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)

Twenty-six domestic reports of suspected adverse reactions from the guar gum-containing diet pill, Cal-Ban 3000 (filed with the FDA) were reviewed. There were 18 instances of esophageal obstruction, seven instances of small bowel obstruction, and one individual who was reported to have died after ingestion of Cal-Ban 3000, but for whom insufficient details were provided to assess causation. There were 14 women and 11 men (mean age 46.3 yr; range 17 to 67 yr) for whom sufficient information was available. Preexisting esophageal or gastric disorders were present in 50% of those with esophageal obstruction, including peptic stricture, pyrosis, hiatal hernia, esophagitis, gastric stapling procedure, Schatzki ring, and muscular dystrophy. Fourteen of these 18 patients with esophageal obstruction were treated successfully by endoscopy, although the tenacious gel-like consistency of the material was often difficult to remove. Two patients required rigid esophagoscopy when flexible endoscopy was unsuccessful. This resulted in the death of one patient who developed a pulmonary embolism after surgical repair of an intraoperative esophageal tear. For the seven patients with small bowel obstruction, no specific predisposing factors were mentioned. One individual required exploratory laparotomy, and inspissated tablets were found in the ileum. These cases, spontaneously reported to the FDA, are very similar to those reported in the literature. The water-holding capacity and gel-forming tendency of guar gum permits it to swell in size 10- to 20-fold, and may lead to luminal obstruction, especially when an anatomic predisposition exists. Such products have been banned in Australia, and Cal-Ban 3000 has recently been removed from the market in the United States. However, unsuspecting patients who are still in possession of the product should be apprised of the potential complications that may arise with its use.
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PMID:Esophageal and small bowel obstruction from guar gum-containing "diet pills": analysis of 26 cases reported to the Food and Drug Administration. 132 94

This prospective randomised study examined the possibility of early resumption of oral hydration and discontinuation of intravenous fluid replacement after emergency or elective abdominal surgery. Following elective cholecystectomy alone or with a choledocholithotomy or an emergency Hartmann's procedure for large bowel obstruction, patients were randomised to early oral hydration (sips of water for 12 h followed by free fluids by mouth for 24 h, when oral intake of food was allowed--intravenous hydration was discontinued 6 h after starting the intake of free fluids orally) or conventional intravenous hydration (intravenous hydration and an oral regimen of water as follows: sips every hour for 12 h, 30 ml every hour for 24 h, 60 ml every hour for 24 h, 90 ml every hour for 24 h, free fluids for 12 h, when food was allowed--intravenous hydration was discontinued 6 h after starting the free fluids). The two regimens were equally effective in maintaining fluid balance and normal plasma and urinary electrolytes without any observed differences in biochemical or metabolic values. Each of free fluids by mouth, discontinuation of intravenous hydration, and consumption of solid food were achieved in the patients on early oral hydration at time periods significantly shorter than those attained with the conventional regimen (P less than 0.001). Similarly, patients on the latter regimen were hospitalised for significantly longer times than those on early oral hydration (P less than 0.001). Early oral hydration after biliary surgery or a Hartmann's procedure effectively maintains fluid balance and has advantages over the conventional intravenous hydration regimen.
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PMID:Duration of intravenous fluid replacement after abdominal surgery: a prospective randomised study. 174 32

Operative repair of giant omphaloceles remains a technical challenge to close the wide abdominal wall defect. Currently, most surgeons remove the amnion to approximate the linea alba and/or skin edges or to suture prosthetic material to the abdominal wall and cover the defect with skin flaps. In doing so, the liver commonly becomes extruded and distended with blood, compounding the problem of reducing all of the viscera within the small abdominal cavity. Furthermore, bowel obstruction from adhesions produced from opening the abdomen is a life-long threat. We describe six cases of giant omphalocele in which the amnion was left intact, and it was progressively inverted into the abdominal cavity by using the silastic silo, as it is used for gastroschisis. The birth weight of these infants ranged from 2,360 to 3,240 g. The abdominal wall defect measured 7.0 cm to 10.5 cm in width, and protruded at least 8 cm beyond the abdominal wall. The first stage of repair was to suture the silastic silo to the skin-amnion junction, and progressively reduce the bowel and liver within the abdomen. The intrabdominal pressure is monitored by nasogastric tube or by an indwelling bladder catheter to avoid pressures greater than 20 cm H2O, which might compromise intestinal and renal circulation. The second stage consisted of incising the skin/amnion junction to expose the linea alba. The linea alba was approximated while leaving the amnion intact and folding it into the abdominal cavity. This avoids entering the peritoneum or interfering with the blood flow to and from the liver.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Amnion inversion in the treatment of giant omphalocele. 183 15

To improve the quality of life of the patient we used completely detubularized sigmoid colon for bladder reconstruction along with radical cystoprostatectomy in 6 men with invasive bladder cancer. Followup was 8 to 20 months. Postoperatively, all of the patients were continent during the day but only 4 (66.7%) were continent at night, although they had to awaken twice to remain dry. Neocystourethroscopy in 4 of the 6 patients revealed no tumor and no stricture at the urethrocolonic anastomosis. However, a stone in the neobladder was found in 1 patients. Urodynamic study of the neobladder showed a low pressure (mean 16.7 cm. water) at the filling phase of water cystometry and an adequate maximal urethral closure pressure (mean 52.0 cm. water) and functional profile length (mean 3.8 cm.). The uroflow rate in all patients was good (1 patient even had a maximal uroflow rate of 31 ml. per second). There was no reflux in any patient. One patient had intestinal obstruction 5 months postoperatively and died 5 months later of widespread metastasis. The remaining 5 patients are alive with a satisfactory quality of life. In conclusion, use of completely detubularized sigmoid colon may be an ideal operation for neobladder construction after radical cystoprostatectomy.
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PMID:Neobladder construction using completely detubularized sigmoid colon after radical cystoprostatectomy. 185 23

Acute large bowel obstruction can be the result of mechanical causes (such as colorectal cancer) or motility disturbances, the latter being termed colonic pseudo-obstruction. Whatever the aetiology, the pathophysiology of large bowel obstruction has clinical significance. Changes in motility augmented by increased colonic blood flow may play a role in dissemination of tumour cells and/or bacteria. Intravascular fluid depletion, especially shortly after intestinal decompression, has important haemodynamic implications. The diagnosis is often confirmed on plain abdominal X-ray, but water-soluble contrast studies are important in distinguishing a mechanical obstruction (which almost always requires an operation) from a pseudo-obstruction (which can usually be managed without surgery). Mortality and morbidity may be reduced by optimization of the patient's condition both before and after the operation using intensive care facilities and by careful timing of surgery. The surgical management of malignant large bowel obstruction is best directed by a senior surgeon. For tumours up to and including the splenic flexure, an extended right hemicolectomy is advisable since it offers adequate removal of the tumour and allows an immediate safe ileocolic anastomosis. More distal tumours should be resected if possible, and there is much to recommend on-table irrigation and immediate anastomosis, although a colostomy with a mucous fistula or Hartmann's procedure still have a place. Endoscopic diagnosis and decompression enables definitive surgery to be undertaken electively and several techniques are being evaluated. Non-operative reduction of sigmoid volvulus by rigid or flexible endoscopy is achieved with high success rates, but is not recommended for caecal volvulus. Resection is usually necessary in both to prevent recurrence. Mortality of colonic volvulus is closely related to bowel viability. Uncomplicated colonic pseudo-obstruction may be managed medically or by endoscopic decompression. It often occurs in association with systemic medical conditions, which need to be treated vigorously. Surgery is indicated if there are signs of impending or frank perforation, or if non-operative measures fail.
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PMID:True and false large bowel obstruction. 193 30

Ascaris lumbricoides is a significant health problem. One billion people worldwide are infected. Most frequently it is seen in malnourished people residing in developing countries. Areas with modern water and waste treatment have a low incidence. The major serious sequelae associated with the parasite is intestinal obstruction, which occurs at a rate of 2 per 1000 people infected. Intestinal obstruction is fatal in 6 per 100,000 children. An estimated 20,000 people die of this infection annually. Although effective chemotherapy is available, long-term cure and ultimate eradication of this parasite requires improved sanitation and change in some cultural habits. The incidence in the United States has seemed to decrease, presumably because of improved sanitation. This problem is still encountered occasionally, necessitating familiarity with the clinical manifestations and treatment modalities. A professional explanation of this parasite and its life cycle will go far to eliminate the guilt of parents whose child has "passed a worm."
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PMID:The roundworm, Ascaris lumbricoides. 201 40

In an attempt to develop prophylactic and therapeutic measures of the intestinal giant-cystic disease caused by Thelohanellus kitauei in the Israel carp, Cyprinus carpio nudus, pathological observations were conducted upon the carps which were hatched in May 1988 and raised in a net cage fish farm at the Soyang lake, managed by Horim Fisheries for the period of 21 months with 1-2 months interval. After a gross inspection of the carps, necropsy was carried out periodically in order to clarify the pathological changes in various internal organs and muscular tissues. Also, the prevalence of the disease was checked during the period from 1988 to 1990. Gross inspections revealed that the infected carps showed some degree of fading in body and gill color, back-emaciation symptoms, reddish anus accompanying erosion and relaxation and pot-belly, as well as discharge of yellowish white mucoid material from the anus. However, most carps died eventually of intestinal obstruction. Other significant necropsy findings included cyst formation of various size in the intestinal mucosa, ascites, anemic condition through internal organs and muscular tissues, hyperemia and dilation of intestines with decreased tension, thinness and fragility, and full contents of semi-fluid or yellowish white mucoid material in the intestinal canals. Based on the morphological characteristics of the spores found in the cysts, parasitic location in the intestines, macro- and microscopic findings of the lesions, the parasites were identified as Thelohanellus kitauei Egusa et Nakajima, 1981. Although monthly changes of water temperature were distinct, the extrusion rates of the polar filaments of the spores stayed constant throughout the year with an exception of a lower rate in July. The lesions initiated from mucosa and submucosa in early July became large swellings and then complete mature forms following the peracute course. From late August the upper cysts were gradually opened and most of the spores were dispersed from anus into the surrounding water through December but only a few lasted until next April. The cysts were completely recovered until next September. Comparing the incidence and prevalence of the disease by year tremendous infection and death rates were checked in the first prevalent year, 1988, but the rates were significantly decreased in the second year, and showed an almost normal status in the third year, 1990. As the above summarized results showed, the disease entity might come to an end in three years after the first prevalent year, however, the spores must be strictly prevented because they could be infective in the water for one year.
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PMID:[Prophylactic and therapeutic studies on intestinal giant-cystic disease of the Israel carp caused by Thelohanellus kitauei. I. Course of formation and vanishment of the cyst]. 209

Motility disorders of the gastrointestinal (GI) tract have traditionally been diagnosed by excluding mechanical small-bowel obstruction. In order to diagnose GI motility disorders in a positive fashion, small-bowel manometry was performed on 15 patients who were referred to the authors with intestinal motility disorders. Intestinal manometry was performed after first positioning a 200-cm multilumen tube into the small intestine. Ports located at 10-cm intervals were perfused with sterile water and connected to pressure transducers to record intraluminal pressures with a multichannel chart recorder. This low compliance water perfusion manometry system allowed examination of both fasting and postprandial motility. Intestinal manometry was able to assist in the diagnosis of two patients that had true mechanical small-bowel obstruction. One patient had a stenosis of the gastrojejunostomy and three patients had a functional gastric outlet obstruction secondary to a motility disorder in the Roux limb. One patient had a functional obstruction from a reversed jejunal loop and eight patients were identified as having intestinal pseudo-obstruction. We found intestinal manometry was a helpful adjunct in the diagnosis of GI motility disorders.
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PMID:The usefulness of small-bowel manometry in the diagnosis of gastrointestinal motility disorders. 236 57

The effect of subcutaneous somatostatin analogue SMS 201-995 (Sandoz Pharmaceuticals Corp., East Hanover, NJ) was investigated in a patient with acute postoperative secretory diarrhea. The patient was hospitalized with bowel obstruction caused by a descending colon adenocarcinoma. One week after left hemicolectomy and transverse colostomy, watery colostomy output, which exceeded 10 L per day developed. Jejunal perfusion studies suggested that the patient's diarrhea was caused by abnormal net secretion of water and electrolytes by the small intestine. Circulating levels of various peptide hormones were normal with the exception of elevated level of pancreatic polypeptide. SMS 201-995 administration reduced colostomy output and normalized many of the abnormalities found during jejunal perfusion. These results indicate that the patient's acute secretory diarrhea, occurring after large intestinal obstruction, originated in the small intestine and that SMS 201-995 can be used to manage this unusual severe postoperative problem.
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PMID:Severe posthemicolectomy diarrhea: evaluation and treatment with SMS 201-995. 239 36

Clinical defaecatory function, neorectoanal manometry and pouchography were assessed in 16 patients treated by restorative proctocolectomy with ileal W-reservoir. The duration after ileostomy closure was 6 to 28 months (mean 17 months). There were no operative deaths and no failures where the reservoir had to be removed. Partial anastomotic dehiscence occurred in one patient, and intestinal obstruction requiring laparotomy in two. Anastomotic stricture, which could be corrected easily by dilatation, occurred in three patients. Daily stool frequency was 4.3 +/- 1.2 at 6 months after ileostomy closure, 3.8 +/- 1.2 at 12 months, and 3.3 +/- 1.0 at 24 months. The clinical score for neorectal function gradually and steadily improved with time as well as daily stool frequency. In the manometric and pouchographic studies, mean anal canal length (3.4 +2- 0.6 cm), mean maximal anal sphincter resting pressure (57.1 +/- 9.7 cm water) and mean maximal reservoir resting pressure (4.3 +/- 2.0 cm water) tended to be less than normal controls but not significantly so. Neorectoanal inhibitory reflex disappeared completely or was greatly decreased in all patients. However, all were capable of spontaneously controlled defaecation. There was an inverse linear relationship between daily stool frequency and maximal tolerated reservoir volume (p less than 0.01). There were inverse linear relationships also between daily stool frequency and horizontal diameter of the reservoir measured on pouchography (p less than 0.05), and daily stool frequency and dilatation ratio of the reservoir (p less than 0.01). From these results, we conclude that a large and wide reservoir allows better defaecatory function.
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PMID:Evaluation of ileal W pouch-anal anastomosis for restorative proctocolectomy. 254 38


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