Chronic Intestinal Obstruction Research Articles

Carcinoid syndrome, octreotide and lanreotide

Partial bowel obstruction is indistinguishable from definitive obstruction at the onset ofsymptoms. No consensus exists regarding the treatment of potentially reversible states of bowel obstruction. On the basis of previous experience, octreotide was used in two patients with chronic intestinal obstruction, resulting in good control of intestinal symptoms and maintenance of a prolonged adequate intestinal transit, preventing the occurrence of definitive bowel obstruction. The results observed stress the early use of octreotide in such delicate clinical situations.

Understanding pediatric intestinal pseudo-obstruction: implications for nurses.

Pseudo-obstruction is actually a group of disorders resulting in bowel dysmotility in the absence of anatomic obstruction. Because of varied pathologic abnormalities of the GI tract involved in the disorder, pseudo-obstruction has been reported in the literature under different names, including hypoganglionosis, chronic adynamic ileus, pseudo-Hirschprung's disease, visceral neuropathy, visceral myopathy, and megacystis-microcolon-intestinal hypoperistalsis syndrome. Although a rare condition, its effects are severe, disabling, and life-threatening in pediatric clients. Prognosis is inversely correlated with age and is especially poor in those children with symptoms as newborns. Management involves promoting nutrition adequate for growth, treating symptoms, and preventing complications. Total parenteral nutrition is almost always required, and its long-term use is associated with chronic cholestasis and potential hepatic failure. Nurses may encounter pediatric clients with this disorder and their families in many different healthcare arenas, such as in radiology departments, ambulatory care, and acute and home care settings. The purpose of this article is to review current literature on this disease and summarize information useful to nurses.

Cellular composition and cytokine content of peritoneal fluid of women with endometriosis

Peritoneal adhesions (PA) are a postoperative syndrome with high incidence rate, which can cause chronic abdominal pain, intestinal obstruction, and female infertility. Previous studies have identified that PA are caused by a disordered feedback of blood coagulation, inflammation, and fibrinolysis. Monocytes, macrophages, fibroblasts, and mesothelial cells are involved in this process, and secreted signaling molecules, such as tumor necrosis factor alpha (TNF-α), interleukin-10 (IL-10), tissue plasminogen activator (tPA), and type 1 plasminogen activator inhibitor (PAI-1), play a key role in PA development. There have been many attempts to prevent PA formation by anti-PA drugs, barriers, and other therapeutic methods, but their effectiveness has not been widely accepted. Treatment by biomaterial-based barriers is believed to be the most promising method to prevent PA formation in recent years. In this review, the pathogenesis, treatment approaches, and animal models of PA are summarized and discussed to understand the challenges faced in the biomaterial-based anti-PA treatments.

Octreotide may prevent definitive intestinal obstruction

Partial bowel obstruction is indistinguishable from definitive obstruction at the onset ofsymptoms. No consensus exists regarding the treatment of potentially reversible states of bowel obstruction. On the basis of previous experience, octreotide was used in two patients with chronic intestinal obstruction, resulting in good control of intestinal symptoms and maintenance of a prolonged adequate intestinal transit, preventing the occurrence of definitive bowel obstruction. The results observed stress the early use of octreotide in such delicate clinical situations.

Megacystis-microcolon-intestinal hypoperistalsis syndrome. A case report

A case of intestinal pseudo-obstruction in the neonatal period is presented. It is known as Megacistis-microcolon-intestinal Hypoperistalsis Syndrome and is a rare cause of intestinal dismotility.A white female newborn weighing 3,110 g was admitted to the Neonatal Surgical Unit of the Hospital de Base with a small omphalocele and a history of biliary vomit. Abdominal X-rays revealed complete absence of intestinal gas. Exploratory laparotomy was carried out, and the findings were great distension of the bladder, a short poorly developed and malrotated bowel with a non-fixed cecum. Surgical treatment consisted of gastrostomy, sigmoid colostomy, vesicostomy and repair of the omphalocele. Multiple biopsies were done in the small and large bowel. Ganglion cells were present in all specimens. The patient did not tolerate enteral feeding, and total parenteral nutrition was readily initiated. Nonetheless, death occurred on the 51st postoperative day. This is a rare syndrome which presents itself at birth as chronic intestinal obstruction. A postmortem examination confirmed the diagnosis.

Prognosis of patients with non-malignant chronic intestinal failure receiving long-term home parenteral nutrition

Long-term survival of patients with intestinal failure requiringhome parenteral nutrition (HPN) has not been clearly shown. The authors describe the survival of these patients and explore the prognostic factors. A total of 217 non-cancer non-AIDS adult patients presenting with chronic intestinal failure enrolled from January 1980 to December 1989 in approved HPN programs in Belgium and France. Data were updatea in March 1991; not one of the patients was lost for follow up. The prognosis factors for survival are explored using multivariate analysis. During the survey 73 patients died, and the mortality rate related to HPN complications accounted for 11% of deaths. Probabilities of survival at 1, 3 and 5 years were 91%, 70%, and 62% respectively. Three independent variables were associated with a decreased risk of death: age of patients younger than 40 years, start of HPN after 1987, and absence of chronic intestinal obstruction. In patients younger than 60 years, included after 1983 and with a very short bowel (≤ 50 cm), (who could represent suitable candidates for small bowel transplantation) the 2-year survival rate was 90%, a prognosis that compares favourably with recent reports on survival after small bowel transplantation. In conclusion, HPN prognosis compares favourably with recent reports of survival after small bowel transplantation.

Small intestinal stricture complicating superior mesenteric vein thrombosis. A study of three cases.

Mesenteric vein thrombosis associated with intestinal stricture, as a consequence of intestinal ischaemia, has only been mentioned twice in published works. The clinical, biological, and morphological aspects as well as the treatment of this morbid association were studied in three patients. In all, a two stage clinical course (initial acute abdominal pain and fever, followed by chronic intestinal obstruction), corresponding to the sequence thrombosis/stricture, was found. x Ray studies showed a regularly contoured intestinal stricture. Surgical resection was required in all three cases for stricture, associated in one case with mesenteric infarction. Anticoagulation treatment was used to preclude recurrence. Increased clinical awareness could lead to the diagnosis of intestinal stricture secondary to mesenteric vein thrombosis more often and at an earlier stage. Treatment consists of evaluation of predisposing features, intestinal resection when necessary, and anticoagulation therapy, as indicated.

Prognosis of patients with nonmalignant chronic intestinal failure receiving long-term home parenteral nutrition

Background/Aims: Long-term survival of patients with intestinal failure requiring home parenteral nutrition (HPN) has been only partly shown. Therefore, we described the survival of these patients and explored prognosis factors. Methods: Two hundred seventeen noncancer non-acquired immunodeficiency syndrome adult patients presenting with chronic intestinal failure enrolled from January 1980 to December 1989 in approved HPN programs in Belgium and France; prognosis factors of survival were explored using multivariate analysis. Data were updated in March 1991; not one of the patients was lost to follow-up. Results: Seventy-three patients died during the survey, and the mortality rate related to HPN complications accounted for 11% of deaths. Probabilities of survival at 1, 3, and 5 years were 91%, 70%, and 62%, respectively. Three independent variables were associated with a decreased risk of death: age of patients younger than 40 years, start of HPN after 1987, and absence of chronic intestinal obstruction. In patients younger than 60 years of age included after 1983 with a very short bowel, who could represent suitable candidates for small bowel transplantation, the 2-year survival rate was 90%, a prognosis that compared favorably with recent reports of survival after small bowel transplantation. Conclusions: HPN prognosis compares favorably with recent reports of survival after small bowel transplantation.

Enzyme therapy for pancreatic insufficiency: present status and future needs.

Pancreatic enzyme extracts have been used for several decades to decrease maldigestion of macro- and micronutrients due to pancreatic insufficiency and to alleviate various abdominal symptoms, including the pain of alcohol-induced chronic pancreatitis and distal intestinal obstruction. Decreasing nutrient maldigestion and malabsorption in pancreatic insufficiency is of additional critical importance because improvement in nutritional status reduces morbidity and mortality. For example, pancreatic sufficient patients with cystic fibrosis (CF) demonstrate a slower decline in pulmonary function. In spite of the recognized importance of pancreatic enzymes, several problems exist with current preparations, and as newer enzyme preparations are marketed, proper evaluation becomes critical. There is a clear need to optimize the constituents of enzyme preparations, improve manufacturing processes, and find better sources of enzymes. Other issues that need addressing include standardization of the ratios of enzymes (lipase, amylase, protease) in these products; the stability of the enzymes at room temperature; the shelf life of the finished product; whether there are significant batch-to-batch differences; and the need for a USP reference standard.

A CASE OF TUBERCULOSIS OF THE SMALL INTESTINE WITH REPEATED CHRONIC ILEUS SYMPTOMS WHICH PRESENTED DIFFICULTIES IN DIAGNOSIS

A case of primary tuberculosis of the jejunum which repeated chronic ileus symptoms for a long term and presented difficulties in diagnosis is described. A 64-year-old woman was seen at the hospital because of chronic abdominal distension and abdominal pain. A chest X-ray film revealed no abnormality but abdominal simple X-ray film showed a significant dilatation of the small intestine and fluid level. Barium meal method revealed a cystic and abnormally dilated lesion in a part of the small intestine. Laparotomy findings included a cystic dilated lesion in the jejunum with a narrowing in the anal side, and numerous swelling mesenteric lymph nodes. Excision of the intestine with end-to-end anastomosis was performed. Based on histopathological examination of the excised specimen, a diagnosis of tuberculosis was made. This case was not of lung tuberculosis associating with intestinal tuberculosis, but of so-called primary tuberculosis of the small intestine. It is rare to encounter such a case as presenting abnormal cystic dilatation and repeating ileus symptoms like this case. In this case an elevated serum CA-125 level was noted in the clinical course. For this, some notes are also presented here in terms of literature review.

Home parenteral nutrition--a 3-year analysis of clinical and laboratory monitoring.

We report a 3-year analysis (1986 to 1989) of the management of 63 home parenteral nutrition patients, 40 with short-bowel syndrome and 23 with chronic intestinal obstruction with or without intestinal resection. Intravenous fluid requirements varied from 0.9 to 6 L/day, and the content of glucose varied between 46 and 531 g/day, protein varied from .0 to 85 g/day, fat from .0 to 100 g/day, sodium from 37 to 695 mEq/day, potassium from 30 to 220 mEq/day, chloride from 60 to 760 mEq/day, and acetate from 0 to 200 mEq/day. Body weight was normalized and well maintained in the majority of patients, but using the strict definition of deficiency as the presence of one abnormal value during 3 years, more than half had abnormal plasma chloride, glucose, alkaline phosphatase, serum glutamic oxaloacetic transaminase, total protein, albumin, selenium, and iron concentrations, and more than a third had low calcium, magnesium, vitamin D, and vitamin C levels. Normochromic anemia was seen in 73% and high blood creatinine associated with low urine volumes in 42%. Most (78%) returned to relatively normal lifestyles, but employability was occasionally impaired by loss of third-party insurance coverage resulting from a therapy that may cost $100,000 per year. Overall mortality was low (5% per year), but 73% needed readmission to hospital, mainly for suspected catheter sepsis. The results indicate that home parenteral nutrition has allowed many patients to survive gut failure and return to work but problems with chronic fluid, electrolyte and micronutrient deficiencies, catheter sepsis, and insurance coverage often restrict optimal rehabilitation.

Intraperitoneal radioimmunotherapy of refractory ovarian carcinoma utilizing iodine-131-labeled monoclonal antibody OC125

Refractory epithelial ovarian cancer is generally confined to the peritoneal cavity and is thus amenable to intraperitoneal (ip) therapy. Radiolabeled monoclonal antibodies raised to tumorassociated antigens offer the promise of selective tumor irradiation while reducing toxicity to normal tissues. We have conducted a phase I therapeutic trial to examine the feasibility of ip radioimmunotherapy utilizing escalating doses of 131I-labeled OC125 F(ab′) 2. Twenty-nine patients were each treated with a single dose of radiolabeled antibody. Twenty-eight patients were evaluable for dose-related toxicity. The toxicities most frequently observed were hematologic and gastrointestinal. Hematologic toxicity was noted in 5 14 (36%) patients receiving 18–87 mCi and in 12 14 (71%) receiving 100–144 mCi ( P = 0.018). The median white blood cell nadir of 2–3K/μl (range, 1.4–3.5K/μl) occurred at a median of 4.5 weeks and the median platelet nadir of 41K/μl (range, 20–78K/μl) at a median of 6.5 weeks. Mild gastrointestinal toxicity was observed in 4 14 patients (28%) at doses < 100 mCi whereas at doses ⩾ 100 mCi, 11 14 (79%) patients developed nausea, vomiting, or chronic ileus ( P = 0.021). This toxicity occurred most frequently in patients with protracted urinary 131I excretion. We conclude that 131I-labeled OC125 can be safely administered ip. Hematologic and gastrointestinal toxicity is predictable and related to the dose and rate of clearance of isotope.

Effects of cisapride in patients with cystic fibrosis and distal intestinal obstruction syndrome

In a double-blind, placebo-controlled, crossover trial, we investigated the effects of the prokinetic drug cisapride in patients with cystic fibrosis and chronic recurrent distal intestinal obstruction syndrome (DIOS). After a baseline period, 17 patients (12.9 to 34.9 years; 12 boys) received, in random order, cisapride (7.5 to 10 mg) and placebo three times daily by mouth, each for 6 months. Gastrointestinal symptoms (flatulence, abdominal pain, fullness, abdominal distension, nausea, anorexia, heartburn, diarrhea, vomiting and regurgitation) were scored three times monthly and physical examinations assessed. At baseline and at each 6-month period, assessment included food intake for 7 days, 3-day stool collection, pulmonary function tests, and abdominal radiographs. During cisapride therapy compared with placebo, there were significant reductions in flatulence (p less than 0.005), fullness, and nausea (p less than 0.05). Patients with the worst symptom scores benefited most from cisapride. With cisapride, 12 patients felt better and three worse (p less than 0.05); physicians judged 11 patients improved and two worse (p less than 0.05). No side effects were noted. There were no significant differences between cisapride and placebo periods in nutritional status, x-ray scores, pulmonary function, food intake (fat, protein, calories), stool size and consistency, and fecal losses of fat, bile acids, chymotrypsin, and calories. For acute episodes of DIOS, intestinal lavage was needed 6 times in 4 patients during treatment with cisapride, and 11 times in 6 patients receiving placebo. In comparison with unselected patients with cystic fibrosis and pancreatic insufficiency who were receiving enzyme supplements and who had no distal intestinal obstruction, fecal fat losses (percentage of intake) were almost twice as high in the study group with DIOS (31.2 +/- 20.6% vs 16.2 +/- 17.6%; p less than 0.01). We conclude that in the dosage used, long-term treatment with cisapride appears to improve chronic abdominal symptoms in patients with cystic fibrosis and DIOS, but fails to abolish the need for intestinal lavage. Cisapride treatment had no effect on digestion and nutritional status of cystic fibrosis patients with pancreatic insufficiency.

Chronic intestinal obstruction: value of percutaneous gastrostomy tube placement

Percutaneous gastrostomy tubes were placed in six patients for treatment of nausea and vomiting associated with chronic intestinal obstruction. There were no complications related to the tubes, and in all patient, symptoms were relieved. For the patient, the advantages of gastrostomy over nasogastric drainage include improved comfort, increased mobility, and a decreased risk of pulmonary aspiration. Percutaneous gastrostomy is a safe procedure and provides excellent palliation for intractable nausea and vomiting in patients with chronic intestinal obstruction.

Granulomatous appendiceal disease in cystic fibrosis

Abdominal pain due to acute appendicitis in patients with cystic fibrosis is uncommon. A review of 572 patients with cystic fibrosis from the cystic fibrosis clinic of the Children's Hospital of Pittsburgh from 1959 to 1983 disclosed only 4 in whom the diagnosis of acute appendicitis lead to appendectomy. In 3 of these the diagnosis was confirmed at operation. In 1 child, laparotomy for a persistent asymptomatic abdominal mass disclosed a huge cecal fecaloma originating in the appendiceal lumen. Histological examination of the appendix established the diagnosis of cystic fibrosis. Large, symptomatic appendiceal granulomas were noted in 6 other children; these simulated abdominal tumors in 2. In 3 others there was smoldering infection and abscess with sepsis and in 1 a colocystic fistula. Such chronic granulomas, acute appendicitis, meconium ileus, and nonsurgical abdominal pain in cystic fibrosis can best be differentiated by careful clinical examination before and after treatment for meconium ileus equivalent. The granulomas involve not only the appendix but also the cecum and ascending colon. Contrast X-ray studies are of little value in diagnosis. The appendix in cystic fibrosis undergoes changes that are diagnostic even in the newborn; the granulomas described here appear to represent a progression of these changes.

Chronic intestinal obstruction caused by a true enterolith: Report of a case

Chronic intestinal obstruction caused by a true enterolith: Report of a case

Carcinoid tumors.

A retrospective study of 86 patients with carcinoid tumors was undertaken covering an 18-year period. The most common sites of tumor were the jejunoileum (28 cases), appendix (22), and rectum (16). These were followed by the bronchus, duodenum, colon, and stomach. Three tumors had such wide-spread metastasis that their primary sites of origin could not be determined. The appendiceal and rectal carcinoids were often benign and usually found as incidental tumors, whereas colon and jejunoileal carcinoids were often metastatic. The jejunoileal carcinoids were commonly associated with multiple tumor sites and had a high frequency of secondary neoplasms. Symptomatic tumors were often metastatic. Chronic intermittent intestinal obstruction was often present with mesenteric metastasis, and liver metastasis was associated with the carcinoid syndrome. The patients' survival was good if aggressive surgical therapy was undertaken for palliation of the tumors.

Modifications of VIP intestinal content associated with abnormal nervous myenteric plexus: A biologic feature of chronic intestinal obstruction

Modifications of VIP intestinal content associated with abnormal nervous myenteric plexus: A biologic feature of chronic intestinal obstruction

Colorectal schistosomiasis

Forty patients with colorectal schistosomiasis who failed to respond to medical therapy were studied. They had dysentery with bloody mucus and anemia, polyps, pericolic masses, and schistosomal ulcers. Two patients had cecal masses which appeared to be intussusception and appendicitis. Three patients had chronic intestinal obstruction. Diverting transverse colostomy, followed by other surgical procedures, is the safest method of management.

The stagnant loop syndrome in childhood: review and report of four patients.

Four children presenting with a range of signs and symptoms were found to have chronic intestinal obstruction. Presentations included massive upper-gastronintestinal bleeding, chronic weight loss simulating neoplasm, andprofound megaloblastic anemia. The pathophysiology involved and a brief review of stagnant loop syndrome in childhood are discussed.