High Intestinal Obstruction Research Articles

High intestinal obstruction presenting as acute renal failure.

High intestinal obstruction presenting as acute renal failure.

Afferent Loop Problems

Summary Problems related to the afferent loop of partial gastrectomy are reviewed. 1.Symptoms of high intestinal obstruction may be seen with acute afferent loop obstruction, commonly in the convalescent phase of gastrectomy; unless this is promptly recognized it will prove fatal. 2.A more insidious syndrome of postprandial fullness, nausea, and epigastric pain promptly relieved by vomiting of bile-stained material is related to chronic partial obstruction of the afferent loop. 3.The afferent loop may produce the blind loop phenomenon leading to malabsorption syndrome, especially related to vitamin B 12 and possibly folic acid. The clinical picture is usually that of a megaloblastic anemia resembling Addisonian pernicious anemia.

Carcinoma of the infrapapillary portion of the duodenum; a case report.

With the increased awareness of malignancies in the pancreaticogastroduodenal area, the accuracy of the diagnosis of duodenal carcinoma has improved. It is one of the differential diagnoses in high intestinal obstruction, gastrointestinal hemorrhage, weight loss, and pain. Carcinoma of the duodenum is rare, as shown in Kleinerman's report of only 0.038% in 487,000 autopsies. The three locations of carcinoma of the duodenum are: the suprapapillary, peripapillary, and infrapapillary areas. Carcinoma presents in the infrapapillary area in 15% of the cases; and only 20% of these are operable. Report of Case This 49-year-old white woman was admitted to the hospital with a history of progressive vomiting for 1 week, and solid food intolerance for about 3 weeks. She had lost 16 pounds in the 3-week period. Since the onset of the vomiting she had tolerated only clear liquids. She denied pain or weakness. The patient had no previous serious illnesses. She

Duodenal obstruction associated with acute pancreatitis of traumatic origin.

Intestinal obstruction and acute pancreatitis are well recognised sequelae of closed trauma to the abdomen but receive scant attention in the radiological and surgical text-books. The occurrence of both conditions simultaneously in the same patient does not seem to have been recorded before. Several cases of high intestinal obstruction following trauma to the upper abdomen have been reported in the literature, all being associated with an intramural haematoma in either the duodenum, upper jejunum or both. The radiological appearance of this lesion was originally described by Liverud (1948), and four more cases were recorded by Felson and Levin (1954), who regarded the appearances described by Liverud as pathognomonic. Proximally there is thickening of the mucosal folds and distally a smooth intraluminal mass with crowding of the valvulae conniventes producing a “coilspring” appearance. A similar appearance is occasionally produced in the absence of trauma in patients with a bleeding tendency, or even in a...

Nephrocalcinosis visible by x-ray associated with chronic glomerulonephritis.

Excerpt In 1947 Vaughan, Sosman and Kinney1presented a single unique case of nephrocalcinosis associated with chronic glomerulonephritis in which the calcification took the form of roentgenographic...

Annular pancreas producing duodenal obstruction in infancy; report of a successfully treated case.

Annular pancreas is a rare congenital anomaly in which the second portion of the duodenum is encircled by a band of pancreatic tissue, leading to symptoms of high intestinal obstruction. The severi...

Duplication of the stomach

Summary A case of duplication of the stomach is reported. The presenting findings were those of high intestinal obstruction with vomiting, marked dehydration, and a palpable epigastric mass. Resection of the distal one-third of the stomach including the duplication was carried out. The recovery was uneventful.

實驗的高位腸管閉塞の諸臟器及び體液の還元型ビタミンCに關する研究

實驗的高位腸管閉塞の諸臟器及び體液の還元型ビタミンCに關する研究

實験的高位腸閉塞の血液學的研究 (第三報)

實験的高位腸閉塞の血液學的研究 (第三報)

胃腸吻合術過誤に依る慢性通過障碍の一症例に就て

胃腸吻合術過誤に依る慢性通過障碍の一症例に就て

Round Table Discussion

Acidosis and alkalosis are terms used to describe opposite types of disturbance of acid-base balance of the body fluids. From the chemical point of view acidosis may be defined as the condition in the blood characterized by a reduction of the BHCO3/HHCO3 ratio, and alkalosis as an increase. When BHCO3 is primarily affected, the disturbance is referred to as metabolic in origin; when HHCO3 concentration is the first to be altered, the resulting change is considered to be of respiratory origin. Primary changes of either BHCO3 or HHCO3 usually stimulate compensatory changes in the other which tend to restore the original normal ratio. When compensation for acidosis is incomplete, an increased H+ ion concentration (decreased pH) of the blood results, and such a change is referred to as acidemia. The opposite condition is called alkalemia. From the clinical point of view a much broader concept of acidosis and alkalosis exists and includes in addition all related changes in metabolism (carbohydrate, fat, protein, water, mineral, enzyme) which may give rise to definite symptoms and signs of illness. Such metabolic changes may be either primary or secondary, and, as either, may be very important in determining prognosis as to life or death. In practice one is prompted to consider the possibility of acidosis or alkalosis by noting suspicious signs or symptoms and then diagnoses with certainty the presence and extent of change by chemical determinations of serum CO2 content and pH. The most important signs and symptoms of acidosis are: hyperpnea, which is considered not primary, stupor, dehydration, ketosis and strongly acid urine. Any or all may be absent. The most important signs and symptoms of alkalosis are: depressed respiration, considered compensatory, or hyperventilation, considered primary, tetany, and forceful vomiting, thought to be the result of pyloric or high intestinal obstruction, and strongly alkaline urine. Again any or all such symptoms may be absent. Furthermore, ketosis may be associated with alkalosis; secretion of alkaline urine may give rise to acidosis, and alkalosis may be accompanied by formation of acid urine. Also, it is not unusual to see in the same subject conditions favoring the development of both acidosis and alkalosis, but with the presence of neither. For absolute diagnosis of acidosis or alkalosis two of the three variables, BHCO3, HHCO3 and pH have to be determined. Since pH and BHCO3 usually move in the same direction, it has been widespread clinical practice to determine only BHCO3 by determining serum CO2 content by the Van Slyke manometric method. In this connection it should be remembered that when so determined about 20/21 of the CO2 comes from BHCO3, the remainder coming from HHCO3 In the past it was customary not to separate BHCO3 and HHCO3, but to record them together as the total CO2 content.

RENAL CALCIFICATION ACCOMPANYING PYLORIC AND HIGH INTESTINAL OBSTRUCTION

The purpose of this paper is to call attention to a not infrequent and often overlooked pathologic state occurring in patients subjected to a loss of gastric or high intestinal secretions over a long period. In medical and surgical wards such patients are frequently seen presenting symptoms of pyloric or high intestinal obstruction or being subjected to continuous gastric or intestinal drainage for the alleviation of distention and vomiting. The alarming clinical picture these patients present is frequently overlooked, and effective treatment of the condition is too often lacking. The patients, therefore, are permitted to succumb to a chemical acid-base imbalance, with its accompanying impaired renal function. At autopsy, they are often found to have extensive and apparently irreparable renal calcification. The early institution of proper therapy in such cases might often forestall this outcome, for the restoration of a proper chemical balance might restore or markedly improve the function

EXPERIMENTAL ADMINISTRATION OF DUODENAL CONTENTS TO DOGS WITH ACUTE HIGH INTESTINAL OBSTRUCTION

Attention has been called repeatedly to the similarity between the symptoms of acute high intestinal obstruction and those of duodenal fistula. Without going into a detailed review of theories as to the cause of death after high intestinal obstruction, we may say that considerable evidence has been presented that the loss of the contents of the upper part of the intestine by vomiting is a most important, or the most important, factor. The fact that dogs with a duodenal fistula suffer a rapid drop in blood chlorides, dehydration, rise of carbon dioxide—combining power and death within a few days, as shown by Eisberg 1 and by one of us, 2 strongly suggests that the loss of duodenal fluid by vomiting is of prime significance. Although the loss of pancreatic juice alone produces symptoms the same as or similar to those enumerated above, it cannot be stated as yet that this

High Intestinal Obstruction In the Dog Treated with Extract of Adrenal Cortex

Acute intestinal obstruction as a representative of a group of conditions that are characterized by hyperazotemia and hypochlo-remia bears resemblance to adrenal insufficiency.1,2,3 Indeed, we described the histologic1 changes of the adrenal glands in the dog with high intestinal obstruction as that of lipoid exhaustion of extreme degeneration of the adrenal cortex.∗In view of Kendall5 separation of 2 fractions of the cortical extract one of which produces results only when salt is administered with it, it seemed desirable to study the combined effect of cortical extract and salt solution in high intestinal obstruction. The amount of salt solution employed was considerably less than previously found sufficient to prevent adrenal exhaustion.High intestinal obstruction was induced on 6 dogs. The method, the preoperative and postoperative care were the same, as employed previously.1 Daily blood studies were made for NaCl, urea nitrogen, CO2 combining power of blood plasma, hemoglobin specific gravity and red...

SHOCK: THE MECHANISM OF DEATH FOLLOWING INTESTINAL OBSTRUCTION

The mechanism by which death results from intestinal obstruction remains a much debated question. The literature on this subject is voluminous, and extensive experimentation has led to dissension rather than to agreement. The reports are characterized by general similarity in the essential results of experimentation and by diversity of interpretation. No attempt will be made here to analyze these reports. The analysis by Cooper 1 considered 161 articles, and reflected the divergent views of the authors. He reviewed the evidence and interpretations and closed his summary with the unanswered question: What is the cause of death in high intestinal obstruction? In studies on shock of various origin in man and on experimental shock, we are struck by the similarity between that condition and the phenomena resulting from intestinal obstruction. When shock is induced in dogs without trauma and without the complicating factor of deep narcosis, a characteristic group of symptoms

Adrenal Glands in Dogs with High Intestinal Obstruction

In high intestinal obstruction in man,1 in the dog,2 and in the monkey3 the essential changes in the blood chemistry are primarily a fall in blood chlorides; usually a rise in alkaline reserve and a rise in non-protein nitrogen. The fall in the blood chlorides is not always conditioned by loss of chloride through vomiting.3 The group of conditions associated with hyperazotemia and hypochloremia4 bear certain clinical and chemical similarities; loss of weight, asthenia, and marked prostration, decline in blood pressure, rapid pulse, shallow respiration, dehydration and anhydremia.The mechanism of the nitrogen retention in these conditions is not well understood, but it would appear to be intimately related in a majority of instances to alterations of salt and water metabolism.4 Both clinically and biochemically the syndrome of hypochloremia and hyperazotemia resembles adrenal insufficiency in Addison's disease.The findings recorded were observed in studies to determine whether the adrenal glands are altere...

Surgical treatment of peptic ulcerations: Billroth I method

The limitations, dangers and indications of the various methods of Billroth I anastomosis for duodenal ulcer have been pointed out. The technique of a typical Haberer modification of a Billroth I end-to-end procedure has been described. None of the variations of the Billroth I method should be used where there is a malfunction or stasis of the duodenum. An orientation of the anatomical relationships is of paramount importance before a resection of the duodenal ulcer is undertaken. The relationship of the part of the duodenum to be removed to the pancreatic duct, hepatic artery, the portal vein and the pancreas should be definitely established before a resection of the duodenum is undertaken. For this reason, in the obviously difficult cases, the common duct should be isolated and identified. If one anticipates an injury to the pancreas or the pancreatico-duodenal artery it is inadvisable to continue with a radical resection of the duodenum. One should proceed with an exclusion resection operation according to Finsterer. The infrapapillary end-to-side type of Billroth I operation is contraindicated on account of the frequency of high intestinal obstruction from too extensive mobilization of the duodenum and kinking at the mesenteric root. The Haberer-Finney end-to-side modification of the Billroth I method is characterized by frequent postoperative vomiting. It should be practiced only under exceptionally favorable anatomical conditions. Where the head of the pancreas is too large, or where the individual is too fat, and where the mobilization of the duodenum appears to be difficult, this method is contraindicated. Eleven cases of the Haberer modification of Billroth I end-to-end and 3 cases of the terminolateral anastomosis of Billroth I procedures are recorded with no mortality and no morbidity. In this group are included 2 cases of jejunal ulceration following gastroenterostomy and also 3 acutely bleeding duodenal ulcers. The Billroth I end-to-end modification by Haberer is anatomically and physiologically a correct operation and gives excellent results. In a larger series of cases Finsterer's modification of Billroth II method will give better functional results and a lower mortality. An understanding of the physiological principles and anatomical relations and the details of technique in the resection of the duodenum and in the completion of the Billroth I anastomosis for duodenal ulcer is of utmost importance. The mortality can be reduced when only those ulcers are attacked which can be removed with safety. For those ulcers which are dangerous to remove some other surgical procedure should be substituted.

About internal restraints after stomach surgery

The author observed two cases of intestinal obstruction due to entrapment after stomach surgery. The author performed over 560 gastric resections and 110 gastroenterostomies. Clinically, this complication manifests itself as high intestinal obstruction, more often acute, less often chronic.

EXPERIMENTAL OBSTRUCTION OF JEJUNUM

It is well recognized that there is a decrease in chlorides and an increase in the carbon dioxide-combining power and in the nonprotein nitrogen and the urea nitrogen of the blood in intestinal obstruction. The role played by water, when administered by mouth, on the extent of these changes and on length of life has been little studied. A more thorough investigation was thought indicated, particularly since determinations of the chemical composition of the blood are being increasingly used as a guide for treatment of obstruction of the pylorus and small bowel. In an earlier study of the changes occurring in the blood incident to high intestinal obstruction, the average length of life of dogs was observed.1These animals were allowed as much water as they wanted, and the average length of life of thirty-five dogs in which the upper part of the jejunum was obstructed was 6.8 days.

RUPTURE OF THE GASTROCOLIC OMENTUM AS A COMPLICATION OF WHOOPING COUGH

The complications of whooping cough are numerous and varied. Rarely, however, does the rupture of an abdominal viscus occur during this disease as the result of severe coughing. The following case is an illustration of this unique complication. <h3>REPORT OF CASE</h3> <i>History.</i>—In consultation with Dr. Charles A. James, I saw a poorly nourished girl, 2 years of age, in the third week of an attack of whooping cough. Two days previously she had an unusually severe attack of coughing which terminated in a convulsion. Following the convulsion the child remained pale, weak and restless. The temperature of the outside atmosphere at this time, midsummer, reached a daily maximum of about 110 F. (43.3 C.). This fact was significant, because fluids given by mouth were not retained, and the child became dehydrated and presented the symptoms of high intestinal or pyloric obstruction. The temperature rose to 105 F. (40.5 C.).