Dynamic Intestinal Obstruction Research Articles

Possible solution to problem of postoperative ileus in oncological surgery

Surgical oncology is not a well-defined discipline. The variety of surgical specialties in oncology is due to the variety of tumor localizations. After operations involving the abdominal organs, it is possible to develop dynamic intestinal obstruction, which is referred to as postoperative paresis of the gastrointestinal tract or postoperative ileus (POI). We did not find any information on the frequency of POI in surgical oncology, however, the frequency of POI in the clinic of colorectal surgery is known to be from 10 to 30 % and after gynecological operations from 10 to 15 %. The issue of POI prevention remains relevant. In a systematic review of recommendations aimed at restoring GI function after abdominal surgery, the most commonly recommended interventions were magnesium-based laxatives (48.6 %) and chewing gum (35.1 %), with other recommendations occurring significantly. less often. However, in domestic reviews, only 1 paragraph is devoted to the possibilities of using chewing gum for the prevention of POI in colorectal surgery and obstetric and gynecological practice, with a limited number of references to literary sources. In real clinical practice, chewing gum has been used after surgery to reduce POI since the beginning of the 21st century. The recommendation for the use of chewing gum in the postoperative period after abdominal surgery has now been included in a number of clinical guidelines. The review considers clinical studies, reviews and meta-analyses that have studied the possibility of using chewing gum in the prevention of POI in oncological surgery.

ПРОФИЛАКТИКА ДИСФУНКЦИИ КИШЕЧНИКА ПОСЛЕ ОПЕРАЦИЙ ВНЕ БРЮШНОЙ ПОЛОСТИ

Introduction. Currently, intestinal dysfunction is an actual problem in abdominal surgery. According to data based on observations in different countries, this complication verified after surgical interventions outside the abdominal cavity. The review is devoted to the analysis of complications in abdominal cavity after non-abdominal operations. Postoperative abdominal complications developed after interventions in the retroperitoneal space, thoracic surgery, operations on pelvic organs, in the lumbar spine and other interventions. All these operations could cause evacuation disturbances and abnormal intestinal transit. Various terms are used to describe this condition, such as “postoperative flatulence”, “dynamic intestinal obstruction”, “functional intestinal stasis”, “postoperative functional intestinal obstruction”, “postoperative intestinal paresis”. The main cause of postoperative intestinal dysfunction is impaired intestinal motility. The purpose of the review is to analyze methods of prevention of intestinal functions that developed after extra - abdominal surgery.

Postoperative ileus in obstetric and gynecological practice: a prospective solution to the problem: A review

In obstetric and gynecological practice, after operations on the abdominal cavity, the development of dynamic intestinal obstruction, which is referred to as postoperative ileus, is possible. The frequency of POI after gynecological surgery averages 1015% (range 525%). Chewing gum has been used in abdominal surgery and obstetric and gynecological practice to reduce postoperative intestinal obstruction since the beginning of the 21st century. The present review considers the main randomized clinical trials, reviews and meta-analyses devoted to the study of the effect of chewing gum after surgical interventions in obstetric and gynecological practice for the prevention of postoperative ileus. The data presented in the review indicate the effectiveness and safety of the use of chewing gum in the postoperative period for the prevention of postoperative ileus in obstetric and gynecological practice.

Перспективное решение проблемы послеоперационного илеуса в урологии и травматологии

In surgical practice, after operations that directly or indirectly affect the organs of the abdominal cavity, it is possible to develop disturbances in the normal coordinated propulsive motility of the gastrointestinal tract. This condition of dynamic intestinal obstruction is referred to as postoperative gastrointestinal paresis or postoperative ileus (POI). We did not find any information on the frequency of POI in urological practice, however, the frequency of POI in the clinic of colorectal surgery is known to be from 10 to 30% and after gynecological operations 10-15%. The issue of treatment and prevention of POI remains relevant. In global clinical practice, chewing gum has been used after surgery to reduce postoperative intestinal obstruction since the beginning of the 21st century. 141 references were found for the query “postoperative ileus, chewing gum” in the PubMed database alone, of which 53 references to randomized clinical trials, 48 to reviews and systematic reviews, and 26 to meta-analyses. The present review considers randomized clinical trials, systematic reviews and meta-analyzes that examined the prevention of POI in urology and traumatology, indicating the effectiveness and safety of the use of chewing gum in the postoperative period for the prevention of postoperative ileus.

Способ расширяющей кишечной пластики мочевого пузыря у больных с лучевыми пузырно-влагалищными свищами и микроцистисом.

Introduction. Radial vesicovaginal fistulas are one of the most difficult problems of urogynecology, despite the fact that modern technologies make it possible to personalize the use of radiation therapy. Standard surgical techniques in the treatment of such patients are ineffective. The search for alternative surgical solutions can improve the results of treatment of patients with radial fistulas and microcystis. Study objective. To compare the effectiveness of augmentation ileocystoplasty and two-stage surgical treatment, represented by expanding intestinal cystoplasty in combination with the use of a Martius or Martius-Symmonds flaps. Materials and methods. The study included 8 patients. The first group included 4 patients who underwent laparotomy, augmentation ileocystoplasty. In 3 patients relapsed fistulas were closed with vaginal access using a Martius flap a few months later. The second group included 4 patients who underwent expanding intestinal cystoplasty by laparotomy, with further formation of Martius or Martius-Symmonds flaps by perineal access and moving them into the pelvic cavity for fixation from the abdominal cavity. Results. The average duration of the operation in the first group was 337.5 minutes, in the second group – 470 minutes. The patients of the first group had no complications of the III-V groups according to Clavien-Dindo. Natural urination was eventually recovered in all patients. In 2 patients of the second group, postoperative complications were recorded: in 1 patient – complication of group IIIa according to Clavien-Dindo – marginal necrosis of the skin flap after abdominoplasty, which required stage necrectomy and secondary skin sutures, in another 1 patient – complication of group IIIb according to Clavien-Dindo – dynamic intestinal obstruction, which required relaparotomy and nasointestinal intubation. There were no relapses of vesicovaginal fistulas. After urination was restored, all patients retained the urge to urinate. Conclusion. The proposed two-stage operation allows not only to eliminate the vesicovaginal fistulas, but also to increase the capacity of the bladder, restore voluntary urination.

Surgical corrections of long ureteral defects (initial experience)

Introduction: Restoration of patency of ureters with long defects is one of the major problems in urology. There are cases when it is impossible to perform plastic surgery of ureter with own tissues or bladder; in these situations, appendicoureteroplasty or kidney autotransplantation can be promising solutions. Material and methods: 4 patients underwent surgical corrections or ureter strictures: two underwent appendicoureteroplasty and two – kidney autotransplantation. To verify the diagnosis of long ureteral defects, standard research methods were used: ante- and retrograde pyeloureterography. Results and discussion: In the early postoperative period, all patients underwent dynamic ultrasonography of the abdominal cavity and retroperitoneal space; in addition, hemodynamics parameters as well as clinical and biochemical laboratory blood parameters were monitored. The early postoperative period in three patients proceeded with no incidents and did not require serious additional studies. In one patient after appendicoureteroplasty dynamic intestinal obstruction developed on the third day post-op, which was resolved conservatively. In the late postoperative period the condition of the patients was satisfactory. There are few articles describing surgical interventions that can treat long ureteral defects, with appendiculoplasty and kidney autotransplantation being the most effective. However, each procedure has own advantages and disadvantages, as well as risks. Conclusion: In our study, we performed these two methods with two patients for each method. Results are promising, but for a better statistical analysis and more thorough follow-up we need more patients for both appendiculoplasty and kidney autotransplantation.

“An observational study of intestinal obstruction in adults”

Background: Mechanical intestinal obstruction is a common surgical emergency. The causes of intestinal obstruction include hernias, postoperative adhesions, malignancy, strictures etc. The etiology of this condition varies in different parts of the world and within same country. Methods: This prospective descriptive study was conducted in department of surgery at a tertiary care teaching hospital. All the adult patients, irrespective of sex with diagnosis of dynamic intestinal obstruction undergoing exploratory laparotomy were included in the study. Laparotomy findings were recorded and in the postoperative period patients were followed up for detection of complications and treatment. Results:45 patients were treated for mechanical intestinal obstruction. Mean age was 49.5 years and male to female ratio was 1.81:1. Most common cause of small bowel obstruction is Small bowel adhesions i.e. 13 patients (39.39%) ; while the most common cause of large bowel obstruction is malignancy arising from different parts of large bowel i.e. 66.67% of patients (8 patients) Wound infection was the commonest postoperative complication. There were 12 deaths in this study giving mortality rate of 26.6%. Conclusions: Bowel Adhesion is the leading causes of mechanical intestinal obstruction in our region.

Профилактика и лечение пареза кишечника у детей

Dynamic intestinal obstruction (DIO) is one of the disorders reported after gastrointestinal (GI) surgical procedures. DIO raises special concerns, as it affects patients’ condition in the postoperative period and increases the duration of hospital treatment. The review section of the article is focused on DIO pathogenetic mechanisms, clinical manifestations, diagnostic criteria, and treatment strategies. In addition to diet therapy and the use of cholinesterase inhibitors, the conservative therapy in children includes various physiotherapy treatment techniques, facilitating intestinal motility The comparative analysis shows that their ultimate efficiency is not the same and that there are significant limitations and differences associated with the access to the optimal areas for electrode placement The article presents the results of introducing an original technique of dynamic electrical stimulation of the intestine with point paravertebral massage which was used in the early postoperative period for 117 children. The children had undergone either emergency surgeries in cases of acute surgical conditions or planned (stage-by- stage) intestinal reconstruction surgeries for preventing DIO.The data have demonstrated the efficacy of electrical stimulation used both as monotherapy and in combination with proserine (the number of required injections was decreased to 1 or 2). Restoration of the intestinal passage was achieved in 95% of cases within the first 24–36 hours after surgery (spontaneous defecation occurred in 70% of patients by the end of the first day). A later response to electrical stimulation with the restoration of peristalsis was determined after small intestine surgeries: spontaneous emptying of the intestine on the first day occurred only in 43% of children versus 52% after surgery of the lower portion of the abdominal cavity KEYWORDS: postoperative intestinal paresis; children; clinical course; diagnostics; electrical stimulation; original technique; acupressure device FOR CITATION: Pen’tkovskaya O.S., Bardenikova S.I. Prevention and treatment of enteroparesis in children. Russian Journal of Woman and Child Health. 2022;5(4):373–381 (in Russ.). DOI: 10.32364/2618-8430-2022-5-4-373-381.

Posthypoxic Changes in Rat Offspring under the Intestinal Wall Transformation

The aim of research is to study posthypoxic transformation of the colon wall using light and electron microscopy in an experimental model of rat offspring.
 Materials and methods. Chronic hypobaric hypoxia at different stages of pregnancy was simulated experimentally in 24 female white mongrel rats using a vacuum flow chamber with a rise to a height of 5000 m at a speed of 25 m/sec for 40 minutes. After delivery, the offspring were examined, subjected to hexenal anesthesia, and then removed from the experiment using decapitation. For light microscopy, resected sections of the small intestine and colon were stained with hematoxylin-eosin, and studied on Topic (Belgium, 2000) and Bio Blue (the Netherlands, 2013). Electron microscopic analysis was performed in a Morgagni 268D transmission electron microscope (FEI, USA).
 Results. Chronic hypoxia, simulated in the first trimester of pregnancy, led to significant changes in the intestinal mucosa in combination with the growth of the connective tissue component in the muscle layer. The risk of developing dynamic intestinal obstruction occurred in the offspring of all groups, this was supported by an increase in the fibrous tissue of the intestinal wall. Pronounced changes in the microcirculatory bed were detected in animals of groups II and III, as they were predisposed to develop pre-ulcer and ulcerative defects in the wall of the small intestine. At the submicroscopic level, it was detected that both adaptive and destructive processes occurred in the wall ultrastructure of the descending colon of the rat offspring after hypoxic exposure in the prenatal period in animals of all experimental groups. In the microcirculatory bed, there was an increased venous congestion, with the most pronounced changes observed in the third trimester.
 Conclusion. Thus, the study of hypoxia in the experiment allows investigating more about all the mechanisms of the pathological process and to translate theoretical knowledge into practical medicine.

Surgical treatment of giant renal tumor: a case report

Renal tumors account for 2 to 3 % of all malignant tumors in adults. Of all patients with renal cell carcinoma, 30 to 40 % have advanced forms of the disease. In the literature, the term "giant renal tumor" is used for tumors larger than 20 cm. In this article, we report a case of surgical treatment for a giant malignant kidney tumor.Patient N., female, 54 years old, referred to an outpatient clinic with complaints of a change in the shape of the abdomen on the left with a palpable large tumor, abdominal pain, shortness of breath, weakness, constipation, episodes of blood in the urine and increased blood pressure. Body mass index 30.2 kg/m2. Ultrasound examination revealed a large tumor in the left retroperitoneal space. Laboratory testing of blood, urine was performed, findings were unremarkable. According to the data of magnetic resonance imaging, the left kidney was transformed into a large cystic solid formation, measuring 30.5 х 17.5 х 17.0 cm, heterogeneously accumulating a contrast agent with a solid component. Patient was admitted to the urology department for surgical treatment. We performed radical nephrectomy on the left with thoracolumbar laparotomy access on the left with resection of the 10th rib, resecting the renal tumor with the adrenal gland, total weight of the complex was 10.7 kg. The histological structure was determined as poorly differentiated renal carcinoma with invasion of the perinephric tissue. In the adrenal gland, fields of fresh erythrocytes with an admixture of tumor tissue were noted. Examined lymph node tissue was completely replaced by tumor cells. Postoperative period was characterized by episodes of dynamic intestinal obstruction. The patient was discharged from the department in a satisfactory condition on the 13th day after the operation, but died 1.5 months after discharge, the cause of death has not been established, as no autopsy was performed. Thus, the size of the tumor is not a contraindication to surgical treatment, which improves the survival rate of patients with malignant renal tumors.

The Role of Pelvic Lymphadenectomy in Organ-sparing Treatment of Muscule-invasive Bladder Cancer

The Role of Pelvic Lymphadenectomy in Organ-sparing Treatment of Muscule-invasive Bladder Cancer

Laparoscopic and robotic radical surgery for liver alveolar echinococcosis

The aim of this study was to estimate the immediate and long-term results of laparoscopic and robotic radical surgery for liver alveolar echinococcosis (AE). From 2013 to 2019 6 patients with AE were undergone radically surgery using minimally invasive technologies. In 5 cases, a laparoscopic liver resection was performed, and in one case a Da'Vinci robotic complex was used. The average lesion size was 60 ± 20 mm. In three cases (50%) patients with P2 stage of the disease were operated on, in 3 cases with P1. In two cases, in patients with stage P2, a right hemihepatectomy was performed, in 2 cases a segmentectomy 8 with atypical resection segment 4 was performed, in one case a posterior sectionectomy was performed, in one case the intervention was performed with atypical resection of 6 segments. The average age of the patients was 55 years (27-79), three women and three men (1:1). The average size of the lesion was 60 ± 20 cm. The mean operation time and blood loss was 344 ± 141 minutes and 350 ± 333 mL. Complications were observed in one case (16.7%), type II according to Clavien-Dindo, represented by dynamic intestinal obstruction, which developed on the 6th day of the postoperative period and was resolved conservatively. Mean hospital stay was 9 ± 3. Laparoscopic and robotic liver resections in the radical treatment of alveococcosis can be safe and feasible in the early stages of alveococcosis (P1-2H0M0), provided they are performed in a specialized hospital with sufficient technical equipment and an experienced surgeon.

Laparoscopic and robotic radical surgery for liver alveolar echinococcosis (Echinococcus multilocularis)

Aim: To estimate the immediate and long-term results of laparoscopic and robotic radical surgery for liver alveolar echinococcosis (AE). Methods: From 2013 to 2019, at the Hepatopancreatobiliary Surgery Department of the Loginov Moscow Clinical Scientific Centre 6 patients with AE were undergone radically surgery using minimally invasive technologies. In 5 cases, a laparoscopic liver resection was performed, and in one case a Da’Vinci robotic complex was used. In all cases a mass was found in the right lobe of the liver, mainly 7-8 liver segments. The average lesion size was 60±20 mm. Results: In three cases (50%) patients with P2 stage of the disease were operated on, in 3 cases with P1. In two cases, in patients with stage P2, a right hemihepatectomy was performed, in 2 cases a segmentectomy 8 with atypical resection segment 4 was performed, in one case a posterior sectionectomy was performed, in one case the intervention was performed with atypical resection of 6 segments. The average age of the patients was 55 years (27-79), three women and three men (1: 1). In 2 cases patients had previous abdominal surgery. The average size of the lesion was 60±20 cm. The mean operation time was 344±141 minutes, the average blood loss was 350±333 ml. An intermittent Pringle maneuvre was used in 4 cases (66,7%) with average ligament clamping time 19 minutes and with pauses of at least 5 minutes. Complications were observed in one case (16,7%), type II according to Clavien-Dindo, represented by dynamic intestinal obstruction, which developed on the 6th day of the postoperative period and was resolved conservatively. Mean hospital stay was 9±3. In all cases, there was histological confirmation of the diagnosis by the results of a study of a remote lesion. The average observation time was 45,4 months (10-84). Conclusion: Laparoscopic and robotic liver resections in the radical treatment of alveococcosis can be safe and feasible in the early stages of alveococcosis (P1-2H0M0), provided they are performed in a specialized hospital with sufficient technical equipment and an experienced surgeon.

Features of salt enteral solution application in the treatment of various forms of acute pancreatitis

The article presents the results of a retrospective study of the intestinal lavage (IL) with saline enteral solution (SES) effectiveness for the treatment of dynamic intestinal obstruction in acute forms of pancreatitis and pancreonecrosis. Objective: to study improve the results of patients treatment in intestinal paresis by various forms of acute pancreatitis, using IL lavage with the use of SES. Materials and methods. The study included 81 patients: 56 (69.1 %) men and 25 (30.9 %) women, average age 59.3 ± 13.4 years, who were hospitalized in the clinic at different times from the onset of the disease: from 24 hours to 7 days. Patients were divided in two groups: 1st group (46 people) included patients who started IL for the first 3 days after the onset of the disease; 2nd group (35 people) consisted of patients who started IL after 3 days of the disease, 30 patients of 2nd grouphad surgery before IL. Results. Prokinetic effect of IL in gastrostasis and dynamic bowel obstruction improve the quality of conservative treatment (up to 78.3 % in 1st group and 37.1 % in 2nd group); avoid open surgical interventions (up to 6.5 % in 1st group, up to 37.1 % in 2nd group), carry out decreasing invasive effects of drainage of limited focus (in 15.2 % of patients in 1st group, 42.9 % in 2nd group); eliminate the phenomen of gastrostasis within 3 days after IL in both groups. Reduction/elimination of the phenomen of dynamic intestinal obstruction after IL within 24 hours (up to 73.8 % in 1st group, up to 97.1 % in 2nd group), allowed to start early enteral nutrition within 48 hours (in 73.9 % of patients of 1st group, up to 42.8 % patients of 2nd group). Conclusions. Early using of intestinal lavage in the complex therapy of acute forms of pancreatitis is safe and effective and reduces the number of purulent-septic complications, prevents the development of multiple organ failure, reduces the overall mortality, prepares the intestine for early enteral nutrition.

Clinical Efficacy of Enteral Saline Solution When Used as Part of Combined Treatment for Various Forms of Acute Pancreatitis

The article presents the results of a retrospective study of the effectiveness of intestinal lavage with enteral saline solution for the treatment of dynamic intestinal obstruction in acute forms of pancreatitis and pancreonecrosis. The objective of this study is to improve treatment results in patients with intestinal paresis with various forms of acute pancreatitis with the use of intestinal lavage with enteral saline solution.Materials and methods. The study included 81 patients, 56 (69.1 %) males and 25 (30.9 %) females, the age averaging at 59.3 ± 13.4 years. These patients were hospitalized at different time intervals counting from the onset of the disorder, ranging from 24 hours to 7 days. Patients were divided in two groups depending on hospitalisation prior to the first procedure of intestinal lavage providing there was no counterindications.Results and discussion. Prokinetic effect of intestinal lavage in patients with gastrostasis and dynamic bowel obstruction help improve the quality of conservative treatment (up to 78.3 % in 1st group and 37.1 % in 2nd group); avoid open surgical procedures (up to 6.5 % in 1st group, up to 37.1 % in 2nd group), perform minimally invasive procedures to drain confined lesions (15.2 % of patients in 1st group, 42.9 % in 2nd group); eliminate manifestations of gastrostasis within 3 days following IL in both groups. The reduction/elimination of dynamic intestinal obstruction within 24 hours following IL (up to 73.8 % in 1st group, up to 97.1 % in 2nd group) made it possible to start early enteral nutrition within 48 hours (73.9 % in 1st group, up to 42.8 % in 2nd group).Conclusions. Early use of intestinal lavage in the complex therapy of acute forms of pancreatitis is safe and effective. It reduces the number of purulent-septic complications, prevents the development of multiple organ failure, reduces the overall mortality, prepares the intestine for early enteral nutrition.

Возможности экспериментального моделирования динамической кишечной непроходимости

Возможности экспериментального моделирования динамической кишечной непроходимости

Percutaneous resonance stimulation in complex correction of intraabdominal hypertension and dynamic intestinal obstruction in patients with severe acute pancreatitis

Aim. To evaluate an effectiveness of non-invasive stimulation of gastrointestinal peristaltic activity in complex correction of motor-evacuation disorders and intra-abdominal hypertension in patients with severe acute pancreatitis.Material and methods. There were 85 patients with severe acute pancreatitis. Patients were divided into two groups: group 1 (n = 43) – percutaneous resonance stimulation; group 2 (n = 42) – routine treatment of acute pancreatitis with intraperitoneal hypertension syndrome and dynamic intestinal obstruction according to normative documents. Intra-abdominal pressure was measured in 1, 3, 5, 7 days after disease onset. Abdominal perfusion pressure and filtration gradient were additionally calculated. Moreover, outcomes were assessed after 1, 3, 5, and 7 days according to visual-analogue scale.Results. There were faster regression of intraperitoneal hypertension followed by normalization of abdominal pressure after 7 days in group 1 compared with group 2 (p ≤ 0.05). Data of visual-analogue scale confirmed patients’ good tolerability of resonance stimulation including absent local discomfort during electrodes deployment and better state of health compared with group 2 (p ≤ 0.05). Infectious complications rate was 20.9% in group 1, 38.1% – in group 2. Sepsis developed in 3 (7%) patients of group 1 and in 7 (16.6%) patients of group 2. Overall mortality was 7% and 14.3% in both groups, respectively. Сonclusion. Percutaneous resonance stimulation is able to improve outcomes in patients with severe acute pancreatitis.

The case of dynamic intestinal obstruction, caused by an individual intolerance to vincristine in a child of 5 years

One of the key enzymes involved in the first phase of biotransformation of drugs is cytochrome P450 (CYP450), represented predominantly in the liver. Vincristine is metabolized mainly by CYP3A5 (75 %) and to a lesser extent CYP3A4 (whose level is lower in children). Low expression (CYP3A5*3 genotype) or even absence of CYP3A5 (in 80 % of Caucasians) and an age-related decrease in CYP3A4 activity leads to a five-fold decrease in vincristine clearance, its cumulation and development of an undesirable side reaction (CPD) — most often peripheral neuropathy, but its characteristic feature is the reduction of achilles reflexes and distal paresis after 2–3 injections. The article presents a case of a rare side effect of vincristine — damage to the nervous apparatus of the intestine with the development of dynamic obstruction. The complication of vincristine therapy is explained by the ethno-dependent decrease / absence of cytochrome P450 3A5, which metabolizes vincristine, which leads to cumulation of the drug.

Psychosomatic and psychopathological paradigms of alcoholic anorexia

IntroductionAlcoholic anorexia (AA), being one of prevalent narcology diseases, up to now has not been studied in psychosomatics and psychopathology paradigm.Aims and objectivesTo identify multifactorial pathopsychological, psychopathological, nervous, alimentary, toxicological constituents of AA pathogenesis.MethodTwenty-four patients with alcohol dependence (males aged 29–37) have been studied. Diagnosis was objectified by psychosomatic, pathopsychological complex international valid tests and rating, adequate for investigation design, laboratory, electrophysiology, biochemical, ultrasound and other methods.ResultsAA was accompanied with mental and physical post-intoxication exhaustion, asthenizing, tremor, dissomnia, depression, pre-delirium signs. Psychosomatic concept was proposed for reasonable identification of intranosological AA clinical forms in narcological clinical course. Anorectic dipsomaniac conditions are explained pathogenetically with psychosomatic mechanisms of deviant addictive craving behaviour as pathopsychological target and patient's intentional complete or partial refuse food consumption in favour of real in time more quick and brutal attainment of alcoholic drunkenness (Ebrietas Alcogolica). This anorexia fabula draws AA closer to Anorexia Nervosa and mostly reflects compulsive obsession with alcohol use. Pathopsychological, psychosomatic, neurogenous mechanisms of alcoholic anorexia of drinking bout early stages are transformed gradually to post-intoxication alimentary, nervous, psychic exhaustion. Meanwhile, АА is valid for alcohol withdrawal syndrome diagnosis and plays situation relapsing role in alcoholizing prolongation.ConclusionsAlcoholic anorexia is starting to declare even at early stages of alcoholic addiction formation. It is more illustrative in periodically recurrent and exaggerating drinking bouts when dynamic intestinal obstruction risk is high. Findings obtained ground alcoholic anorexia attribution to urgent conditions with necessary integrated relieving therapy and secondary prevention.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Pattern of dynamic intestinal obstruction in adults at tertiary care centre

Background: Mechanical intestinal obstruction is a common surgical emergency. The causes of intestinal obstruction include hernias, postoperative adhesions, malignancy, strictures etc. The etiology of this condition varies in different parts of the world and within same country. Aim of this study was to determine the etiology of intestinal obstruction, evaluate the factors affecting morbidity and mortality in our region. Methods: This prospective descriptive study was conducted in department of surgery at a tertiary care teaching hospital at Solapur from June 2012 to June 2014. All the adult patients, irrespective of sex with diagnosis of dynamic intestinal obstruction undergoing exploratory laparotomy were included in the study. Laparotomy findings were recorded and in the postoperative period patients were followed up for detection of complications and treatment. Results: 50 patients were treated for mechanical intestinal obstruction. Mean age was 49.5 years and male to female ratio was 1.7:1. External hernia (50%) was the commonest cause of intestinal obstruction followed by postoperative adhesion (39%).Wound infection was the commonest postoperative complication. Conclusions: External hernia is the leading causes of mechanical intestinal obstruction in our region. Old age, delayed presentation, associated co-morbidities, increases the morbidity and mortality in these patients.