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)

Between 1985 and 1990, 517 patients were treated for colorectal malignancies at our department of surgery. Nd:YAG laser therapy was used in 37 cases (7.1%). The mean age of these 22 men and 15 women was 71.4 years (range: 22-96 years). One hundred-twenty-nine Nd:YAG laser treatments were performed. Indications for laser treatment were (1) palliative tumor reduction (n = 21), (2) preresectional laser recanalization for obstructing carcinoma (n = 6), and (3) curative treatment (n = 10). Laser related complications included one perforation of the rectum and one rectovaginal fistula. One fatal pulmonary embolism occurred. After palliative treatment, five patients died because of tumor progression (mean survival time: 16 months), two because of other reasons. All patients with obstructing tumors could be recanalized successfully. After curative treatment, eight patients are still alive without tumor recurrence (mean survival time: 25.5 months), and two died of other causes. Palliative Nd:YAG laser treatment of colorectal malignancies is a competitive alternative to conventional surgery. Recanalization of obstructing tumors is an excellent treatment for large bowel obstruction, making one-stage resections possible. Curative treatment should be reserved for special cases only.
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PMID:Nd:YAG laser treatment of colorectal malignancies: an experience of 4 1/2 years. 137 43

The impact of para-aortic field radiation therapy upon survival was studied among 26 patients with para-aortic nodal metastases from carcinoma of the endometrium. Seventeen of these 26 patients received postoperative radiation therapy to the para-aortic field as a part of their primary therapy. Sixteen of the 17 also received adjuvant hormonal therapy. Nine of 17 patients (53%) are alive without evidence of disease (18-55 months) with a median survival time of 27 months. Of the remaining eight patients, six (35%) died of endometrial cancer at 6-38 months, with a median survival time of 14.5 months. Five of these patients had distant disease. Two of the 17 patients (12%) died of intestinal obstruction felt to be secondary to radiation enteritis, one of whom was disease free. No difference in survival was detected in patients treated with radiation therapy with microscopic versus macroscopic nodal involvement. Of the nine patients who did not receive para-aortic radiation, eight were treated with hormonal therapy (n = 6) or chemotherapy (n = 2). Seven patients died of disease from 5-28 months, with a median survival time of 13 months. One patient is alive at 12 months. Survival in the 17 patients treated with para-aortic radiation was better than the eight patients not treated with para-aortic radiation (p = 0.004). This survival difference remained significant for patients with microscopic but not macroscopic nodal disease. Para-aortic field radiation appears to improve survival, but has a significant complication rate, and should be reserved for patients with histologic evidence of para-aortic metastases.
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PMID:Radiation therapy for surgically proven para-aortic node metastasis in endometrial carcinoma. 152 60

Congenital and acquired diverticula of the jejunum and ileum in the adult are unusual and occur in approximately 1 percent to 2 percent of the population. They are pulsion diverticula thought to be the result of intestinal dyskinesia. These lesions can produce a significant diagnostic and therapeutic dilemma. They are multiple in the jejunum and solitary distally and are characteristically found in 60- or 70-year-old males. The diagnosis may be confirmed with contrast studies of the small intestine, arteriography, or nuclear scan. Consider these disorders in patients with 1) unexplained gastrointestinal bleeding, 2) unexplained intestinal obstruction, 3) an unexpected cause of acute abdomen, 4) chronic abdominal pain, 5) anemia, or 6) malabsorption. Medical therapy is helpful in controlling diarrhea and anemia, while surgical therapy is reserved for hemorrhage, obstruction, perforation, or failure of medical management. Asymptomatic diverticula discovered on routine contrast studies need not be resected. At surgery, incidental diverticula should be removed when evidence of dilated, hypertrophied loops of small bowel with large diverticula is found. Intraoperative air distention will aid in diagnosis. Resection and primary anastomosis is the preferred treatment for non-Meckelian diverticula. Diverticulectomy is reserved for a Meckel's diverticulum without evidence of ulceration. An incidental Meckel's diverticulum should be removed in the presence of mesodiverticular bands or ectopic tissue. Removal of a Meckel's diverticulum is not advised in the patient with Crohn's disease but may be performed in the patient undergoing restorative proctocolectomy for ulcerative colitis.
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PMID:Clinical implications of jejunoileal diverticular disease. 158 62

Crohn's disease of the small intestine is usually managed by medical therapy with surgery being reserved for obstruction or fistula formation. A patient is described who developed small bowel obstruction due to an adenocarcinoma of the ileum after over twenty years of medical therapy for Crohn's disease, originally diagnosed at a laparotomy for acute abdominal pain. The possibility of malignancy in such long-standing disease should be considered.
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PMID:Small bowel adenocarcinoma complicating Crohn's disease. 160 69

The records of 230 adhesive small bowel obstruction (ASBO) episodes in 181 patients have been reviewed to observe the place of conservative treatment and to establish criteria to predict the success of conservative trial. Immediate operation has been reserved for 81 episodes that have presented with fever and leucocytosis and/or localized abdominal tenderness, or complete obstruction. The remaining 149 episodes have initially undergone conservative trial. Although 110 episodes (73.8%) have been cured with conservative trial, 39 (26.2%) subsequently necessitated surgical intervention. No adverse occurrences have been observed during or after delayed operations. There was no strangulated bowel nor mortality both in delayed operation and conservatively treated groups. Recurrence has occurred with rate of 18.75% and 36.47% after surgery and conservative treatment, respectively, being significantly different (P less than .01), but the treatment method of the previous episode has been without influence on the method used in the recurrent obstruction (P less than .05). Among the assumed predictive criteria, age at recent laparotomy (P less than .02), time elapsed between recent laparotomy and obstructive episode (P less than .01), the primary condition necessitating laparotomy (P less than .01), the incision of previous laparotomy (P less than .05), and duration of conservative trial (P less than .01) correlated significantly with the success of conservative trial. The number of previous laparotomies and obstructive episodes (P less than .05) have not showed correlation. By the conservative approach used in selected patients with ASBO, 40% overall have been spared operation, without any adverse occurrences. Using the proposed criteria, the success rate of conservative treatment can be predicted.
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PMID:Adhesive small bowel obstruction in children: the place and predictors of success for conservative treatment. 1716 Dec 16

A review of 561 cases of cecal volvulus that were published between 1959 and 1989 along with 7 new cases, was performed to characterize the clinical and laboratory profile and to evaluate the various surgical options in treating this life-threatening condition. The age and sex distribution of these patients have changed over the years and shifted toward older patients (mean, 53 years) and female predominance (female:male ratio, 1.4:1). The clinical presentation was usually of distal closed-loop small bowel obstruction. Forty-six percent of the plain abdominal radiographs were suspected for cecal volvulus, but only 17 percent were diagnostic. Barium enema had a high rate of accuracy (88 percent) and was associated with minimal complications. True volvulus was 6 times more common than bascule, and gangrenous cecum was found in 20 percent of cases. Detorsion alone and cecopexy had almost similar complications, mortality, and recurrence rates (15, 10, and 13 percent, respectively), whereas, resection, which was performed primarily for gangrenous cecum, had higher rates. However, the highest rates of complications (52 percent), mortality (22 percent), and recurrence (14 percent) were noticed after cecostomy. These data suggest that resection should be reserved for patients with necrotic cecum and that detorsion is sufficient for patients with viable cecum. Cecostomy should be abandoned.
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PMID:Cecal volvulus. 220 66

Three cases are reported of gastrointestinal histoplasmosis in patients who came from the Caribbean or South America and had lymphoma, acquired immunodeficiency syndrome, and prior local radiation therapy. The patients had small-bowel obstruction with ileal involvement, mucosal erythema, and friability on colonoscopy with colonic involvement and an exophytic rectal mass with rectal involvement. Review of the 77 reported cases of gastrointestinal histoplasmosis shows that this is a clinical subset of disseminated histoplasmosis. With gastrointestinal involvement, pulmonary symptoms are uncommon and gastrointestinal symptoms predominate. Fever is less common than in other forms of dissemination. The most common lesions are a mass or ulcers, which often mimic inflammatory bowel disease or carcinoma. Terminal ileal involvement predominates in one third. The complement fixation test was positive in about three quarters of cases tested, but the skin test is not diagnostically useful. In one quarter of patients there is other evidence of immunosuppression. In the immunosuppressed, gastrointestinal histoplasmosis must be considered, even in a patient from a nonendemic area, who presents with lesions appearing like carcinoma or inflammatory bowel disease. When feasible, endoscopic examination and biopsy with stains and culture for histoplasmosis is recommended for diagnosis. Medical management is recommended, with surgery reserved for acute emergencies or when mandatory for diagnosis.
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PMID:Gastrointestinal histoplasmosis. 327 25

Fifty cases of abdominal tuberculosis, seen over a 10-year period, are reviewed. A mass in the abdomen, with or without intestinal obstruction, was the commonest mode of presentation. Biochemical, haematological and bacteriological tests were of limited help in making a definite diagnosis, which was largely based on laparoscopic findings or on biopsy material obtained at operation. Laparoscopy was considered a simple, safe and reliable method for diagnosis, and it was at times possible to avoid a laparotomy. At operation, only the minimum of surgery was attempted. Division of bands, adhesiolysis, and conservative resection were performed, according to the intraoperative findings. Bypass operations are reserved for duodenal obstruction or extensively involved bowel. The prognosis was found to be excellent and the mortality negligible.
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PMID:Abdominal tuberculosis in children. 621 2

Two complications of herniography are presented: a hematoma of bowel causing intestinal obstruction, and a cellulitis of the abdominal wall causing septicemia. A technical error probably caused the hematoma and gastroenteritis played a role in the cellulitis. We have now narrowed our indications for herniography. We think it should be reserved for more difficult diagnostic problems such as recurrent inguinal hernia, recurrent hydrocele or eventration of the diaphragm.
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PMID:Hematoma of bowel and cellulitis of the abdominal wall complicating herniography. 644 64

6 cases of small bowel adenocarcinomata are described. In 5 cases out of 6 the diagnosis was only possible at the moment of operation, which became necessary for the complications of the tumour. Five patients were urgently operated on for intestinal obstruction, and one for peritonitis. The reserved nature of the prognosis of such tumours is emphasized, as well as the fact that their diagnosis is often interoperative.
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PMID:[Complications of primary malignant tumors of the small intestine]. 652 88


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