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

During 1994 through 1999, we have treated five patients (3 boys, 2 girls) with total colonic aganglionosis (TCA) and ileal involvement. In three of them we performed a diverting ileostomy in the neonatal period and at the age of four and five months respectively in the remaining two patients, due to intestinal obstruction. In these two last patients a diagnosis of Hirschsprung's disease was made by anorectal manometry and rectal biopsies in the neonatal period. During laparotomy, a cutaneous ileostomy was created in all patients at the distal end of normal ileum, which was 30 to 110 cm (mean = 71 +/- 37 cm) from the ileocecal valve. After operation, a short bowel syndrome developed in three patients causing fluid and nutritional problems that required prolonged total parenteral nutrition (TPN). The definitive operative repair is performed at 4.5 to 14 months (mean = 8 +/- 3.7 months) by a 12 to 20 cm side-to-side ileocolostomy created between the ileum and aganglionic ascending color (Boley procedure) and ileorectal primary anastomosis (Rehbein procedure) using a circular stapler. Rectal dilatation, irrigation of the colon with saline, loperamide hydrochloride and resincholestyramine were begun in all patients postoperatively. Oral antibiotic prophylaxis, was given to the three patients who suffered from SBS. Oral feedings with semielemental diet were tolerated once stools were semiformed and TPN was discontinued at 8 to 34 days (mean = 21 +/- 1.7 days). postoperatively. After the definitive operation, enterocolitis developed in two patients, requiring one of them a short hospitalization during the episode. A possible explanation for the low incidence of enterocolitis in this series is the systematic postoperative use of irrigations of the colon with saline in all patients. These five patients have been followed-up for growth, development, bowel habit and continence. Follow-up has ranged from 15 to 62 months (mean = 32.2 +/- 19.2 months). Presently, all patients in this series have full enteral feeding and one to three bowel movements per day, with formed or semiformed stools. No patients is incontinent of stool. The patient's body weights (74 to 93%) and heights (89 to 92%) for their age were below average (four patients) or within normal range (one patient). Hemoglobin levels are within normal range in all patients. One patient has iron deficiency and another one has serum ferritin concentration below normal. Three patients have folic acid deficiency. Vitamin B12 absorption is normal in all patients. Although we can not conclude this is a better procedure than others, with is use we have obtained satisfactory results, with an excellent survival, scanty morbidity, a rapid return of bowel function and continence, and an acceptable physical development. During long-term follow-up, patients mus be evaluated for iron and folic acid deficiency.
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PMID:[Colonic aganglionosis with ileal involvement. Ileocolic plasty]. 1148 Jan 97

A 79-year-old female patient with rheumatoid arthritis treated with NSAIDs on long-term developed iron-deficiency anaemia and subsequently subacute intestinal obstruction. Barium enema showed multiple diaphragm-like strictures. At colonoscopy the lumen of the ascending colon was divided into compartments by multiple thin circumferential mucosal membranes. Right hemicolectomy was carried out. The histology of the resected specimen confirmed diaphragm disease of the large bowel. Diagnosis is usually difficult, even at laparotomy, due to the poor external presence of the disease. Such lesions are rare (about 10 cases have been reported in the world literature) and are similar to those previously described in the small bowel. With the increasing world-wide use of NSAIDs, clinicians must be aware of this rare gastrointestinal complication, which may require emergency surgical intervention.
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PMID:[Membranous constriction of the colon caused by non-steroidal anti-inflammatory drugs--case report]. 1461 96

Whole bowel irrigation (WBI) should not be used routinely in the management of the poisoned patient. Although some volunteer studies have shown substantial decreases in the bioavailability of ingested drugs, no controlled clinical trials have been performed and there is no conclusive evidence that WBI improves the outcome of the poisoned patient. Based on volunteer studies, WBI should be considered for potentially toxic ingestions of sustained-release or enteric-coated drugs particularly for those patients presenting greater than two hours after drug ingestion. WBI should be considered for patients who have ingested substantial amounts of iron as the morbidity is high and there is a lack of other options for gastrointestinal decontamination. The use of WBI for the removal of ingested packets of illicit drugs is also a potential indication. WBI is contraindicated in patients with bowel obstruction, perforation, ileus, and in patients with hemodynamic instability or compromised unprotected airways. WBI should be used cautiously in debilitated patients or in patients with medical conditions that may be further compromised by its use. The concurrent administration of activated charcoal and WBI may decrease the effectiveness of the charcoal. The clinical relevance of this interaction is uncertain. A review of the literature since the preparation of the 1997 Whole Bowel Irrigation Position Statement revealed no new evidence that would require a revision of the conclusions of the Statement.
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PMID:Position paper: whole bowel irrigation. 1582 69

Capsule endoscopy is a new technique for the study of small intestine particularly in cases of obscure gastro-intestinal bleeding or chronic iron-deficiency anemia. In our study we present a case of 62 years-old man with a chronic iron-deficiency anaemia developed at least six months before and refractory to iron therapy. The patient was submitted to upper gastro-intestinal endoscopy and to partial colonscopy due to abdominal adhesions for previous abdominal surgery. A capsule endoscopy was indicated to achieve a definitive diagnosis. Wich discosed an intestinal obstruction. So far a surgical resolution was indicated. The surgery revealed a stricturing neoplasia of the cecum in which the capsule endoscopy was retained.
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PMID:[Incidental diagnosis of caecum adenocarcinoma due to retention of endoscopic videocapsule: a clinical case]. 1690 Aug 42

Angiodysplasia is a relatively rare lesion that however may be a major source of upper and lower gastrointestinal bleeding. It's mostly related to the aging and degeneration of the blood vessels, as it occurs in older adults. Clinical presentation is variable, ranging from asymptomatic cases over iron deficiency anaemia to acute or recurrent bleeding. We present a case of 60 year-old woman presented with anaemia and intestinal obstruction. Diagnosis can usually be made using endoscopy, sometimes with additional biopsy. Treatment can be symptomatic, including iron supplements and transfusion therapy or causal, including therapeutic endoscopy (laser, electrocautery, heater probe or injection sclerotherapy), therapeutic angiography and surgery.
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PMID:[Duodenal angiodysplasia: an unusual cause of intestinal obstruction]. 1856 71

The usual form of presentation of celiac disease is chronic diarrhoea and deficiencies of vitamin D, vitamin K, iron and vitamin B12, due to malabsorption. Intestinal obstruction secondary to an intussusception is rare in adults and usually is a complication of carcinoma of the colon or post-operative adhesions. We report a 45 year-old female consulting for diarrhoea and vomiting lasting one week and progressive abdominal bloating. A plain abdominal X ray showed air fluid levels in the small bowel and a CT scan showed an intussusception. She was operated and discharged but continued with diarrhoea. She was admitted again and a new CT scan showed three intussusceptions that were resolved with the administration of oral contrast media. Antiendomisial antibodies were positive and a celiac disease was diagnosed. After one year with a gluten free diet, the patient remains asymptomatic.
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PMID:[Celiac disease presenting as an intestinal intussusception. Report of one case]. 1903 Jun 64

In recent years, a growing number of severely obese adolescents and their families have sought out surgical treatment because behavioral or medical therapies were not successful. A number of reports have suggested that bariatric surgery for this patient group is safe and can provide durable weight loss. However, most of these reports have been retrospective studies with short-term outcomes, and more long-term, prospective studies are needed to optimize care for these patients. Evaluation of the severely obese patient for surgery involves multiple factors, including the overall maturity of the patient; joint discussions with the patient and his or her family; a complete medical evaluation; evaluation by a child psychologist or psychiatrist; and a minimum of 6 months of private, interdisciplinary, multifaceted lifestyle preparation. Surgical options are restricted to severely overweight adolescents without endocrine disorders who have achieved puberty and have failed more conservative therapies. The Roux-en-Y gastric bypass is the most commonly performed procedure in adolescents, but the laparoscopic adjustable gastric band procedure is growing in popularity. Postoperatively, patients are evaluated 2 weeks after surgery and then every 1 to 2 months for the first postoperative year; every 2 months to 6 months in the second year, depending on the individual case; and then annually for life. A careful diet plan backed by continuing family support is essential. Short- and long-term complications are similar to those seen in adults, and include bowel obstruction, bleeding, blood clots, nausea, gallstones, hernia, and vitamin and iron deficiencies.
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PMID:Bariatric surgery for the severely obese adolescent. 1908 45

Trichobezoars are intraluminal accretions of ingested hair. The Rapunzel syndrome is a rare form of gastric trichobezoar, with extension into the small bowel, and may be complicated by obstruction, perforation or peritonitis. The majority of reported cases are from Asian countries. We describe the second case from England who, like the earlier report, is also a 14-year old Asian girl who presented with small bowel obstruction. The pathology was missed 2 years previously when she presented with slim stature, iron-deficiency anaemia and frontal alopecia. This report highlights the need for a higher index of suspicion, particularly in Asian girls to avoid missing the diagnosis and early elective intervention.
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PMID:The Rapunzel syndrome: is it an Asian problem? (case report and review of literature). 1932 1

Follow-up of the large numbers of patients undergoing bariatric surgery poses problems for surgical programs and for internists who care for morbidly obese patients. Early surgical follow up is concentrated on the perioperative period to ensure healing and care for any surgical complications. It is especially important to treat persistent vomiting to avoid thiamine deficiency. Subsequently, monitoring weight loss and resolution of comorbidities assumes more importance. Identification and management of nutritional deficiencies and other unwanted consequences of surgery may become the responsibility of internists if the patient no longer attends the office of the operating surgeon. The long-term goal is to avoid weight regain and deficiencies, especially of protein, iron and vitamin B12, and calcium and vitamin D. Abdominal pain and gastrointestinal dysfunction should be investigated promptly to exclude or confirm such conditions as small bowel obstruction or gallstones. Good communication between bariatric surgeons and internal medicine specialists is essential for early and accurate identification of problems arising from bariatric surgery.
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PMID:Short- and long-term surgical follow-up of the postbariatric surgery patient. 2020 86

Accidental ingestion of foreign bodies is a common problem in infants and childhood, but ingestion of magnetic construction toys is very rare. In the case of ingestion of multiple parts of these magnetic construction toys, they may attract each other through the intestinal walls, causing pressure necrosis, perforation, fistula formation or intestinal obstruction. A 20-month-old boy presented with a three-day history of abdominal pain and bilious vomiting. Physical examination revealed a slighted distended abdomen. The -white blood cell count was increased, but the C-reactive protein was normal. Ultrasound and X-ray of the abdomen showed a distended bowel loop in the right upper quadrant, a moderate amount of free intraperitoneal liquid and 4 foreign bodies. Emergency laparotomy was performed and 2 perforations in the ileum were detected. The perforations were caused by a magnetic construction toy and 2 iron globes. The fourth foreign body was a glass marble. The foreign bodies were removed, both perforations were primarily sutured. The child was discharged on postoperative day 10 after an uneventful recovery. Parents should be warned against the potential dangers of children's constructions toys that contain these kinds of magnets.
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PMID:[Small bowel perforation caused by magnetic toys]. 2054 90


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