Development Of Intestinal Obstruction Research Articles

МОРФОЛОГИЧЕСКИЕ ИЗМЕНЕНИЯ В ПЕЧЕНИ ПРИ МУКОВИСЦИДОЗЕ У ДЕТЕЙ

Background. Cystic fibrosis (CF) is an autosomal recessive disease caused by a mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene, characterized by damage to vital organs, a severe course and an unfavorable outcome. Liver cirrhosis is a relatively rare manifestation of cystic fibrosis. Objective. To study the causes of death, hepatic morphological changes in CF according to autopsy data and to present a description of a case of CF with rapidly progressing liver cirrhosis in a 6-year-old child. Material and methods. An analysis of clinical, laboratory and instrumental studies of CF and the results of hepatic morphological changes was carried out according to the data of 10 autopsies performed at the State Healthcare Institution "GRCPB". Results. Among the 10 patients died from a mixed form of CF, there were 5 patients aged 1-3 months, 2 patients aged 1.5 years, 1 patient aged 4.5 years, 1 patient aged 6 years and 1 patient was 19 years old. Infant patients had predominant intestinal damage with the development of intestinal obstruction and peritonitis, older age groups had lung damage with the development of chronic pulmonary heart disease, chronic pulmonary heart failure, and to a lesser extent - pathology of the pancreas and gastrointestinal tract. In one 6-year-old patient, CF was complicated by diabetes mellitus as well as liver cirrhosis with portal hypertension. All patients had severe protein-energy deficiency, psychosomatic and psychopathological symptoms. The results of pathohistological examination of the liver of infant patients showed dilation of the interlobular bile ducts with cholestasis and periductal fibrosis. The severity of these liver changes increased gradually alongside with patients’ age, including the progression of fatty degeneration. In a number of cases, diffuse fibrosis was recorded, resulting in liver cirrhosis with portal hypertension. At autopsy, the extrahepatic bile ducts and gallbladder were dilated and filled with bile of a viscous consistency. Conclusions. The nature of hepatic morphological changes in CF depends on the age of the patients and on the influence of exogenous factors. Only timely diagnosis and early complex therapy for CF will reduce the progression of irreversible processes in various organs and prolong the life of patients.

LAPAROSCOPIC ILEOCECAL RESECTION OF CROHN'S DISEASE: THE EXPERIENCE OF THE MOSCOW CLINICAL RESEARCH CENTER

Background: the most common surgical intervention for complicated forms of Crohn's disease is ileocecal resection. This operation is performed in a planned manner with the ineffectiveness of conservative therapy. Also, the operation is performed according to emergency indications with the development of intestinal obstruction or septic complications. In the vast majority of cases, it is possible to perform a laparoscopic approach, thereby reducing the risks of complications and accelerating the recovery of the patient in the postoperative period.Aim: evaluation of the results of laparoscopic ileocecal resection in patients with Crohn's diseaseMaterials and methods: the study included 46 patients (21 women, 25 men) who underwent laparoscopic ileocecal resection for the stricture form of Crohn's disease. 18 patients were operated on for emergency indications, 28 – for planned indications. The mean age was 37.6 year.Results: conversion to laparotomy was performed in 4 patients (8.7%). The mean operative time was 128.2 minutes. Complications that required reoperation were in 3 patients (6.5%). 4 patients (8.7%) had purulent-septic wound complications.Conclusion: laparoscopic ileocecal resection for stricture Crohn's disease is a simple, easily reproducible operation, both in planned surgical interventions and in emergency cases.

Intussusception in a Newborn. Clinical Observation

Intestinal intussusception in a newborn is a casuistic rarity, the clinical symptoms of which are nonspecific, and patients are regarded for a relatively long time as patients with necrotic enterocolitis. There are no unambiguous radiological signs of this pathology, especially with atypical variants of intussusception, when even pneumoirrigography is uninformative. In the vast majority of cases, the diagnosis is made only intra-operatively, when the development of intestinal obstruction or perforated peritonitis determines the need for surgical intervention. The publication presents a unique observation of preoperative echographic diagnosis and successful cure of prolonged small-intestinal invagination in a premature newborn 2 days of life, the cause of which was Meckel’s diverticulum.

Intussusception in a Newborn. Clinical Observation

Intestinal intussusception in a newborn is a casuistic rarity, the clinical symptoms of which are nonspecific, and patients are regarded for a relatively long time as patients with necrotic enterocolitis. There are no unambiguous radiological signs of this pathology, especially with atypical variants of intussusception, when even pneumoirrigography is uninformative. In the vast majority of cases, the diagnosis is made only intra-operatively, when the development of intestinal obstruction or perforated peritonitis determines the need for surgical intervention. The publication presents a unique observation of preoperative echographic diagnosis and successful cure of prolonged small-intestinal invagination in a premature newborn 2 days of life, the cause of which was Meckel’s diverticulum.

Results of Colostomy Use in Children with Anorectal Malformation

Introduction. Anorectal malformations in children are still one of the most challenging problems in pediatric coloproctology. The incidence of anorectal malformations in recent years has no tendency to decrease and, according to various authors, ranges from 1 in 4000-5000 live births. Most pediatric surgeons continue to adhere to the opinion about the advisability of preliminary colostomy and delayed proctoplasty at the age of 6-18 months or when the child reaches a certain body weight (8-10 kg.). They are motivating this tactic with the possibility of creating an optimal condition for performing a complex intervention, reducing anesthetic risk, avoiding technical errors. Objective is to improve treatment outcomes for anorectal malformations in children with prior colostomy. Materials and methods. The work is based on the results of treatment of 154 children with anorectal malformation, with preliminary colostomy in the clinic of the Tashkent Pediatric Medical Institute for the period from 2000 to 2020. Along with routine and general clinical examination methods, all children underwent: X-ray of the abdominal cavity, colostography, fistuloirrigography, excretory urography, cystography, ultrasound of the perineum (small pelvis), neurosonography (NSG) screening tests. Results. 154 (10*0%) children had colostomy as a palliative stage of treatment. Of these 117 (76%) children developed colostomy on the first day of life, with the development of intestinal obstruction. In 37 (24%) children, the formation of a colostomy was performed directly by us. 9 (5.8%) children as the first stage before primary radical correction with a high form of the defect and 10 (6.5%) children previously operated on and requiring re-corrective operations, 5 (3.2%) patients underwent colostomy after the development of complications in the early postoperative period. In 13 (8.5%) cases, colostomies were formed with identified concomitant anomalies and defects that clinically "dominated" over anorectal malformation. In 2 (5.4%), a double sigmastoma was imposed, in 2 (5.4%) a distal single-barreled sigmastoma, in 5 (13.5%) the Hartmann type terminal sigmastoma. Conclusion. The use of colostomy in children with anorectal malformation made it possible to carry out the necessary surgical tactics in a timely and differentiated manner. To reduce the frequency, nature of complications and early disability, to improve the quality of life and social adaptation of patients.

Синдром Бувере (клінічний випадок)

Gallstone disease is one of the most common surgical nosologies, which tends to increase steadily. More than 2.5 million cholecystectomy surgeries are performed annually in the world: in European countries – from 45 to 80 thousand, in the United States – more than 700 thousand choledocholithiasis with the development of mechanical jaundice. Diagnosis of these complications in most cases is not difficult, and the provision of surgical care is standardized. Bouvet’s syndrome (syn. Acute biliary ileus, Gallstone ileus) is a very rare complication of gallstone disease and is caused by the development of inflammatory degenerative-dystrophic changes between the gallbladder and the duodenal wall, leading to the formation of fistulas through which -intestinal tract with the development of obstruction. However, it should be noted that only in 7–10% of cases, the formed fistula can cause the migration of stones and the development of intestinal obstruction. By 2008, only about 300 cases of the syndrome had been described in the world literature. Patients with a long history of stone disease, frequent episodes of exacerbation of cholelithiasis, female gender, old age are the main risk factors for Bouvere syndrome. Compared to other types of mechanical obstruction, the frequency of biliary ileus is only 1–4% and can reach 24% in people over 70 years. The complexity of the diagnosis is due to the nonspecificity of the initial manifestations, comorbidity of patients, late treatment. Postoperative mortality in acute calculous cholecystitis ranges from 0.28% to 3.01% (on average in Ukraine 0.94–0.81%), and in Bouvere syndrome can reach 24%. The main direct causes of death are bleeding, perforation, acute pancreatitis, severe dyselectrolyte disorders. The possibility of widespread use of computed tomography and magnetic resonance imaging greatly simplifies the diagnostic search. However, unfortunately, preoperative diagnosis of the syndrome is achieved only in a quarter of patients. Minimally invasive methods, given the growth of scientific publications and personal experience, can be successfully used to correct this pathology as a final method. A literature review of the etiology, pathogenesis, clinical manifestations, prevalence, methods of diagnosis and treatment of Bouvet syndrome is presented. Clinical case (short description). Presented own clinical observation of Bouvere syndrome in a patient hospitalized in the surgical department of the KNP «Regional Clinical Hospital named after O.F. Gerbachevsky» with the phenomena of duodenal immobility and long history of stone-bearing. Consecutive use of endoscopic and instrumental imaging methods allowed accurate diagnosis, and the use of laparoscopic access made it possible to perform minimally invasive correction of pathology in this patient. Conclusions. Gallstone disease is one of the most common surgical pathologies. Bouvere syndrome is a rare complication of the latter. Clinical symptoms are less specific, so the use of additional instrumental examinations allows accurate preoperative diagnosis. Due to the low efficiency of endoscopic methods of correction surgery is the main tool. The increase in scientific publications on the use of laparoscopic and video-assisting techniques makes it possible to argue about the relatively high efficiency of the latter in the correction of this pathology. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. The authors declare no conflicts of interests. Key words: Gallstone disease, acute intestinal obstruction, Bouveret syndrome.

A Mouse Model of Intestinal Partial Obstruction

Intestinal obstructions, that impede or block peristaltic movement, can be caused by abdominal adhesions and most gastrointestinal (GI) diseases including tumorous growths. However, the cellular remodeling mechanisms involved in, and caused by, intestinal obstructions are poorly understood. Several animal models of intestinal obstructions have been developed, but the mouse model is the most cost/time effective. The mouse model uses the surgical implantation of an intestinal partial obstruction (PO) that has a high mortality rate if it is not performed correctly. In addition, mice receiving PO surgery fail to develop hypertrophy if an appropriate blockade is not used or not properly placed. Here, we describe a detailed protocol for PO surgery which produces reliable and reproducible intestinal obstructions with a very low mortality rate. This protocol utilizes a surgically placed silicone ring that surrounds the ileum which partially blocks digestive movement in the small intestine. The partial blockage makes the intestine become dilated due to the halt of digestive movement. The dilation of the intestine induces smooth muscle hypertrophy on the oral side of the ring that progressively develops over 2 weeks until it causes death. The surgical PO mouse model offers an in vivo model of hypertrophic intestinal tissue useful for studying pathological changes of intestinal cells including smooth muscle cells (SMC), interstitial cells of Cajal (ICC), PDGFRα+, and neuronal cells during the development of intestinal obstruction.

A Mouse Model of Intestinal Partial Obstruction

Intestinal obstructions, that impede or block peristaltic movement, can be caused by abdominal adhesions and most gastrointestinal (GI) diseases including tumorous growths. However, the cellular remodeling mechanisms involved in, and caused by, intestinal obstructions are poorly understood. Several animal models of intestinal obstructions have been developed, but the mouse model is the most cost/time effective. The mouse model uses the surgical implantation of an intestinal partial obstruction (PO) that has a high mortality rate if it is not performed correctly. In addition, mice receiving PO surgery fail to develop hypertrophy if an appropriate blockade is not used or not properly placed. Here, we describe a detailed protocol for PO surgery which produces reliable and reproducible intestinal obstructions with a very low mortality rate. This protocol utilizes a surgically placed silicone ring that surrounds the ileum which partially blocks digestive movement in the small intestine. The partial blockage makes the intestine become dilated due to the halt of digestive movement. The dilation of the intestine induces smooth muscle hypertrophy on the oral side of the ring that progressively develops over 2 weeks until it causes death. The surgical PO mouse model offers an in vivo model of hypertrophic intestinal tissue useful for studying pathological changes of intestinal cells including smooth muscle cells (SMC), interstitial cells of Cajal (ICC), PDGFRα+, and neuronal cells during the development of intestinal obstruction.

Perforated jejunal diverticulum: a rare case of acute abdomen

Jejunal pseudo-diverticulosis is a rare acquired herniation of the mucosa and submucosa through weakened areas of the muscularis mucosa of the mesenteric aspect of the bowel. They are asymptomatic in the majority of cases; however, they can present with a wide spectrum of non-specific symptoms such as chronic abdominal discomfort, postprandial flatulence, diarrhoea, malabsorption and steattorhoea. In up to 15% of cases, more serious acute complications may arise such as the development of intestinal obstruction, haemorrhage or as in our case, localized peritonitis secondary to perforation. Perforation carries an overall mortality rate of up to 40% and exploratory laparotomy followed by copious lavage with segmental resection and primary anastomosis remains the mainstay of managing such sequalae of jejunal pseudo-diverticulosis. Our case report highlights the importance of maintaining a high clinical suspicion of a perforated jejunal diverticulum in an elderly patient presenting with an acute abdomen.

Late intestinal obstruction after radical cystectomy and urinary diversion: urological and oncological perspectives

Objective: The aim of this study was to review different management modalities and outcome of patients presenting with late intestinal obstruction (IO) after radical cystectomy (RC) or palliative cystectomy (PC).Materials and methods: Files of patients who presented with IO between January 1978 and June 2014 were reviewed. Patients who developed IO following either RC or PC more than 30 days after surgery were included. Patients’ characteristics and management protocols were evaluated. Predictors for failure of conservative management and unfavorable outcome after surgical explorations were evaluated. Symptom-free and overall survival rates of patients with malignant IO was were recorded.Results: The prevalence of IO was 2.8% after RC (118 out of 4199 patients) and 10% after PC (nine out of 87). Colonic diversions had the highest prevalence (6.2%), followed by ileal loop conduit (2.9%); the lowest prevalences followed Kock pouch and ileal W neobladder (1.7% and 1.6%, respectively). Postoperative urinary leakage from a ureteroenteric anastomosis was the only predictor for surgical intervention (p = 0.039). Nine cases had been explored for malignant obstruction (eight after RC and one after PC). The mean ± SD elapsed time before death was 3.6 ± 2 months (range 0.5–17 months).Conclusions: Urinary diversion with colonic segments carries more risk for the development of IO in comparison with ileal segments. Postoperative urinary leakage after cystectomy and urinary diversion may be a contributory factor for surgical exploration in cases with late IO.

Obstrucción intestinal secundaria a formación de adherencias postoperatorias en cirugía abdominal. Revisión de la literatura

The development of intestinal obstruction after upper and lower abdominal surgery is part of the daily life of each every surgeon. Despite this, there are very few good quality studies that allow enable assessment of the frequency of intestinal obstruction to be assessed, even although postoperative adhesions are the cause of considerable direct and indirect morbidity and its prevention can be considered a public health problem. And yet, in Mexico, at this time, there is no validated recommendation validated on the prevention of adhesions, or more particularly, in connection with the use of a variety of anti-adhesion commercial products which have been marketed for at least a decade.Intraperitoneal adhesions develop between surfaces without peritoneum of the abdominal organs, mesentery, and abdominal wall. The most common site of adhesions is between the greater omentum and anterior abdominal wall previous. Despite the frequency of adhesions and their direct and indirect consequences, just there is only one published a recommendation (from gynaecological literature), regarding peritoneal adhesion prevention.As regards of colorectal surgery, performed more than 250,000 colorectal resections are performed annually in the United States, and from 24% to 35% of them will develop a complication. The clinical and economic financial burden of these complications is enormous, and surgeries colorectal surgery been specifically highlighted as a potential point prevention point of surgical morbidity.

Importance of the Early Management of Omphalocele Minor

Background: This study was conducted to characterize the clinical features, associated anomalies, operative management, and operative findings in babies with omphalocele minor. Material and Methods: This was a prospective study conducted over a period of 2 years, from 2011 to 2013. The clinical, radiological, and operative findings of all the babies diagnosed with omphalocele minor were recorded and analyzed. Results: A total of 12 patients of omphalocele minor were admitted to our department. Ten babies required immediate exploration within first 5 days of life. The main indication of exploration was mechanical intestinal obstruction due to either associated atresia (five patients) or obstruction caused by mechanical compression of the gut by the small abdominal wall defect in remaining seven patients. Atretic segment was seen within the sac in two patients, distal ileal atresia in one, atresia at the neck of the abdominal wall defect in one, and ascending and transverse colonic atresia in one patient. Out of 10 patients in whom exploration was needed, 9 required resection anastomosis and in 1 patient intestine within the omphalocele sac had pregangrenous changes and did not require resection. There were three mortalities in our series; rest of the patients were doing well during the follow up. Conclusion: Omphalocele minor although apparently seems to be a minor anomaly, but, as shown in our series,it has the potential of causing intestinal obstruction due to associated gut atresia or compression from tight abdominal defect. We conclude and recommend that all the patients with omphalocele minor should be admitted and observed for the possible development of intestinal obstruction and hence for early surgical intervention to prevent subsequent complications.

Inhibition of Akt pathway phosphorylation as a mechanism in the pathogenesis of functional intestinal obstruction in carcinomatosis peritonei

The purpose of this study was to confirm our hypothesis that the development of functional intestinal obstruction in carcinomatosis peritonei (CP) is related to cytokine-mediated inhibition of the Akt pathway and to investigate the phenomenon of relative adrenal insufficiency in CP. Human adrenocortical cells (NCI-H295R) were treated with serum derived from eight cancer patients who had intestinal obstruction and functional adrenal insufficiency. Serum from three normal healthy subjects and three who had CP but without intestinal obstruction or adrenal insufficiency were used as controls. The differential effects of serum on the treated cells were studied using Western blot analysis. Cortisol production of these treated cells was assayed with cortisol ELISA kits. Phosphorylation of Akt at Ser473 and Ser308 in cells was significantly reduced when treated with serum from patients with intestinal obstruction but not controls. Phosphorylation of PDK1 at Ser241, mTOR downstream targets like p70S6 at Thr421/Ser424 and Thr389, and lastly 4EBP-1 at Ser70 a downstream target of p70S6 was reduced by approximately 50%, 40%, and 70%, respectively. There was enhanced phosphorylation of elF4E an initiating factor in protein translation in cells treated with patient serum compared to controls. Cortisol synthesis was stimulated upon treatment with patient serum but not with control serum. Inhibition of Akt phosphorylation is a mechanism that could play a major role in the development of intestinal obstruction in carcinomatosis peritonei. The identification of the mediating cytokines will lead to the development of cogent targeted therapeutic strategies.

Significance of overall treatment time for the development of radiation-induced intestinal complications. An experimental study in the rat.

Late normal tissue reactions generally are believed to be independent of treatment time. However, previous studies suggest a relationship between acute mucosal injury and development of intestinal obstruction and enterocutaneous fistula formation. Thus, the pathogenesis of late intestinal complications may be complex, and mucosal cell proliferation during treatment may be important. This study assessed the influence of overall radiation treatment time on development of intestinal injury and complications after localized fractionated irradiation of rat ilium. Ninety-four male rats underwent orchiectomy, and a loop of small intestine was transposed to the scrotum. Orthovoltage irradiation was administered to the transposed, but functionally intact, intestine using 9 fractions of 5.6 Gy with interfraction intervals of 24, 48, or 72 hours. The animals were observed for complications and killed in groups 2 and 26 weeks after irradiation for assessment of injury. Incidence of intestinal complications and quantitative and semiquantitative histopathologic assessment of injury were used as endpoints. Increasing total treatment time by extending interfraction intervals from 24 to 48 hours significantly reduced radiation injury and the incidence of intestinal complications. Differences in mucosal and fibrotic changes were most prominent. No significant differences were found between groups with interfraction intervals of 48 and 72 hours. Overall treatment time significantly influenced development of chronic radiation enteropathy. Thus, rapidly proliferating cells, as found in the intestinal mucosa, appear to be involved in the pathogenesis of intestinal complications. This probably represents consequential damage secondary to disruption of mucosal integrity.