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Query: UMLS:C0021843 (bowel obstruction)
 9,927 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Postoperative adhesions are an almost invariable consequence of abdominal and pelvic surgery. Their most important morbidity is small-bowel obstruction, but other sequelae include female infertility and dyspareunia and increased risk of visceral injury at subsequent laparotomy or laparoscopy. Whether chronic abdominal pain is truly a consequence of adhesions is debatable, although it is likely to be accepted as an entity by both patients and their legal advisors. Of 14 successful claims dealt with by a British medical defence organization, 5 were for perforations after laparoscopic division of adhesions, 2 for adhesions after laparoscopic surgery, 1 for infertility as a result of adhesions and 6 for delayed diagnosis of obstruction. General practitioners, surgeons and gynaecologists need to be aware of the increasing burden of medicolegal claims arising from these complications.
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PMID:Medicolegal consequences of postoperative intra-abdominal adhesions. 1158 68

One of the complications of abdominal surgery is the occurrence of intra-abdominal adhesions. The problems related to these adhesions have created a major impact on the health care system, thereby incurring a substantial cost to health care. In the field of gynaecology, adhesion-related problems include infertility, abdominal pain and bowel obstruction.
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PMID:Introduction--prevention of adhesion formation: the journey continues. 1172 66

Adhesion development can have a major impact on a patient's subsequent health. Adhesions are a significant source of impaired organ functioning, decreased fertility, bowel obstruction, difficult re-operation, and possibly pain. Consequently, their financial sequelae are also extraordinary, with more than one billion dollars spent in the USA in 1994 on the bowel obstruction component alone. Performing adhesiolysis for pain relief appears efficacious in certain subsets of women. Unfortunately even when lysed, adhesions have a great propensity to reform. Adhesions are prevalent in all surgical fields, and nearly any compartment of the body. For treatment of infertility and recurrent pregnancy loss, lysis of intrauterine adhesions results in improved fecundability and decreased pregnancy loss.
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PMID:Clinical implications of postsurgical adhesions. 1172 62

Whether induced by infection, inflammation, ischemia, and/or surgical injury, peritoneal adhesions are the leading cause of pelvic pain, bowel obstruction and infertility. It is clear that while postsurgical peritoneal wounds heal without adhesions in some patients, others develop severe scarring from seemingly equal procedures; in addition, in the same patient, adhesions can develop at one surgical site and not in another. The mechanisms underlying the predisposition to form adhesions as well as their site specificity are completely unknown. However, a large number of intraperitoneal surgical procedures are performed each day in the USA, and thus many patients are at risk of developing postoperative adhesions. Therefore, understanding of adhesion formation at the molecular level is essential and in the absence of such information, attempts to prevent patients from developing adhesions will remain an empirical process. The unprecedented advancement in molecular biology during the past decade has led to the identification of many biologically active molecules with the potential of regulating inflammatory and immune responses, angiogenesis and tissue remodeling, events that are central to normal peritoneal wound healing and adhesion formation. Although, the insight into their importance in the development of tissue fibrosis has substantially increased, their major roles in peritoneal biological functions and adhesion formation remain at best speculative. This article reviews the clinical implications of adhesions and attempts to highlight some of the key molecules i.e. growth factors, cytokines, chemokines, proteases and extracellular matrix, that are recognized to regulate inflammation, fibrinolysis, angiogenesis, and tissue remodeling, events that are central to peritoneal wound repair and adhesion formation. Finally, the article discusses the potential application and site specific delivery of several active compounds that are developed to alter the local inflammatory and immune response i.e., cytokine/chemokine network, targeted gene delivery and development of a new generation of biomaterials to prevent adhesion formation. Such understanding of peritoneal biology not only assist us to better manage patients with adhesion, but also those with endometriosis and malignant diseases that affect the peritoneal cavity.
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PMID:Peritoneal molecular environment, adhesion formation and clinical implication. 1189 50

Intra-abdominal adhesion formation is a major complication of serosal repair following surgery, ischaemia or infection, leading to conditions such as intestinal obstruction and infertility. It has been proposed that the persistence of fibrin, due to impaired plasminogen activator activity, results in the formation of adhesions between damaged serosal surfaces. This study aimed to assess the role of fibrinolysis in adhesion formation using mice deficient in either of the plasminogen activator proteases, tissue-type plasminogen activator (tPA) or urokinase-type plasminogen activator (uPA). We hypothesize that, following serosal injury, mice with decreased peritoneal fibrinolytic activity will be more susceptible to adhesion formation. Adhesion formation was induced in tPA- and uPA-deficient and wild-type mice following either surgical trauma to the serosa with haemorrhage and acute or chronic intraperitoneal inflammation. Adhesion formation was assessed from 1 to 4 weeks post-injury. Mice deficient in tPA were more susceptible to adhesion formation following both a surgical insult and a chronic inflammatory episode compared with uPA-deficient and wild-type mice. In addition, the time of maximal adhesion formation varied depending on the nature of the initial insult. It is proposed that the persistence of fibrin due to decreased tPA activity following surgery or chronic inflammation plays a major role in peritoneal adhesion formation.
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PMID:Role of plasminogen activators in peritoneal adhesion formation. 1202 39

Laparoscopy, is technique, indications, contraindications, and complications as well as the author's personal experience with it are described. It is a new procedure for diagnosis and treatment of intraabdominal and pelvic conditions. It is a safe and effective method of tubal ligation with shorter hospitalization time. The complete procedure for laparoscopy is discussed in the article. Most patients are able to leave the hospital the day of surgery, and the clips are removed in the office in 72 hours. Laparoscopy is used in sterilization and diagnostically in cases of infertility, pelvic pain, congenital anomalies, second look procedures, and removal of IUD. It should not be used in patients in whom anesthesia is contraindicated, or those with intestinal obstruction, peritonitis, and extensive abdominal scarring. The recovery rate is virtually 100% within 24 to 48 hours following laproscopy. Complications in the author's experience with laparoscopy include, perforation of inferior epigastric artery, postoperative PID, pneumo-omentum failure, pelvic vessel hematoma, and adenocarcinoma of the endometrium.
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PMID:Diagnostic laparoscopy -- a new diagnostic and therapeutic modality. 1225 2

Postoperative abdominal adhesions may lead to intestinal obstruction and infertility. The effect of continuous release of streptokinase to the peritoneal cavity on postoperative adhesions was examined under experimental conditions. Peritoneal adhesions were induced in rats and the animals were further treated by intraperitoneal administration of streptokinase solution, polyhydroxybutyrate-co-hydroxyvalerate (PHBV) membrane alone and streptokinase loaded PHBV membrane and compared to sham operated and untreated groups. Formation of adhesions was evaluated by quantitative macroscopic grading, histopathologically with light microscopy, on the following week. Streptokinase loaded PHBV prevented postoperative adhesion formation in 90% of the cases. PHBV membrane alone also reduced the severity of adhesions due to its anti-adhesive properties. Histopathological examination revealed limited foreign body reaction due to PHBV. Continuous streptokinase activity in the peritoneal cavity during early post-surgical period prevents postoperative adhesion.
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PMID:Reduction of surgery-induced peritoneal adhesions by continuous release of streptokinase from a drug delivery system. 1256 87

Adhesions cause bowel obstruction, chronic abdominal pain, and infertility. In this review, the incidence, clinical signs, diagnostic procedures, and treatment of these sequels of abdominal surgery are discussed. Laparoscopic treatment of bowel obstruction, chronic pain, and infertility is feasible in selected patients and has been reported to cause fewer newly formed adhesions. Randomized controlled trials to compare open and laparoscopic surgery for adhesions should be executed with long-term follow-up to assess the success rates of adhesiolysis and compare the morbidity and mortality.
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PMID:Abdominal adhesions: intestinal obstruction, pain, and infertility. 1263 22

To determine the mortality and survival rates, side effects of surgery and adjuvant chemo- and radiotherapy, somatic development, and fertility, the data of 142 patients under the age of 1 year operated upon for solid malignant tumors from 1975 through 1983 were analyzed. The follow-up period ranged from 16 to 25 years (mean 20); 79 patients survived. The male/female ratio of the survivors was 51/28. Investigations were based on the Hungarian Tumor Registry, personal interviews with the patients and their parents, and detailed questionnaires. Fifty-one patients died, 44 of them before the age of 3 years; 13 were lost to follow-up. Of the 79 survivors, 48 had abdominal and 31 extra-abdominal tumors (35 neuroblastomas, 21 renal tumors, 15 soft-tissue sarcomas, 5 gonadal tumors, 2 sacrococcygeal carcinomas, 1 hepatic tumor). Side effects of surgical intervention included partial urinary incontinence (2), partial fecal incontinence (1), intestinal obstruction (2), nerve injury (1), thorax deformity (4), and scar formation resulting in psychological problems (12). Chemotherapy alone (41 patients) resulted in side effects in 19 patients, radio- and chemotherapy in combination (23) caused side effects in 20. Fifteen patients did not receive adjuvant therapy. The most serious late side effects were 24 spinal deformities, one-half of them severe, breast underdevelopment, muscular deformity, and renal damage. In 19 patients more then one side effect was detected. Height and weight gain decreased ( P < 0.01 and <0.05, respectively) in the first 8-10 years of follow-up and accelerated significantly ( P < 0.05 and <0.05, respectively) in the second half of follow-up. The short follow-up time (16-25 years) permitted only limited analysis of infertility. Whenever possible, surgical excision should be the treatment of choice. No routine aggressive chemotherapy is indicated. Radiation therapy, which frequently results in long-term musculoskeletal morbidity, should be avoided. Catch-up somatic development occurred in the second part of the follow-up period.
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PMID:Long-term follow-up of cancer in neonates and infants: a national survey of 142 patients. 1270 Sep 18

Acute appendicitis is the most common acute abdominal condition that results in surgical intervention in childhood. The clinical diagnosis of acute appendicitis in children can be challenging. Approximately one-third of children with the condition have atypical clinical findings and are initially managed nonoperatively. Complications associated with delayed diagnosis of this condition include perforation, abscess formation, peritonitis, sepsis, bowel obstruction, infertility, and death. The use of cross sectional imaging has proven useful for the evaluation of suspected acute appendicitis in children. Both graded compression sonography and CT have been widely utilized in the imaging assessment of the condition. The principal advantages of sonography are its lower cost, lack of ionizing radiation, and ability to assess ovarian pathology that can often mimic acute appendicitis in female patients. The principal advantages of CT include less operator dependency than sonography as reflected by a higher diagnostic accuracy, and enhanced delineation of disease extent in perforated appendicitis.
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PMID:Imaging of acute appendicitis in children. 1274 99


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