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This is a review of 261 patients operated for 271 instances of mechanical intestinal obstruction over a 5-year period in a developing country in the tropics. The pattern of intestinal obstruction in Chinese is similar to that in Caucasians, where adhesions account for the largest number of cases. The occurrence in Malays, Indians, Pakistanis and Ceylonese is similar to that in other developing communities where external hernia is commonest while adhesive or tumour obstruction is rare; however, these racial groups do not exhibit the high incidence of intussusception and volvulus found in Africa and India. The operative mortality was 13-9 per cent, which is comparable to that in Western series. The major adverse factors in intestinal obstruction, i.e. extremes of age, associated disease, gangrenous bowel, large bowel obstruction and malignancy, were confirmed. Fluid and electrolyte imbalance was frequent, as in other tropical series, but with intensive preoperative correction it was not an important adverse factor.
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PMID:The pattern of intestinal obstruction in Malaysia. 100 47

One hundred severty-one cases of mechanical intestinal obstruction were studied. One hundred fifteen had small bowel obstruction and fifty-six had large bowel obstruction. Adhesion (32.8 per cent), hernia (21.6 per cent), and neoplasm (18.1 per cent) were the cause of obstruction in more than 70 per cent of all cases. More than 40 per cent of patients were older than 60 years and the average age was 52.7. The numbers of males and females were approximately equal. There were twice as many whites as blacks, and the mortality rate was higher among blacks. The overall uncorrected mortality rate was 18.7 per cent. Operation was performed in 105 patients (61.4 per cent), with a postoperative mortality of 19 per cent and corrected postoperative mortality of 4.5 per cent. Contributing factors that were significant were high incidence of metastatic diseases, elderly patients, and delay in admission.
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PMID:Intestinal obstruction. 115 23

Emergency equine abdominal surgery is easiest and most efficiently carried out with a team of surgeons. The surgical site should be as protected as possible by the use of sterile drapes and wound protectors. A ventral midline laparotomy incision has been found to be the most convenient approach to most equine intestinal obstructions. A standing laparotomy through the left paralumbar fossa gives adequate exposure for exploration of the abdomen and is, therefore, useful as a diagnostic tool. Horses tolerate having both ventral midline and left paralumbar laparotomy incisions well. If the cause of the intestinal obstruction is not readily apparent upon opening the abdominal cavity, a thorough systematic exploration of the abdominal cavity is necessary. If the problem cannot be found with the bowel in situ, intestine must be exteriorized for examination. The decision as to the extent of adequate bowel resection often depends on a subjective assessment of bowel function. In equivocal cases, the surgeon should choose to resect some normal bowel rather than taking a chance on leaving compromised bowel in place. Incarcerations are frequent causes of small intestinal obstructions. The small intestine may become incarcerated in the epiploic foramen, the inguinal canal or in an umbilical hernia. Thromboembolic compromise to intestinal vessels results in the longest lengths of embarrassed bowel requiring resection. Impactions are the most common obstructions associated with the caecum. Large colon torsions of 270 degrees or less may be corrected by surgical manipulation; with 360 degrees torsions of the large colon, however, vascular compromise is usually sufficient to devitalize this organ. Enterotomy of the large colon allows retrieval of most enteroliths from its lumen. Enterotomy of the right dorsal colon is also useful for removal of foreign bodies which cause obstruction of the most proximal portion of the small colon. In our Clinic a two-layer end to end anastomosis is usually utilized. Recently introduced automated stapling and ligating instruments have been useful in decreasing surgical time. Antibiotics, usually furacin and sodium or potassium penicillin in 2 litres of Normasol-R, are placed in the peritoneal cavity before closure of the abdomen. A Penrose drain is commonly placed into the abdominal cavity to provide drainage of the peritoneal cavity after surgery. The peritoneum is sutured with No 0 chromic gut in a simple continuous pattern. A second Penrose drain may be placed between peritoneum and ventral body wall, with its ends retracted through stab incisions in the skin. The linea alba is closed with simple interrupted sutures of stainless steel wire or No. 3 chromic gut. Employing the above described principles and techniques has increased the success of abdominal surgery in our Clinic.
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PMID:Surgical techniques in equine colic. 117 35

The significant increase in the number of people older than seventy forces the physician to be acquainted with both psychological and physical alterations induced by aging and to devote an ever increasing proportion of time for recognition and treatment os such alterations. In the medical sense, the biological and physiological age is more important than the chronological age. With increasing age there is--especially concerning the digestive tract and its accessory organs--a rise in the incidence of organic affections and a decline in the frequency of functional disorders. Besides it is wise to know, that the increasing age there is often a coexistence of multiple degenerative disorders and disease states, involving many body systems and organs. On the background of this recognition it is also important to know, that prognosis too varies with age because of the coexistence of individually prognosticated disease states and moreover to realize, that elderly patients do not tolerate invasive and prolonged surgical procedures. Structural or functional disturbances of the digestive organs by aging processes do not cause death per se, but can become one important factor; degenerative sclerotic vascular alterations bear relationship to the poorly contractile vasculature that brings up difficulties in the control of hemorrhagic gastroduodenal ulcers. Many gastrointestinal disorders in elderly patients occur with an equal frequency in younger patients, some are more common in the geriatric population; these include hiatal hernia, carcinoma of esophagus, stomach, pancreas, bile ducts and colon, intestinal obstruction (ileus) by neoplastic growth, gallstone ileus, external hernia and operative adhesions and especially diverticular diseases of the colon and its complications and ischemic colitis by mesenteric vascular occlusion. Cirrhosis of the liver is often diagnosed for the first time in the older age groups while acute viral hepatitis uses to run a cholestatic course and is therefore often misdiagnosed as mechanical obstruction. In general history is difficult to obtain, the response of the organism with temperature and white blood count to stress is often delayed and rigidity associated with an underlying inflammatory disease involving the peritoneum is often delayed and rigidity associated with an underlying inflammatory disease involving the peritoneum is often atypical. Because of this limited reaction to severe stress, early surgical intervention is imperative in the elderly patients.
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PMID:[Problems of the so-called geriatric gastrointestinal diseases]. 120 46

A patient who initially had a small-bowel obstruction was found, at laparotomy, to have an internal hernia through a defect of the falciform ligament. Simple resection of the round ligament was curative. The defect is presumed to have been congenital in origin. No previous report could be found in our review of the literature.
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PMID:Small-bowel obstruction due to congenital anomaly of the falciform ligament. 125 26

Traumatic diaphragmatic hernias, although quite common are frequently overlooked as a cause of intestinal obstruction. The hernia may produce significant symptoms acutely or manifest itself many years following the initial injury. A high index of suspicion is necessary to diagnose intestinal obstruction due to incarcerated diaphragmatic hernia. The operation should be performed through the transabdominal approach when hernia occurs acutely, and the transthoracic approach is recommended when herniorrhaphy is performed long after the time of injury. A case of incarcerated traumatic diaphragmatic hernia that occurred 19 years following a gunshot wound of the chest is reported. The intestinal obstruction was initially thought to be due to cancer of the splenic flexure of the colon.
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PMID:Incarcerated diaphragmatic hernia: report of an unusual case. 125 58

The only case of obturator hernia in over 230,000 admissions is discussed. In the review of the recent English literature, a total of 30 cases, including our own, was collected. Characteristics of the condition were analyzed. The median age of the patients was 67 years; the majority were females in a ratio of 9:1 and both sides were equally affected. This entity occurs with the signs and symptoms of small bowel obstruction and, in almost one half of the patients, the pathognomonic Howship-Romberg sign.
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PMID:Obturator hernia: report of a case and brief review of its status. 126 79

Transomental hernia is a very rare condition with less than 50 cases reported. This hernia nearly always causes bowel obstruction and may result in a high mortality rate because of strangulation and gangrene. A typical case of transomental hernia is presented and the literature is reviewed with emphasis on the need for early diagnosis and operation.
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PMID:Transomental hernia. 126 80

A 3-week-old boy presented with repeated episodes of vomiting and constipation. At laparotomy a jejunal diverticulum arising from its antimesenteric border and extending retroperitoneally was found. The narrow neck of diverticulum caused a situation similar to a Richter's hernia. The fundus of diverticulum was attached to the upper pole of left kidney. A retroperitoneal jejunal diverticulum is a new addition to the cause of neonatal intestinal obstruction.
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PMID:Retroperitoneal jejunal diverticulum: cause of intestinal obstruction. 146 85

Obturator hernia is rare and is usually discovered by chance at operation or autopsy. In certain cases obturator hernia may cause sliding and strangulation of abdominal viscera inside the hernial sac, presenting clinically as bowel obstruction. An 83-year-old woman with signs of bowel obstruction was operated after 48 hours of conservative treatment and a small bowel loop was found strangulated inside the sac of an obturator hernia.
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PMID:[Incarcerated obturator hernia causing bowel obstruction]. 147 63


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