Laparoscopic treatment of small bowel obstruction with intussusception,volvulus and appendicitis caused by an inflammatory Meckel's diverticulum

Indications and contraindications for diagnostic laparoscopy in cases of intestinal obstructions are discussed in connection with a 16-year-old patient's case report with small bowel obstruction including intussusception, volvulus and appendicitis caused by an inflammatory Meckel's diverticulum. The use of diagnostic laparoscopy in cases of intestinal obstructions is controversial. In the described case we performed completely laparoscopically the derevolving and desusception of the volvulus and intussusception, the appendectomy and resection of the diverticulum. The procedure itself and the postoperative course were uneventful.     

Laparoscopic treatment of small bowel phytobezoar obstruction

An intestinal bezoar causing obstruction is usually treated by an open approach, either with manual mechanical fragmentation or with enterotomy and removal of the bezoar. In this article, we report the minimally invasive surgical management of a 59-year-old man in whom a bezoar obstructing the small intestine developed at the site of an adhesion from a previous gastric surgery. The bezoar was laparoscopically broken down and milked through the ileocecal valve. In the future, the laparoscopic approach may be the treatment of choice for patients with a bezoar when surgery is indicated.     

术后早期炎性肠梗阻的诊治体会(附19例临床报告)

目的:探讨术后早期炎性肠梗阻的临床特点及诊断、治疗方法。方法:回顾19例炎性肠梗阻病人的治疗方法,包括禁食、胃肠减压、全胃肠外营养、中药、糖皮质激素和生长抑素的应用。结果:19例全部治愈,平均治愈时间15.7天。结论:采用非手术疗法治疗术后早期炎性肠梗阻并发症少、安全、效果满意。     

术后早期炎性肠梗阻的诊断与治疗

目的 探讨术后早期炎性肠梗阻的特点和诊断、治疗原则。方法 分析近期内经治的术后早期肠梗阻５例。结果 ５例病人均经胃肠减压,应用生长抑素、肾上腺皮质激素等治愈,平均治愈时间为１３天,无一例肠坏死。结论 术后早期肠梗阻的时间概念最好定在１个月以内。术后早期炎性肠梗阻的特点有：（１）发生在手术后早期,常于术后３～７天左右开始出现梗阻症状;（２）症状以腹胀为主,腹痛相对较轻;（３）肠梗阻症状、体征十分典型     

术后早期炎症性肠梗阻的发病机制与诊治进展

术后早期炎症性肠梗阻是一种机械性和动力性并存的粘连性肠梗阻,并且发生在腹部手术后早期,主要由手术创伤或腹腔内无菌性炎症等原因引发肠壁水肿及渗出而成。了解术后早期炎症性肠梗阻的病因、发病机制、临床表现、及诊治进展,有助于减少该病的发病率和提高该病的治愈率。本文就此作一综述。     

Laparoscopic treatment of acute small bowel obstruction*

BACKGROUND: Symptoms of obstruction in the intestinal tract involve the small intestine in three quarters of cases and the large intestine in one-quarter. The most common causes of an acute small intestinal obstruction are postoperative adhesions (64.8%) and strangulated hernias (14.8%). The overall incidence of postoperative small bowel obstruction is 4.6%. Because it offers a conservative and targeted means of removing the obstruction, laparoscopy is increasingly used for acute small bowel obstruction. With proper selection of patients, the success rate is very high. This work presents the selection criteria, technique and results for a three-year period. METHODS: Twenty-one patients, 13 men and 8 women aged 28 to 69 years, underwent surgery between January 2008 and December 2010. Selection criteria for a laparoscopic procedure were anesthesia risk of not more than ASA 3, diameter of the dilatated loop of small intestine of not more than 5 cm, radiological image of a change in caliber as an indication of a focal passage disorder, exclusion of paralytic ileus, and no history of diffuse peritonitis. The patients underwent surgery in general anesthesia. The approach for the first trocar was umbilical in 18 cases and in the right or left flank in three cases, but always with open technique. Three trocars were always used. RESULTS: In 7 patients, there was an isolated band from a previous operation, usually an appendectomy; in 5 cases there were postoperative adhesions and a band. Three patients had a volvulus and in one of them, a 20 cm segment of the small intestine was already gangrenous. Two patients had an incarcerated hernia, one inguinal and one Bochdalek. Two patients had a stenosing tumor in the terminal ileum, one of which was a carcinoid and the other, the first manifestation of a lymphoma. One patient had an endometriosis focus as stenosis focus and another had a massively inflamed Meckel's diverticulum that obstructed passage in the small intestine. Two patients – the volvulus with small intestinal gangrene and the Bochdalek hernia – required conversion to open technique. One patient with diffuse adhesions and a band had to undergo open surgery 10 days later. There was no case of an intraoperative accidental intestinal injury. All the patients who underwent laparoscopy were discharged within a week. Hospitalization was significantly longer for the converted patients. The patient with the Boachdalek hernia died after 26 days of irreversible cardiopulmonary failure. CONCLUSIONS: With strict selection, laparoscopic treatment of small intestinal obstruction is a valuable option in visceral acute surgery. Patients with an isolated focal obstruction seem to benefit from laparoscopic surgery on the basis of reduced perioperative morbidity and short hospitalization.     

Laparoscopic management of small bowel obstruction caused by a Sigmoid Mesocolic hernia

Internal hernias involve protrusion of viscera through the peritoneum or mesentery into a compartment in the abdominal cavity. Hernias occurring through the meso-sigmoid are rare and the most common presentation of this entity is an acute small intestinal obstruction. Pre-operative diagnosis is often difficult and the diagnosis is usually made at surgery. Traditionally, open surgery is used to manage a meso-sigmoid hernia. We report a patient with meso-sigmoid hernia causing intestinal obstruction managed successfully by the laparoscopic approach.     

Enteroscopic treatment of early postoperative small bowel obstruction

Background: Early postoperative small bowel obstruction (EPSBO) occurs in 1% of patients undergoing laparotomy and has a mortality rate exceeding 17%. Nasogastric (NG) decompression is successful in avoiding reoperation in 73% of patients. Repeat laparotomy has been recommended when obstruction does not resolve after 14 days of NG decompression. We report four patients with EPSBO treated successfully with push enteroscopy after failed NG decompression. Methods: Four patients who failed NG decompression underwent push enteroscopy instead of repeat laparotomy. EPSBO was diagnosed if obstruction lasting more than 14 days developed after initial resolution of postoperative ileus, high NG output persisted postoperatively for 21 days in the absence of sepsis, or radiographic signs of obstruction persisted. Small bowel series or computed tomography were utilized when radiographic assessment was necessary. The Olympus SIF 100 push enteroscope was introduced with an overtube using topical anesthesia and intravenous sedation. After maximal insertion, the enteroscope was withdrawn without evacuation of insufflated air. NG tubes were placed after enteroscopy and patients were followed clinically. Flatus, defecation, and tolerance of a general diet defined resolution of EPSBO. Results: EPSBO resolved 24 to 36 h following enteroscopy, and all patients were discharged on general diets 48 h after return of bowel function. Readmission has not been necessary during 18- to 30-month follow-up. Conclusions: Our experience suggests that push enteroscopy is successful in treating EPSBO and should be considered prior to reoperation. Push enteroscopy may eliminate the hazards of repeat laparotomy and reduce the morbidity, treatment cost, and lengthy hospital stays associated with this uncommon surgical complication.     

Laparoscopic diagnosis and treatment of acute small bowel obstruction resulting from a congenital band

Acute small bowel obstruction is a common problem, especially for those patients with previous abdominal surgery that can cause postoperative adhesions. Acute, non-postoperative small bowel obstruction is less common and has various etiologies. We report a case of acute small bowel obstruction without previous abdominal surgery. The patient underwent laparoscopic exploration, and a congenital band was found to cause direct compression of the ileum and entrapment of a segment of bowel loop. There was evidence of bowel strangulation. The color and peristalsis of the entrapped bowel loop recovered gradually after division of the band, and segmental bowel resection was avoided. He has remained asymptomatic since the procedure. We suggest early and aggressive surgical intervention for patients with acute, non-postoperative small bowel obstruction to avoid possible complications of bowel strangulation and gangrene. A laparoscopic approach may be a safe, feasible, and favorable option for correct diagnosis and appropriate treatment in this situation.     

术后早期炎性肠梗阻的特点与诊断治疗原则

目的：探讨术后早期炎性肠梗阻的特点和诊断治疗原则。方法：回顾经治的7例术后早期炎性肠梗阻,21－59岁,术后4－9天发生肠梗阻,结合献进行分析探讨。结果：先经保守治疗,包括胃肠减压,完全胃肠外营养,应用生长激素,生长抑素和肾上腺皮质激素等。3例肠梗阻症状解除,例需经手术治疗,术后症状缓解,其中1例发生肠瘘。结论：术后早期炎性肠梗阻多发生在术后2周内,临床症状以呕吐,腹胀为主,腹痛相对较轻,发病原因包括机械性梗阻因素和肠动力障碍性因素,很少发生绞窄,治疗宜先行保守治疗,无效后考虑手术治疗。     

Laparoscopic treatment of small bowel obstruction arising on adhesions

OBJECTIVES: Determine the feasibility of laparoscopy, with the objective as well as the subjective benefits offered to patients, and the possible contra-indications of this type of surgery in the treatment of mechanical intestinal ileus. PATIENTS AND MATERIAL: This concerned 20 patients who came to the hospital with a picture of intestinal obstruction. All had a history of at least one abdominal operation. The diagnosis of mechanical occlusion due to band adhesions was presumed on the basis of the clinical and complementary examinations, particularly x-rays, and confirmed in the course of the operation. All patients were operated by laparoscopy after failure of non-invasive treatment. RESULTS: Results obtained are encouraging since 60% of the patients were successfully treated by laparoscopy alone. The patients' comfort and length of hospital stay are improved by laparoscopy. There is no relation between previous surgical history and the results of the technique. CONCLUSIONS: Most failures were due to the time interval between onset of symptoms and the operation. Early operation therefore seems to increase the chances of success.     

Early postoperative small bowel obstruction

BACKGROUND: Early postoperative small bowel obstruction (EPSBO) is a distinct clinical entity that is often difficult to differentiate from postoperative ileus. METHODS: A literature search was performed for articles dealing with early postoperative small bowel obstruction using Medline and Google. RESULTS AND CONCLUSION: When bowel function does not return within 5 days after surgery, causes of persistent ileus should be excluded and treated. Most instances of mechanical EPSBO can be treated expectantly for at least 10-14 days with almost no risk of bowel strangulation. Some causes of obstruction (for example herniation at a laparoscopic trocar site) require early reintervention, whereas in other cases (such as radiation enteritis, carcinomatosis) reintervention may be deferred indefinitely. Many episodes of EPSBO resolve without the cause being elucidated.     

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1　术后早期炎性肠梗阻的定义腹部手术后并发的肠梗阻有多种类型 ,并且术后不同时期所发生的肠梗阻原因也不相同。术后早期炎性肠梗阻(ｅａｒｌｙｐｏｓｔｏｐｅｒａｔｉｖｅｉｎｆｌａｍｍａｔｏｒｙｉｌｅｕｓ ,ＥＰＩＩ)发生在腹部手术后早期 ,系指由于腹部手术创伤或腹腔内炎症等原因导致肠壁水肿和渗出 ,形成的一种机械性与动力性同时存在的粘连性肠梗阻 ,腹部手术创伤指广泛分离肠管粘连、长时间的肠管暴露以及其它由于手术操作所造成的肠管损伤。腹腔内炎症指无菌性炎症 ,如腹腔内积血、积液或其它能够导致腹腔内无菌性炎症物质的残…     

术后早期肠梗阻的诊断与治疗

目的　探讨术后早期肠梗阻的特点、诊断和治疗。方法　回顾性分析我院 1995年 6月至 2 0 0 1年 12月收治的术后早期肠梗阻 8例的诊治经过。结果　本组 8例经胃肠减压、生长抑素、肾上腺皮质激素、中药等治疗治愈 ,平均治愈时间 18d ,无一例肠坏死。结论　术后早期肠梗阻常发生在术后 1周左右 ,应首选保守治疗     

术后早期炎性肠梗阻的诊断与治疗

目的：探讨术后早期炎性肠梗阻的特点和诊断、治疗原则。方法：分析近年治疗的术后早期炎性肠梗阻68例的临床资料。结果：23例行手术治疗者，术后发生肠瘘16例（69.6%），死亡4例（17.4%）。45例经非手术疗法治愈，平均治愈时间13.6d，无1例再手术。结论：术后早期炎性肠梗阻多发生在术后1-2周，可表现为典型的肠梗阻体征，治疗应首先采取保守疗法。     

Laparoscopic approach to small bowel obstruction

Historically, laparotomy and open adhesiolysis have been the treatment of choice for patients requiring surgery with small bowel obstruction (SBO), although laparotomy itself is an independent risk factor for bowel obstruction. Laparoscopy is known to create fewer intra-abdominal adhesions than open laparotomy. The observation that many patients with SBO have isolated adhesive bands has led to the use of laparoscopy as primary treatment of SBO by some authors. Although the laparoscopic approach to SBO has been described, the outcomes and indications are not well established. We will review the available literature regarding the laparoscopic approach to SBO. Additionally, we will describe the technique and make recommendations regarding which patients may be best suited for a trial of laparoscopy for adhesiolysis.     

Laparoscopic adhesiolysis for small bowel obstruction

BACKGROUND: Historically, laparotomy and open adhesiolysis have been the treatment for patients requiring surgery for small bowel obstruction. Laparoscopic adhesiolysis has not gained wide acceptance. The indications and outcomes of laparoscopic adhesiolysis for small bowel obstruction are not well established. The purpose of this paper is to review the literature on laparoscopic adhesiolysis for small bowel obstruction and to discuss patient selection, surgical technique, and outcomes. DATA SOURCES: Medline search from 1980 to 2002. CONCLUSIONS: Laparoscopic adhesiolysis has been shown to be safe and feasible in experienced hands. For selected patients, laparoscopic adhesiolysis offers the advantages of decreased length of stay, faster return to full activity, and decreased morbidity. Patient selection and surgical judgment appear to be the most important factors for a successful outcome.     

Laparoscopic surgery for small bowel obstruction

At the beginning of the laparoscopic surgery, intestinal obstruction was considered an absolute contraindication for this approach, because of the high risk of injuring the bowel. Today, the increased experience allows to apply this method in certain selected cases of small intestine obstruction. We realised a retrospective study, over a period of 7 and a half years (January 1997 - June 2004), regarding the patients admitted and treated in our department for small intestine obstruction, both by open surgery (88 cases) and by laparoscopic surgery (11 cases). We compared the preoperative characteristics of the two subgroups, highlighting the importance of a careful selection of the cases for the success of the laparoscopic approach. We analysed the postoperative evolution of these patients (return of bowel function, postoperative wound evolution, hospital stay, socioeconomic reintegration), which allowed us to draw the conclusion that some of the patients with obstruction of the small intestine may benefit from the advantages of the mini-invasive surgery.