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

Twelve patients with Crohn disease aged from 11.3 to 17.1 years, underwent intestinal resection. Eight were prepubertal or in early puberty and 4 in mid or late puberty. Pre-operative assessment included acceleration and compression barium studies and total colonoscopy. In six patients the surgical indication was failure of medical management and in six intestinal obstruction. All but one were in remission 12 months after surgery. Height velocities in the eight pre and early pubertal patients increased dramatically during 6- and 12-month post operative measurement periods compared with preoperative growth. Height velocities in the mid and late pubertal patients showed much less increase. In selected patients, surgical treatment can induce remission resulting in catch-up growth and sustained growth acceleration. In prepubertal and early pubertal patients surgery is likely to improve final adult height.
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PMID:Acceleration of linear growth following intestinal resection for Crohn disease. 220 59

Complications of barium sulphate studies abound in the literature but there are very few recorded instances of large bowel obstruction due to inspissated barium and faeces forming a 'barolith'. A patient who suffered this complication is reported.
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PMID:Large bowel obstruction due to an impacted barolith--a delayed complication of a barium study. 221 44

Colocolic intussusception is an uncommon cause of pediatric intestinal obstruction in North America; 95% of cases are ileocolic in location, with an equal percentage in which no pathologic lead point is evident on barium enema or laparotomy. In the last 20 years less than 3% of approximately 32,500 reported cases of intussusception originated in the colon. In a significant number of these cases juvenile polyps were identified as leading points. The majority of juvenile polyps occur in the rectosigmoid colon within the reach of a standard pediatric sigmoidoscope. These tumors most often cause painless hematochezia. Occasionally, juvenile polyps may grow large and serve as lead points for colocolic intussusception when located in the proximal colon. Pediatric patients presenting with documented colocolic intussusception should suggest the possibility of a colonic polyp or other mass lesion. Careful physical examination and barium studies should provide important diagnostic clues. Treatment is aimed at removing the lead point in patients presenting with intestinal obstruction. Colonoscopic polypectomy performed by an experienced endoscopist may serve as an alternative to surgical removal of the polyp. We report a case in a three-old-child of colocolic intussusception caused by a colonic polyp, and review some of the salient features of this clinical entity.
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PMID:Colocolic intussusception in a three-year-old child caused by a colonic polyp. 222 16

We have reported two cases of intestinal obstruction due to traumatic diaphragmatic hernia, both resulting from apparently trivial knife wounds. When TDH is due to a penetrating injury, it tends to produce symptoms of intestinal obstruction. A high index of suspicion, a chest x-ray film, and barium studies of the gastrointestinal tract are usually needed to make the diagnosis, though CT scans, ultrasonography, laparoscopy, and radionuclide scanning may also be useful. Surgeons and emergency physicians should be aware of the potential for TDH when there is a history of a penetrating wound of the chest or abdomen.
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PMID:Traumatic diaphragmatic hernia and intestinal obstruction due to penetrating trunk wounds. 223 72

This paper is a retrospective study of all children with intussusception, who were treated in the pediatric surgical clinic in the Dr. v. Hauner'sches Kinderspital of the University of Munich from 1970 to 1988. In this time we evaluated 99 cases out of 101 children. Points of interest were epidemiological data, such as sex ratio, average age, place of residence, exact documentation of the anamnesis typical of this pediatric surgical entity, of diagnosis, site of intussusception as well as of frequency of conservative barium enema reduction and surgical treatment respectively. 68 patients of these evaluated 99 cases had to be operated. As far as postoperative courses are concerned bowel obstruction occurs in 6 patients, 4 cases developed a relapse of intussusception and one child died.
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PMID:[Invagination in childhood]. 227 33

In a 6.5 year period starting January 1982, 121 patients (74 male, 47 female; 1.6:1) with complicated gastroesophageal reflux referred to Alberta Children's Hospital, University of Calgary, required a Nissen fundoplication at a mean age of 35.5 months (range 3 weeks to 18 years). The median age of onset of symptoms was less than 1 month. Symptoms and indications for surgery included regurgitation (88%), failure to thrive (52%), reflux-associated pulmonary symptoms and aspiration (48%), biopsy evidence of esophagitis (35%) with heartburn (17%), dysphagia (18%), hematemesis (17%), anemia (13%), and hypoproteinemia (22%). Sixty-four percent of the patients had a syndrome or chromosomal abnormality, respiratory disease, or neuromuscular disorder. The barium contrast upper-gastrointestinal radiographic series, performed in all patients, identified structural [gastric outlet obstruction (2%), esophageal stricture (11%), erosive esophagitis (9%)], and functional abnormalities [gastroesophageal reflux (90%), barium aspiration (8%), esophageal hypoperistalsis (30%), delayed gastric emptying (4%)]. Barium contrast upper gastrointestinal radiographic series identified gastroesophageal reflux with a sensitivity of 90% (compared to history), was 50% sensitive and 92% specific for erosive esophagitis (compared to biopsy), was 59% sensitive and 74% specific for esophageal dysmotility (compared to esophageal manometry), and there was a significant (p less than 0.01) association between barium aspiration and prior evidence of aspiration pneumonitis. Esophageal manometry demonstrated a significantly (p less than 0.001) lower esophageal sphincter pressure in patients compared with controls, but no significant correlation with failure to thrive, aspiration pneumonia, biopsy evidence of esophagitis, or parameters of the 24-hour esophageal pH study. Twenty-four hour pH monitoring showed significantly (p less than 0.05) more reflux episodes than in asymptomatic controls and there was significant (p less than 0.05) correlation between the percentage of time pH was less than 4 and the presence of hypoalbuminemia, and biopsy-proven erosive esophagitis or Barrett's esophagus. Endoscopic appearance was 91% sensitive and 60% specific for esophagitis when compared to biopsy. Nissen fundoplication was completely effective at resolving gastroesophageal reflux in 83%, and associated with marked improvement in 15%. No patient died as a result of fundoplication. Major complications included: recurrence of symptoms requiring reoperation (2%), subsequent mechanical bowel obstruction (8%), wound infection or pneumonia (12%).
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PMID:Investigation and outcome of 121 infants and children requiring Nissen fundoplication for the management of gastroesophageal reflux. 227 17

The early detection and management of recurrence following curative resection for colorectal carcinoma can prolong survival. However, at the present time there is no consensus on the appropriate follow-up protocol for such patients. This investigation was undertaken to determine which tests and procedures are most useful in detecting recurrence and the frequency with which they should be employed. Another purpose of this study was to identify those patients at high risk for recurrence. Sixty-five patients who underwent curative resection of adenocarcinoma of the colon and rectum were followed for at least two years or until recurrence. Thirty were classified as Duke's A carcinoma of the colon, 18 were Duke's B, and 17 were Duke's C. Mean follow-up was 44.9 months. The follow-up regimen consisted of clinical exam, liver function tests, carcinoembryonic antigen (CEA) level, and chest x-ray every three months for the first two years postoperatively and every six months thereafter, and colonoscopy or barium enema and proctoscopy every six months for the first two years postoperatively and every year thereafter. Seventeen patients (26%) had a recurrence; 24% per cent of these developed within one year, 65 per cent developed within two years, 82 per cent developed within three years, and 94 per cent developed within four years of resection. Recurrence was detected by CEA in eight patients, chest x-ray in five, endoscopy in three, and laparotomy for small-bowel obstruction in one patient.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Postoperative surveillance of patients with carcinoma of the colon and rectum. 229 7

Gastrointestinal contrast studies were performed in 96 (27 percent) of 342 patients with small-bowel obstruction including 57 upper gastrointestinal and 39 barium-enema examinations. In 34 patients, upper gastrointestinal examination disclosed either obstruction or failure of contrast to reach the cecum in 24 hours; all 34 patients required surgery. The remaining 23 patients who had upper gastrointestinal studies recovered with tube decompression. Barium enema demonstrated obstruction in 13 (33 percent) of 39 cases of suspected small-bowel obstruction and localized obstruction in the colon rather than small bowel in 9 of 13 cases. Barium enema was 100 percent predictive of surgery when obstruction was shown, but was not helpful in predicting surgery when obstruction was not demonstrated. Surgery was required in 42 percent of patients whose barium enema did not show obstruction. Barium enema also was performed in 19 of 23 patients with large-bowel obstruction and showed the level of obstruction in all cases. All patients with large-bowel obstruction required surgery except for three who recovered after barium-enema reduction of intussusception or volvulus. Barium upper gastrointestinal examination is recommended in small-bowel obstruction when plain films are nondiagnostic, and in selected cases of small-bowel obstruction that do not resolve with a short trial of tube decompression. Barium enema is not recommended in suspected small-bowel obstruction but should be performed in all cases of large-bowel obstruction, except when perforation is a possibility or when the cecum measures 10 cm or larger in diameter.
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PMID:Use of gastrointestinal contrast studies in obstruction of the small and large bowel. 235 Oct 7

Hirschsprung's disease (HD) is a neurogenic form of intestinal obstruction characterized by a congenital absence of ganglion cells in the submucosal and myenteric plexuses. Acquired aganglionosis (AAG) is a rare condition that may occur following various pull-through procedures for HD. This report describes five boys with acquired aganglionosis. In all cases, the presence of normal ganglion cells was confirmed on review of biopsies of the pull-through segments at the initial operation. The original pull-through procedure included Soave (2), Duhamel (2), and Swenson (1) operations. Three procedures were initially performed at other institutions. Recurrent symptoms including abdominal distention, obstipation, enterocolitis, and failure to thrive developed 7, 11, 12, 18, and 30 months postoperatively (mean, 15.6 months). The diagnosis of AAG was delayed 1.5 to 9 years after the onset of recurrent symptoms. Full column barium enema studies revealed a transition zone or narrow area in the rectosigmoid or descending colon in four children. Repeat full thickness rectal biopsies at 3.0 cm above the anal verge in the pull-through segment confirmed the absence of ganglion cells in each case. Two children (post Swenson and Duhamel) were successfully revised with a Swenson procedure. Two additional children (post Soave and Duhamel) were successfully treated with extended posterior anomyomectomy procedures. The remaining boy now has a preliminary colostomy and is awaiting a second procedure. Vascular compromise of the distal bowel segment at the time of the initial pull-through procedure may contribute to the selective loss of ganglion cells postoperatively as neural tissues are most sensitive to hypoxia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Acquired aganglionosis: a rare occurrence following pull-through procedures for Hirschsprung's disease. 229 33

The radiological findings are described in four patients who developed strictures of the small bowel, and who had received non-steroidal, anti-inflammatory drugs (NSAIDs) for 1.5-15 years. Clinical presentation was that of subacute small bowel obstruction. Small bowel barium studies showed multiple discrete strictures. Some strictures were indistinguishable from those of regional enteritis. Others however were narrow "diaphragm-like" septae encroaching on and markedly narrowing the ileal lumen, and shown histologically to be due to submucosal fibrosis. It is suggested that these strictures are likely to be consequent on NSAIDs administration and that radiologists and surgeons need to be aware of these "diaphragms" which can be very difficult to detect on barium examination, either small bowel follow-through or enteroclysis, and at laparotomy.
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PMID:"Diaphragm-like" strictures of the small bowel in patients treated with non-steroidal anti-inflammatory drugs. 233 29


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