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

Percutaneous endoscopic gastrostomy (PEG) has become a commonly performed procedure to provide nutritional support to chronically ill patients. Following a PEG-related death, we retrospectively reviewed our complication rate with that of the published values. In the past 48 months at Madigan Army Medical Center and Eisenhower Army Medical Center, 147 PEGs have been performed. We have had 20 minor complications and 5 major complications, with 2 reported deaths directly related to the procedure. Minor complications included 14 cases of localized cellulitis and 5 cases of prolonged ileus. The major complications included two cases of necrotizing fasciitis (both fatal), two cases of tube extubation within 24 hours, both resulting in surgical gastrostomy, and one bowel obstruction requiring laparotomy. Both patients who developed necrotizing fasciitis had several predisposing factors including diabetes, malnutrition, obesity, and long-term hospitalization. In conclusion, we believe PEG is an extremely valuable procedure which should be utilized with caution in the immunocompromised or morbidly obese patient.
Mil Med 1992 Jul
PMID:Complications of percutaneous endoscopic gastrostomy. 152 71

Meckel's diverticulum is the most common congenital abnormality of the small bowel; it occurs in approximately 2% of the population. Complications of Meckel's diverticulum include hemorrhage, usually associated with heterotopic tissue within the diverticulum, intussusception, development of benign or malignant neoplasms, and inflammation. Formation of one or more enteroliths within a diverticulum is rare. An extremely rare complication is mechanical small bowel obstruction secondary to extrusion of an enterolith from a Meckel's diverticulum (Meckel's stone ileus). A case of Meckel's stone ileus is described herein, with a review of the literature of this extremely rare complication.
Mil Med 1992 Feb
PMID:Meckel's stone ileus. 160 94

Foreign bodies (FBs) of the pharynx are likely to stop at the palatine or lingual tonsils, the cricopharyngeal muscle, or the beginning of the esophagus; they may be removed with direct vision. FBs of the esophagus should be located by esophagram; endoscopy may be diagnostic and therapeutic; sharp objects may cause laceration and vascular injury. In the stomach, the FB may pass through the intestinal tract or stop at the pylorus or duodenum; if after 5-6 days there is no evidence of passage in the duodenum, it should be recovered by gastrotomy or endoscopy. FBs in the small intestine, calculi, or phytobezoar usually stop at the ileocecal valve and should be recovered by enterotomy. They may produce a coloenteric or enteroenteric fistula leading to an inter-intestinal abscess leading to intestinal obstruction. They may pass in the colon and stop at the rectosigmoid junction leading to perforation simulating perforating sigmoid diverticulum. FBs of the rectum may be recovered by sigmoidoscopy. The strategy is exact radiological location and evaluation of whether there is absence or presence of retroperitoneal or perirectal air. Intraperitoneal perforation should be immediately treated by suture of the perforation and temporary sigmoid colostomy. Perforation below the peritoneal reflexion is treated by diverting sigmoid colostomy and extraperitoneal perirectal drainage. Compound lacerations of the rectosigmoid junction may need Hartmann's procedure followed three weeks later by a terminoterminal or terminolateral anastomosis using the EEA stapler.
Mil Med 1989 Jan
PMID:Foreign bodies of the gastrointestinal tract, surgical considerations. 249 98

Internal stenting (sutureless plication) for intestinal adhesions was performed operatively in 16 patients. Subsequent recurrent obstruction occurred in four patients. Other complications occurred in three patients and included retained tube, jejunostomy-site abscess, and intestinal fistulization. Four patients died for an in-hospital mortality of 25%. Internal stenting for adhesions should be used cautiously. Its use should probably be restricted to the setting of severe adhesive small bowel obstruction particularly when numerous enterotomies are incurred during the course of adhesiolysis.
Mil Med 1993 Jul
PMID:Indications for internal stenting in intestinal obstruction. 835 Oct 50

Percutaneous endoscopic gastrostomy is an effective means of obtaining enteral access in patients who need chronic nutritional support. We describe a complication resulting from the inability to remove an inner bumper. This bumper migrated into the terminal ileum, where it lodged, causing bowel obstruction. Literature review revealed no reports of similar complications.
Mil Med 1993 Feb
PMID:Bowel obstruction from retained inner bumper following removal of gastrostomy tube: a case report. 844 95

Small bowel obstruction is a common cause of acute abdominal distress, accounting for up to 20% of emergency admissions to surgical services. Although the majority of obstructions will resolve with conservative therapy alone, there are currently no reliable tests for identifying the patients who will require operation. Barium contrast studies have the potential to rapidly identify patients with complete small bowel obstruction, but many surgeons are hesitant to use them for fear of inducing complications. We report the results of a randomized, prospective trial comparing immediate oral barium contrast studies with plain abdominal X-rays in patients presenting with signs and symptoms of small bowel obstruction. End points included time to resolution of the symptoms or operation, total number of hospital days, and morbidity. Sixty-four patients completed the study; of these, 23 received contrast studies and 41 had plain radiographs only. Six of the contrast group (26%) and 11 of the plain radiograph group (27%) ultimately went to operation. Barium contrast studies had a sensitivity of 100% for diagnosing complete obstruction, whereas the sensitivity of serial plain radiographs was only 82%. Among those going to operation, the time from admission to operation was 8.2 hours in the contrast group and 12.4 hours in the plain radiograph group, but this result did not reach statistical significance (p = 0.25). Total hospital days were similar between the two groups (8 vs. 12 days, p = 0.40). There were no complications resulting from the oral administration of barium. Small bowel contrast studies using barium are safe and may shorten the time to operation in patients presenting with signs and symptoms of small bowel obstruction.
Mil Med 1997 Nov
PMID:Contrast radiography in small bowel obstruction: a prospective, randomized trial. 935 22

Ischemic colitis is the most common form of intestinal ischemia. It most commonly involves the left side of the colon presenting with acute onset of abdominal pain followed by bloody diarrhea. Involvement of only the right or ascending colon is an infrequent occurrence. Because this problem is less recognized than its counterpart involving the left colon, the correct diagnosis and management may not be readily considered. We present a case of ischemic colitis presenting as a distal small bowel obstruction with emphasis on evaluation and management of this unusual clinical problem.
Mil Med 2008 Mar
PMID:Ischemic colitis of the ascending colon: a diagnostic and management conundrum. 1841 40

We report the case of a 19-year-old military trainee that presented to the emergency department with a 3-week history of diffuse abdominal pain, 1 to 2 hours postprandially. The timing, onset, quality, and location of her pain was concerning for intestinal angina. Her serum chemistry, hematology, and liver function tests were normal. The radiologist's interpretation of the computed tomography angiogram of the abdomen was an abnormally narrow takeoff angle of the superior mesenteric artery (SMA) from the aorta near the third portion of the duodenum. She was diagnosed with SMA syndrome and received additional evaluation and treatment by her gastroenterologist and surgeon. SMA syndrome is rare and can cause bowel obstruction, perforation, gastric wall pneumatosis, and portal venous gas formation. Computed tomography angiography can be used to promptly diagnose this syndrome in the emergency department.
Mil Med 2013 Mar
PMID:Superior mesenteric artery syndrome in a young military basic trainee. 2370 34

Chilaiditi's sign is a radiological finding that occurs when the small or large intestine is positioned superior to the liver in the sub-diaphragmatic space. This is typically an asymptomatic radiological sign, but when symptoms occur, e.g., abdominal pain, nausea, emesis, it is termed Chilaiditi's syndrome. Currently, majority of the cases of Chilaiditi's syndrome, described in the literature, requiring operative intervention are due to large bowel obstruction or colonic volvulus. The following is a single case report of a patient presenting to Keesler Medical Center in Biloxi, Mississippi. This report details a 57-yr-old female who has found to have Chilaiditi's syndrome causing a high-grade small-bowel obstruction. She failed non-operative intervention and required exploratory laparotomy, lysis of adhesions, and manual reduction of small bowel from the sub-diaphragmatic space. The rate of failure of non-operative management of Chilaiditi's syndrome has not been established. Our patient had a surgical history of laparotomy and was found to have adhesions superior to her liver. Patients with prior abdominal surgery may require a lower threshold for operative management for Chilaiditi's syndrome due to the possibility of concomitant adhesive disease particularly if the prior procedure involved the upper abdomen.
Mil Med 2018 05 01
PMID:Chilaiditi's Syndrome Causing High-Grade Small-Bowel Obstruction Requiring Exploratory Laparotomy. 2941 92