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

A model of non-occlusive colonic ischemia (NCI) was produced in the dog, incorporating both moderately decreases systemic pressure and increased intralumenal colonic pressure. These factors may play an etiologic role in human NCL. When differences between mean systemic and mean distention pressures were 30 mmHg or less, severe mucosal injury occured. In no case was the muscularis injured. Moderate systemic hypotension alone, or moderate colonic distention alone, did not produce significant colonic ischemic injury. Colonic distention with pressures of 60 mmHg alone resulted in colonic mucosal necrosis, but these pressures are beyond those ordinarily encountered clinically, even in large bowel obstruction. Angiography may be useful in demonstrating reduced flow to the colon during development of colonic ischemic injury. However, angiography is not a sensitive method in the diagnosis of nonocclusive colonic ischemic injury, once that injury has been established and inciting factors have subsided.
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PMID:Non-occlusive ischemic colitis: angiographic aspects in a canine model. 75 28

The authors present the results of a study of the amount of water and potassium in small samples of skeletal muscle and of the intestinal wall of albino rats. Five groups of 10 animals were separated according to the following conditions: peritonitis, pyloric obstruction, intestinal obstruction, mesenteric ischemia and a control group. The results suggest that skeletal muscle is capable of buffering the increased amount of potassium liberated by the tissues which undergo acute trauma, until a critical concentration is reached. Further studies are needed to clarify some of the conflicting results obtained.
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PMID:[Metabolic response and aggression: potassium and water content of skeletal muscles]. 82 84

Nonischemic intussusception is defined as a variant of acute intussusception exhibiting less acute symptoms of abdominal pain, vomiting, and diarrhea in the older child, longer duration of symptoms (usually 4-14 days), signs of imcomplete bowel obstruction, and absence of intestinal ischemia. Over a 10 yr period (1964-1973) 20 children with this disease were treated without mortality or recurrence at three children's hospitals in Chicago, Illinois. The higher incidence of diarrhea, the lower incidence of a palpable abdominal mass, and the lower incidence of blood per rectum in nonischemic intussusception predispose to diagnostic errors and delays in treatment. Despite the longer duration of symptoms, this variant of intussusception can be treated initially with a careful attempt at barium hydrostatic reduction. If this fails, easy operative manual reduction is the rule.
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PMID:Nonischemic intussusception. 89 56

Return to the abdominal cavity of an intestinal loop which had suffered from ischemia, may induce, after a free interval, disordered transit or frank intestinal obstruction, sometimes peritonitis. This is always dangerous, especially in elderly patients. The authors report 5 cases which illustrate this danger, in daily surgery, and recall the rules for treatment of strangulated hernia.
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PMID:[Stenosis of the small intestine after strangulated hernia]. 95 99

To determine the results of our experience with the use of staples for construction of anastomoses following colonic resection, a series of 223 anastomoses performed in 205 patients was reviewed. Indications for operation included malignancy, benign neoplasms, inflammatory bowel disease, and several miscellaneous entities. A functional end-to-end anastomosis using the standard GIA cartridge and the TA 55 instruments was performed. The operative mortality was 1.5% with none of the deaths related to the anastomosis. Intraoperative complications encountered included bleeding (21), leak (1), tissue fracture (1), instrument failure (4), and technical error (3). Early postoperative complications related or potentially related to the anastomosis included bleeding (5), pelvic abscess (1), fistula (1), peritonitis (2), ischemia of anastomosis (1). Late complications included five patients with small bowel obstruction, two of whom required operation. Anastomotic recurrences developed in 5.9% of patients. Our experience gained with stapling instruments has shown them to be a reliable method for performing anastomoses in the colon in a safe and expeditious manner.
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PMID:The stapled functional end-to-end anastomosis following colonic resection. 140 8

In 19 patients with closed-loop intestinal obstruction, including 16 patients with strangulating obstruction, the findings at examination with computed tomography (CT) were retrospectively correlated with the surgical and pathologic findings and evaluated by two radiologists. Signs of closed-loop obstruction, present in 15 patients, were associated with the configuration of the incarcerated loop of small bowel, abnormalities detected at the site of obstruction, or both. These abnormalities were the following: a U-shaped, distended, fluid-filled bowel loop; the whirl sign; the beak sign; a triangular loop; two adjacent collapsed loops of bowel at the site of obstruction; or all of these. CT signs of strangulation, seen in 10 of the 16 patients with ischemic or infarcted bowel, were associated with the appearance of the bowel wall (thickening, high attenuation, and the target sign), abnormalities in the attached mesentery, or both. In mechanical obstruction of the small bowel, detection of ischemic changes in the bowel wall or mesentery with CT indicates strangulation. Absence of CT findings of ischemia or infarction does not rule out strangulation.
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PMID:Closed-loop and strangulating intestinal obstruction: CT signs. 143 36

The frequency of surgical complications after liver transplantation remains high. Sixty transplants were done in 48 patients during 4 years. Eleven patients were retransplanted (re-transplant rate, 20%) for primary nonfunction (6), arterial thrombosis (3), warm ischemia (1), and rejection (2). Right pleural effusions were drained in 13 patients and left ones in 2. Forty-eight re-explorations excluding retransplantation were performed in 20 patients. Twelve laparotomies were for control of postoperative intraabdominal bleeding. The majority of these patients (8/10, 80%) were transplanted with reduced-size grafts. Early postoperative vascular complications were detected in 12 grafts (5 portal vein occlusions, 7 arterial thromboses). All 5 patients with portal vein (PV) occlusions were reexplored, and PV flow was reestablished in all 5. Biliary leaks were diagnosed in 6 patients and were associated with arterial thromboses in 2 cases. Reoperation was required in 4 of 6 patients. Bowel perforation occurred in 4 patients; 2 small bowel, 1 duodenum, and 1 colon. There was 1 postoperative bowel obstruction requiring laparotomy. Two splenectomies were required in 4 patients with splenic infarction. Resection of part of a transplanted liver was done in 1 patient to exclude septic infarcts. Pancreatitis was diagnosed in 4 patients and one required laparotomy for control of pancreatic hemorrhage. Intraabdominal abscesses required open drainage in 2 patients and percutaneous drainage in 4. Seven thoracotomies were done in 6 patients: 5 open lung biopsies, 1 for control of hemorrhage, and 1 for diaphragmatic plication. The current high survival rates following liver transplantation require aggressive surgical management of a myriad of complications and numerous procedures are necessary both as treatment modalities and as diagnostic aids.
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PMID:Surgical complications in children after liver transplantation. 147 91

Acute aortic occlusion frequently occurs with catastrophic visceral, spinal, or lower extremity ischemia and is most often caused by embolic or thrombotic events in older individuals with known cardiovascular disorders. This case describes the rapid development of the clinical signs of acute aortic occlusion in a young and completely healthy individual. Aortic occlusion was produced by extrinsic compression of the juxtarenal aorta from a closed-loop small intestinal obstruction contained within a peritoneal encapsulation, an extremely rare intraabdominal developmental anomaly.
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PMID:Acute aortic occlusion as a result of extrinsic compression from peritoneal encapsulation. 149 52

Small bowel volvulus is an uncommon but important cause of small intestinal obstruction. It often results in ischemia or even infarction. Delay in diagnosis and surgical intervention increases morbidity and mortality rates. Based on cause, small bowel volvulus can be divided into primary and secondary type. Goals for treatment of small bowel volvulus should include physician awareness of this uncommon diagnosis, accurate workup, and advanced surgical intervention. The presentation and subsequent management of 35 patients with small bowel volvulus confirmed by laparotomy are reviewed and discussed. The incidence of small bowel volvulus in the adult European and North American is low. The resultant mortality rate, however, makes diagnosis critically important. The cardinal presenting symptom is abdominal pain. There is no single specific diagnostic clinical sign or abnormality in laboratory or radiologic finding. In practice, the diagnosis can only be made by laparotomy. The failure to perform an exploratory laparotomy cannot be justified. Early diagnosis and early surgery are the keys for successful management of strangulation obstruction of the small bowel.
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PMID:Acute small bowel volvulus in adults. A sporadic form of strangulating intestinal obstruction. 150 17

This elderly male with a long history of alcohol abuse presented with an acute pleural trauma and hemopneumothorax, which may have served as the precipitating medical illness for cecal volvulus. He subsequently developed bacterial peritonitis as a complication of his bowel obstruction. It is probable that his pleural cavity was seeded hematogenously via a bacteremia from his peritonitis, thus accounting for the empyema with species typical of bowel flora. Cecal bascule is a type of cecal volvulus that causes intestinal obstruction. Diagnosis is difficult, but a delay in recognition may result in intestinal ischemia, perforation, sepsis, and even death. Cecal ischemia or gangrene cannot always be determined based on physical examination or laboratory findings. Plain films of the abdomen may be helpful, and barium enema has been advocated by some authors. However, laparotomy is often necessary for definitive diagnosis and therapy. While cecal volvulus has not been reported to occur frequently in the elderly, the relatively common occurrence of anatomic predisposition in addition to the widespread use of respirators and the increasing age and number of medical illnesses of our population make it possible that cecal volvulus will be seen with increasing frequency in the future.
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PMID:Cecal bascule: an overlooked diagnosis in the elderly. 172 51


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