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

Acute colonic pseudo-obstruction is a functional disorder that closely mimics mechanical large bowel obstruction, and in which inadvertent laparotomy carries a high mortality. Eleven such patients were treated by pharmacological manipulation of the autonomic innervation to the colon with guanethidine and neostigmine. Eight responded to treatment with passage of flatus and/or stool within 10 min with complete resolution of symptoms. In three patients the treatment failed. Postural hypotension occurred in only one patient and no other serious side-effect was apparent. This pharmacological approach to the management of acute colonic pseudo-obstruction is suggested as an alternative to the other treatment options of colonoscopic decompression or surgery, when conservative management has failed.
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PMID:Acute colonic pseudo-obstruction: a pharmacological approach. 141 11

Until relatively recently, the nasogastric (NG) tube has been used routinely for decompression in the patient with small- or large-bowel anastomosis. To determine if routine postoperative NG decompression benefited such patients, 102 patients were randomized prospectively to either NG decompression or no-NG tube. Excluded were patients with chronic bowel obstruction, peritonitis, gross fecal contamination or spillage, and previous abdominal or pelvic irradiation. There were 52 patients in the no-NG group and 50 in the NG group. Patients in the no-NG group had earlier bowel sounds, return of flatus, oral intake and first bowel movement. Four patients (8%) in the no-NG group, compared with one patient (2%) in the NG group, required subsequent decompression. Length of hospital stay was significantly (p < 0.001) shorter in the no-NG group. There were no significant differences in the presence of atelectasis, postoperative fever, wound infections and anastomotic leaks between the two groups. The authors conclude that routine nasogastric decompression is not warranted after elective surgery involving small- or large-bowel anastomosis.
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PMID:A prospective randomized trial of routine postoperative nasogastric decompression in patients with bowel anastomosis. 145 82

In a double-blind, placebo-controlled, crossover trial, we investigated the effects of the prokinetic drug cisapride in patients with cystic fibrosis and chronic recurrent distal intestinal obstruction syndrome (DIOS). After a baseline period, 17 patients (12.9 to 34.9 years; 12 boys) received, in random order, cisapride (7.5 to 10 mg) and placebo three times daily by mouth, each for 6 months. Gastrointestinal symptoms (flatulence, abdominal pain, fullness, abdominal distension, nausea, anorexia, heartburn, diarrhea, vomiting and regurgitation) were scored three times monthly and physical examinations assessed. At baseline and at each 6-month period, assessment included food intake for 7 days, 3-day stool collection, pulmonary function tests, and abdominal radiographs. During cisapride therapy compared with placebo, there were significant reductions in flatulence (p less than 0.005), fullness, and nausea (p less than 0.05). Patients with the worst symptom scores benefited most from cisapride. With cisapride, 12 patients felt better and three worse (p less than 0.05); physicians judged 11 patients improved and two worse (p less than 0.05). No side effects were noted. There were no significant differences between cisapride and placebo periods in nutritional status, x-ray scores, pulmonary function, food intake (fat, protein, calories), stool size and consistency, and fecal losses of fat, bile acids, chymotrypsin, and calories. For acute episodes of DIOS, intestinal lavage was needed 6 times in 4 patients during treatment with cisapride, and 11 times in 6 patients receiving placebo. In comparison with unselected patients with cystic fibrosis and pancreatic insufficiency who were receiving enzyme supplements and who had no distal intestinal obstruction, fecal fat losses (percentage of intake) were almost twice as high in the study group with DIOS (31.2 +/- 20.6% vs 16.2 +/- 17.6%; p less than 0.01). We conclude that in the dosage used, long-term treatment with cisapride appears to improve chronic abdominal symptoms in patients with cystic fibrosis and DIOS, but fails to abolish the need for intestinal lavage. Cisapride treatment had no effect on digestion and nutritional status of cystic fibrosis patients with pancreatic insufficiency.
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PMID:Effects of cisapride in patients with cystic fibrosis and distal intestinal obstruction syndrome. 223 Dec 17

Of 84 patients who underwent restorative proctocolectomy with an ileoanal reservoir in 21 Italian departments of surgery, 51 had ulcerative colitis, 32 familial polyposis and 1 intractable constipation. Follow-up information is available for all 58 patients who had their ileostomy closed, the length of follow-up ranging between 2 and 78 months. There were no operative deaths. A failure rate (i.e. excision of the pouch) of 3 per cent was observed. Sepsis was the most common postoperative complication, and was most often related to ileoanal anastomosis dehiscence (15 per cent), followed by small-bowel obstruction requiring laparotomy (10 per cent). Clinical 'pouchitis' occurred in 14 per cent of patients after ileostomy closure. The average frequency of defaecation was four motions per 24 h; evacuation was spontaneous in all patients and only 5 per cent complained of troublesome faecal soiling while 34 per cent had occasional incontinence to flatus and mucus. Patients with a short or absent rectal cuff had a lower rate of incontinence (30 versus 48 per cent, difference not statistically significant) without any increase in the frequency of genito-urinary disorders. None of the two most used reservoirs, the J (n = 40) and S pouch (n = 17) showed significant superiority in terms of bowel frequency and continence. Incontinence was more likely in patients whose ileostomy closure had been delayed for more than one year.
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PMID:Clinical and functional results after restorative proctocolectomy. 283 77

In order to prevent the development of the dynamic intestinal obstruction the prolonged peridural blockade, intravenous and intraaortal injection of the solution of novocain were used with reference to the phase of the pathological process. Results of the examination of 200 patients has shown that these measures facilitate passage of flatus and stools, shortens the staying of the patients at the hospital and reduces the amount of postoperative complications and lethality.
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PMID:[Prevention of dynamic intestinal obstruction in children with peritonitis]. 384 Jun 16

Meteorism might be a symptom of organic intestinal obstruction, which needs surgical treatment in most cases. However it is often a functional phenomenon. It may be produced by aerophagy, followed by sonor, non fetid flatulence. Large amounts of gas are produced by the contact of gastric acidity with alcaline pancreatic secretion and by enzymatic digestion of food. Most of these gases are absorbed by the intestine and exhaled. In the colon bacterial fermentation and putrefaction produce fetid gas which is expulsed as flatus. Overeating, bacterial invasion of the small intestin, inflammatory and circulatory disturbances of the small bowel and obstipation favour meteorism. The treatment depends of the origin of meteorism.
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PMID:[Pathogenetic basis and therapeutic management of meteorism (author's transl)]. 611 Mar 77

A continent reservoir ileostomy was constructed in 85 patients, 9 of whom were adolescents. Indications for the procedure included organic problems related to the ileostomy as well as psychologic and sexual difficulties related to an external appliance. Fifty-eight patients had conversion from a conventional ileostomy. Twenty-five patients underwent total proctocolectomy and Kock ileostomy. An intussuscepted "nipple valve" was used in all cases. Follow-up ranged from 4 to 10 months. There were no operative deaths. Eighty-two patients are completely continent with regard to both flatus and stool. Only two patients wear an external appliance. No one has requested a return to a conventional ileostomy. No reservoirs have been removed. Ten of the initial 17 patients (59%) required at least one additional surgical procedure for early or late complications, the most frequent of which were intestinal obstruction, sliding or prolapse of the nipple valve and fistula. Technical modifications have reduced this morbidity; they included using SGIA staples across the nipple valve and a fascial sling around the outlet. These modifications have been used in 28 additional patients and in 5 from the original series. Ten of these 33 patients (30%) have required intra-abdominal operation for revision, 5 because of sliding of the nipple valve. Further modifications using a Marlex mesh sling have been made in 40 additional patients and in 7 patients from the original series. Six of these 47 patients (11%) have undergone or will undergo intra-abdominal operation for revision. Only one case of nipple valve sliding has occurred in this group. Marlex mesh has now been replaced by Prolene mesh. The benefits of the continent ileostomy are substantial. The author's results have continued to improve with experience and with the technical modifications outlined.
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PMID:Evolution of the Kock continent reservoir ileostomy. 711 52

A continent Kock ileostomy was constructed in 17 patients with histologically proven ulcerative colitis; in 11 a conventional ileostomy was converted to a Kock ileostomy and in 4 the Kock ileostomy was carried out in conjunction with proctocolectomy. There were no operative deaths. All patients are completely continent with regard to flatus and stool. No patient requires an external appliance and all agree that the quality of their lives has greatly improved. However, 10 patients (59%) required at least one additional surgical procedure for early or late complications, the most frequent of which were intestinal obstruction and valve slipping. In an attempt to reduce morbidity, several technical modifications were made. The preliminary results of the modified techniques used in 17 patients are described. The benefits of the continent ileostomy are substantial despite the high initial morbidity. The authors recommend the use of the continent ileostomy in selected patients.
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PMID:Continent reservoir ileostomy: 1. Early experience and evolution of the surgical technique. 737 57

During laparoscopic cholecystectomy, gallbladder perforation with leakage of bile and/or gallstones into the abdominal cavity occurs frequently. When this occurs, our practice has been to lavage the operative field and retrieve as many gallstones as possible. We were concerned, however, that complications secondary to infection or adhesions might develop. To address this issue, our first 250 consecutive patients undergoing laparoscopic cholecystectomy were surveyed by postal questionnaire. In the 35-48 months (mean, 41 months) since operation, six patients (2.6%) died of nonbiliary causes. Of the 225 patients (90%) who completed the questionnaire, 73 (33%) suffered intraoperative gallbladder perforation. There were no late wound or intraabdominal infectious complications and no patient has required reoperation for intraabdominal sepsis or bowel obstruction. In the entire group, gastrointestinal symptoms were prevalent and included flatulence (40%), loose stools or fecal urgency (35%), belching (23%), and nausea (4%). The prevalence of these complaints was similar in patients with and without gallbladder perforation. Intraoperative gallbladder perforation during laparoscopic cholecystectomy, therefore, does not cause adverse long-term complications when accompanied by operative lavage and stone removal.
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PMID:The influence of intraoperative gallbladder perforation on long-term outcome after laparoscopic cholecystectomy. 748 16

A 72-year-old man presented with constipation of 45 days' duration, with history suggestive of recurrent episodes of subacute intestinal obstruction relieved by passage of fluid and flatus; he had noticed an abdominal lump 30 days prior. Examination revealed a lump corresponding to the contours of the entire large intestine. X-ray showed barium outlining the colon. Enquiry revealed that he had undergone a barium enema study 10 days prior to appearance of the lump. The diagnosis of barium inspissation was confirmed at laparotomy; total colectomy with ileo-rectal anastomosis was done.
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PMID:Colonic chemobezoar--intestinal obstruction due to barium inspissation. 924 91


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