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

The primary use of laparoscopy is as a surgical tool, with sterilizations being the overwhelming indication. The laparoscope is used less frequently as a non-surgical tool, with the major indication being for diagnosing infertility and/or amenorrhea, and for evaluation of obscure pelvic pain. There would seem to be several indications for laparoscopy that have been neglected, these being in confirming the diagnosis of acute pelvic inflammatory disease; in the evaluation of malignancies and abdominal-pelvic trauma; and the surgical treatment of pelvic pain. Lapar-The majority of these contraindications are relative, and depend soley on the laparoscopist's ability and his clinical judgment. The problems of hernias seem to have been over-emphasized. The laparoscopist should be aware of potential problems with umbilical hernia, and he probably can ignore hiatal hernias except when they are large and quite symptomatic. However, generalized abdominal peritonitis, significant hemoperitoneum with intestinal obstruction are felt by most authors to be absolute contraindications. The most frequent complications of laparoscopy involve the physoperitoneum. Except for cardiac arrest the most serious complications involve electrical burns to small bowel.
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PMID:Indications, contraindications and complications of laparoscopy. 12 9

Laparoscopy is reviewed in this keynote lecture of the 1st annual meeting of the American Association of Gynecological Laparoscopists in Las Vegas, Nevada, November 1972. The pneumoperitoneum may produce pressure on the inferior vena cava and stomach and cause splinting of the diaphragm leading to impaired ventilation, reduction in venous return to the heart, and possible regurgitation of stomach contents. Absorption of carbon dioxide may cause a rise of partial pressure of carbon dioxide with associated cardiac arrhythmias. All of these problems are controlled or prevented by a general anesthetic with intubation by a cuff tube, good muscle relaxation, and controlled ventilation by a respirator. Laparoscopy may be used to determine intact ectopic pregnancy and study female sterility, early endometriosis, acute salpingitis, chronic pelvic inflammatory disease, small uterine or other masses, and primary and secondary amenorrhea. Surgical uses include puncture and/or aspiration of ovarian cysts or tubo-ovarian cysts, removal of foreign bodies, resection of adhesions, tubal sterilization, and ventrosuspension of uterus. Contraindications include difficulty in establishing an adequate pneumoperitoneum; acute peritonitis, ileus, or intestinal obstruction; and inadvisability of penumoperitoneum or Trendelenburg position. Laparoscopy can diagnose the extent and nature of pelvic and abdominal cancer and evaluate treatment. Reported complications with laparoscopy include puncture of vessels, perforation of intra-abdominal viscus, parietal or omental emphysema, cardiorespiratory embarrassment, and effects of high-pressure gas injections. A woman infertile due to absent or useless oviducts but with a healthy uterus and at least 1 healthy functioning ovary could seemingly be assisted through recovery of oocytes via laparoscopy, fertilization and cleavage of the ovum in vitro, and finally embryo transfer into her uterus. The first 2 steps have already been accomplished for women.
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PMID:Gynecological laparoscopy. 426 3

Barium enema examination is a well known and useful adjunctive technique for the diagnosis of acute appendicitis when its clinical presentation is atypical. The combination of a mass effect on the cecum and nonfilling of the appendix have been considered virtually pathognomonic radiographic findings. These appearances on barium enema examination may also be encountered in patients with small-bowel obstruction, acute enterocolitis, pelvic hemorrhage and adhesions, and pelvic inflammatory disease. In three of five cases, these radiographic findings contributed to the decision to perform laparotomy, at which a histologically normal appendix was removed. The value of the barium enema examination in suspected but atypical acute appendicitis must be tempered by the recognition that occasionally other diseases with acute presentations produce similar findings.
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PMID:Nonspecificity of barium enema findings in acute appendicitis. 661 Mar 41

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

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

Our patient presented with abdominal pain, weight loss, and fever with evidence of oral thrush and pelvic inflammatory disease on exam. Radiographs demonstrated a small bowel obstruction with free air. An exploratory laparotomy demonstrated 2 perforations of the distal ileum. Pathologic exam revealed features consistent with histoplasmosis. We discuss gastrointestinal involvement of histoplasmosis in AIDS and its treatment.
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PMID:Ileal perforation secondary to histoplasmosis in AIDS. 1114 55

Perihepatitis or Fitz-Hugh-Curtis syndrome is a complication of pelvic inflammatory disease that usually leaves characteristic violin string adhesions on the anterior liver surface. These adhesions are common incidental findings on subsequent laparoscopy or laparotomy and are considered benign. We present a case of partial mechanical small bowel obstruction as a sequel of this syndrome that was diagnosed and treated laparoscopically.
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PMID:Mechanical partial small bowel obstruction in a patient with Fitz-Hugh-Curtis syndrome. 1132 24

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

We report the case of a 33-year-old woman whose medical history included three normal pregnancies without previous abdominal or pelvic surgery. She presented with small bowel obstruction. An abdominal computed tomography (CT) scan study revealed air fluid levels in the pelvis. Laparoscopic exploration revealed a viable ileal loop incarcerated through the mesoligamentum teres. The intestinal loop was reduced and the broad ligament defect was closed with a laparoscopic absorbable clip. Among internal hernias, hernias through a defect in the broad ligament represent only 4-7%. Defects within the broad ligament can be either congenital (ruptured cystic structures reminiscent of the mesonephric or mullerian ducts) or secondary to operative trauma, pregnancy and birth trauma, or prior pelvic inflammatory disease. CT scan may be diagnostic by showing incarceration of a dilated intestinal loop in the Douglas pouch with air fluid levels. This is the first reputed case of a totally laparoscopic repair of a bowel incarceration through a broad ligament defect.
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PMID:Small bowel incarceration in a broad ligament defect. 1239 55

A 19-yr-old adolescent, who was hospitalized because of pelvic inflammatory disease (PID) due to Chlamydia trachomatis, developed bile-stained emesis. A mild amount of free fluid in the pelvis was found on abdominal ultrasound but there was no sonographic evidence of a pelvic mass or of a tubo-ovarian abscess. Plain radiography and computer tomography (with contrast) of the abdomen revealed a high-grade partial small bowel obstruction. Conservative treatment, which included intravenous fluids and antibiotics together with continuous bowel decompression via nasogastric tube, led to resolution of the small bowel obstruction within 2 days and to resumption of oral feeding within 4 days of treatment. Follow-up for 6 months after this episode was uneventful. The present case calls for inclusion of plain radiography of the abdomen in the evaluation of PID associated with emesis. It also suggests that, in a clinically stable patient diagnosed with small bowel obstruction associated with PID, conservative treatment could be attempted before any operative intervention is considered.
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PMID:Small bowel obstruction in an adolescent with pelvic inflammatory disease due to Chlamydia trachomatis. 1280 34


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