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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

During 1983-1990, 113 patients with congenital choledochus cysts were operated upon with the procedure called the spur valve jejunal interposition following total cystectomy, and satisfactory results were recorded in two years follow-up. However, early complications happened in 26.5% patients e.g. postoperative bile leakage, blood vomiting, small intestinal intussusception, adhesive intestinal obstruction, chyliform ascites, and disruption of wound. Six months-2 years after operation, reflux into bile duct and rapid emptying were observed in some cases in barium examination, and abdominal pain was found in 10% of the patients. The latter was probably due to bile gastritis, which never occurred in conventional Roux-y. An experimental study showed two types of reflux into artificial bile duct. Reflux due to intestinal distention should be checked by an one way valve, while reflux due to normal peristalsis of intestine would be naturally prevented by the intrabiliary pressure formed by the normal bile flow in a narrow bile duct. A spur valve serves an one way stopper and makes the artificial bile duct narrow. In conventional Roux-y, the biliary drainage limb (the artificial bile duct) is the natural path from the distal jejunum while the duodenal drainage limb is just a side-path of the G. I. tract. A wedge anastomosis designed for Roux-Y may convert the natural and side path relationship of the two drainage limbs and would be benefit to avoid reflux into the artificial bile duct.
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PMID:[Spur valve jejunal interposition in choledochus cystectomy]. 191 90

Intussusception occurs most commonly in the first five years of life and is classically associated with intense intermittent abdominal pain, vomiting, bloody mucoid diarrhea, and a palpable abdominal mass. These cardinal findings are frequently not present, however, particularly outside the usual age range. The emergency physician must therefore be vigilant in considering intussusception as a potential cause for intestinal obstruction in all patients, if ischemic complications are to be avoided. We present three cases of "unusual" intussusception, and provide a review of this entity and a guide to its consideration and work-up in the emergency department.
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PMID:Unusual cases of intussusception. 194 Feb 39

Twelve children with end stage renal disease requiring dialysis received enteral feedings via nasogastric (NG) or gastrostomy (G) tube between 1984 and 1989 for provision of adequate nutrition. Records were reviewed for frequency and types of complications seen. Six patients, ages 1 week to 16 months received NG feedings for a total of 32 months. Complications included persistent vomiting with recurrent aspiration (2), persistent vomiting with peritoneal dialysis (PD) exit site leak (1), sinusitis (1), and refusal to continue NG feeds because of patient/parental anxiety (1). Three of the 6 were changed to G tube feedings after 2 days to 3 months. The complication rate was 1 per 6.4 patient months. Nine patients, ages 4 days to 11 years, received G tube feedings for 64 months. The complication rate was similar, 1 per 7.1 months. Complications were PD fluid leak around G tube exit site (1), G tube infection (2), G tube obstruction requiring tube replacement (3), tube migration producing intestinal obstruction (1), and gastrocutaneous fistula (2). Both methods were associated with similar complication rates, although somewhat different types of complications were seen. The young dialysis patient may have certain unique risks in addition to the complications generally associated with enteral feedings.
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PMID:Complications of nasogastric and gastrostomy tube feedings in children with end stage renal disease. 198 21

Intestinal obstruction is a relatively common clinical problem in patients with advanced cancer, particularly those with colorectal and ovarian tumours. A proportion of patients have a non-malignant cause for their obstruction, but in the remaining patients obstruction will be caused by advanced malignancy itself. In the past, most patients were either managed surgically or by nasogastric intestinal decompression and intravenous hydration. Surgery in patients with advanced cancer is associated with high mortality and morbidity. Effective surgical decompression is difficult. We have managed 24 patients with advanced abdominal malignancy and previous operative or radiological evidence of intestinal obstruction without operation. The technique is only appropriate for patients in whom a solitary or correctable obstructing lesion can be excluded. The patient is encouraged to take free fluid and a diet low in fibre. Intestinal colic is managed with morphine, the dose required being titrated for each individual patient against background pain and colic. Vomiting is controlled by the parenteral administration of antiemetic drugs. To simplify drug administration, morphine and metoclopramide are mixed in the same syringe and infused subcutaneously simultaneously. In our 24 patients the mean survival rate after the onset of complete obstruction was 29.2 days. The mean dose of morphine infused was 9.2 mg/h, and the mean dose of metoclopramide was 6.9 mg/h. The case of an 82-year-old male patient is presented. We commend the technique to surgeons contemplating surgery in these very difficult patients. It is simple, relatively non-invasive and saves the patients the pain, discomfort and complications of unproductive surgery.
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PMID:Non-operative management of malignant intestinal obstruction. 208 97

The increased use of child safety seats and seat belt restraints has significantly reduced the incidence of severe head injuries associated with motor vehicular accidents. However, an increase in the number of both acutely recognized intestinal perforations and delayed obstructions due to ischemic strictures has been noted. This report describes two children with delayed onset of intestinal obstruction related to the "seat belt syndrome" who presented with bilious emesis 3 to 6 weeks following an unrecognized lap belt injury. At laparotomy, a volvulus around an omental band adherent to a resolving traumatic mesenteric hematoma was the basis of the obstruction in both cases. The volvulus resulted in a stricture in each instance that required resection and end-to-end anastomosis. The diagnosis of posttraumatic intestinal obstruction should be suspected in children who develop nausea and bilious emesis following motor vehicular accidents in which they were wearing lap belts.
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PMID:Delayed onset of intestinal obstruction in children after unrecognized seat belt injury. 221 49

A case of gallstone ileus in a patient with carcinoma of the ovary is presented. A 78-year-old female with stage III carcinoma of the ovary underwent optimal debulking surgery followed by six courses of chemotherapy and a microscopically positive second-look laparotomy. She was treated by whole-abdomen pelvic radiation. She then developed progressive nausea, vomiting, abdominal distension, and eventually complete small bowel obstruction. The diagnosis of gallstone ileus was made preoperatively based on the radiological findings. The pathophysiology of gallstone ileus is discussed in the differential diagnosis of patients treated for carcinoma of the ovary.
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PMID:Gallstone ileus masquerading as recurrent carcinoma of the ovary. 222 79

Gallstones are usually silent. Less commonly, patients with cholelithiasis develop symptoms and/or complications; biliary fistula occurs in 3% to 5% of the cases. When a large stone is passed and occludes the duodenum, gastric outlet obstruction (the Bouveret syndrome) may result. In reported cases, the stones are usually larger than 2.5 cm. The usual presenting symptoms are those of bowel obstruction: abdominal pain, nausea, and vomiting. Less commonly, the patients experience melena and, rarely, hematemesis. We describe a patient who had the largest stone reported to cause hematemesis rather than bowel obstruction and to be diagnosed endoscopically. The 5 X 4 X 3 cm stone was extracted surgically. Endoscopic diagnosis and extraction of stones up to 3 cm in size has been reported, avoiding the need for surgery.
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PMID:The Bouveret syndrome: an unusual cause of hematemesis. 222 12

In a double-blind, placebo-controlled, crossover trial, we investigated the effects of the prokinetic drug cisapride in patients with cystic fibrosis and chronic recurrent distal intestinal obstruction syndrome (DIOS). After a baseline period, 17 patients (12.9 to 34.9 years; 12 boys) received, in random order, cisapride (7.5 to 10 mg) and placebo three times daily by mouth, each for 6 months. Gastrointestinal symptoms (flatulence, abdominal pain, fullness, abdominal distension, nausea, anorexia, heartburn, diarrhea, vomiting and regurgitation) were scored three times monthly and physical examinations assessed. At baseline and at each 6-month period, assessment included food intake for 7 days, 3-day stool collection, pulmonary function tests, and abdominal radiographs. During cisapride therapy compared with placebo, there were significant reductions in flatulence (p less than 0.005), fullness, and nausea (p less than 0.05). Patients with the worst symptom scores benefited most from cisapride. With cisapride, 12 patients felt better and three worse (p less than 0.05); physicians judged 11 patients improved and two worse (p less than 0.05). No side effects were noted. There were no significant differences between cisapride and placebo periods in nutritional status, x-ray scores, pulmonary function, food intake (fat, protein, calories), stool size and consistency, and fecal losses of fat, bile acids, chymotrypsin, and calories. For acute episodes of DIOS, intestinal lavage was needed 6 times in 4 patients during treatment with cisapride, and 11 times in 6 patients receiving placebo. In comparison with unselected patients with cystic fibrosis and pancreatic insufficiency who were receiving enzyme supplements and who had no distal intestinal obstruction, fecal fat losses (percentage of intake) were almost twice as high in the study group with DIOS (31.2 +/- 20.6% vs 16.2 +/- 17.6%; p less than 0.01). We conclude that in the dosage used, long-term treatment with cisapride appears to improve chronic abdominal symptoms in patients with cystic fibrosis and DIOS, but fails to abolish the need for intestinal lavage. Cisapride treatment had no effect on digestion and nutritional status of cystic fibrosis patients with pancreatic insufficiency.
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PMID:Effects of cisapride in patients with cystic fibrosis and distal intestinal obstruction syndrome. 223 Dec 17

The diagnosis of malrotation is easily made in the neonatal period, but is often delayed in older patients. Among 82 patients treated for malrotation in this institution, 45 patients presented with symptoms related to their malrotation, seven were diagnosed at exploration for concomitant intrinsic duodenal obstruction, and 30 patients had malrotations discovered as incidental findings at laparotomy or autopsy. Among the 45 symptomatic patients, 25 (56%) underwent surgery in the first month of life, whereas 20 patients (44%) underwent surgery at an older age. In this last group, the mean age at surgery was 51.5 months (range, 2 months to 16 years), the mean age of onset of symptoms was 2 years (range, 0 to 15 years) and the mean delay in diagnosis was 1.7 years. Although bilious vomiting was the presenting symptom among all patients undergoing surgery in the neonatal period, clinical features of older patients included intestinal obstruction (7), chronic abdominal pain (4), malabsorption/diarrhea (3), peritonitis/septic shock (2), solid food intolerance (1), common bile duct obstruction (1), abdominal distention (1), and delayed transit postappendectomy (1). The frequency of midgut volvulus was equal among both groups. Unusual forms of malrotation were more frequent in patients undergoing surgery beyond the neonatal period. In this group there was evidence of chronic venous and lymphatic obstruction with one case of superior mesenteric vein thrombosis and two cases of intestinal gangrene. A Ladd's procedure was performed in all cases and the most frequent postoperative complication was adhesive intestinal obstruction. There were no deaths. Awareness of the unusual presentation in patients who present beyond the neonatal period may help reduce delays in diagnosis and surgical treatment. We believe that laparotomy is indicated in all patients with malrotation, even if they are asymptomatic.
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PMID:Malrotation presenting beyond the neonatal period. 227 27

Superior mesenteric artery (SMA) syndrome is a rare cause of small bowel obstruction in both adult and pediatric populations. Of 14 patients with the diagnosis from 1979 to 1987, eight had confirmatory upper gastrointestinal studies and were able to be followed for an average of 32 months. All eight were of similar age (range, 14.2 to 19 years), body build (asthenic), and clinical presentation. The presentation included nausea and intermittent, voluminous, bile-stained vomiting, despite intervening periods of normal appetite and bowel sounds. The average delay in diagnosis was five days. Nasogastric drainage and intravenous fluids were the mainstay of treatment and were successful in every case. Fifty percent of the patients had more than one episode requiring treatment; each episode resolved with simple treatment. Two of three patients with body casts required cast removal. No patient required intravenous hyperalimentation, removal of spinal instrumentation, or abdominal surgery to relieve the obstruction. Three of the eight patients had not had spinal surgery or cast immobilization.
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PMID:Superior mesenteric artery syndrome in pediatric orthopedic patients. 229 37


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