Cause Of Mechanical Small Bowel Obstruction Research Articles

Retained staples as a cause of mechanical small-bowel obstruction

The use of mechanical stapling devices in endoscopic surgery has become widespread and commonplace. Although problems have been identified with these, to our knowledge no description has been made of retained, free intraperitoneal staples causing significant morbidity. We describe the case of a patient who underwent laparoscopically assisted vaginal hysterectomy. Four weeks postoperatively she developed a mechanical small-bowel obstruction which was caused by a free intraperitoneal staple creating an obstructing band. The obstruction was relieved laparoscopically. We believe that while retained free intraperitoneal staples are generally of no clinical consequence, surgeons should be aware that the potential exists for significant morbidity.

Effect of intraperitoneal fibrinolysin on reformation of intestinal adhesions.

POSTOPERATIVE ADHESIONS are the commonest cause of mechanical small-bowel obstruction, and the prevention of such adhesions has been the subject of considerable investigation. A complete and excellent review of such studies appeared in Surgery, Gynecology and Obstetrics in May, 1960. Surgical lysis has been reported by one author to increase adhesions, by another to decrease them. Reperitonealization is of questionable benefit, and anticoagulants are probably more dangerous than useful. Lanolin and other lubricants have received clinical trials without benefit of preliminary study, and grafts of omentum and amnion are of questionable value and cumbersome to use. Studies have shown that promotion of early postoperative peristalsis by feeding, diathermy, or neostigmine (Prostigmin) is of questionable benefit. Results of intraperitoneal administration of streptokinase and streptodornase are inconclusive. Hyaluronidase may be of some value and deserves further investigation. Steroids have been reported to be effective. As pointed out by Connolly and Smith