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

Small bowel obstruction is a common disorder in surgical practice. The major morbidity of bowel obstruction relates to intestinal distension and ischemia. We hypothesized that octreotide, a potent inhibitor of gut secretion, would reduce mortality in a mouse model of lethal small bowel obstruction. C57 mice were anesthetized with urethane and prepared with either proximal jejunal or distal ileal obstruction. After 8 hours, surviving mice were randomized to receive either octreotide (100 micrograms/kg) or saline subcutaneously every 8 hours. Octreotide significantly improved survival in mice with proximal obstruction by life table analysis. Mean survival increased from 31 +/- 3 to 41 +/- 4 hours. In distal obstruction, octreotide treatment resulted in a trend towards improved survival; however, this trend failed to reach statistical significance by life table analysis. The improvement in survival in this mouse model suggests that octreotide may be a valuable adjunct in the treatment of patients with small bowel obstruction.
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PMID:Improvement in survival of mice with proximal small bowel obstruction treated with octreotide. 173 78

In patients with midgut carcinoid tumors a curative, radical tumor removal should be attempted when possible. As these tumors are generally malignant, irrespective of size, the radical surgery implies that intestinal resection for excision of a primary tumor should be combined with an extended mesenteric resection. When the patients present with the carcinoid syndrome the disease is, with few exceptions, too advanced for curative surgery. However, surgery often has to be performed also in patients with the advanced carcinoids. Patients with more extensive disease may thus benefit from surgical debulking of large mesenteric or hepatic metastases. Moreover, when the patients present with abdominal symptoms it is important to exclude a threatening major abdominal complication, such as intestinal obstruction or ischemia. As these complications may cause malnutrition and deterioration, it is important to treat them properly, sometimes by repeated surgery.
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PMID:Abdominal surgery in patients with midgut carcinoid tumors. 185 12

Small-bowel volvulus is an uncommon but important cause of small-bowel obstruction and often results in ischemia or infarction. Clinical examination and plain film radiography may be nondiagnostic, leading to delay in surgical intervention with subsequent increase in morbidity and mortality. We present two patients in whom the diagnosis of strangulating small-bowel volvulus was made by computed tomography (CT), allowing rapid surgical correction of this potentially life-threatening condition.
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PMID:CT diagnosis of acquired small bowel volvulus. 222 14

In prevention of the recurrent intestinal obstruction we performed at the Department of Pediatric Surgery of the University of Mannheim a sutureless plication of the small bowel with fibrin glue only over the last 7-year period. The postoperative course was uncomplicated in all patients. The clinical and experimental experiences suggest that the high concentrated human fibrinogen is able to start healing of the lesions of the serosa to prevent intraabdominal adhesions prospectively. Furthermore the time saving and easy procedure is to be stressed. First of all the high risk of tissue necrosis or intestinal perforation due to ischemia by sutures and stitches like in the traditional technique of plication is not present.
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PMID:[Use of fibrin glue in prevention and therapy of intra-abdominal adhesions]. 231 50

Pneumatosis intestinalis (PI) occurs in a wide variety of patients, some of whom require urgent surgery, while others can be observed with resolution of symptoms and radiographic findings. During 1 year, 27 patients with PI were prospectively evaluated for clinical, laboratory, and radiographic features that would be useful in predicting the need for surgery, the pathologic findings, and patient outcome. Sixteen of the twenty-seven patients underwent laparotomy, with only one negative exploration. Of the 11 patients not explored, there were two deaths in moribund patients. Seven of nine patients with jejunostomy tubes, recent gastrointestinal anastomoses, inflammatory bowel disease, lactulose therapy, or chemotherapy who did not have clinical evidence of an acute surgical abdomen or metabolic acidosis survived without surgery (two deaths unrelated to the gastrointestinal tract). Patients presenting with bowel obstruction and PI required surgery in seven of nine cases, did not have necrotic bowel, and had 11% mortality. Eight patients with ischemic bowel had a 75% mortality rate, despite surgery. Patients with PI and clinical evidence of bowel obstruction or ischemia usually require urgent surgery, while asymptomatic patients without metabolic acidosis can be safely observed.
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PMID:Pneumatosis intestinalis. Surgical management and clinical outcome. 237 47

In this study the attention was focused on the possible application of the new low-osmolar water-soluble contrast media in already existing routines for radiologic diagnostic work-up and management of the abdominal emergencies of simple intestinal obstruction and ischemia: Iohexol was a good, or better, alternative to sodium diatrizoate regarding taste acceptance and patient reactions: Seventy-five per cent of patients characterized the taste of iohexol as good or neutral, while 52% gave sodium diatrizoate similar scores. The scores were also consistently in favor of iohexol as compared with sodium diatrizoate for the other chosen criteria; nausea, vomiting and diarrhea, but a larger number of patients may be needed for conclusive evaluation. Water-soluble media may have therapeutic effects on intestinal obstruction when preceded by conventional gastric suction using a short gastric tube: Twenty-three of 25 patients with subtotal small bowel obstruction due to peritoneal adhesions improved following the ingestion of either iohexol or sodium diatrizoate. Hyperosmolar contrast media might stimulate peristalsis and dilute the bowel contents, hence, easing the passage through a subtotally obstructed bowel. In rats, a direct relationship was found between contrast medium osmolality and the degree of intestinal distension, fluid influx to the bowel lumen and the speed of contrast medium progression. The water-soluble, low-osmolar contrast media seem promising as diagnostic aids in examination of the gastrointestinal tract: The low-osmolar contrast media gave better intestinal details on films than both barium sulphate and sodium diatrizoate in rats with intestinal obstruction or ischemia when high volumes of radiopaques were employed. Also in patients iohexol retained its radiographic density in the small bowel better than sodium diatrizoate. The diagnostic efficacy of the water-soluble radiographic media varied directly with their osmolality and the resulting fluid influx to bowel lumen. Hyperosmolality stimulated contrast medium progression and bowel distension, and reduced the radiographic density of the contrast media and the alignment to the bowel wall. Water-soluble contrast media may aid the diagnosis of bowel ischemia and the evaluation of the degree of ischemic injury: No bladder opacification, following absorption of water-soluble contrast media from the simply obstructed bowel, was observed in the majority of the animals and was only faintly present in 8%. Distinct radiographic opacification of the urinary bladder in rats with intestinal ischemia was demonstrated as early as 1-2 hours after the administration of contrast medium.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Water-soluble contrast media in obstructed in ischemic small intestine. A clinical and experimental study. 264 49

Intestinal edema, luminal distention, and ischemia are common pathologic processes involved in producing the intestinal damage found during surgical exploration for acute abdominal disorders in the horse. The severity of intestinal edema depends on the degree of altered intravascular forces and changes in capillary permeability. Capillary hydrostatic pressure rises as the less pliable venules and veins become occluded during intestinal obstruction. Concurrently, the production of various endogenous products that damage the vascular wall leads to increases in capillary permeability and protein exudation, causing fluid movement into the interstitium and consequent tissue edema. The information presently available indicates that luminal distention does not produce the morphologic damage observed during natural conditions. However, slight intestinal edema was observed with experimental distention of the equine small intestine. Although the effects of increased luminal pressure appear minor, in the overall scheme of intestine damage, many processes are occurring together, and the luminal distention may be additive in the production of intestinal damage. The intestinal damage occurring during natural obstructions is most likely related to both the severity of the ischemia and the subsequent reperfusion injury. Experimentally, an ischemic insult produces a consistent sequence of mucosal alterations to both the equine small and large intestine. Severity of ischemia may be the limiting factor in determining the clinical outcome in cases in which the ischemic insult is irreversible; however, if the intestinal tissue survives the ischemia, the reperfusion injury may substantially increase the damage, producing an irreversible injury. The proposed mechanisms responsible for the reperfusion injury include the presence of highly reactive cytotoxic oxygen radicals. The intestinal epithelium and vascular endothelium are both capable of producing these unstable compounds. Secondly, the influx and activation of neutrophils may also release oxygen radicals. During experimental ischemia, neutrophils gradually move to the affected area; however, during reperfusion their numbers dramatically increase and may play a significant role in producing intestinal damage. Therapy for intestinal damage involves first determining the viability of the affected intestine. All nonviable bowel should be resected and viable intestine anastomosed. The care and maintenance of intestine of questionable viability are presently based on therapy in humans and experimental information concerning the pathophysiologic mechanisms of intestinal ischemia.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:The pathophysiology of intestinal damage: effects of luminal distention and ischemia. 267 Jan 6

We report our experience acquired over the last seven years with the management of necrotizing enterocolitis in neonates. This condition occurs mainly in small-for-dates, premature, critically ill infants. Diagnosis rests on the combination of clinical evidence of intestinal obstruction with non-specific signs of a decline in general health and suggestive roentgenographic findings. Mortality has fallen from 80% to 24% over the last eight years as a result of advances in the medical management of low-birth-weight infants, earlier treatment of bowel ischemia suspected on the basis of inconspicuous manifestations, and improvements in neonatal intensive care and surgical techniques.
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PMID:[Primary ulcero-necrotizing enterocolitis of the newborn. Advancements in management. Improvement in prognosis]. 293 Jan 30

Four newborn patients with congenital syphilis and intestinal obstruction are discussed in this report. In three cases, the obstruction was due to inspissated meconium, simulating the features of meconium ileus in one, meconium plug in the second, and associated with perforation of the terminal ileum in the third. An exocrine pancreatic insufficiency and a motility disturbance of the intestine due to syphilitic infection during fetal life could be the probable etiologic factor. The fourth patient had multiple ileal stenoses. Ischemia due to the prenatal syphilitic arteritis of the bowel wall can be responsible for this pathology. Attention is drawn to the association between congenital syphilis and neonatal intestinal obstruction.
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PMID:Intestinal obstruction in the newborn with congenital syphilis. 318 93

The records of 6,452 consecutive patients who underwent cardiopulmonary bypass procedures were examined for intra-abdominal complications. There were 60 complications in 51 patients for an incidence of 0.94 per cent. The mortality rate was 59 per cent. Complications included bleeding in the gastrointestinal tract in 20, intestinal ischemia in 16, acute cholecystitis in 11, pancreatitis in five, small intestinal obstruction in three, perforated ulcer in two, hepatic necrosis in two and splenic laceration in one instance. Clinical risk factors included advanced age, emergency operation, valvular surgical treatment, hypotension, intra-aortic balloon pump, pressors and reoperation. Patients with a prolonged pump time had an increased risk of intraabdominal complications (p less than 0.001).
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PMID:Intra-abdominal complications of cardiopulmonary bypass operations. 349 28


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