that functional obstruction due to distal nonstenosing inflammatory disease may be a factor.
Intestinal motility, absorption, and secretion are altered after intestinal obstruction, but at what point the normal bacterial barrier function of the viable gut fails after intestinal obstruction is unclear. Thus, we tested whether after simple intestinal obstruction bacteria would translocate across the viable intestinal wall to cause systemic infection. Within 6 hours of intestinal ligation 1 cm proximal or distal to the ileocecal valve, bacteria had translocated to the mesenteric lymph nodes, and by 24 hours after intestinal obstruction, bacteria had spread to the liver, spleen, and blood stream. Bacterial translocation rarely occurred in the animals undergoing laparotomy and sham intestinal ligation, indicating that bacterial translocation was not due to surgical stress. Based on the results of these studies, bacterial translocation induced by intestinal obstruction appears to be due to disruption of the ecology of the normal gut microflora, leading to intestinal overgrowth with certain enteric bacilli and mucosal damage. Although the exact mechanism(s) by which simple mechanical obstruction injures the intestine is not known, the fact that mucosal injury did not occur in germ-free mice suggests that bacteria may play a role in the pathogenesis of obstruction-induced intestinal injury.
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In intestinal obstruction, phenols were produced in the distended loop proximal to obstruction by enteric bacteria. Clinically, in 17 cases of non-strangulated intestinal obstruction, phenols were detected in 15 cases and mean concentration of phenols was 4.2 +/- 9.7 micro g/ml(mean +/- 1 SD). In the fraction of phenols, p-cresol was detected in 15 cases and mean concentration was 3.8 +/- 7.7 and phenol was detected in 4 cases and mean concentration was 0.5 +/- 2.6. Phenols were decreased as clinical improvement of intestinal obstruction. Enteric bacteria in enteric juice ranged from 10(4) to 10(10)/ml and its change paralleled to phenols concentration. Mean urinary concentration of phenols in intestinal obstruction was increased to 297 +/- 415 mg/day compared to control (less than 50 mg/day). Its change also paralleled to phenols concentration in enteric juice. Closed ileal loop was made in dogs and phenols were infused in the loop. Phenols were increased in the portal vein 5 min after the infusion and in the femoral vein 60 min after the infusion. Phenols, which was thought to be toxic to the host, were proved to be produced in the distended intestine and excreted from the kidney.
Acute intestinal obstruction is an emergency that frequently requires operative intervention, either immediately or within several days. Because of the difficulty in distinguishing strangulation obstruction from simple obstruction, a philosophy of operating on all patients with intestinal obstruction has been advocated by many physicians. On the other hand, the approach of attempting tube decompression on most patients rather than immediate operation has also been advocated. Both of these approaches are extreme and somewhat simplistic in dealing with a problem that often is complex. Fluid and electrolyte replacement, intestinal tube decompression, and appropriate surgical management are crucial to the successful management of these patients. This text presents a summary of the pathogenesis and various etiologies of intestinal obstruction and offers some diagnostic and treatment guidelines that will assist the clinician in the management of his patients.
Today, intestinal adhesions represent the most frequent etiology for complete or partial intestinal obstruction. Although partial obstruction can be treated nonoperatively with a considerable likelihood of success, intestinal strangulation cannot uniformly be predicted or prevented. Complete intestinal obstruction is associated with a significant incidence of strangulation if not treated by a vigorous surgical approach. Consequently, complete intestinal obstruction secondary to adhesions is still a surgical disease. Attempts at control of the adhesion process include mechanical methods to prevent subsequent obstruction and chemical methods to prevent the adhesion process itself. The invasive mechanical methods appear dated. A variety of agents have been used either systemically or in the peritoneal cavity to prevent the establishment of intra-abdominal adhesions. Agents that do not contribute to subsequent morbidity or impede the native host defense mechanisms should be utilized. High-molecular-weight dextran and nonsteroidal anti-inflammatory agents show some promise of being both safe and effective. As is frequently the case, the bottom line in preventing and treating intra-abdominal adhesions is appropriate surgical technique. Intestinal adhesions can be related clearly to leaving damaged, devitalized, or ischemic tissue in the peritoneal cavity or to excessive roughness in handling of tissues. Steps such as avoidance of excessive suture material and unnecessary handling of the bowel will do much to prevent subsequent adhesion generation. Likewise, the surgical lysis of intraperitoneal adhesions is frequently fraught with complications such as intra-abdominal abscess or postoperative incisional failure. This is again related to surgical technique and most directly to the use of blunt dissection to divide adhesions. Knife dissection in the lysis of adhesions is recommended. This technique, combined with excellent intraoperative hemostasis, can be associated with a marked diminution in the incidence of postoperative fistulas and abscesses.
Mechanic intestinal obstruction, caused by the passage of biliary calculus from vesicle to intestine, through fistulization, although not frequent, deserve study due to the morbi-mortality rates. Incidence in elder people explains the association with chronic degenerative diseases, increasing complexity in terms of therapy decision. Literature discusses the need and opportunity for the one or two-phase surgical attack of the cholecyst-enteric fistule, in front of the resolution on the obstructive urgency and makes reference to Gallstone Ileus as an exception for strong intestinal obstruction. The more frequent intestinal obstruction observed is when it occurs a Gallstone Ileus impacting in terms of ileocecal valve. The authors submit a Gallstone Ileus manifestation as causing strong intestinal obstruction, discussing aspects regarding diagnostic and treatment.