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

Adhesion formation is of major concern to the pelvic surgeon. Most patients develop postoperative adhesions regardless of whether the mode of access to the abdominal cavity is by laparoscopy or laparotomy. Infertility is related to adhesions in the pelvis in 15-20% of cases. Peritoneal adhesions are the main cause of mechanical bowel obstruction in 65-80% of cases and contribute to a large extent to health-care expenditures. To prevent the formation of postoperative adhesions, a variety of medications have been studied such as glucocorticoids, heparin, dextran 70, saline solution, antibiotics, promethazine, antihistamines, prostaglandin synthesis inhibitors, Ringer's lactate solution, calcium-channel blockers and barriers such as Interseed and Gore-Tex. Such adhesions can be induced when operating on myomas and endometriosis. Experimental and clinical studies have demonstrated various mechanisms of action to be involved in adhesion prevention when gonadotropin-releasing hormone agonists (GnRH-a) are used for treatment. The following have been demonstrated and suggested: (1) Hypoestrogenic condition was found in rats to be associated with decreased adhesion formation. This could be related to the influence on estrogen-dependent growth factors and growth modulators by reliable and constant inhibition of ovarian estradiol biosynthesis and secretion, but also non-competitive estrogen antagonism seems to play a role. (2) Treatment with GnRH-a reduces the growth hormone release stimulated by growth hormone-releasing hormone. (3) GnRH-a treatment influences neoangiogenesis by affecting vascular endothelial growth factor and basic fibroblastic growth factor. (4) GnRH-a reduce the basal rate of coagulatory processes. The frequency and extent of fibrin-generating and degrading processes are reduced. Activity of the plasminogen activating inhibitor is reduced, suggesting an improvement infibrinolytic reactivity. (5) GnRH-a use alters the vascular resistance index, pulsatility index and vascular peak velocity, and possible immune response. (6) Avoidance of bleeding can reduce fibrin and therefore decreases the matrix for invasion by fibroblasts. (7) GnRH-a reduce the degree of inflammation postoperatively. Adhesion prevention seems to be at its best when pre- and postoperative GnRH-a treatment is administered. At present, there are trends to operate without prior treatment with GnRH-a. Based upon the data available, it seems worthwhile to consider preoperative and also postoperative treatment with GnRH-a: pretreatment for at least 2-3 months seems to be indicated, and a similar time after operation, to block the events associated with adhesion formation.
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PMID:Gonadotropin-releasing hormone agonists for prevention of postoperative adhesions: an overview. 1562 74

It is very rare that endometriotic lesions in the rectovaginal septum cause ileus. We report a case of bowel obstruction due to endometriotic lesions in the rectovaginal septum in a 22-year-old woman whose barium enema presented with apple-core-like findings. Diagnostic and treatment modalities were discussed. Preoperative and postoperative gonadotropin-releasing hormone analog and aromatase inhibitor therapy promote relief of clinical symptoms, a reduction of tumor volume and a better approach to radical surgery.
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PMID:Bowel obstruction due to endometriosis in the rectovaginal septum. 1920 49

Most surgical procedures performed by obstetrician-gynecologists are associated with pelvic adhesions that cause subsequent serious sequelae, including small bowel obstruction, infertility, chronic pelvic pain, and difficulty in postoperative treatment, including complexity during subsequent surgical procedures. This study was conducted to determine if gonadotropin-releasing hormone analogues (GnRHa) affect the expressing tissue-type plasminogen activator (t-PA) and its inhibitor-1 (PAI-1) in peritoneal cells in culture. Human peritoneal Met5A cells were used to examine the effects of GnRHa leuprolide, buserelin and goserelin on the levels of t-PA and PA-1. Antigen concentrations were measured in conditioned media and cell lysates by real-time PCR and ELISA. GnRH receptor (GnRHR) mRNA was determined by RT-PCR. GnRHR mRNA was detected in Met5A cells. Exposure of Met5A cells to GnRHa induced a rapid decrease of PAI-1 level in cultured medium but not in cell lysate (protein and mRNA). These effects of GnRHa on PAI-1 were not associated with any changes in t-PA level. These results suggest that GnRHa may be an effective stimulator of local peritoneal fibrinolytic activity, as it decreases PAI-1 secretion in peritoneal Met5A cells by a mechanism linked to GnRHR.
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PMID:GnRH receptor and peritoneal plasmin activity. 2023 28

Deep infiltrating endometriosis (DIE) is a complex disorder that affects 6% to 12% of all women in the reproductive age. In these cases, treatment is more difficult with possible incomplete pain relief and a considerable possibility of recurrence. Here, the authors report a case of a 41-year-old woman with a history of severe dysmenorrhea, dyspareunia, and chronic pelvic pain because of deep infiltrating pelvic and peritoneal endometriosis, who underwent segmental colorectal resection three years ago for large bowel obstruction due to colonic endometriosis. To ensure complete removal of the disease, the authors injected gonadotropin-releasing hormone agonist (GnRHa) in three periodic cycles before laparoscopic surgery. We performed laparoscopic hysterectomy and deep pelvic nodule resection and pelvic adhesion releasing. After five days of hospitalization, the patient recovered totally and was not experiencing any pain at three months' follow-up. Laparoscopic treatment has more become the standard of treatment for DIE. A review of the literature regarding pathology and physiology of DIE and surgical aspects of its management is undertaken. The authors would like to renew the current laparoscopic surgery in curing the DIE, as they believe that this is also a useful addition to the literature.
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PMID:A laparoscopic surgery for deep infiltrating endometriosis and the review of literature. 2973 63