Common Cause Of Obstruction Research Articles

Comparative Ultrasonographic, Magnetic Resonance Sialographic, and Videoendoscopic Assessment of Salivary Duct Disorders

Salivary duct disorders are the second most common cause of obstruction after calculi. Magnetic resonance sialography has been recently proposed as a means of diagnosing a heterogeneous group of salivary disorders, and so we compared it with sialoendoscopy in evaluating stenoses and sialectasia in 24 patients with obstructive symptoms and ultrasonographic results negative for calculi or masses. All of the patients (19 of whom had recurrent unilateral or bilateral swollen parotid glands and 5 of whom also had recurrent swollen submandibular glands) underwent dynamic color Doppler ultrasonography and dynamic magnetic resonance sialography with lemon juice stimulation of saliva; 18 patients also underwent diagnostic sialoendoscopy. Ultrasonography and color Doppler ultrasonography showed duct dilatation in all patients (bilateral in 5 with parotid stenosis). Magnetic resonance sialography confirmed duct dilatation and stenosis in all of the patients, and revealed the simultaneous presence of calculi in 4 cases. A parotid sialocele was found in 4 cases. The magnetic resonance sialographic findings were confirmed in the patients who underwent sialoendoscopy. No side effects were observed. Magnetic resonance sialography following prediagnostic ultrasonography allows an adequate diagnosis of salivary duct disorders such as stenosis and sialectasia, as confirmed by objective sialoendoscopic assessment. Magnetic resonance sialography also makes it possible to visualize the salivary duct system up to its tertiary branches and, in this regard, may be considered a valid, noninvasive method for the evaluation of salivary duct disorders.

Multiple sequential intussusceptions causing bowel obstruction in a preterm neonate

We present a case of multiple sequential intussusceptions in a preterm neonate that resulted in mechanical bowel obstruction. The differential diagnosis of abdominal obstruction in a neonate is extensive, requiring a thorough review of presentation and methodical workup to determine etiology (Teitelbaum DH. Obturation obstruction of the intestine. In: O'Neill JA, editor. Principles of pediatric surgery. St. Louis (MO): Mosby, 2003. p. 605-612). Rare causes must be considered in a patient with no obvious etiology on contrast studies and persistent symptoms. Intussusception, a common cause of obstruction and pain in older infants and children, can rarely occur in neonates and is unfortunately difficult to diagnose preoperatively (J Pediatr . 1955;47:87-94; Pediatr Surg Int . 1998;13:232-236; Ann Saudi Med. 2000; 20:310-312; Eur J Pediatr . 1999;158:830-832; J Paedatr Child Health. 2004;40:388-391; Radiology. 1977;125:463-466; J Perinat Med. 2004;32:190-194).

Biliary Tract Obstruction Secondary to Malignant Lymphoma: Experience at a Referral Center

Lymphoma is a rare cause of biliary obstruction and, on cholangiography, may mimic other causes of obstructive jaundice. The optimum treatment for these patients is unclear. The aim of this study is to evaluate the incidence, clinical and imaging findings, management, and outcome of biliary obstruction caused by lymphoma. Our database was searched retrospectively for patients with biliary obstruction due to lymphoma between 1999 and 2005. Biliary obstruction secondary to lymphoma was found in 7 (0.6%) of 1123 patients with malignant biliary obstruction. One patient had benign biliary obstruction related to lymphoma. Of the eight patients (five male, three female; mean age, 34.50 +/- 17.93 years), four had Hodgkin's disease and four had non-Hodgkin's lymphoma. Biliary obstruction occurred as part of the initial or early presentation of lymphoma in two patients. The most common cause of obstruction was compression of the biliary tract by enlarged lymph nodes (six patients). Cholangiographic appearances were diverse: narrowing of the common bile duct (six patients), splayed and narrowed common bile duct (one patient), and multiple strictures and dilatations of the intrahepatic bile ducts (one patient). Biliary drainage was performed in all patients including endoscopic stent placement in six patients, nasobiliary drainage in one, and choledochoduodenostomy in one. Hyperbilirubinemia resolved in all but one of the patients with a stent; however, none could be maintained in a stent-free condition. Five patients died within 1 year after onset of jaundice. One of the surviving patients developed a late benign stricture at the site of the earlier lymphoma. We conclude that lymphoma should be considered in the differential diagnosis of obstructive jaundice, particularly in younger patients. We suggest that biliary drainage by the endoscopic or percutaneous route is necessary for the treatment of these patients. Late benign strictures may develop. Biliary obstruction is a sign of poor prognosis in lymphoma.

Acute mechanical bowel obstruction: Clinical presentation, etiology, management and outcome

To identify and analyze the clinical presentation, management and outcome of patients with acute mechanical bowel obstruction along with the etiology of obstruction and the incidence and causes of bowel ischemia, necrosis, and perforation. This is a prospective observational study of all adult patients admitted with acute mechanical bowel obstruction between 2001 and 2002. Of the 150 consecutive patients included in the study, 114 (76%) presented with small bowel and 36 (24%) with large bowel obstruction. Absence of passage of flatus (90%) and/or feces (80.6%) and abdominal distension (65.3%) were the most common symptoms and physical finding, respectively. Adhesions (64.8%), incarcerated hernias (14.8%), and large bowel cancer (13.4%) were the most frequent causes of obstruction. Eighty-eight patients (58.7%) were treated conservatively and 62 (41.3%) were operated (29 on the first day). Bowel ischemia was found in 21 cases (14%), necrosis in 14 (9.3%), and perforation in 8 (5.3%). Hernias, large bowel cancer, and adhesions were the most frequent causes of bowel ischemia (57.2%, 19.1%, 14.3%), necrosis (42.8%, 21.4%, 21.4%), and perforation (50%, 25%, 25%). A significantly higher risk of strangulation was noticed in incarcerated hernias than all the other obstruction causes. Absence of passage of flatus and/or feces and abdominal distension are the most common symptoms and physical finding of patients with acute mechanical bowel obstruction, respectively. Adhesions, hernias, and large bowel cancer are the most common causes of obstruction, as well as of bowel ischemia, necrosis, and perforation. Although an important proportion of these patients can be nonoperatively treated, a substantial portion requires immediate operation. Great caution should be taken for the treatment of these patients since the incidence of bowel ischemia, necrosis, and perforation is significantly high.

Report on management of obstructive azoospermia

Azoospermia, defined as complete absence of sperm from the ejaculate, is present in less than 1% of all men and in 10 to 15 percent of infertile men. Although there are many causes of azoospermia, obstruction of the ductal system is responsible for approximately 40% of cases (1). Obstructive azoospermia may result from epididymal, vasal, or ejaculatory duct pathology. Vasectomy is the most common cause of vasal obstruction. Severe genitourinary infections, iatrogenic injury during scrotal or inguinal surgical procedures and congenital anomalies are other common causes of obstructive azoospermia.

Ileuskrankheit

Intestinal obstruction may be mechanical or non-mechanical (adynamic ileus). Adhesions and external hernias are the most common causes of obstruction in small intestine, whereas carcinoma, sigmoid diverticulitis, and volvulus are the most common causes in large intestine obstruction. Distension of the intestine caused by gas and fluid accumulation in the obstructed segment is the key pathophysiological mechanism initiating ileus with subsequent multiorgan failure and death. Surgery should always be undertaken if complete obstruction or strangulation is suggested and ileus is established. Before operation, the fluid and electrolyte balance should be restored and decompression instituted by means of a nasogastric tube. Delaying the operation because of improvement in patient well-being during resuscitation is only justified in those suffering from large intestine obstruction due to colorectal carcinoma. Purely nonoperative treatment is safe only in the presence of incomplete obstruction and best utilized in patients with postoperative adynamic ileus or repeated episodes of partial obstruction.

Evaluation of the causes of Upper Airway Obstruction Leading to Tracheostomy in Shiraz

Introduction: To determine the causes of upper airway obstruction leading to tracheostomy; endoscopic evaluation was done in Khalili Hospital, Iran. Materials and Methods: During a 2 year period, 47 patients who underwent tracheostomy,were evaluated endoscopically to determine the causes of airway obstruction leading to tracheostomy. Results: forty-seven cases were included in the study including 40 males and 7 females with mean age of 31.9 years. The most common cause of obstruction was subglottic stenosis (40.5%) and laryngeal carcinoma (38.3%). The cause of subglottic stenosis in the majority of the patients was prolonged endotracheal intubations (95%). Other less common causes were direct laryngeal trauma (4.5%), vocal cord paralysis (2.1%), supraglottitis (2.1%), tracheal foreign bodies (2.1%), severe trismus (2.1%), and status asthmaticus (2.1%). Conclusions: Subglottic stenosis secondary to prolonged intubations is the major cause of upper airway obstruction leading to tracheostomy. Converting endotracheal intubations to tracheostomy in patients who need prolonged ventilator support may prevent subglottic stenosis and decrease the rate

Acute laryngeal obstruction in a Nigerian Hospital: Clinical presentation and management

To determine the clinical presentations and management of patients with acute laryngeal obstruction. A retrospective study of 36 patients with acute laryngeal obstruction to the accident and emergency unit (A&E), emergency paediatric unit (EPU) and the Ear, Nose and Throat diseases clinic (ENT) of the University of Ilorin Teaching Hospital between January 1998 and the December 2002 are presented. The age ranges of the patient were between 1.5 years to 46 years (mean age 29.6 years with male/female ratio of 2:1 Breathlessness (83.3%), hoarseness (66.7%), and noisy breathing (50%) were the main symptoms at presentation. These 36 patients represented 4.9 % of the in-patients seen by the Otolaryngologists during the period under review and 75% of cases of acute upper airway obstruction managed during this period. The commonest cause of obstruction in this study was laryngeal tumours (47.2%)-laryngeal carcinoma (27.8%) in the adults and juvenile laryngeal papillomas (19.4%) in the paediatric age group; other causes were laryngeal infections (acute and chronic) represented 20% of aetiologic factors. Impacted laryngeal foreign bodies occurred in 5(13.9%) all in the paediatric age group. Eleven (30.6%) were managed conservatively with antibiotics and antikoch's therapy; 12(33.3%) had emergency tracheostomy prior to definitive treatment of direct laryngoscopy in 10 patients (27.8%) for biopsy, removal of foreign bodies and extirpations of juvenile laryngeal papillomas and 3(8.3%) were managed by endotracheal intubations. Health education of the public is recommended to ensure early presentation in hospital as soon as symptoms of laryngeal tumours are noticed and health care providers should refer such cases early.

Acute abdomen: intestinal obstruction

Intestinal obstruction is a common and dangerous surgical emergency that is associated with a high mortality if managed inappropriately; results are usually good if it is diagnosed and treated early. Obstruction of the small intestine and large intestine are fundamentally different in their cause and management (although differentiation between the two merges in distal small-intestine and proximal large-intestine obstruction). In general, obstruction of the small intestine presents with colicky abdominal pain and vomiting, whereas distension and absolute constipation tend to be more common in obstruction of the large intestine. The causes of intestinal obstruction can be mechanical or paralytic in origin, and can be subdivided into small- and large-intestinal obstruction. Obstruction of the large intestine accounts for about 80% of all intestinal obstructions (the most common cause in ‘developed countries’ is adhesions), whereas adenocarcinoma of the colon is the most common cause of obstruction of the large intestine. A number of pathophysiological changes occur in intestinal obstruction, and these changes determine the clinical picture. Obstruction of the small intestine is characterized by dehydration and hypovolaemia due to fluid losses; obstruction of the large intestine is influenced by the competency of the ileocaecal valve. These features are diagnosed clinically and by radiography, but the decision to operate is a clinical (based on abdominal examination and clinical suspicion of potential pathology). Despite improvements in management, the mortality ranges from 10–30% (depending on type of obstruction and the presence of perforation) in the UK.

Report on management of obstructive azoospermia

Report on management of obstructive azoospermia

Urodynamically defined stress urinary incontinence and bladder outlet obstruction coexist in women.

The definition and significance of female bladder outlet obstruction (BOO) are poorly understood. We identified patients with urodynamic evidence of BOO in a cohort of women with stress urinary incontinence (SUI). Women with SUI were identified from a videourodynamic data base and pressure flow studies were reexamined. Subjects were excluded if detrusor pressures could not be measured. BOO was diagnosed if the maximum flow rate was less than 12 ml per second and detrusor pressure at maximum flow was greater than 20 cm water or maximum detrusor pressure was greater than 20 cm water in those without measurable flow. Clinical and urodynamic characteristics were compared in the obstructed and unobstructed groups. Of 104 eligible subjects 19 (18.3%) had BOO. Maximum flow rate, mean flow rate and voided volume were significantly less in the BOO group than in the unobstructed group (8.7 vs 13.5 ml per second, p = 0.004, 5.9 vs 7.9 ml per second, p = 0.001 and 180 vs 272 ml, p = 0.008). Detrusor pressure at maximum flow, maximum detrusor pressure and post-void residual volume were significantly greater in the BOO group than in the unobstructed group (28 vs 15 cm water, p <0.0001, 31 vs 19 cm water, p <0.0001 and 71 vs 10 ml, p = 0.008). Etiologies of BOO identified in the 19 subjects included prior anti-incontinence or prolapse surgery in 6, neurological conditions in 4, cystocele in 2, dysfunctional voiding in 3 and idiopathic in 5. SUI and BOO can coexist even in the absence of common causes of obstruction.

Obstructed Labour in Adigrat Zonal Hospital, Tigray Region, Ethiopia

Background: Obstructed labour is a common cause of maternal and pernatal morbidity and mortality in developing countries. There are few data from Ethiopia, although the problem is believed to be common. Objective: To describe the frequency, causes, complications and treatment outcome of mothers with obstructed labour. Methods: a retrospective (April 1, 1993 – March 30, 2001) review of delivery registration books, operation theatre books and patients records. Results: Of 5,980 hospital deliveries during the study period 195(3.3%) were admitted for obstructed labour. Only 14.1% of all cases had received antenatal care, and the majority (88%) came from rural areas. Mean duration of labour was 45.4 hours for cases of obstructed labour. The most common cause of obstruction was cephalopelvic disproportion (64.9%) followed by malposition/malpresentation (32.5%). Caesarean section was performed in 88 of the 195 cases (46.1%), craniotomy in 31(16.2%), instrumental delivery in 27 (14.1%), hysterectomy in 28(14.6%) and repair of ruptured uterus in 17(8.9%). Maternal and neonatal fatality rates were 3.7% and 55.5% respectively. Serious complication increased with parity. Conclusion: The incidence and complications of obstructed labour are remarkably high. To improve the situation better access to optimal antenatal and intrapartal care, together with early referral of high-risk patients must be facilitated. Ethiop.J.Health Dev. 2003;17(3):175-180

Best practice policies for male infertility

University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; University of Louisville School of Medicine, Louisville, Kentucky; Baylor College of Medicine, Houston, Texas; Brown University, Providence, Rhode Island; Cleveland Clinic Foundation, Cleveland, Ohio; New York Presbyterian Hospital-Cornell, New York, New York; University of Virginia School of Medicine, Charlottesville, Virginia; Mayo Medical School, Rochester, Minnesota; University of Pennsylvania School of Medicine, York, Pennsylvania; University of California, Davis, Davis, California; and SUNY Health Science Center at Brooklyn, Brooklyn, New York

A CASE OF AFFERENT LOOP OBSTRUCTION DUE TO INVASION OF CARCINOMA OF THE TRANSVERSE COLON

A case of afferent loop obstruction due to invasion of carcinoma of the transverse colon is reported. A 69-year-old man was admitted to the hospital because of fever, abdominal pain and nausea. There was a previous history of undergoing a Billroth II antecolic gastrectomy for gastric ulcer 25 years before admission. He was diagnosed as having an advanced carcinoma of the transverse colon by a total colonoscopy and Ba-enema study. The temperature rose to 39°C suddenly, and the laboratory studies revealed leukocytosis and an elevation in CRP level. Ultrasonography and computed tomography revealed a large cystic mass adjacent to the pancreas head and a diagnosis of obstruction of the afferent loop was made. Endoscopic drainage of the afferent loop was attempted but failed. Therefore, an emergency operation was performed on the same day and the obstructed afferent loop was drainaged. Thirteen days after the drainage, he underwent a radical operation for the transverse colon carcinoma. However, he died of carcinomatous peritonitis and multiple lung metastasis 2 months after the operation. Afferent loop obstruction is a complication following gastrectomy, though it is rare. The most common causes of obstruction are internal hernia, adhesion, and flexion. According to the literature, only 2 cases of obstruction of afferent loop due to invasion of colonic carcinoma including our case have been reported in Japan.

Tracheostomy in Children

Tracheostomy is more hazardous in children than in adults, and carries special risks in the very young. The past 20 years have seen a large shift in the age distribution of tracheostomy. Whereas formerly the operation was done largely for management of epiglottitis and laryngotracheobronchitis, today the prime indication is subglottic stenosis in infants consequent upon intubation for respiratory distress syndrome and prematurity. We have reviewed experience with 57 tracheostomies in 56 children under 12 years old managed from a university hospital. All operations were done as elective procedures, in standard fashion, by otolaryngologists. Forty (70%) were in children under 1 year old, the indications being upper airways obstruction (41), failed extubation (11), and long-term assisted ventilation (5). Subglottic stenosis was the commonest cause of obstruction (21 operations). In 91.4 accumulated years with a tracheostomy there were 11 complications related to tracheostomy, one of which (a blocked tube) was fatal. Thirty-nine children were decannulated, the mean duration of cannulation being 21 months. In this series we suggest that the low morbidity and mortality rates were due to management by otolaryngologists; to postoperative intensive care; and, for the majority cared for at home, to careful education of parents and visits by specialist nurses.

Transaortic Renal and Visceral Endarterectomy

In 1946 Dos Santos’ performed the first endarterectomy serendipitously during a femoral thrombectomy. When the pathology report described a fragment of the inner arterial wall, he immediately recognized the significance of this procedure. Wylie et a1.2 pioneered the technique in the United States and performed the first renal and aortic endarterectomy in 1952. Transaortic endarterectomy evolved at the University of California, San Francisco, under Wylie and was later extended to the visceral arteries. This article describes the technique of transaortic renal and visceral endarterectomy. Aortic atherosclerosis is the most common cause of obstruction of the renal and visceral artery ostia; the resultant vascular bed ischemia leads to renovascular hypertension, ischemic nephropathy, and/or chronic visceral ischemia. As the aortic atherosclerotic process “overflows” into the orifices of the renal and visceral arteries, the abnormality is usually confined to the proximal 2 cm of the ve~se l .~ This distribution of disease makes it particularly suitable for transaortic endarterectomy. Successful endarterectomy must begin in the aorta and continue into the renal or visceral artery where the disease terminates in a predictably smooth, tapered end point or transition to a more normal intimal lining. A general principle of endarterectomy warrants emphasis; that is, the correct cleavage plane is

Fatal intestinal obstruction in the mentally handicapped.

In a retrospective study of hospital records over a 50-year period, data on 32 patients who died as a result of intestinal obstruction are presented and compared with comparison groups and national mortality statistics. There was a higher incidence and lower mean age at death of fatal intestinal obstruction compared with the total national population. The mean age at death significantly increased over the study period. Intestinal volvulus was a common cause of obstruction particularly in those with cerebral palsy. There was a high prevalence of chronic constipation and megacolon. Foreign-body obstruction was de facto related to pica, but overall, there was a low prevalence of pica. Overall, mean IQ was low, but only significantly so in the male subjects. The length of acute illness was short; in 22 patients it was less than 24 h. Vomiting and abdominal distension were often absent and abdominal signs were recorded only in five patients. Pain or distress was recorded in only nine patients. Only eight patients were correctly diagnosed before death and only two had surgery. The results suggest that fatal intestinal obstruction is more common in mentally handicapped people and chronic constipation and megacolon are risk factors. Intestinal obstruction in mentally handicapped people can present late and with deceptively minimal signs and symptoms.

NON-INVASIVE MANAGEMENT OF FETAL OBSTRUCTIVE UROPATHY

Fetal outcome was studied in 43 consecutive cases of fetal obstructive uropathy in which no prenatal treatment was undertaken: 12 babies survived. In the 31 who did not survive, oligohydramnios was present in 24 and urethral atresia was the most common cause of obstruction (in 27). At necropsy, bilateral renal dysplasia was found in 23 and pulmonary hypoplasia in 13; 16 had structural or chromosomal anomalies, less than half of which were detected by prenatal ultrasound. In the survivors, 8 had posterior urethral valves, 1 had oligohydramnios, and 2 had associated anomalies. Obstructive uropathy is often associated with other anomalies which may escape prenatal ultrasound detection, and studies to determine the efficacy of intrauterine decompression techniques must allow for this observation.

Intestinal Obstruction

Intestinal obstruction remains a serious clinical challenge, and this book provides a modern view of the subject, including reports of contemporary research. The author, Professor Harold Ellis of Westminster Hospital, London, is familiar to surgeons throughout the world. He supplements his extensive personal experience with contributions from others, mostly from his own hospital staff. For example, he has contributions from his radiologists and a separate section on obstruction in neonates and children. This 356-page monograph deals both with common causes of obstruction, such as ileus, hernia, tumor, and adhesions, and also with more esoteric lesions, such as vascular insufficiency and pseudo-obstruction of the colon. Professor Ellis discusses the increasing incidence of postoperative adhesions as the leading cause of intestinal obstruction. In a typically scholarly fashion, he quotes his own research experience in the production of postoperative adhesions, but in a delightful style, he exhorts us not to damn all intraperitoneal

Dacryocystorhinostomy utilizing an anterior lacrimal sac flap to periosteum technique.

Dacryocystorhinostomy is used in the effective treatment of epiphora secondary to obstruction of the lacrimal drainage system. Common causes of obstruction include canalicular disruption, lacrimal sac fibrosis, and external and internal nasal trauma. Most techniques of dacryocystorhinostomy attempt to suture the lacrimal sac mucosa to the nasal mucosa. At best this is technically difficult, and the mucosa frequently tears. A technique is presented using an anteriorly based lacrimal sac pedicle flap sutured to the periosteum of the anterior lacrimal crest. The sutured flap is quite strong, and the procedure is technically simpler than others. A brief description of the causes of lacrimal obstruction is given. The Jones primary and secondary dye tests for lacrimal system patency are reviewed.