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 28,634 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors report a case of acute necrotising enteritis occurring on the 7th day after total hysterectomy with bilateral removal of the adnexa for fibroids in a 45 year-old woman. This is the first case in the literature to occur after hysterectomy. The clinical picture included the onset of intestinal obstruction with severe general toxic manifestations. The diagnosis was made at operation and, in spite of intestinal resection, the patient died on the 6th day, with liver and renal failure, anuria and irreversible collapse. The blood and stool cultures were negative, but the histological appearance of the lesions, without any apparent suppuration, were in favour of a vascular etiology. Necrosis of the mucosa and inflammatory oedema of the sub-mucosa, were accompanied by vascular changes suggesting thrombosis and congestion.
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PMID:[Acute postoperative necrotizing enteritis. Apropos of one case after total hysterectomy with bilateral annexectomy]. 110 50

Over two years in a major hospital in northern Uganda 12 cases of primary volvulus of the small bowel were seen out of a total of 65 cases of intestinal obstruction which did not include external hernias. This relatively high incidence was associated with drinking large amounts of local "kongo" beer. General systemic symptoms of circulatory collapse were conspicuous by their absence. The kongo beer was found to have a high concentration of serotonin, and this substance may have caused the volvulus of the small bowel in three quarters of the cases.
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PMID:Volvulus of the small bowel. 126 49

Twenty-six patients with Bochdalek hernias and 15 with Morgagni hernias were evaluated in a survey of children presenting over the age of 8 weeks during a 20 year period. Ten of the children had previously normal chest radiographs. Radiological assessment at presentation was incorrect with 15 Bochdalek and two Morgagni hernias. These errors were more common in interpretations by general radiologists. Inappropriate thoracocentesis had been performed in four cases misdiagnosed as pneumothoraces. Barium studies, fluoroscopy, erect views and plain radiographs after nasogastric intubation were helpful investigations. Post-operative evidence of lobar collapse and pulmonary hypoplasia was frequently not appreciated at the time of clinical and radiological follow-up. Other congenital anomalies were commonly seen, particularly with Morgagni hernias. Bowel malfixation and malrotation, an important association, was frequently present but was occasionally overlooked at operation, necessitating further surgery for bowel obstruction.
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PMID:Childhood diaphragmatic hernias presenting after the neonatal period. 339 73

Patients with intra-abdominal processes that require prompt surgical intervention, including appendicitis, perforated viscus, ischemic bowel, volvulus, and bowel obstruction, often present with signs and symptoms of an acute abdomen. Several medical problems can mimic an acute abdomen. Overwhelming postsplenectomy infection is a life-threatening condition that can present with acute abdominal symptoms. The incidence of overwhelming postsplenectomy infection ranges from 1% to 25%, and is caused by Streptococcus pneumoniae in 50% of cases. Capnocytophaga canimorsus, a bacteria commonly found in dog saliva, accounts for less than 1% of cases. Overwhelming postsplenectomy infection has a rapidly deteriorating course that progresses to respiratory and renal failure, cardiovascular collapse, and death. The mortality associated with overwhelming postsplenectomy infection is 60% to 80%. Early diagnosis and institution of appropriate antibiotic therapy and supportive care is essential to improve patient outcome. A previously healthy woman who had undergone splenectomy secondary to trauma 11 years earlier presented with symptoms of an acute abdomen. A diagnosis of overwhelming postsplenectomy infection due to C canimorsus was made based on her peripheral blood smear and blood culture findings. Early aggressive care and antibiotic treatment resulted in a successful outcome for this patient with no long-term morbidity. This patient's clinical course demonstrates the importance of early diagnosis and treatment of overwhelming postsplenectomy infection.
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PMID:Postsplenectomy Capnocytophaga canimorsus sepsis presenting as an acute abdomen. 986 57

Bowel obstruction is an acute alarming situation with limited diagnostic conditions. Therapeutic decisions must be taken in time. Diagnostic differentiation between incomplete or complete bowel obstruction, intestinal obstruction and paralytic ileus is often uncertain and the underlying cause difficult to detect. Besides plain films in acute abdomen the ultrasound examination presents important additional informations: 1st Dilated intestinal loops and gas caps correlate with the characteristic x-ray finding, i.e. erected dilated intestinal loops with fluid levels. The location of the obstruction is defined in small bowel obstruction by differentiation between jejunum (with Kerckring folds) and ileum (without Kerckring folds). In large bowel obstruction the caecum is dilated and a collapse of the distal colon is detectable. 2nd Additional sonographical findings are: oedema of the intestinal walls, hyperpendulum peristalsis or absence of peristalsis, sedimentation of intestinal contents, pearlstring-like lined up gas bubbles under the ventral intestinal walls, and concomitant ascites. Duplex sonographical studies of the intestinal peristalsis may help to differentiate between mechanical obstruction and paralytic ileus. 3rd In bowel obstruction stenoses can be detected as a result of tumour, Crohn's disease diverticulitis, invagination, strangulated hernias or gall stone ileus. Intestinal adhesions cannot be found by ultrasound. Small and large bowel is dilated in paralytic ileus. Numerous causes like acute pancreatitis, ureteral colic, free gastrointestnal perforation and so on can be diagnosed. 4th In ileus of vascular disorder early diagnosis is high important, but inspite of colour flow imaging diagnostic possibilities are limited. 5th Sonographical diagnosis is of special interest when the x-ray plain films is "empty". The lack of massive fluid collection and meteorism allows an optimal ultrasound examination. In this early phase disorders of peristalsis and intestinal walls are reliably found, and it is easier to find the cause of bowel obstruction. In this way the definitive diagnosis can be arrived at earlier, because it still takes up to 6 hours to obtain the classical x-ray finding. There is a rule that the earlier ultrasound is done, the more findings one will get.
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PMID:[Ultrasound ileus diagnosis]. 1002 58

Meckel's diverticulum is an uncommon cause of acute abdominal pain and small bowel obstruction in adults. We present a case of a 31-yr-old man with recurrent vomiting and abdominal pain in whom the diagnosis of Meckel's diverticulum was not suspected until CT of the abdomen revealed multiple fluid-filled, dilated loops of ileum with distal collapse after normal abdominal radiographs. We suggest that CT may be helpful when the diagnosis of Meckel's diverticulum is suspected.
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PMID:Meckel's diverticulum causing intestinal obstruction. 1177 61

Congenital segmental dilatation of a portion of the small intestine in neonates causing intestinal obstruction is quite uncommon. We hereby report 2 such cases. In both infants, there was localized dilatation of the ileum with collapse of the distal bowel and functional intestinal obstruction without loss of continuity of the bowel wall or lack of ganglion cells.
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PMID:Segmental ileal obstruction in neonates--a rare entity. 1973 34

Closed duodenal loops may be made in dogs by ligatures placed just below the pancreatic duct and just beyond the duodenojejunal junction, together with a posterior gastro-enterostomy. These closed duodenal loop dogs die with symptoms like those of patients suffering from volvulus or high intestinal obstruction. This duodenal loop may simulate closely a volvulus in which there has been no vascular disturbance. Dogs with closed duodenal loops which have been washed out carefully survive a little longer on the average than animals with unwashed loops. The duration of life in the first instance is one to three days, with an average of about forty-eight hours. The dogs usually lose considerable fluid by vomiting and diarrhea. A weak pulse, low blood pressure and temperature are usually conspicuous in the last stages. Autopsy shows more or less splanchnic congestion which may be most marked in the mucosa of the upper small intestine. The peritoneum is usually clear and the closed loop may be distended with thin fluid, or collapsed, and contain only a small amount of pasty brown material. The mucosa of the loop may show ulceration and even perforation, but in the majority of cases it is intact and exhibits only a moderate congestion. Simple intestinal obstruction added to a closed duodenal loop does not modify the result in any manner, but it may hasten the fatal outcome. The liver plays no essential role as a protective agent against this poison, for a dog with an Eck fistula may live three days with a closed loop. A normal dog reacts to intraportal injection and to intravenous injection of the toxic substance in an identical manner. Drainage of this loop under certain conditions may not interfere with the general health over a period of weeks or months. Excision of the part of the duodenum included in this loop causes no disturbance. The material from the closed duodenal loops contains no bile, pancreatic juice, gastric juice, or split products from the food. It can be formed in no other way than by the activity of the intestinal mucosa and the growth of the intestinal bacteria. This material after dilution, autolysis, sterilization, and filtration produces a characteristic effect when introduced intravenously. When in toxic doses it causes a profound drop in blood pressure, general collapse, drop in temperature, salivation, vomiting, and profuse diarrhea, which is often blood-stained. Splanchnic congestion is the conspicuous feature at autopsy and shows especially in the villi of the duodenal and jejunal mucosae. Adrenalin, during this period of low blood pressure and splanchnic congestion, will cause the usual reaction when given intravenously, but applied locally or given intravenously it causes no bleaching of the engorged intestinal mucosa. Secretin is not found in the duodenal loop fluid, and the loop material does not influence the pancreatic secretion. Intraportal injection of the toxic material gives a reaction similar to intravenous injection. Intraperitoneal and subcutaneous injections produce a relatively slow reaction which closely resembles the picture seen in the closed duodenal loop dog. In both cases there is a relatively slow absorption, but the splanchnic congestion and other findings, though less intense, are present in both groups. There seems, therefore, to be no escape from the conclusion that a poisonous substance is formed in this closed duodenal loop which is absorbed from it and causes intoxication and death. Injection of this toxic substance into a normal dog gives intoxication and a reaction more intense but similar to that developing in a closed-loop dog.
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PMID:INTESTINAL OBSTRUCTION : I. A STUDY OF A TOXIC SUBSTANCE PRODUCED IN CLOSED DUODENAL LOOPS. 1986 44

A definite intoxication develops as a result of a closed intestinal loop and toxic material accumulates in the closed loops. Much evidence has been submitted to show that this loop poison causes the intoxication observed after producing a closed intestinal loop. Sufficient evidence has been presented to prove that the essential poison is present in these closed intestinal loops, and usually in concentrated form. Chemical study of the contents of closed intestinal loops shows that a single substance or group of substances possesses toxic properties. This resists autolysis and pancreatic and ereptic digestion. It is thrown out of solution by five volumes of alcohol or by half saturation with ammonium sulphate. It is readily soluble in water and is not injured by boiling. It is not removed by dialysis. The method of isolation excludes practically all substances except primary proteoses. The characteristic resistance to digestive enzymes suggests a heteroproteose. Proteose intoxication in dogs gives a picture identical with that described after poisoning with intestinal loop fluid: early salivation and vomiting, followed by diarrhea and prostration, fall in temperature and blood pressure, and finally death in collapse. Autopsy shows essentially a splanchnic paralysis and remarkable engorgement of liver and spleen, but especially of the mucosa of the duodenum and small intestine. The blood shows great concentration due to loss of fluid and may remain incoagulable because of an excess production of antithrombin. Proteoses escaping from the blood are excreted in the urine. This toxic proteose concerned in intestinal obstruction has not yet been isolated in the urine, but may be excreted by the kidneys. This probably explains the clinical improvement and lessened intoxication noted after transfusion. Experimental evidence points to a primary proteose as the essential poison concerned in the intoxication of closed intestinal loops and intestinal obstruction.
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PMID:INTESTINAL OBSTRUCTION : V. PROTEOSE INTOXICATION. 1986 66

Newborn intestinal obstructions are a common reason for admission to neonatal ICUs. The incidence is estimated to be approximately 1 in 2000 live births. There are 4 cardinal signs of intestinal obstruction in newborns: (1) maternal polyhydramnios, (2) bilious emesis, (3) failure to pass meconium in the first day of life, and (4) abdominal distention. The presentation may vary from subtle and easily overlooked findings on physical examination to massive abdominal distention with respiratory distress and cardiovascular collapse. A careful history and physical examination often identify the diagnosis. Concomitant resuscitation (volume, gastric decompression, and ventilatory support) may be necessary.
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PMID:Neonatal bowel obstruction. 2259 16


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