Simple distal ileal obstruction.

Abstract

Abdominal distention, persistent cramps, vomiting, and exaggerated peristaltic activity often lead to the diagnosis of small-intestinal obstruction. Visualization of gaseous and fluid dilatation of the lesser bowel and absence of gas in the colon on scoutroentgenograms are generally regarded as confirmatory evidence. While reliable in many patients with acute obstruction, these criteria are not necessarily applicable to the diagnosis of distal ileal block. This may be produced by inflammatory adhesions from such diverse conditions as appendicitis, pelvic inflammatory disease, diverticulitis and postoperative or congenital bands. Regional ileitis, small-intestinal lymphomas, and granulomas also cause ileal stenosis. Intraluminal and extrinsic neoplasms, endometriosis, and various hernias are additional factors. The present study of the radiological aspects of simple ileal obstruction was undertaken to assess the diagnostic value of scout films and contrast examinations of the gastrointestinal tract. Observations were made on 14 patients, 5 men and 9 women from thirty to seventy years old. Symptoms, often ill defined, had been present for two weeks to more than seven years. These consisted of intermittent borborygmi, mild or sometimes severe abdominal cramps, nausea, distention, and occasional regurgitant vomiting. Successive bouts of diarrhea occurred in 2 patients. One had been treated for sprue for more than three years because of steatorrhea and a small-intestinal deficiency pattern on repeated radiographic examinations. Complaints frequently were attributed by physician and patient to such causes as emotional disturbances, virus attacks, dietary indiscretions, and allergies. Frequent intervals of complete absence of discomfort were noted by some patients with longstanding complaints. Four patients had persistent symptoms of fluctuating intensity continuously for about two weeks. Physical examination frequently revealed few or no significant changes. Visible peristalsis and abnormal bowel sounds were noted from time to time in 4 patients, and were fairly persistent during periods of severe symptoms. Moderate distention was present in 6 patients with mild distress. In 11 no gross abnormalities in the passage of gas or stool were evident. Three had diminished bowel activity for several days. While no definite abdominal masses were palpated, the admission diagnosis in 3 instances included the possibility of ovarian cysts because of distended fluid-filled ileal loops in the pelvis. Intestinal obstruction was the admission diagnosis in 5 patients and was considered likely in 3 others. In 5 ileal obstruction was suggested mainly by the radiologic observations. In 1 case the diagnosis was not made until operation disclosed a gastric carcinoma with extrinsic pelvic peritoneal metastases causing ileal stenosis. A review of the gastrointestinal films showed that the dilated ileum had been misinterpreted as an elongated and distended sigmoid.