Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0021843 (bowel obstruction)
 9,927 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

An open cuff technic was employed in 2421 consecutive patients with total abdominal hysterectomy. Extraperitoneal drainage was purpose of the method. The two most serious complications were postoperative hemorrhage (7 cases, 0.28 percent) and intestinal obstruction (6 cases, 0.24 percent). The morbidity rate was 20.8 percent. Of those without colporrhaphy (two-thirds), the morbidity rate was 18.2 percent. Prophylactic antibiotics were not used in the latter group. In no instance was a pelvic abscess or cluff abscess recognized. Death occurred in 1 case (0.041 percent). This method may diminish the occurrence of apical infections above a closed vagina by allowing immediate extraperitoneal drainage. Postoperative bleeding and intestinal obstruction, along with other rare conditions, continue to represent occasional but severe complicantions.
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PMID:Open cuff method of abdominal hysterectomy. 115 36

This paper describes an experience with 29 additional cases of urogenital sinus malformation with an anorectal anomaly, usually rectal atresia with rectovaginal fistula. Right transverse divided colostomy is recommended in the neonate. Low end colostomy is contraindicated. After colostomy has been performed to relieve the intestinal obstruction, the urinary tract is the most life-threatening aspect of cloacal malformation. Intermittent catheterization of the bladder and/or urine-filled vagina can often provide adequate decompression; however, simple cystostomy or tube vaginostomy may be required in some. Major urinary diversion should be avoided. Occasionally, the urinary tract should be repaired before correcting other aspects of the malformation. In most cases rectal pull-through should not be performed first as an isolated procedure. In the majority of cases, all three systems can be repaired simultaneously, ie, rectum, vagina, and urinary tract. However, that is usually a large undertaking. The posterior sagittal midline approach, often together with an abdominoperineal approach, has proven very useful in these cases. An overall experience with 64 cloaca patients has shown that most can be repaired with a satisfactory functional and anatomic result.
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PMID:Repair of cloacal anomalies: current techniques. 379 84

The case of a 32-year old woman (gravida 3 para 2) in whom a Copper-7 IUD perforated the uterus, lodging both within the myometrium and the lumen of the small intestine is described. The patient presented in the emergency room 18 months after IUD insertion with heavy vaginal bleeding and passage of tissue. A diagnosis of spontaneous abortion was made. In this case, the small bowel had to be resected and side-to-side anastomosis was performed. This patient was asymptomatic until 3 weeks prior to admission. Other cases demonstrate acute symptoms of peritonitis and intestinal obstruction or more chronic complaints of vague abdominal pain and diarrhea. An IUD string that is not visible at the external os of the cervix generally reflects upward retraction of the string or unnoted spontaneous expulsion of the IUD. However, on occasion it can be associated with uterine or even intestinal perforation, as occurred in this case. Pain on insertion, also noted in this case, can serve as a warning sign of perforation. In this patient, the device was inserted 5 weeks after delivery, lending support to the recommendation that puerperal insertion be avoided. It is important to know the exact location of an ectopic IUD to prevent dangerous attempts at removal through the vagina. Laparoscopy and ultrasound are generally helpful in localizing the IUD and preparing the patient for laparotomy and possible bowel resection.
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PMID:Asymptomatic perforation of the small intestine by a copper-7 intrauterine device. 386 28

A variety of operations have been proposed for the treatment of radiation injuries of the rectum. In this study, the procedure advocated by the late Sir Alan Parks--resection of the diseased segment down to its points of fixation to the vagina, bladder or prostate; with perianal mucosal stripping of the anorectal segment and primary coloanal (pull-through) anastomosis--was performed in 11 patients. In two others, an attempt at colorectal anastomosis was abandoned because of extreme scarring in the pelvis. The procedures were done following definitive treatment of carcinoma of the rectum (seven patients), carcinoma of the cervix (two patients), carcinoma of the uterus (one patient), carcinoma of the ovary (one patient), seminoma (one patient), and carcinoma of the bladder (one patient). One patient died from a pulmonary embolus on the seventh postoperative day. Of the survivors with a coloanal anastomosis, all had successful closure of their temporary colostomies with follow-up from one to six years. In eight, continence was assessed as being good or excellent. Four patients required anastomotic dilation and another required a surgical procedure for anastomotic stricture. There was one instance each of reoperation for small bowel obstruction and ileocolic fistula. There were no instances of recurrence of hemorrhage, fistulas, perineal pain or tenesmus. The Parks procedure obviates the need for a difficult dissection of the lower rectum and separation of tissues damaged by radiation and avoids the need for eversion techniques. Its selective use is advocated for patients suffering from severe radiation injuries of the rectum.
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PMID:Parks' coloanal pull-through anastomosis for severe, complicated radiation proctitis. 397 3

Recurrences of clinical Stage I endometrial carcinoma after initial treatment are rare. They are nonetheless a serious complication, uniformly associated with poor survival outcome. Between 1969-1980, 20 patients with clinical Stage I endometrial carcinoma were treated for recurrent tumor at the time of first relapse. Nonpapillary adenocarcinoma represented 70% of the primary tumors (pure adenocarcinoma, 50%; adenosquamous, 15%, clear cell, 5%) and papillary adenocarcinoma, 30%. The most common presenting symptom was vaginal bleeding, occurring in 95% of patients. The median time to recurrence after completion of primary treatment was 9.5 mo: Adenocarcinoma relapsed at a median time of 33 mo, adenosquamous, 6 mo and papillary adenocarcinoma, 4 mo. The vagina was the site of relapse in 65% of patients, the abdomen in 20%, the pelvis in 10% and the lung in 5%. Ninety-five percent of recurrences were treated with curative intent. Complications were seen in three patients, small bowel obstruction (2 pts) and vaginal vault necrosis (1 pt); however, these patients responded effectively to conservative treatment. Minimum follow-up of 4 years was available in 18 pts (90%). Actuarial 4 yr overall and NED survival was 50%, respectively, with a median survival of 39 mo to date. There have been no deaths from further recurrence of endometrial cancer beyond 39 mo. Significant prognostic factors for 4 year survival were 1) recurrence site--vagina, 82% (9/11 pts) vs extravagina, 0% (0/7 pts; median survival: 8 mo) [p = .0001]; and 2) histologic cell type--non-papillary carcinoma, 75% (9/12 pts) vs papillary adenocarcinoma, 0% (0/6 pts; median survival: 8 mo) [p = .002]. Our review suggests that: (1) Histology and site of relapse are important prognosticators of treatment outcome; (2) Long term survival may be achieved in vaginal recurrences with aggressive local treatment; and (3) There may be a role for multimodality ovarian type treatment in overall management of recurrent papillary adenocarcinoma, a cell type that appears to exhibit a tendency towards extrapelvic spread refractory to definitive loco-regional treatment.
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PMID:Recurrent stage I endometrial carcinoma: results of treatment and prognostic factors. 399 92

This editorial consists of summaries of the discussions on incidence, pathogenesis, prognosis and patient follow-up, and transcripts of the discussions on detection and treatment of endometrial carcinoma, from a symposium held in Carefree, Arizona. 75% of the cancers occur in postmenopausal women; average age is 52 years, but is decreasing. Endometrial carcinoma rose from 20.3 to 46.3% of all uterine cancers in Cleveland University Hospitals from 1941-1970. Older patients are often diabetic, overweight, nulliparous, with anovulatory or familial history; young women frequently resemble mild Stein-Levinthal syndrome. Clinically, 20% of patients are assymptomatic, others may have softer or larger uterus, larger ovaries, irregular postmenopausal bleeding, or lengthy onset of menopause. The Gravlee jet wash is indicated for high risk patients and those about to take estrogen. Endometrial carcinoma first affects epithelium, then endometrial stroma, then upper myometrium, lower myometrium, then other organs, perhaps via lymphatics, vagina, tubes, but ascites is uncommon. Generally, U.S. physicians use intrauterine radium followed by surgery, British use surgery first, and Swedish use radiation only. Cases must be treated individually, e.g. surgery only for minimal cancer, radium and surgery for more serious cases, and preoperative external radiation also for advanced disease. Although radiation lessens chance of implantation during surgical trauma, insertion of intrauterine radium enhances spread of tumor cells. Injectable progestins sometimes control metastatic disease, although they require 8 weeks to act. Progestins may help those with late recurrence, squamous metaplasia, or who are under 50 years of age. Estrogens are rarely effective. Prognois for terminal patients often includes subjective improvement, bowel obstruction, lung complications, hemorrhage. Radiation side effects and menopausal symptoms are often problems for cured patients. In young cured patients the endometrium should be suppressed with progestins or oral contraceptives.
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PMID:Endometrial cancer: rising incidence, detection and treatment. 469 33

The smuggling of illicit drugs, either swallowed or inserted into the rectum or vagina, is gaining in popularity, particularly in view of the difficulty of its detection and the potentially large financial gains. Such contraband includes heroin (especially in Western Australia), cocaine, and marijuana and its derivatives. This practice is not without complications--drug intoxication, which may be fatal, and intestinal obstruction by foreign bodies have been reported. We review the cases of "body packing" reported in the literature and those detected in Western Australia over the past two years, and describe three cases of the ingestion of heroin-filled condoms, with resultant complications.
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PMID:Drug smuggling by internal bodily concealment. 663 8

Recurrent ovarian cancer after negative findings at second-look laparotomy is common. A retrospective review of 57 patients who developed recurrent tumor after a negative second-look laparotomy was undertaken to evaluate treatment efficacy and prognostic factors. All patients received primary platinum-based chemotherapy. Recurrences occurred in the abdomen or pelvis (40 patients), lymph nodes (7), liver (4), lungs (3), and vagina (3). Recurrent disease was diagnosed at a mean interval of 20 months after second-look surgery. Of the 38 patients who underwent laparotomy for recurrence, 36 (95%) had > 0.5 cm disease. After cytoreductive surgery 14 patients (37%) were left with minimal (< 0.5 cm) residual disease. Intestinal resection or bypass was performed on 10/38 patients (26%) with one requiring a colostomy. There was no operative mortality and one complication (small bowel obstruction). Treatment after recurrence consisted of platinum-based chemotherapy (88%), with the remaining patients receiving irradiation or hormonal therapy. At a mean follow-up from recurrence for the entire group of 20 months, 18/38 (47%) explored patients are alive. All 19 patients who were not explored died with a median survival time from recurrence of 9 months. Patients who underwent a laparotomy and patients with < 0.5 cm residual disease had a significant survival advantage (P < 0.0001). Initial stage, grade, disease-free interval, and disease found at laparotomy did not influence survival. Recurrent ovarian carcinoma after platinum-based chemotherapy is associated with a grave prognosis when the patient is deemed inoperable or when distant metastasis are found. Patients with disease reduced to < 0.5 cm showed a significant survival advantage.
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PMID:Cytoreductive surgery in ovarian carcinoma patients with a documented previously complete surgical response. 770 1

Smuggling of narcotics by internal concealment has increased considerably worldwide, including in the Scandinavian countries. During the period 1988-92, Norwegian custom officials reported 245 seizures where packets of narcotics had been inserted into the rectum or vagina, or had been swallowed. Based on two fatal cases as a result of intestinal obstruction and cocaine intoxication respectively, this report summarizes the main features of the "body packer" syndrome.
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PMID:[Smuggling of narcotics in body cavities]. 794 Apr 55

In the Netherlands a 34-year old pregnant women presented at the obstetrics and gynecology department of OLVG Hospital in Amsterdam with uterine bleeding. She was at 11 weeks gestation and had an IUD in situ. A vaginal ultrasound revealed that the pregnancy was intact so the physicians could not remove the IUD. She returned 12 days later because she was suffering from an incomplete spontaneous abortion. The physicians removed the IUD and performed an aspiration curettage. They did not administer antibiotics. 10 days after the operation the woman suffered worsening pain in the right thigh and leg and had difficulty walking, a fever, and general sickness. She was breathing very rapidly. Repeated vaginal ultrasounds revealed that she had retained the conceptus. The physicians prescribed respiratory support and antibiotics (claforan, gentamicin, and metronidazole). Blood culture indicated Staphylococcus aureus. Computer tomography revealed a retroperitoneal abscess at the level of the right iliopsoas muscle near the os ilium and the sacro-iliac joint. The physicians performed an extraperitoneal incision and drainage of the abscess and a repeat aspiration curettage. Staphylococcus aureus was isolated from all abscess samples, the conceptus, the cervix, the vagina, the urine, and the sputum. The physicians continued gentamicin and metronidazole treatment. They dismissed her after a complete recovery 16 days after the 2nd aspiration curettage. Possible complications of psoas abscess are sepsis, pulmonary embolism, hemorrhage, and bowel obstruction. Antibiotic prophylaxis in abortion curettage may prevent late sequelae, such as psoas abscess and pelvic inflammatory disease.
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PMID:Psoas abscess related to spontaneous abortion, intra-uterine contraceptive device and curettage. 838 62


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