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

A questionnaire regarding details of their illness, social, educational and religious background and various aspects of rehabilitation since surgery was completed by 1,803 persons who underwent ileostomy for ulcerative colitis between 1930 and 1970. The majority of participants were operated on since 1960, reported an above-average education, lived in metropolitan areas, had surgery performed as a single stage proctocolectomy, and were chronically ill for an average of almost 7 years from the onset of disease to ileostomy. An unexplained high incidence of Jewish patients was noted; in addition, Jewish patients comprised almost half of those who had a family history of inflammatory bowel disease. Although some participants reported major postoperative problems including unfavorable alterations in stomal structure and function, bowel obstruction, delayed perineal healing and nephrolithiasis, most patients were satisfied with life with an ileostomy, presently maintaining their health, employment, marriage and sexuality.
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PMID:Ileostomy in ulcerative colitis. A questionnaire study of 1,803 patients. 721 86

Deaths and complications related to proctocolectomy in inflammatory bowel disease remain a serious problem for the general surgeon. Review of experience at a general hospital over a 25-year period disclosed that although there was substantial morbidity and 12.5% mortality there was a notable improvement over the last 10 years of the study. This was due mainly to a more aggressive surgical approach, meticulous preparation of the bowel for elective procedures, more physiologic monitoring peroperatively, careful replacement of fluid losses and intensive care postoperatively. Many patients with septic and nonseptic complications required reoperation. Intestinal occlusion by adhesions and ileostomy dysfunction are the most common nonseptic complications. One-stage proctocolectomy is a good choice for elective surgery but should be used with caution in emergency situations.
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PMID:Death and complications after total colectomy for inflammatory bowel disease. 728 8

Eosinophilic gastroenteritis is an inflammatory bowel disease of which the etiology is not understood. The clinical picture tends to be variable and is related to the particular layer of bowel involved. There may be ileo-colitis with obstructive symptoms, disturbances of gastric emptying or a diffuse small bowel problem with mal-absorption in relation to eosinophilic gastroenteritis. The majority of children present with intestinal obstruction and surgical intervention is necessary. The differential diagnosis in relation to other obstructive bowel diseases is difficult and can usually only be done following biopsy or resection with histopathological investigation. A peripheral blood eosinophilia is present in only two-thirds of the patients.
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PMID:[Surgical aspects of eosinophilic gastroenteritis (author's transl)]. 731 54

Adhesions were demonstrated by small bowel meal in six patients with symptoms of intermittent small bowel obstruction following surgery for inflammatory bowel disease. The radiographic criteria for the diagnosis of adhesions and the distincton from recurrent Crohn's disease are discussed.
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PMID:The radiological demonstration of adhesions following surgery for inflammatry bowel disease. 742 86

A number of surgical methods, including use of the long intestinal tube, have been designed to decrease the incidence of recurrent small bowel obstruction. The aim of the present study was to review the indications, morbidity, and long-term results of the long intestinal tube at the Mayo Clinic. During the 12-year period 1981-1992, 47 patients had such tubes placed. The patients formed a complex surgical group: 46 patients had previously undergone at least one laparotomy (median 4, range 1-10); 41 patients had been hospitalized at least once for small bowel obstruction (median 3, range 1-15); and all 41 of these patients had undergone at least one previous laparotomy for obstruction (median 2, range 1-7). Eleven patients had a history of inflammatory bowel disease, and eight had a history of irradiation. In addition to dense adhesions in 46 patients, operative findings included large bowel tumors in six patients, intraperitoneal carcinomatosis in four, intraabdominal abscess in four, and small bowel stricture in three. Twenty patients required either a small bowel or large bowel resection, and three had a stoma fashioned. Only one case of morbidity (tube retraction) was related to tube placement. Among the 36 patients with complete follow-up, nine patients developed episodes of recurrent adhesional small bowel obstruction after a mean follow-up of 48 months, although only one required laparotomy. Of the remaining 11 patients it is known that two developed small bowel obstruction, one of whom required laparotomy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Twelve-year experience with the long intestinal tube. 767 11

A 35-year-old female presented with recurrent right lower quadrant pain, nausea, and vomiting. She was afebrile with diffuse abdominal tenderness. Plain x-ray of abdomen revealed small bowel obstruction. A barium x-ray of the small bowel showed stricture of the terminal ileum. A CT scan of the abdomen showed a 6-cm mass in right lower quadrant. She was empirically managed as having Crohn's disease. She underwent laparotomy after failure of medical management with high-dose steroids. There was ulceration and narrowing of terminal ileum. Frozen sections revealed endometriosis. Ileocecectomy was performed. Histopathology of resected specimen confirmed the diagnosis of endometriosis, and there was no evidence of chronic inflammatory bowel disease or neoplasia. Ileal endometriosis should be considered in the differential diagnosis of Crohn's disease in menstruating females presenting with perimenstrual symptoms.
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PMID:Small bowel endometriosis masquerading as regional enteritis. 817 27

Intestinal involvement of endometriosis requiring treatment is 5%, but only 0.7% needs intestinal resection. The authors report two cases of colic endometriosis and illustrate problems in diagnosis and management of this disease. Usually intestinal endometriosis takes the form of asymptomatic superficial serosal implants, encountered incidentally at laparotomy for other diseases, but it can also result in obstruction and occasionally bleeding. Any premenopausal woman with episodic bowel symptoms associated with gynecologic complaints should be suspected of endometriosis of the colon. Diagnosis can be suspected by double-contrast enema examination and colonoscopy with biopsy, although neither is likely to establish the diagnosis with certainty. In fact there are no radiologic or diagnostic imaging findings that are specific for endometriosis and unequivocal diagnosis requires microscopic examination. Differential diagnosis includes primary carcinoma of the colon and other benign diseases (pelvic inflammatory disease, diverticulitis, inflammatory bowel disease, pelvic abscess, polyps, etc.). The treatment of patients with uncomplicated, but symptomatic gastrointestinal endometriosis depends on the age of the patient and her childbearing attitude. Resection of the affected bowel should be done in patient with pain, bleeding, changes in bowel habits and intestinal obstruction and it is necessary to avoid neglecting a malignant tumor. Total abdominal hysterectomy and bilateral oophorectomy is the treatment of choice in the perimenopausal and menopausal women. In symptomatic women desiring children the only resection of involved colon may be appropriate treatment. In these subjects hormonal therapy can be useful.
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PMID:[Endometriosis of the large intestine. A report of 2 clinical cases]. 825 7

Chronic small bowel obstruction may be related either to disordered motility or to progressive chronic stenoses. Disordered motility (or intestinal pseudo-obstruction) is the consequence for muscular and/or intrinsic nerve impairment with 2 main types, one of which is primary (including so-called visceral myopathies and visceral neuropathies), the other one being secondary (generally due to systemic, or sometimes immunologic disease). Chronic stenoses have a different pathophysiology and occur in the setting of chronic inflammatory bowel disease or of systemic diseases such as vasculities. Chronic stenoses lead to intestinal stasis and in fine to mechanical obstruction. In any case, chronic obstruction poses difficult diagnostic and therapeutic problems. Management calls for tight medico-surgical cooperation. Atypical surgical operations may be warranted, and specific, sometimes aggressive medical care is mandatory. Moreover the nutritional consequences of chronic small bowel obstruction may become highly disabling due to alimentary restriction, disordered transit, bacterial overgrowth and malabsorption. In this setting nutritional support should be a matter of prime concern.
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PMID:[Chronic small intestine obstructions]. 834 44

An increasing number of case reports and controlled trials have drawn attention to NSAID-induced side effects in the lower gastrointestinal tract. In this review we also report 9 cases of colonic ulcers and 7 cases of diaphragm disease of the ascending colon, most of them associated with the long-term intake of slow release diclofenac. NSAIDs not only can exacerbate preexisting conditions such as inflammatory bowel disease or diverticular disease, but may also induce de novo enteropathy, colitis, collagenous colitis ulcers and strictures. Complications such as bleeding, perforation or bowel obstruction may require surgery. From the literature and our own experience we conclude that the use of slow release formulations has shifted the toxicity of NSAIDs from the upper to the lower gastrointestinal tract. This must be considered in differential diagnosis and checked by endoscopy if appropriate.
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PMID:[Nonsteroidal antirheumatic drugs and acetylsalicylic acid: adverse effects distal to the duodenum]. 866 76

We examine the indications and the operative options for proceeding to emergency surgery in patients with inflammatory bowel disease. Emergency surgery is absolutely mandatory in case of generalized peritonitis due to bowel perforation. Other life-treating complications are acute disease not responding to medical treatment, toxic megacolon, bowel obstruction and massive hemorrhage. Early medical treatment of these conditions often prevents most severe clinical expressions and improves the prognosis. However surgery should be performed immediately if there is no improvement within 5 days of medical management in case of acute colitis, within 24-48 hours in case of toxic megacolon, within 48-72 hours in patients with intestinal obstruction or severe bleeding, or if the patient deteriorates during this period. In such circumstances, subtotal colectomy with ileostomy and mucous fistula of distal sigmoid colon is the best procedure. That is because it is relatively easy to perform and consents a simpler restorative operation than other procedures preserving the rectum. Moreover it leads to lower morbidity and mortality than the total proctocolectomy that should be reserved to patients with severe rectal disease or sphincter lesion. The most important factors influencing outcome of complicated or severe inflammatory bowel disease are the choice of the appropriate timing for surgery and the procedure performed.
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PMID:[Emergency surgical treatment of ulcerative rectocolitis and Crohn's disease of the colon]. 892 34


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