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

The clinical presentation, operative findings and outcome in 40 patients who required surgery for bowel disease after radiotherapy are presented. The type of presentation varied according to the time after radiotherapy. In the first month, many patients had a proctitis but none required surgery. Five patients were operated on within one month, 2 for radiation-induced acute ileitis and 3 for exacerbations of pre-existing disease (diverticular disease 2, ulcerative colitis 1). The commonest time of presentation was between 3 and 18 months after radiotherapy, when 20 patients needed surgery for bowel disease caused by radiation-induced local ischaemia. Twelve of these patients had chronic perforation, 6 had severe rectal bleeding and 2 had painful anorectal ulceration. Fifteen patients presented between 2 and 24 years after radiotherapy, usually with incomplete intestinal obstruction due to a fibrous stricture, but 2 patients had rectal carcinoma. Wide resection of the involved bowel was the principal method of treatment but any anastomosis was protected by a proximal defunctioning stoma. There was no operative mortality but 10 patients have died subsequently. The danger of dismissing these patients as having incurable malignancy is stressed because, although the condition is infrequent, it is usually amenable to adequate surgery.
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PMID:Bowel disease after radiotherapy. 686 19

This paper draws attention to the continuing problem of chronic radiation injury to bowel. Fifty-seven symptomatic patients with this disorder were studied, 31 with predominantly small bowel injury and 26 with colonic disease. The mean latent interval following irradiation was 4.7 years. Small bowel disease presented initially as intestinal obstruction (19 cases) or malabsorption (11 cases) and the radiation related mortality in small bowel disease was 32%, while that for colonic disease was 4%. There was a high incidence of prior pelvic surgery and of adjunctive chemotherapy in patients developing small bowel disease. Analysis of the radiotherapy techniques used highlighted that an unsatisfactory distribution of radiation dosage occurred when parallel opposed fields were used particularly where one field only was treated daily. Difficulty in matching external beams with intracavity sources may also have contributed to radiation injury.
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PMID:Chronic radiation injury to the intestine: a clinico-pathological study. 695 95

The results of 88 consecutive small-bowel enemas were compared retrospectively with the results of 52 routine small-bowel series and 50 barium enemas done in the same patients. Ninety-six percent of the diagnoses made by small-bowel enema were correct, as compared to only 65% made by routine small-bowel series. The incorrect studies were mostly false negatives and the abnormalities missed included regional enteritis, small-bowel obstruction, and intestinal lymphoma. The barium enema failed to achieve ileal reflux in 26% of patients and had a 23% false negative rate when reflux was achieved. Because small-bowel series as done by conventional methods was significantly less accurate, we believe small-bowel enema should be considered in patients with suspected small-bowel disease when other studies are negative.
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PMID:Small-bowel enema. An underutilized method of small-bowel examination. 717 60

Patients often present to the surgeon with abdominal pain, tenderness, and fever. Many exhibit progressive sepsis due to abdominal pathology. Delay in diagnosis and treatment often occurs due to the use of multiple, time-consuming, expensive diagnostic studies. We delineate the use of diagnostic laparoscopy in subsets of patients in whom confusion exists as to the cause of abdominal sepsis--i.e., females in child-bearing years, elderly patients, obese patients, immunosuppressed patients, and patients with suppression of physical findings. The methodical assessment of the entire abdominal cavity is performed utilizing manipulation of the patient's position (Trendelenburg, supine, reverse Trendelenburg, left side up, right side up) and meticulous inspection of the entire small bowel. Diagnoses included acute appendicitis, gangrenous appendicitis, perforated appendicitis with peritonitis or abscess, gangrenous cholecystitis, ischemic bowel disease, perforating carcinoma of the colon, perforating diverticulitis with abscess or peritonitis, tubo-ovarian abscess, closed-loop small-bowel obstruction, megacolon, and perforation of the colon. Laparoscopic treatment of 96% of the patients was performed successfully and a laparoscopic-assisted approach was used in the remainder. There was one mortality (cardiac) and no major morbidity. The development of a Formal Diagnostic Exploratory Laparoscopic (FDEL) approach has aided in the assessment of each of the diagnoses of sepsis in the abdominal cavity. The diagnostic and therapeutic approach laparoscopically avoids extensive preoperative studies, avoids delay in operative intervention, and appears to minimize morbidity and shorten the postoperative recovery interval.
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PMID:Use of laparoscopy in the diagnosis and treatment of patients with surgical abdominal sepsis. 759 89

Fetal obstructive bowel disease was diagnosed in 29 patients at 22-37 weeks (median 32 weeks) of gestation, seven (24 per cent) of whom also displayed other anomalies. Polyhydramnios was present in 20/29 cases (69 per cent). An abnormal karyotype existed in 7/29 cases (24 per cent), of which six were diagnosed prenatally (trisomy 21, n = 5; 69,XXX, n = 1) and one postnatally (trisomy 21). There was always an association with the ultrasonic 'double bubble' sign. Obstructive bowel disease was confirmed postnatally in 20/29 (69 per cent) cases, i.e., oesophageal atresia (n = 1), duodenal obstruction (n = 12), and small bowel obstruction (n = 7). Other anomalies existed in 6/29 (21 per cent) cases, i.e., multicystic kidney (n = 1) and multiple congenital anomalies (n = 5). The perinatal mortality rate was 35 per cent (7/20).
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PMID:Prenatal ultrasonic diagnosis of obstructive bowel disease: a retrospective analysis. 787 51

The purpose of our study was to determine if a normal small-bowel enteroclysis excludes small-bowel disease in adult patients, using long-term follow-up as the major reference standard. We reviewed 193 consecutive small-bowel enteroclysis (SBE) studies completed during a period from January 1987 to February 1989, of which 83 were judged to be normal at the time of the study. Eight of these latter patients were excluded due to inadequate follow-up. The indications included detection of gastrointestinal bleeding, small-bowel obstruction, Crohn's disease, nonspecific abdominal pain, chronic diarrhea, and a miscellaneous group. Each patient was followed for at least 3 years by chart review or until a definite diagnosis was established. Six of the 75 patients whose SBE was originally interpreted as normal were eventually judged to have small-bowel disease. The remaining 69 patients were judged to be free of small-bowel disease by autopsy, surgical laparotomy, endoscopic observation or biopsy, or long-term follow-up for at least 3 years. Therefore, a normal SBE correctly excluded small-bowel disease in 69 of our 75 patients (true negatives) and failed to diagnose disease in six patients (false negatives), for a specificity of .92 +/- .03 (SE). In this experience, SBE was sufficiently specific in most patients to exclude small-bowel disease.
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PMID:Does a normal small-bowel enteroclysis exclude small-bowel disease? A long-term follow-up of consecutive normal studies. 819 40

Intestinal motility was studied in 11 children with a transient enterostomy secondary to a neonatal organic small intestine obstruction (5 total colon Hirschsprung's disease, 2 necrotizing enterocolitis, 1 intussusception, 3 ileal atresia). Eight children presented with a postobstructive enteropathy (severe grade I [5], moderate grade II [3]) and three were considered as controls (grade III). They were assigned to one of the three groups on the basis of the duration of parenteral nutrition and constant rate enteral nutrition needed and the oral feeding tolerance. Barium small intestine transit showed no persistent partial obstruction or peritoneal adhesions. The abnormal inert marker transit times were statistically correlated with the clinical groups as well as duodenal manometric abnormalities. Manometric recordings were characterised by the absence (grade I) or abnormal phase III (grade II) of the migrating motor complex and decreased motility index (grades I and II). This study confirms that this enteropathy is due to a chronic alteration in motility induced by prenatal or postnatal obstructions.
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PMID:Duodenal manometry in postobstructive enteropathy in infants with a transient enterostomy. 830 64

To understand the surgical approach to acute abdominal pain, the internist must be familiar with common presentations of most abdominal emergencies; these emergencies include acute appendicitis, acute gall bladder disease (biliary colic, acute cholecystitis, and acute pancreatitis), ischemic bowel disease and ischemic colitis, abdominal aortic aneurysm, and intestinal obstruction. Nothing compares to experience; this article reviews the salient points that deserve consideration.
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PMID:An internist's approach to acute abdominal pain. 837 23

Eight tests of hemostasis were measured in 233 horses with colic. Blood samples were obtained at admission and for 4 consecutive days of hospitalization. Data were analyzed retrospectively by outcome, by broad-category diagnosis group, by small intestinal disorder, and by smaller categories for comparing specific diseases. Nonsurviving horses and horses with the most severe forms of intestinal ischemia had changes interpreted as hypercoagulative, the intensity of which was increased on the first and second mornings (sample times 2 and 3) after admission, when most significant differences for results of specific tests were detected. Nonsurvivors had decreased antithrombin III activity and prolonged prothrombin and activated partial thromboplastin times; those with strangulating obstructions also had decreased protein C and plasminogen activities. During hospitalization and with survival, these changes tended to reverse. In most horses, regardless of diagnosis or outcome, concentration of fibrin degradation products and fibrinogen, and alpha 2-antiplasmin activity increased over time. Whether these changes reflected specific effects of colic or of the acute-phase response was not determined. In comparisons of small intestinal disorders (proximal enteritis, strangulations, and impactions), diagnostically distinguishing features were not found. Likewise, in comparisons of specific diseases (small vs large intestinal impaction, proximal enteritis vs colitis, small vs large intestinal obstruction), diagnostically distinguishing features were not found.
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PMID:Analysis of hemostasis in horses with colic. 840 38

Small bowel lymphomas account for 20 to 40% of primary gut lymphomas in Western populations and are among the most common malignant tumours of the small bowel. We studied 119 cases of primary small bowel lymphoma presenting over 4 decades. Two thirds of the patients were men with a peak age incidence in the 7th decade. Common presenting features included abdominal pain, weight loss, small bowel obstruction, and acute abdomen. Tumours were classified using the Kiel European Association for Haematopathology Geneva Workshop scheme and phenotyped on paraffin sections; 66% were B cells, and 34% were T cell. In all cases, the antibodies L26 and polyclonal CD3 reliably distinguished between B- and T-cell tumours. Of the B-cell lymphomas, 62% were diffuse high grade, 20% were low-grade lymphomas of mucosa-associated lymphoid tissue, 11% had both low- and high-grade components, and 7% were other low-grade types. Of the T-cell lymphomas, 83% were high grade, and 49% were enteropathy associated. Most T-cell lymphomas were ulcerated plaques or strictures in the proximal small bowel; B-cell lymphomas tended to be annular or polypoid masses in the distal and terminal ileum. Survival data showed that low-grade B-cell lymphomas had the best outcome and T-cell lymphomas the worst. Adverse prognostic features included perforation, high-grade histology, multiple tumours and advanced stage.
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PMID:Primary lymphoma of the small intestine. A clinicopathological study of 119 cases. 847 Jul 58


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