Intestinal obstruction

Intestinal obstruction is a common surgical emergency, accounting for up to 20% of admissions with acute abdominal pain. Of these, 80% will have small bowel obstruction, the common cause being adhesions. Colorectal cancer is the most common cause of large bowel obstruction. The cardinal features of obstruction are abdominal pain, vomiting, distension and absolute constipation. Initial management comprises adequate fluid resuscitation, decompression with a nasogastric tube and early identification of strangulation (tachycardia, tenderness, fever and leukocytosis) requiring operative intervention. Appropriate use of contrast imaging can differentiate between patients that are likely to settle conservatively and those that will require surgery.     

Intestinal obstruction

Intestinal obstruction is a common surgical emergency, accounting for up to 20% of admissions with acute abdominal pain. Of these, 80% will have small bowel obstruction, the most common cause being adhesions. Colorectal cancer is the most common cause of large bowel obstruction. The cardinal features of obstruction are abdominal pain, vomiting, distension and absolute constipation. Initial management comprises adequate fluid resuscitation, decompression with a nasogastric tube and early identification of strangulation (signs of which may include tachycardia, tenderness, fever and leucocytosis) requiring operative intervention. Appropriate use of contrast imaging can differentiate between patients that are likely to settle conservatively and those that will require surgery.     

Intestinal obstruction

Intestinal obstruction is a common surgical emergency, accounting for up to 20% of admissions with acute abdominal pain. Of these, 80% will have small bowel obstruction, the most common cause being adhesions. Colorectal cancer is the most common cause of large bowel obstruction. The cardinal features of obstruction are abdominal pain, vomiting, distension and absolute constipation. Initial management comprises adequate fluid resuscitation, decompression with a nasogastric tube and early identification of strangulation (signs of which may include tachycardia, tenderness, fever and leucocytosis) requiring operative intervention. Appropriate use of contrast imaging can differentiate between patients that are likely to settle conservatively and those that will require surgery.     

Intestinal obstruction

Intestinal obstruction is a common surgical emergency, accounting for up to 20% of admissions with acute abdominal pain. Of these, 80% will have small bowel obstruction, the most common cause being adhesions. Colorectal cancer is the most common cause of large bowel obstruction. The cardinal features of obstruction are abdominal pain, vomiting, distension and absolute constipation. Initial management comprises adequate fluid resuscitation, decompression with a nasogastric tube and early identification of strangulation (signs of which may include tachycardia, tenderness, fever and leucocytosis) requiring operative intervention. Appropriate use of contrast imaging can differentiate between patients that are likely to settle conservatively and those that will require surgery.     

从10例肠胆石性梗阻病例中所得的启示

目的 提高肠胆石性梗阻的诊断水平和手术处理技能.方法 回顾性分析1992年1月～2007年12月间湖南省人民医院肝胆科收治的10例肠胆石性梗阻病例的临床资料.结果 10例均经手术治疗,5例桥襻结石梗阻中,4例均施桥襻切开取石,1例肠坏死施桥襻切除重建,5例回肠胆石梗阻,胆石位于距回盲瓣20～30 cm,均施肠切开取石.8例获平均4年2个月随访.效果良好率达100%.结论 肠胆石性梗阻临床少见,易于误诊,肝胆管结石是其发病的基础,只掌握其临床特征才能正确诊断和处理.     

内镜下经鼻型肠梗阻导管在粘连性肠梗阻中的应用

目的探讨内镜下经鼻型肠梗阻导管在治疗粘连性肠梗阻中的应用价值。 方法回顾性分析2012年9月至2013年9月吉林大学中日联谊医院收治的粘连性肠梗阻患者30例,其中15例在术前行肠梗阻导管肠减压治疗,术中行肠梗阻导管小肠内支架排列,作为观察组;另外15例术前行胃肠减压治疗,术中未进行肠排列,仅应用防粘连材料,作为对照组。分别对比两组患者的手术时间、术中出血量、术后排气时间、术后住院时间、术后再次出现肠梗阻的概率等,观察其临床疗效。 结果观察组的术后排气时间(1.52 ± 0.87)d,术后2年内复发概率6.7%;对照组的术后排气时间(2.63 ± 0.59)d,术后2年内复发概率40.0%。两组患者在手术时间、术中出血量、术后住院时间比较,差异无统计学意义(P > 0.05),但是在术后排气时间及术后2年内复发概率上,观察组明显优于对照组[(1.52 ± 0.87)d vs (2.63 ± 0.59) d (P＝0.013)、1例 vs 6例(P＝0.001)]。 结论肠梗阻导管肠排列能有效的促进术后肠道功能的恢复,并预防粘连性肠梗阻的复发。     

Degree of bowel distension on plain-radiographs— A surgical-radiological study of new criteria in mechanical intestinal obstruction

Three hundred sixty clinical cases which presented with or without mechanical intestinal obstruction were evaluated in order to discover reliable quantitative and qualitative criteria for pre-surgical x-ray diagnoses. It was discovered that small bowel distension of above 1.0 (ratio) together with obvious gas fluid level is usually indicative of small bowel obstruction, while large bowel distension of above 1.5 (ratio) together with obvious gas fluid level is usually indicative of large bowel obstruction. Subsequent surgery confirmed that there exists a correlation between the degree of small bowel distension seen on radiographs prior to surgery and the actual small bowel distension secondary to small bowel obstruction measured during surgery. The present results may be diagnostically useful in the radiological differentiation of mechanical intestinal obstructions from other abdominal conditions.     

奥曲肽在急性粘连性肠梗阻中的应用

目的评价奥曲肽对急性粘连性肠梗阻的治疗作用。方法将安徽医科大学第二附属医院2009年1月至2011年1月期间诊断为急性粘连性肠梗阻的52例患者根据治疗方式分为治疗组(n=28)和对照组(n=24),治疗组在常规治疗的基础上应用奥曲肽,对照组仅给予常规治疗,比较2组的治疗效果。结果治疗成功率治疗组为89.3%(25/28),明显高于对照组的66.7%(16/24),2组比较差异有统计学意义(P<0.05)。与对照组比较,治疗组肛门排气排便时间明显提前、住院时间明显缩短及胃肠减压量明显减少(P<0.05)。结论在急性粘连性肠梗阻常规治疗的基础上加用奥曲肽静脉滴注能明显改善肠梗阻患者的临床症状、提高治疗成功率。     

腹腔镜治疗粘连性肠梗阻的研究进展

随着腹腔镜技术的迅速发展,腔镜技术已经在很多学科领域得到广泛应用,利用腹腔镜技术治疗粘连性肠梗阻取得了良好的临床疗效.与传统开腹手术相比较,腹腔镜有其独特的优势.只要严格掌握手术适应证及禁忌证,腹腔镜应用于粘连性肠梗阻手术是一种安全、经济、有效的手术方式,值得推广.本文就腹腔镜治疗粘连性肠梗阻的优势、适应证及禁忌证、手术操作技巧及要点、粘连性肠梗阻的预防等的研究进展作简要综述.     

Intestinal obstruction from appendiceal abscess in a newborn infant

Perforated appendix in the newborn period is rare, its symptoms are occult and its outcome is disastrous. Associated mechanical small bowel obstruction as part of the clinical picture is rare indeed. We have treated a premature infant who presented with prolonged intermittent vomiting. Factors contributing to difficulty in diagnosis and to eventual succussful management are discussed.     

Intestinal obstruction caused by splenic volvulus: Report of a case

Torsion of a wandering spleen is rare, usually presenting as acute abdomen, and is commonly misdiagnosed. In special cases, ultrasonography, arteriography, and additional scintigraphy are extremely valuable in the preoperative diagnostic management. We herein present an unusual case of torsion of a wandering spleen in a 19-year-old female. The presenting symptom was acute gastrointestinal obstruction due to pressure of the enlarged and ptotic spleen in the pelvis. The intestinal obstruction with signs of peritonitis made a laparatomy with removal of the infarcted spleen imperative. After the operation, the patient made a complete recovery.     

迷你腹腔镜治疗小儿粘连性肠梗阻

目的 评价迷你腹腔镜治疗小儿粘连性肠梗阻的临床意义。方法 2001年3月至2004年1月，应用迷你腹腔镜行肠粘连松解术治疗粘连性肠梗阻18例，并对其临床资料进行分析。结果 本组病例手术时间15～45(平均30)min；术后第1天下床活动；术后肛门排气时间12～28(平均22)h；术后第2天开始进食，3～5(平均4)d痊愈出院，均无并发症发生。随访3～18个月，全组术后恢复良好，均无复发。结论 选择性地应用迷你腹腔镜，行肠粘连松解术治疗小儿粘连性肠梗阻，操作简单，疗效安全可靠。     

开腹手术、高频电刀与超声刀治疗粘连性肠梗阻疗效分析

目的比较开腹手术、高频电刀与超声刀治疗粘连性肠梗阻的临床效果,探讨粘连性肠梗阻手术方式以及腹腔镜治疗肠粘连的优越性。方法回顾性分析1999年6月至2010年6月应用超声刀治疗粘连性肠梗阻27例及高频电刀手术治疗粘连性肠梗阻23例患者的临床资料,并与同期30例开腹手术对比分析。结果平均手术时间超声刀组为（62．1±17．7）min,高频电刀组为（98．0±37．0）min,开腹手术组为（115．0±20．2）min。与另外两组比较,超声刀组手术时间显著降低;与开腹手术组比较,高频电刀组手术时间显著下降（P〈0．01）。3组平均术中出血量分别为（13．9±4．4）ml、（35．0±6．4）ml和（150．0±35．0）m1．超声刀组低于另外两组,高频电刀组低于开腹手术组差异有统计学意义（P〈0．01）。平均术后住院时间分别为（3．2±0．5）d、（6．1±1．0）d和（11．8±4．0）d,超声刀组与高频电刀组显著低于开腹手术组（P〈0．01）。超声刀组无一例发生并发症,高频电刀组发生2例,开腹组发生7例,组间差异有统计学意义（P〈0．05）。结论超声刀及高频电刀治疗粘连性肠梗阻具有创伤小、术后康复快、并发症少及住院时间短等优点。超声刀治疗效果优于高频电刀。     

急攻疗法配合复方泛影葡胺造影治疗粘连性肠梗阻

为探讨粘连性肠梗阻的有效治疗方法,采用急攻疗法配合复方泛影葡胺治疗粘连性肠梗阻115例。结果显示,110例临床缓解,5例24h后症状加重而手术。结果表明,急攻疗法配合复方泛影葡胺治疗粘连性肠梗阻不但方法简便,而且可及时动态观察病情,随时提供手术指征,安全有效。     

腹腔镜肠粘连松解术治疗粘连性肠梗阻的临床体会

目的:探讨腹腔镜肠粘粘连松解术治疗粘连性肠梗阻的手术方法及并发症发生原因。方法:回顾分析2009年4月至2012年6月为10例粘连性肠梗阻患者行腹腔镜粘连松解术的临床资料。结果:10例均顺利完成腹腔镜手术,无一例中转开腹。手术时间30～60 min,平均(45±11)min;术中出血量10～20 ml,平均(15±3)ml。术后6～24 h均可下地活动,术后持续胃肠减压,排气时间1～3 d。患者均痊愈出院,术后随访2～12个月,腹部切口愈合良好,无肠漏及再次粘连性肠梗阻发生,效果满意。结论:腹腔镜肠粘连松解术具有操作简单、术后康复快、复发率低、节省费用等优点,可明显降低再次形成粘连及再发肠梗阻的可能性,值得推广应用。     

Intestinal Transplantation for Chronic Intestinal Pseudo-Obstruction in Adult Patients

Intestinal transplantation (ITx) has become a life-saving procedure for patients with irreversible intestinal failure who can no longer be maintained on parenteral nutrition (PN). This report presents the results of our experience on ITx in patients suffering from chronic intestinal pseudo-obstruction (CIPO). Between December 30, 2000 and May 30, 2003 six adult patients affected by CIPO underwent primary ITx at our Center. Pre-transplant evaluation, indication for ITx and surgical technique are reported. On December 30 2003, the mean follow-up was 25.0 months. No peri-operative deaths occurred in the study population and five out of six patients are alive, with 1-year patient and graft survival of 83.3% and 66.6%. Although our series is limited by the number of patients, our experience suggests that ITx transplantation should be considered in adult patients suffering from CIPO and PN life-threatening complication.     

Distal Intestinal Obstruction Syndrome (DIOS) in Patients with Cystic Fibrosis After Lung Transplantation

Background  Cystic fibrosis (CF) is the commonest inherited life-threatening disease in Caucasians. With increased longevity, more patients with CF are developing gastrointestinal complications including the distal intestinal obstruction syndrome (DIOS), in which ileocecal obstruction is caused by viscid mucofeculent material. The optimal management of DIOS is uncertain. Methods  The medical records of all patients with CF who underwent lung transplantation at this institution during a 15-year period were reviewed. The definition of DIOS required the presence of both clinical and radiological features of ileocecal obstruction. Results  One hundred twenty-one patients with CF underwent lung transplantation during the study period. During a minimum 2-year follow-up, there were 17 episodes of DIOS in 13 (10.7%) patients. The development of DIOS was significantly associated with a past history of meconium ileus (odds ratio 20.7, 95% C.I. 5.09–83.9) or previous laparotomy (odds ratio 4.93, 95% C.I. 1.47–16.6). All six patients who developed DIOS during the transplantation admission had meconium ileus during infancy, and five had undergone pretransplant laparotomy for CF complications. First-line treatment for all patients was a combination of medication (laxatives, stool softeners, and bowel preparation formulas). This was successful in 14 of the 17 DIOS but needed to be given for up to 14 days. The other three patients required laparotomy with enterotomy and fecal disimpaction. This provided definitive resolution of DIOS except in one patient who presented late and died despite ileal decompression and ileostomy. Conclusions  DIOS occurred in approximately 10% of CF patients after lung transplantation. Patients with a history of meconium ileus or previous laparotomy are at high risk of developing DIOS. Patients with DIOS require early aggressive management with timely laparotomy with enterotomy and possible stoma formation when non-operative therapy is unsuccessful. Presented at the Forty-Eighth Annual Meeting of the Society for Surgery of the Alimentary Tract, Washington DC, May 19–23, 2007. Financial support: None     

Distal intestinal obstruction syndrome: an important differential diagnosis for abdominal pain in patients with cystic fibrosis

As life expectancy for those with cystic fibrosis (CF) now exceeds 40 years of age, adult hospitals away from specialized CF services are being exposed more frequently to people with acute complications of CF. Well‐known manifestations of CF include pulmonary disease and pancreatic insufficiency with malabsorption. However, a less well‐known entity is distal intestinal obstruction syndrome (DIOS), which is an important cause of obstructive symptoms in people with CF that must be differentiated from other causes of bowel obstruction. However, one confounding factor is that adults with CF may have elements of both DIOS and mechanical bowel obstruction due to adhesions from previous operations. A recent tragic outcome in a young adult with CF highlights the need for all doctors, both junior and senior, especially those who are not directly involved in day‐to‐day CF care, to understand the features of DIOS and the appropriate management, which differs from that of a mechanical bowel obstruction. This review aims to highlight the clinical and pathophysiological features of DIOS, differentiate it from other causes of bowel obstruction and contrast management strategies. Improved knowledge of DIOS will help to facilitate appropriate recognition and permit optimal, multidisciplinary management of this CF complication.