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1.
Chronic intestinal pseudo-obstruction: manifestations, natural history and management 总被引:2,自引:0,他引:2
v. stanghellini r. f. cogliandro r. de giorgio g. barbara b. salvioli & r. corinaldesi 《Neurogastroenterology and motility》2007,19(6):440-452
Chronic intestinal pseudo-obstruction (CIPO) is a rare pathological condition characterized by a marked derangement of gut propulsive motility mimicking mechanical obstruction, in the absence of any lesion occluding the gut lumen. This disease is often associated with a disabling and potentially life-threatening complications and is still too often unrecognized even in referral centres. As a result, patients receive neither appropriate care nor recognition of their severe health condition. Medical and surgical therapies are often unsatisfactory and long-term outcome turns out to be poor in the vast majority of cases. This article focuses on the main clinical features, the management and long-term outcome of patients affected by CIPO, with particular emphasis on those aspects which remain a matter of debate. 相似文献
2.
Carlos Alberto García López Fernando Laredo-Sánchez José Malagón-Rangel Miguel G Flores-Padilla Haiko Nellen-Hummel 《World journal of gastroenterology : WJG》2014,20(32):11443-11450
Intestinal pseudo-obstruction secondary to systemic lupus erythematosus (SLE) is a rare syndrome described in recent decades. There are slightly over 30 published cases in the English language literature, primarily associated with renal and hematological disease activity. Its presentation and evolution are a diagnostic challenge for the clinician. We present four cases of intestinal pseudo-obstruction due to lupus in young Mexican females. One patient had a previous diagnosis of SLE and all presented with a urinary tract infection of varying degrees of severity during their evolution. We consider that recognition of the disease is of vital importance because it allows for establishing appropriate management, leading to a better prognosis and avoiding unnecessary surgery and complications. 相似文献
3.
Intestinal pseudo-obstruction (IPO) either acute or chronic is a condition including features of intestinal ileus in absence of mechanical obstruction. Our paper presents such a rare case of idiopathic IPO in a 53-year-old male patient with recurrent episodes of pseudo-obstruction, which were successfully resolved by anticholinesterase agents, motilin agonists or colonic decompression. However, the patient finally underwent total colectomy. Huge colonic dilatation was identified intraoperatorily, while histology showed a neuropathic variant of chronic intestinal pseudo-obstruction. Etiologic mechanisms and current therapeutic methods are reviewed in this paper, which concludes that IPO is a condition in which conservative treatment usually fails. Total colectomy with ileoanal pouch may be the only solution in these situations. 相似文献
4.
PURPOSE: Colonoscopy has been the principal tool for decompression in acute colonic pseudo-obstruction, known as Ogilvie's syndrome. The objectives of this study were to determine the immediate effect of colonoscopy on the cecal diameter (measured on supine radiographs) and to delineate possible correlations in the diameters of dilated segments of the colon. METHODS: The charts and radiographs of 24 patients who had colonoscopic decompression for acute colonic pseudo-obstruction between 1992 and 1997 at the San Diego Veterans Affairs Medical Center and the University of California, San Diego Hospitals were reviewed. We measured cecal, transverse, descending, and sigmoid colon diameters on serial radiographs up to the point of clinical resolution. RESULTS: Mean ± standard deviation cecal diameter change (between initial and post-decompression films) was –2±3.4 cm at four hours and –2.2±3.3 cm one day after decompression. On the daily radiographs between colonoscopic decompression and clinical resolution, there was a close correlation between the diameter of the cecum and that of the transverse colon (P<0.05). There was no correlation between the cecal diameter and that of the descending or sigmoid colon. CONCLUSIONS: Colonoscopic decompression only causes a small decrease in cecal size in the patient with acute colonic pseudo-obstruction. Dilation patterns of the cecum and transverse colon are significantly correlated in acute colonic pseudo-obstruction. This correlation provides additional support to the contention that the same pathophysiology affects these two segments of the colon.Presented at the joint meeting of the Northwest Society of Colon and Rectal Surgeons, Northern California Society of Colon and Rectal Surgeons, and Southern California Society of Colon and Rectal Surgeons, Incline Village, Nevada, August 18 to 21, 1999. 相似文献
5.
目的对开腹手术后麻痹性肠梗阻发生的危险因素进行分析。方法回顾性分析2011年1月至2014年12月730例接受开腹手术治疗患者临床资料,采用回归分析方程确定麻痹性肠梗阻发生的危险因素。结果开腹手术患者并发麻痹性肠梗阻发生率为5.6%。单因素分析显示年龄≥60岁、手术时间≥3 h、低蛋白血症、肠粘连范围广、疾病恶性程度和术后白细胞计数≥10×109/L患者麻痹性肠梗阻发生率高,差异具有统计学意义(χ2=5.452、5.295、10.365、9.527、4.905、10.442,P0.05)。多元回归分析显示腹部手术史、手术时间长、肠粘连范围广和无肠道准备是开腹手术后麻痹性肠梗阻发生的危险因素(P0.05)。结论腹部手术史、手术时间长、肠粘连范围广和无肠道准备是开腹手术后麻痹性肠梗阻是麻痹性肠梗阻发生的危险因素,临床工作中应当对上述患者予以干预。 相似文献
6.
系统性红斑狼疮合并肠假性梗阻12例临床分析 总被引:18,自引:3,他引:18
目的 分析系统性红斑狼疮(SLE)合并肠假性梗阻病人的临床表现及实验室检查,提高对SLE合并肠梗阻的认识。方法对12例SLE合并肠梗阻的病人进行回顾性分析,收集整理其临床资料及有关实验室检查,分析其发病情况、临床累及脏器、实验室检查、病程、治疗及预后等特点。结果发病年龄2l~56岁,平均36岁,平均病程31个月。死亡5例。以肠梗阻为首发症状者2例。有肾脏累及者9例,血液系统累及者6例,中枢神经系统累及者2例,循环系统累及者8例。其他:胃肠出血4例,腹水4例。2例以肠梗阻为首发症状者入院前分别误诊为溃疡性结肠炎和肠炎。2例曾行剖腹探查并部分小肠切除术,病理报告均提示肠道血管炎。结论SLE合并肠梗阻患者病情较重,常伴有其他脏器累及,病死率较高。以肠梗阻为首发症状的SLE患者易被误诊。有肠梗阻症状并有其他脏器累及者应排除有无SLE可能。肠道血管炎是引起肠梗阻的主要原因。 相似文献
7.
Luis Carlos Álvarez-Perdomo Paola Andrea Pedraza-Atahualpa Álvaro Eduardo Mondragón-Cardona Freddy Escobar-Montealegre Carlos Eduardo Jiménez-Canizales 《The Egyptian Rheumatologist》2018,40(3):213-216
Introduction
Systemic lupus erythematosus (SLE) is an autoimmune disease with multiple systemic manifestations. The disease itself typically causes only 2–30% of SLE-associated gastrointestinal conditions.Case report
We present the case of a 16-year-old male with history of SLE diagnosed 5 months prior to admission. Patient was non-compliant to medical treatment. He presented with 20?days of cough, mucopurulent and blood-tinged sputum, progressive shortness-of-breath and abdominal bloating. Patient was found to have multiple organ dysfunction due to an active lupus flare that developed during hospitalization, and required treatment with high doses of corticosteroids and close observation in an intensive care unit. Despite initial improvement of symptoms, he continued with abdominal pain, bloating, abolished bowel sounds and poor food intake. An abdominal X-ray showed signs of intestinal obstruction, establishing the diagnosis of intestinal pseudo-obstruction (IpsO). Patient then displayed a marked improvement of his gastrointestinal condition following treatment with 400?mg/kg/day of intravenous immunoglobulin (IVIgG) for 5?days.Conclusion
Intestinal pseudo-obstruction is an unusual clinical manifestation of SLE and may represent a diagnostic challenge. We underscore the importance of a prompt and precise recognition of this condition, which is likely to have a positive impact on clinical outcomes. IpsO is caused by a non-mechanical obstructive bowel injury. Evidence points towards to the use of IgG and steroid for five days as the mainstay of therapy for patients with IpsO. 相似文献8.
目的 :选择检查急性结肠假性梗阻的有效方法。方法 :本组共收集 11例 ,全部病例摄X线平片 ,其中 1例碘水口服全消化道检查、2例钡剂灌肠检查、5例碘水灌肠检查、2例口服碘水 钡剂灌肠检查、1例碘水灌肠检查 纤维结肠镜检查。结果 :全组病例均未发现结肠病变 ,分别诊断为麻痹性或功能性结肠梗阻 (急性结肠假性梗阻 )。结论 :以碘水灌肠检查最为安全、方便 ,适应证广泛 ,是检查急性结肠假性梗阻的首选方法。 相似文献
9.
《Amyloid》2013,20(2):76-78
Intestinal pseudo-obstruction is a condition characterised by clinical manifestations of mechanical obstruction of the intestine in the absence of any organic occlusion of the lumen. This syndrome has rarely been reported to complicate the course of systemic amyloidosis. We describe the case of a 64-year-old man who presented with the syndrome of small bowel pseudo-obstruction secondary to AL amyloid infiltration of the gastrointestinal tract. We comment on the pathophysiology and on the clinical importance of amyloidosis-associated intestinal pseudo-obstruction. 相似文献
10.
Rosemary Mander MSc PhD RGN SCM MTD Professor of Midwifery Graeme D. Smith BA PhD RGN Senior Lecturer 《Midwifery》2010,26(6):573-578
Objectiveto review all published papers examining medical diagnosis of Ogilvie's syndrome and pregnancy with a view to assessing the implications of the diagnosis and the condition itself for childbearing women, midwives and medical practitioners.Designsystematic review.Search strategyMEDLINE, CINAHL, EMBASE, Web of Science and Cochrane databases were searched from 1950 to 2006 inclusive. Papers were read by two independent researchers and selected if they informed the link between Ogilvie's syndrome and childbearing or were concerned with other aspects of maternal mortality.Findings23 papers fulfilled the selection criteria and were of a suitable standard. Inconsistencies in relation to the diagnosis of Ogilvie's syndrome were noted, and an increase in maternal deaths from this condition was reported up to 2002.Key conclusionsthis paper highlights the strengths and weaknesses of medical diagnosis, as exemplified by Ogilvie's syndrome. The scientific basis of diagnoses such as Ogilvie's syndrome may deserve attention. This diagnosis has been shown to be unstable, both in temporal and aetiological terms. The midwifery and nursing reaction to the abrupt appearance of this condition is, at best, unfortunate. The attribution of blame to midwifery practices is deserving of a more robust response.Implications for practicethere may be clinical implications of the diagnosis of Ogilvie's syndrome for other aspects of maternity (including any nursing) care. A particularly significant area is the widely recognised increase in the caesarean rate with which Ogilvie's syndrome has been closely linked. 相似文献