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Query: UMLS:C0021831 (enteropathy)
 4,403 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Crohn's disease (regional enteritis) is a chronic non-specific inflammatory intestinal disorder of unknown etiology. Most commonly the terminal ileum in involved, a segmentary involvement of the bowel wall is rather characteristic. Main symptoms are recurrent abdominal pain, fever, diarrhea and weight loss. Radiological and endoscopic examination confirms the diagnosis, granulomas in the biopsy specimen are pathognomonic. In differential diagnosis ulcerative and ischaemic colitis have to be ruled out. Conservative therapy with prednisolone and salazopyrin is the method of choice, however, complications like small bowel obstruction, toxic megacolon and fistulae ask for surgical intervention.
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PMID:[Morbus Crohn (enteritis regionalis)]. 0 46

On-study barium radiographs of 535 patients in the National Cooperative Crohn's Disease Study have been analyzed for the pattern of distribution of bowel disease and the individual features that characterized bowel involvement. On-study and off-study radiographs of 403 of these patients were compared under code to judge radiographic response to drug treatment and discover correlations of radiographic findings with clinical response. Patients with more clinically active disease had more colonic disease on x-ray. Duodenal abnormalities were recognized in 22% of the patients and radiographically typicaly Crohn's disease of the duodenum in 8%. Recurrent Crohn's disease and that characterized by small bowel obstruction each displayed a characteristic appearance. Overall there was little evidence of radiographic improvement during the study, and little correlation between clinical response and evidence of radiologic improvement. Only patients treated with prednisone for more than 6 mo showed statistically significant radiologic improvement. Patients with definite radiographic progression or regression were found in each treatment group. Both fistula and stricture with obstruction were associated with a poor clinical response to all therapies. In view of the evidence from this study that radiographic findings do not correlate with clinical symptoms or response, the ritual use of x-ray to follow patients with Crohn's disease is unnecessary.
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PMID:Radiographic findings of the National Cooperative Crohn's Disease Study. 3 81

In the great majority of patients treated with radiation, only transitory injury to the bowel occurs, but in five percent of patients, permanent damage to the small bowel or rectum is seen. Symptoms of radiation enteropathy may begin four to six months after the treatment is completed or may not present until several years later. Most often, the patient presents with abdominal pain, diarrhea, hematochezia, and signs of malnutrition. Others may present, initially, with intestinal obstruction, perforation, or fistulization. It is important to differentiate this clinical syndrome from recurrent cancer by appropriate radiological studies and biopsies.This paper presents four patients who were treated with radiation for invasive carcinoma of the cervix and subsequently developed radiation enteritis. All were treated surgically and are surviving.
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PMID:Surgical management of radiation enteritis. 44 53

Small intestinal obstruction without colonic dilation can be the mode of presentation in a variety of colonic diseases, including carcinoma, diverticulitis, and colitis. Plain abdominal roentgenograms may lead the unwary physician into errors of diagnosis and treatment by suggesting primary small bowel disease. Barium enema examination of the colon will keep the wary physician out of such traps. We describe five patients with small bowel obstruction who had a variety of colonic diseases diagnosed by barium contrast studies. If the reason for intestinal obstruction is not apparent and the need for emergency surgery is not compelling, we recommend an immediate contrast study of the colon to aid in evaluating possible colonic pathology.
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PMID:Isolated small bowel obstruction as the presenting feature of colonic disease. 88 24

Repeated or prolonged organic obstruction of the small intestine in the neonatal period can lead to severe refeeding problems, despite a transient ostomy. These problems are thought to result from a postobstructive enteropathy (POE) of the apparently normal small intestine segment above the obstruction. Ten infants with a POE, characterized by limited oral caloric and carbohydrate intakes and increased ostomy effluent, were compared with 8 controls with an enterostomy and a normal postoperative refeeding pattern. There was no statistical difference in the histomorphometric appearance of the mucosa or its digestive or absorptive capacity (brush-border hydrolases, glucose transport) between the two groups. The effluent and duodenal floras of the two groups were similar. However, all POE patients showed significant abnormal peristalsis characterized by barium and carmin transit times. This suggests that repeated or prolonged obstruction in the neonatal period could lead to a POE, caused by chronic motricity abnormalities of the small intestine above the obstruction. Although this POE is more frequent after small bowel atresia, it may also occur with other conditions causing prenatal and postnatal intestinal obstruction.
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PMID:Postobstructive enteropathy in infants with transient enterostomy: its consequences on the upper small intestinal functions. 147 4

Acute radiation enteropathy is usually self-limited and rarely requires surgical intervention. Chronic radiation enteropathy may occur months, years, or decades after treatment. Patients may present with crampy abdominal pain, diarrhea, or cachexia or may present acutely with bowel obstruction or fistula. The bowel and its mesentery are shortened, and mucosal ulceration and submucosal fibrosis are present. The vasculature of the bowel is markedly compromised by progressive endarteritis. Ideally, nutritional support should be given and surgery performed electively. Regardless of presentation, both large and small bowel must be evaluated for concurrent problems. At surgery, resection and restoration of continuity of the gastrointestinal tract is optimal management. Recurrent obstruction and fistulae are real risks, and optimal management is resection of bowel damaged by radiation and anastomosis using bowel spared from irradiation. However, if the patient is unstable or necessary dissection and mobilization of the bowel judged too morbid, bypass of the affected loop is acceptable. Occasionally, only diversion of the bowel by enterostomy is possible.
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PMID:Surgical management of radiation enteropathy. 192 57

Forty-two patients underwent a resection for acute or chronic complications of Crohn's disease during the years 1983-1987. The colon was involved in 38% (16 patients), the small bowel in 31% (13 patients) and the ileocaecal region in 31%. In small bowel disease, the indication for operation was either an intestinal obstruction or an internal abscess. In colonic locations, poor response to medical therapy was the indication for operation in 10 patients (63%), and an acute complication in the remaining cases. The operations performed were always "radical resections": 13 resections of small bowel, 13 ileocaecal resections, 7 ileocolectomies with ileosigmoidostomies, 6 ileocolectomies with ileorectostomies, 2 left side hemicolectomies with colorectostomies and one total coloproctectomy. There was no operative mortality. A post-operative complication occurred in two patients (4.8%). The recurrence rate was 12% after 30 months average follow up in the 34 patients with only one operation for Crohn's disease. There was no second recurrence in the 8 patients operated for a first recurrence. The factors affecting recurrence after resection were: a short pre-operative time interval since first clinical symptoms: 4.6 years versus 5.3 years without recurrence (p less than 0.01); the colonic location of the Crohn's disease (p less than 0.02). Colonic location rate of the disease was found to be higher in this study as compared to others. Since "radical resection" fails to cure all patients, surgery should be restricted to acute on chronic complications.
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PMID:[Crohn disease: results of a series of 42 intestinal resections]. 231 Jan 43

Rhabdomyolysis, secondary to chronic small bowel obstruction. The authors report the case of a 48-year old man, who developed rhabdomyolysis based only upon hypokalemia secondary to a chronic gastro-intestinal disorder (chronic obstruction of the small bowel). They would like to point out that despite the rare occurrence of rhabdomyolysis associated with hypokalemia, this pathological condition cannot be underestimated. Complaints of acute myalgia and general muscle weakness are characteristic. Early recognition of this syndrome is mandatory because myoglobinuria could provoke acute renal failure with eventual fatal outcome.
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PMID:[Hypokalemia with rhabdomyolysis secondary to chronic small bowel obstruction]. 233 25

The records of 51 patients diagnosed with enterovesical fistulas at Virginia Mason Medical Center from 1974 to 1988 were reviewed. Diverticulitis (41%), Crohn's disease (17%), and colorectal cancer (16%) were the major causes. In 50 of 51 patients, the diagnosis was made on the basis of the clinical history and the urine culture. Radiologic and endoscopic studies failed to identify the fistula in 20%, though all were confirmed at operation or autopsy. In four of eight patients with fistulas secondary to colorectal cancer, malignancy was not diagnosed preoperatively. Operation was performed in 84% of the patients. One-stage resection of the bowel was performed in 66% of patients with the intent of removing the fistula. The complication rate was 8% with no deaths. All multi-stage procedures were performed for fistulas complicated by abscess or bowel obstruction. There were two postoperative deaths in patients with metastatic cancer undergoing palliative diversion. All eight patients treated by diverting colostomy had persistent fistulas and urinary sepsis. All eight patients treated with antibiotics but without operation were free of complications of the fistula until death from other causes. Enterovesical fistula is a clinical diagnosis. Preoperative studies should be used to delineate the bowel disease and search for malignancy rather than to see the fistula, which is clinically apparent. One-stage resection of the involved bowel is the procedure of choice in the absence of abscess or bowel obstruction. When resection is not feasible, medical management with antibiotics is preferable to colostomy.
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PMID:Management of enterovesical fistulas. 233 17

Due to paucity of suitable animal models, it has been difficult to study the development of long-term intestinal complications following fractionated irradiation. We recently developed a model which allows multiple radiation exposures of a short segment of rat ileum without the need for repeated surgery. In the present series, this model was used to study the influence of shortening the total treatment time (accelerated fractionation) on development of radiation enteropathy. Male rats were orchiectomized and a short segment of distal ileum was transposed to the scrotum. Starting 3 weeks after surgery, the scrotum containing the intestinal segment was x-irradiated with 20 fractions of 2.8 Gy (total dose 56 Gy). Two fractionation schedules were compared: One fraction per day (total treatment time 26 days) and 3 fractions per day (total treatment time 7 days). Actuarial survival curves were obtained, and the degree of radiation injury was assessed 2, 8, and 26 weeks after the last radiation exposure using a semiquantitative histopathologic scoring system. There was no mortality from acute radiation injury in either treatment group. All animals of the 1-fraction/day group survived the observation period (26 weeks). In the 3-fraction/day group, there was significant mortality due to intestinal obstruction, and cumulative mortality at 26 weeks was 100%. Radiation injury, as assessed by the histopathologic scoring system, was also more pronounced in this group than in the 1-fraction/day group. We conclude that shortening the total treatment time significantly increases the severity of late intestinal complications. Our data are suggestive of an association between acute mucosal damage and chronic radiation injury of the small intestine.
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PMID:Intestinal complications following accelerated fractionated x-irradiation. An experimental study in the rat. 233 76


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