Etiology Of Intestinal Obstruction Research Articles

Etiology of Intestinal Obstruction - Correlation between Pre-operative and Per-operative Findings with Histopathology

Background: Intestinal obstruction is one of the most common causes of acute abdomen and often requires surgical intervention. However, pre-operative and per-operative diagnosis often do not correlate with postoperative histopathology done in suspected cases. Therefore, the study was designed to identify the etiology of intestinal obstruction correlating to pre-operative and per-operative findings with postoperative histopathological findings in suspected cases. Methods: A cross sectional study was conducted at the department of General Surgery, Mymensingh Medical College & Hospital, Mymensingh for 18 months following ethical approval from Institutional Review Board (IRB) of Mymensingh Medical College. During the study period, all patients with suspected intestinal obstruction admitted in Department of Surgery were included based on selection criteria. Total 103 patients were assessed in pre-operative and per-operatively. Histopathological examination was done in suspected cases where diagnosis could not be confirmed without histopathology. Data collection was done with a data collection form. After collection of all the required data, final analysis was carried out by using the SPSS version 21.0. Results: Among 103 cases of intestinal obstruction, mean age was 45.50±14.37 SD (years) with male female ratio-1.78:1. About 66% came from rural areas and 34% were from urban areas. Abdominal pain was the commonest symptom present among the cases which was observed in 91.3% cases. Others common symptoms were vomiting, abdominal distension absolute and relative constipation in 72.8%, 69.9%, 12.6% and 63.1% cases respectively, while abdominal tenderness was the commonest sign present in all cases. Among study population, 68.9% was small bowel obstruction and 31.1% was obstruction in large bowel. According to per-operative findings 22.3% cases were suspected as malignant. Finally 24.3% cases were proved as malignant in subsequent histopathological examination and 75.7% cases

Alternativni terapijski pristupi kod paralitičkog ileusa u perzijskoj medicini

Paralytic ileus is a prevalent medical condition following surgery, exerting a significant financial impact on the healthcare system. Despite its considerable implications, there has been limited progress in advancing both diagnostic and curative approaches to address ileus. This study seeks to introduce alternative diagnostic methodologies rooted in Persian medicine (PM) for paralytic ileus. Our investigation involved a thorough review of literature, including The Canon of Medicine, and an exploration of various PM texts for relevant references. The findings were systematically compared with contemporary medical documentation. According to Persian medicine, paralytic ileus is classified as a type of ‘Gholanj’ disease. Persian medicine physicians extensively documented this disease, presenting detailed insights. While some aspects of PM viewpoints and the etiology of intestinal obstruction were humoral-theory-based, a majority of his definitions align with current medical concepts. Additionally, Persian medicine physicians proposed numerous therapeutic approaches for managing ileus, such as the Hoghne method, rectal suppositories, topical application of medicines, sitz baths, and the use of laxatives. Gaining a deeper understanding of the pathophysiology and exploring alternative treatment options outlined in Persian medicine can prove valuable for future studies aimed at enhancing the management of paralytic ileus.

RETROSPECTIVE STUDY OF INTESTINAL OBSTRUCTION IN 50 CASES IN A TEACHING HOSPITAL

Mechanical bowel obstruction is a frequently encountered surgical emergency and continues to remain a challenge to surgeons despite advances in eld of medicine, pathophysiology, surgical technique and conservative management. This retrospective study in patients operated for acute mechanical bowel obstruction in our department, was intended to highlight the common causes of intestinal obstruction in this geographical location of the study which had suggested measures for treatment of the condition. 50 patients who underwent exploratory laparotomy for intestinal obstruction were compared in terms of age, sex, symptoms, etiology of intestinal obstruction, site of obstruction, operative procedure performed and post operative complications.

The role of obstructive resection in the treatment of acute intestinal obstruction complicated by bowel necrosis

Methods of surgical intervention in acute intestinal obstruction with necrosis of the strangulated area of the intestine are the subject of ongoing discussions. There is no doubt that every patient with this disease should undergo emergency surgery. However, diagnosing necrosis of the strangulated area is not easy. For this reason, a number of authors recommend refraining from emergency surgery for all patients with intestinal obstruction during dynamic follow-up, which can last up to 14 days. Over the past century, the etiology of intestinal obstruction has shifted from strangulated hernia to postoperative adhesive disease, which has led to a paradigm shift in methodological approaches. In order to successfully manage acute intestinal obstruction with suspected strangulation, the clinician today must be able to distinguish between patients requiring urgent surgery and those who should receive conservative therapy.In this paper, we consider the surgical approach of delayed anastomosis formation on significant clinical material, including tactical approaches, timing and necessary conditions for anastomosis formation in patients with intestinal obstruction complicated by necrosis of the strangulated area.The complex of therapeutic measures in the treatment of patients with acute intestinal obstruction complicated by necrosis of the strangulated area of the intestine, intraoperative perforation of the intestine during separation of adhesions, both in conditions of peritonitis and without it, should include obstructive resection of the intestine in combination with the formation of an anastomosis in a delayed order, as well as or planned sanitation of the abdominal cavity. All this makes it possible to reduce the incidence of interintestinal anastomosis failure from 86.7 to 0.96% of cases, and postoperative mortality from 41.8 to 14.4%.

Imaging Signs for Determining Surgery Timing of Acute Intestinal Obstruction.

We aimed to analyze the computed tomography (CT) imaging signs of bowel wall ischemia in patients with acute intestinal obstruction and construct an imaging prediction model to guide clinical treatment. The CT imaging signs of patients with acute intestinal obstruction diagnosed in our center in recent 6 years were collected for retrospective analysis. The etiology of intestinal obstruction and incidence rate of bowel wall ischemia were recorded, and the specific CT findings of bowel wall ischemia, including mesenteric edema, bowel wall thickening, and fish tooth sign, were analyzed. Among the 302 patients selected, 130 surgically treated patients were eligible for analysis. Bowel wall ischemia in acute intestinal obstruction showed an incidence rate of 14.90%, and the incidence rates of bowel wall ischemia in intra-abdominal hernia, intussusception, incarcerated external abdominal hernia, and volvulus were about 92.30%, 50%, 35.71%, 33.33%, and 12.59%, respectively. The incidence rate of bowel wall ischemia in simple adhesive intestinal obstruction was about 12.59%, and that in malignancy-induced intestinal obstruction was about 6.56%. Univariate analysis revealed 5 factors with statistical significance, including bowel wall thickening, mesenteric edema, bowel wall pneumatosis, ascites, and fish tooth sign. Multivariate logistic regression analysis indicated that fish tooth sign, bowel wall thickening, and mesenteric edema were able to predict bowel wall ischemia, and the corresponding partial regression coefficients were 2.164, 1.129, and 1.173, odds ratios (ORs) were 8.707, 3.093, and 3.232, sensitivity was 0.356, 0.400, and 0.844, and specificity was 0.859, 0.835, and 0.529, respectively. Imaging signs of bowel wall thickening, mesenteric edema, and fish tooth sign are valuable in predicting bowel wall ischemia, among which bowel wall thickening and mesenteric edema have relatively high specificity and fish tooth sign has a relatively high sensitivity. Furthermore, a fish tooth sign has the most favorable predictive value for bowel wall ischemia in acute intestinal obstruction, followed by bowel wall thickening and mesenteric edema.

Acute intestinal obstruction secondary to left paraduodenal hernia: a case report

Paraduodenal hernia, the most common type of internal herniation, is rare in the etiology of intestinal obstruction. Delayed diagnosis and surgical intervention may result in significant morbidity and mortality risk. This report presents a case of left paraduodenal hernia resulting in acute intestinal obstruction. A 43-year old male patient was admitted with a diagnosis of acute intestinal obstruction. A left paraduodenal hernia was identified by computed tomography findings of an encapsulated cluster of dilated small bowel loops occupying the left upper quadrant between the stomach and pancreas, and the presence of an engorged and displaced vascular pedicle at the orifice of the hernia. Upon further investigation, the dilated proximal jejunal segments were found in the left paraduodenal fossa, enclosed in a hernia sac. After reducing the intestinal segments to the abdominal cavity, the orifice of the hernia sac was closed by suturing to the retroperitoneum. Paraduodenal hernia should be considered as a possible etiology in cases of acute intestinal obstruction with unremarkable presentations. Physicians should be familiar with the demonstrative imaging findings of computed tomography of a paraduodenal hernia. Early surgical intervention is critical to prevent the significant morbidity and mortality associated with this condition.

Secondary Causes of Intestinal Obstruction: Rigorous Preoperative Evaluation is Required

The clinical presentation, management and outcome of patients with small intestinal and large bowel obstruction unrelated to adhesive or primary colonic neoplastic disease is not well described. The aim of this study was to determine the clinical presentation, evaluation, operative management, and outcome in patients with secondary causes of intestinal obstruction. The medical records of 200 patients who underwent an operation for intestinal obstruction from January 1995 through December 1997 were reviewed. Seventy-three patients (37%) had secondary causes of intestinal obstruction, and these records were reviewed in detail. The cohort included 37 men and 36 women with a mean age of 52 +/- 2 years. The etiology of intestinal obstruction was metastatic neoplastic obstruction (19%), colonic volvulus (18%), Crohn's disease (14%), herniae (11%), diverticular disease (7%), and miscellaneous causes (31%). Six patients (8%) had intestinal motor disorders and a misdiagnosis of intestinal obstruction. The clinical presentation of patients with secondary causes of obstruction was similar to typical patients with adhesive small bowel obstruction. Preoperative evaluation included frequent use of CT (42%), but intestinal contrast studies were used in 13 (18%) patients only. Two-thirds of the patients required an intestinal resection, and 50 per cent of the patients with a misdiagnosis had a nontherapeutic celiotomy. Operative mortality and morbidity were 3 per cent and 48 per cent, respectively, and 15 per cent of patients required reoperation. Suspected intestinal obstruction from secondary causes requires rigorous preoperative evaluation with liberal use of intestinal contrast examinations to avoid misdiagnosis, operative complications, and reoperations.

Re: The etiology of intestinal obstruction in patients without prior laparotomy or hernia

Re: The etiology of intestinal obstruction in patients without prior laparotomy or hernia

Small Bowel Obstruction Associated with a Leiomyomatous Uterus

A 38-year-old woman developed small bowel obstruction shortly after a cholecystectomy because of a massively enlarged leiomyomatous uterus. Small bowel obstruction is a relatively rare complication from fibroid tumors and results from entrapment of the bowel between serosal pedunculated fibroids (as in this patient), adhesions to infarcted leiomyomas, or from compression of the small bowel by the large mass. Large uterine leiomyomas clearly must be considered in the etiology of intestinal obstruction.

A clinical study of acute intestinal obstruction : Meyer, Karl A. and Brams, William A.Illinois M. J., Jan., 1927, li, 43

INTRODUCTION : Intestinal obstruction is defined as any hinderance to the passage of intestinal contents. It may be classified as dynamic and adynamic obstruction. Dynamic obstruction is one of the most serious and frequently encountered emergencies presenting as acute abdomen. The present study is conducted with objectives to find out the frequency of various etiological factors of intestinal obstruction and to evaluate the morbidity and mortality in adult patients presenting with intestinal obstruction. AIMS AND OBJECTIVES : 1. To study incidence and various etiology of intestinal obstruction. 2. To study the various modes of presentation, importance of early diagnosis and management. 3. To study the role of imaging studies in determining site and etiology. 4. To study the morbidity and mortality rate in acute intestinal obstruction. MATERIALS AND METHODOLOGY : All patients who presented with symptoms and signs of bowel obstruction, admitted and managed surgically from June 2014 to June 2016 in the Department of General Surgery are included in this study. Diagnosis is based on the history, clinical findings, and supported by ultrasonography and radiological studies (plain x-rays) in all patients. Final diagnosis is made at exploratory laparotomy. Inclusion Criteria : 1. All patients presenting to emergency department with features of intestinal obstruction and are treated surgically. 2. Patients in the age group 15 to 75 years. 3. Patients who are haemodynamically stable. Exclusion Criteria : 1. Patients presenting with subacute intestinal obstruction and treated surgically. 2. Paediatric age group patients. CONCLUSION : This study on acute intestinal obstruction was aimed at studying the age and sex distribution, various etiologies, clinical presentations, treatment and outcomes of acute intestinal obstruction. Acute intestinal obstruction remains to be one of common surgical surgeries. Males are commonly affected mostly during their fifth decade. Obstructed/strangulated inguinal hernia remains to be the most common cause followed by adhesions. They usually present with abdominal pain with multiple air fluid levels in their X-ray abdomen erect view. The initial management of patients with acute intestinal obstruction should focus on aggressive fluid replacement, decompression of the obstructed bowel, and on prevention of aspiration. Surgery remains the cornerstone of treatment. Earlier diagnosis and timely intervention are associated with excellent prognosis. Delayed diagnosis leading to strangulation and increased age are associated with poor outcomes.