Incidence Of Intestinal Obstruction Research Articles

The effect of preoperative mechanical bowel preparation in paediatric bowel surgery on postoperative wound related complications: A meta-analysis.

Mechanical bowel preparation (MBP), a routine nursing procedure before paediatric bowel surgery, is widely should in clinical practice, but its necessity remains controversial. In a systematic review and meta-analysis, we evaluated the effect of preoperative MBP in paediatric bowel surgery on postoperative wound-related complications in order to analyse the clinical application value of MBP in paediatric bowel surgery. As of November 2023, we searched four online databases: the Cochrane Library, Embase, PubMed, and Web of Science. Two investigators screened the collected studies against inclusion and exclusion criteria, and ROBINS-I was used to evaluate the quality of studies. Using RevMan5.3, a meta-analysis of the collected data was performed, and a fixed-effect model or a random-effect model was used to analyse OR, 95% CI, SMD, and MD. A total of 11 studies with 2556 patients were included. Most of studies had moderate-to-severe quality bias. The results of meta-analysis showed no statistically significant difference in the incidence of complications related to postoperative infections in children with MBP before bowel surgery versus those with No MBP, wound infection (OR 1.11, 95% CI:0.76 ~ 1.61, p = 0.59, I2 = 5%), intra-abdominal infection (OR 1.26, 95% CI:0.58 ~ 2.77, p = 0.56, I2 = 9%). There was no significant difference in the risk of postoperative bowel anastomotic leak (OR 1.07, 95% CI:0.68 ~ 1.68, p = 0.78, I2 = 12%), and anastomotic dehiscence (OR 1.67, 95% CI:0.13 ~ 22.20, p = 0.70, I2 = 73%). Patients' intestinal obstruction did not show an advantage of undergoing MBP preoperatively, with an incidence of intestinal obstruction (OR 1.95, 95% CI:0.55 ~ 6.93, p = 0.30, I2 = 0%). Based on existing evidence that preoperative MBP in paediatric bowel surgery did not reduce the risk of postoperative wound complications, we cautiously assume that MBP before surgery is unnecessary for children undergoing elective bowel surgery. However, due to the limited number of study participants selected for this study and the overall low quality of evidence, the results need to be interpreted with caution. It is suggested that more high quality, large-sample, multicenter clinical trials are required to validate our findings.

O6: Trends in the mortality, incidence, and disability-adjusted life-years of intestinal obstruction and paralytic ileus: an observational study of the Global Burden of Disease database

Abstract Background Intestinal obstruction and paralytic ileus place a substantial burden on global healthcare systems despite its aetiology often being amenable to preventative healthcare interventions. Further characterisation of the disease burden in EU15+ countries may help optimise the delivery of healthcare services. This observational analysis assessed the trends in mortality and incidence of intestinal obstruction and paralytic ileus in European Union (EU) 15+ countries between the years 1990 and 2019. Methods Sex-specific age-standardised mortality rates (ASMRs), age-standardised incidence rates (ASIRs) and disability-adjusted life years (DALYs) data for intestinal obstruction and paralytic ileus were extracted from the 2019 Global Burden of Disease (GBD) study. Temporal trends across the observation period were analysed using Joinpoint regression analysis. Results The median ASMRs across EU15+ countries in 2019 were 1.96/100,000 and 2.16/100,000 for females and males, respectively. Between 1990 and 2019 the median percentage change in ASMR was -8.11% for females and +5.50% in males. The median ASIRs in 2019 for females and males were 150/100,000 and 133/100,000, respectively, with a median percentage change of +18.7% for females and +15.3% for males during the observation period. Decreasing trends in DALYs were observed over the 30-year study period, with median percentage changes of -11.86% and -5.80% for females and males, respectively. Conclusion Overall, increasing ASIRs of intestinal obstruction/paralytic ileus were observed across EU15+ countries, with modest overall decreases in ASMRs. Variations in both diagnostic and management strategies for intestinal obstruction/paralytic ileus over the observation period are likely contributors to the changing disease burden.

Clinical efficacy of anastomotic reinforcement suture in preventing anastomotic leakage after rectal cancer surgery: a systematic review and meta-analysis.

Anastomotic leakage (AL) is a common postoperative complication of rectal cancer, with an incidence of about 10%, and the efficacy of reinforced sutures for preventing AL remains contentious. This study investigated the safety and effectiveness of reinforcement sutures for preventing AL after rectal cancer surgery. The present authors conducted a systematic search in the PubMed, Embase, Cochrane Library, Sinomed, Web of Science, Wanfang, VIP, and CNKI databases for randomized controlled trials (RCTs) and nonrandomized studies up to June 2023. We performed a meta-analysis to evaluate the efficacy of anastomotic reinforcement sutures after rectal cancer surgery. The primary outcome measures were AL, anastomotic bleeding, and infection rates. Eleven articles (1921 subjects) were analyzed, with 912 and 1009 cases in the reinforced and unreinforced suture groups, respectively. The reinforced suture group showed a lower AL incidence (odds ratio [OR]=0.25, 95% CI 0.17-0.37, P< 0.00001), lower infection rate (OR=0.41, 95%CI 0.19-0.89, P<0.05), shorter hospital stay (mean difference [MD]=-0.57, 95%CI -1.15-0.00, P≤0.05), and earlier anal exhaust (MD=-0.12, 95%CI -0.23-0.00, P<0.05). However, the operative time (MD=18.25, 95% CI 12.20-24.30, P<0.00001) was longer for reinforced sutures than for unreinforced sutures. There were no significant differences between the suture techniques in intraoperative blood loss MD=2.74, 95% CI -4.50-9.97, P>0.05), incidence of anastomotic bleeding (OR=0.49, 95%CI 0.12-1.97, P>0.05), and incidence of intestinal obstruction (OR=0.65, 95%CI 0.27-1.61, P>0.05). Existing articles indicate that anastomotic reinforcement sutures can significantly reduce AL incidence. However, this conclusion still requires confirmation based on multicentre, high-quality RCTs with large sample sizes.

Network meta-analysis comparing the clinical outcomes and safety of robotic, laparoscopic, and transanal total rectal mesenteric resection for rectal cancer

Objective: To methodically assess the clinical effectiveness and safety of robot-assisted total rectal mesenteric resection (RTME), laparoscopic-assisted total rectal mesenteric resection (laTME), and transanal total rectal mesenteric resection (taTME). Methods: A computer search was conducted on PubMed, Embase, Cochrane Library, and Ovid databases to identify English-language reports published between January 2017 and January 2022 that compared the clinical efficacy of the three surgical procedures of RTME, laTME, and taTME. The quality of the studies was evaluated using the NOS and JADAD scales for retrospective cohort studies and randomized controlled trials, respectively. Direct meta-analysis and reticulated meta-analysis were performed using Review Manager software and R software, respectively. Results: Twenty-nine publications comprising 8,339 patients with rectal cancer were ultimately included. The direct meta-analysis indicated that the length of hospital stay was longer after RTME than after taTME, whereas according to the reticulated meta-analysis the length of hospital stay was shorter after taTME than after laTME (MD=-0.86, 95%CI: -1.70 to -0.096, P=0.036). Moreover, the incidence of anastomotic leak was lower after taTME than after RTME (OR=0.60, 95%CI: 0.39 to 0.91, P=0.018). The incidence of intestinal obstruction was also lower after taTME than after RTME (OR=0.55, 95%CI: 0.31 to 0.94, P=0.037). All of these differences were statistically significant (all P<0.05). There were no statistically significant differences between the three surgical procedures regarding the number of lymph nodes cleared, length of the inferior rectal margin, or rate of positive circumferential margins (all P>0.05). An inconsistency test using nodal analysis revealed no statistically significant differences between the results of direct and indirect comparisons of the six outcome indicators (all P>0.05). Furthermore, we detected no significant overall inconsistency between direct and indirect evidence. Conclusion: taTME has advantages over RTME and laTME, in terms of radical and surgical short-term outcomes in patients with rectal cancer.

Bowel obstruction incidence in urinary diversion patients: A meta-analysis study.

Bowel obstruction is a common complication that occurs in patient who underwent urinary diversion with an incidence of 0.7%-11%. Although previous studies have published risk factors, prevention and management of postoperative paralytic ileus, and data on urinary postdiversion bowel obstruction in the literature are still scarce and thus require further investigation of the diversion technique which allegedly has differences in pathogenesis, management, and results. To that end, this study conducted a systematic review study to compare two different diversion techniques, namely ileal conduit and continent diversion, especially orthotopic neobladder. This study is a systematic review by searching study in online databases such as PubMed, EBSCOhost, and ProQuest. Inclusion criteria included are full-text articles, English language, and articles of the past 10 years. After searching, we analyzed quantitatively using the RevMan application for meta-analysis. From 3403 studies, we got 12 studies that were included in the analysis. In a study conducted from the study of van Hemelrijck et al. stated that intestinal obstruction has an incidence of 50.73-1000, the third-highest when compared with advanced complications such as death (145.07/1000 population) and urinary tract infections (127.03/1000 population). It was found that odds ratio was 0.64 (0.45-0.91). The ileal conduit and orthotopic neobladder methods have no significant difference in the incidence of intestinal obstruction.

Клінічний випадок гострої кишкової непрохідності під час вагітності в пацієнтки з ектракорпоральним заплідненням та великим інтергенетичним інтервалом

The great importance in the development of acute intestinal obstruction (AIO) is the change in intestinal kinetics during pregnancy. In pregnant women, the rhythmic function of the intestine slows down due to an increase in the threshold of excitability of its receptors to biologically active substances. The article provides an overview of modern literary sources on the problem of acute intestinal obstruction in pregnant women. According to foreign literature sources, the incidence of intestinal obstruction in pregnant women is 1:3600–1:66000, and complications of diseases of the digestive system rank 4th among the causes of maternal mortality during pregnancy — 9%. According to domestic scientific sources, the frequency with which intestinal obstruction occurs in pregnant women is 1:40000–1:50000 births, mortality reaches 35–50%, stillbirth — 60–75%. The development of the disease is caused by physiological changes in the body of a pregnant woman. With increasing gestational age there are changes in the anatomical arrangement of the abdominal organs. From the second trimester of pregnancy, the uterus extends beyond the pelvis and gradually occupies the entire abdominal cavity. The increase in the size of the uterus due to hypertrophy and hyperplasia of muscle fibers, amniotic fluid, fetal growth, leads to increased intraabdominal pressure, displacement of the small intestine and lumbar colon up, thereby creating conditions for compression of intestinal loops, nodules, development. The modern classification, clinic, diagnostics and methods of treatment of this surgical pathology are presented. The author presents his own clinical case of acute intestinal obstruction in a 51-year-old pregnant woman with the sixth desired pregnancy, which occurred as a result of assisted reproductive technologies and a large intergenetic interval. Both surgeon and obstetrician-gynecologist treat intestinal obstruction in pregnant women. Conservative treatment is carried out simultaneously with diagnostic procedures. No effect of conservative therapy for 2 hours is an indication for surgery. The main purpose of surgery is to eliminate the causes of intestinal obstruction and restore bowel function. The scope of surgery is determined in each case individually and depends on the type of AIO and the age of the disease. The chosen tactics of the preoperative period, the volume of surgery, anesthesia and adequate management of the postoperative period can cure acute surgical pathology, maintain the desired pregnancy, avoid the development of obstetric and surgical purulent-septic complications. 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. No conflict of interest was declared by the authors. Key words: sharp bowel obstruction, pregnancy, extracorporal impregnation, large intergenic interval.

HOW TO DEFINE THE LEVEL OF INTESTINAL RESECTION IN COMPLICATED FORMS OF INTESTINAL OBSTRUCTION IN CHILDREN

Introduction. The bowel (intestinal) obstruction is a very common case in pediatric surgical practice. Intestinal transit disorders in children are caused by organic or functional problems of congenital origin or by acquired pathology. The incidence of intestinal obstruction is steadily increasing. This is due to an increasing number of cases with congenital gastrointestinal tract malformations as well as to an increasing number and volume of surgical intestinal interventions. Materials and methods. 76 patients, aged 0 months - 14 years, with various forms of intestinal obstruction were taken into the study. All patients were divided into 2 groups. The control group had 30 patients who were treated in medical facilities of the first level; the studied group included 46 patients who were operated in our clinic. In patients from the studied group, the viability of intestine and the level of resection were defined using the original technique “ Detection of the area of local necrosis and the level of intestine resection in children with intestinal obstruction “ , patent No 2 690744, Russian Federation, developed on the basis of another patent No 2 594 978 of Russian Federation “A technique for modeling local intestinal wall necrosis in the experiment.” The technique is as follows: While performing electrical stimulation of the intestinal wall with neurostimulator HNS 12, one can see a characteristic funnel-shaped depression indicating intestinal necrosis. The level of resection is determined by moving the electrode from the central part of the studied zone to distal and proximal directions until the circular contraction of the intestine appears. Results. This technique prevented relaparotomies, reduced transfer to enteral feeding by 33%, reduced the incidence of prolonged intestinal paresis by 62.5%, reduced patients’ stay in ICU by 41% and postoperative hospital stay by 24% as well as accelerated rehabilitation process by 27.3%. Conclusion. The technique developed for detecting the area of local necrosis and the level of intestinal resection promotes a most careful resection of the affected area of the intestine till healthy tissues, as well as prevents complications requiring surgical correction.

A retrospective study of age and sex distribution in non-traumatic acute abdomen in a tertiary care hospital

Background: Acute abdominal pain is one of the most frequent causes of admission to emergency departments. Here the difference of outcomes or etiology of acute abdominal pain according to age is an important criteria. The aim is to study the age and sex distribution of these conditions. In Trichy SRM Medical College Hospital and Research Centre, Irungalur, Trichy. Methodology of study: This study material consists of 200 cases of Acute Abdomen admitted in Five Surgical units in our Department Of Surgery, Trichy SRM Medical College Hospital And Research Centre, during the period from Oct 2017 to sep 2019.All the patients admitted with acute abdomen pain were thoroughly examined and appropriate investigation taken.Results: Among 200 patients acute appendicitis is the commonest non traumatic abdominal emergency with male dominance in 3rd decade. Duodenal perforation is common in males of 4th and 5th decade. There is a decrease in the average age of peptic ulcer perforation with an overwhelming majority of male patients. The incidence of intestinal obstruction is equal in both males and females, mostly due to post-operative adhesions. Inguinal hernia is the commonest obstructed hernia with male dominance with a shift towards the younger age group.Conclusion: Judging from the results of this present study it comes to a firm conclusion that acute abdominal emergencies incidence is more common in males when compared to female and the most common age group is 20-50 years.

Effect of transcutaneous electrical acupoint stimulation combined with chewing gum on postoperative gastrointestinal function after colorectal cancer resection

Objective To explore the effects of transcutaneous electrical acupoint stimulation (TEAS) combined with chewing gum on the recovery of gastrointestinal function after colorectal tumor resection. Methods A total of 156 patients who underwent laparoscopic radical resection of colorectal cancer in Department of Gastrointestinal Surgery in Guangxi Medical University Affiliated Tumor Hospital were selected as participants in this study by convenience sampling from September of 2016 to September of 2017 and divided into the conventional group, TEAS group, combination group with 52 patients in each group based on random number table. The conventional group received conventional nursing care after surgery, and the TEAS group received TEAS intervention apart from that, and the combination group received gum chewing combined with TEAS intervention. The first bowel sounds, first anal exhaust, first anal defecation, first tolerance to solid food, hospitalization time and complications were compared among the three groups. Results There were significant differences in the first anal exhaust, the first tolerance to solid food and the first defecation time among the three groups (P 0.05) , but the incidence of intestinal obstruction in the combination group was lower than that in the TEAS group and the conventional group with statistical difference (P< 0.05) . Conclusions TEAS combined with chewing gum can promote the recovery of gastrointestinal function and reduce the incidence of ileus after radical resection of rectal cancer. Key words: Colorectal neoplasms; Transcutaneous electrical acupoint stimulation; Chewing gum; Gastrointestinal function

Prevalence of Intestinal Obstruction in Patients Attending Tertiary Care Institute of Gujarat

Background: Intestinal defined as obstruction in forward propulsion of the contents as obstruction in the intestine either due to mechanical or neurological cause. Aim of the present study was to know the various causes of intestinal obstruction and also to analyse the symptomatology of intestinal obstruction. Subjects and Methods: The present study was under taken with the aim to evaluate the various causes and the mode of presentation. A total of 60 cases of the intestinal obstruction attending Department of Surgery, tertiary care institute of Gujarat for the period of two years were included in the study. All the patients were assessed clinically in details after admission. All the pathological and biochemical investigations were carried out in all the patients. Results: The mean age was found to be 43 years. The intestinal obstruction was found to be more common in male as compared to female. More number of cases was of small bowl obstruction as compared to large bowel obstruction. Majority of the patients had the symptoms of tenderness. It was found in 93% of the cases. Next was the pain present in the abdomen found in 83%, followed by vomiting present in 80% of the cases. Conclusion: The incidence of intestinal obstruction is more common in males compared to females. Patients with a clinical picture of obstruction of the bowel demand vigorous correction of fluid and electrolyte, which can be severe, and life threatening. Intestinal obstruction is more common in the age group of 30-60 years. Large bowel obstruction is more common in patients above 40 years than in younger group. Intestinal obstruction was also found more common in young children.

Laparoscopic radical cystectomy with pelvic re-peritonealization: the technique and initial clinical outcomes

BackgroundDelayed bowel function recovery and postoperative ileus are relatively serious complications of laparoscopic radical cystectomy (LRC). Our study aimed to determine whether performing pelvic re-peritonealization reduces the incidence of these complications.MethodsClinical data of 78 patients who had undergone LRC with pelvic re-peritonealization from August 2015 to December 2017 were retrospectively collected and compared with those of 92 patients who had undergone LRC alone between January 2013 and July 2015 in our institution. Differences in duration of surgery, estimated blood loss, time to recovery of bowel function, the complications of intestinal and blood vessel injury, and incidence of postoperative ileus between the two groups were analyzed.ResultsBaseline characteristics such as age, sex and BMI were balanced between the two groups. There were no significant differences in duration of surgery (P = 0.072), estimated blood loss (P = 0.717), or incidence of intestinal obstruction (P = 0.225) between the two groups. Interestingly, patients who had undergone pelvic re-peritonealization recovered bowel function more rapidly than those had not (2.79 d vs. 3.72 d, P = 0.001). Additionally, hospitalization stay was significantly shorter for patients with re-peritonealization than for those without (5.46 d vs. 6.68 d, P = 0.029).ConclusionsCompared with LRC alone, LRC with pelvic re-peritonealization as described in the present study had comparable perioperative complications, but was associated with more rapid gastrointestinal recovery and shorter hospitalization stay.

V05-09 THE TECHNIQUE AND CLINICAL APPLY OF PELVIC RE-PERITONEALIZATION IN THE ERAS PROGRAM FOR PATIENTS RECEIVED LAPAROSCOPIC RADICAL CYSTECTOMY

You have accessJournal of UrologyBladder Oncology & Diversion1 Apr 2018V05-09 THE TECHNIQUE AND CLINICAL APPLY OF PELVIC RE-PERITONEALIZATION IN THE ERAS PROGRAM FOR PATIENTS RECEIVED LAPAROSCOPIC RADICAL CYSTECTOMY Qiang Lu, Pengchao Li, Qiang Cao, Jian Qian, Xiao Yang, Rui Zhou, Wenbo Yuan, Xiaheng Deng, and Jun Tao Qiang LuQiang Lu More articles by this author , Pengchao LiPengchao Li More articles by this author , Qiang CaoQiang Cao More articles by this author , Jian QianJian Qian More articles by this author , Xiao YangXiao Yang More articles by this author , Rui ZhouRui Zhou More articles by this author , Wenbo YuanWenbo Yuan More articles by this author , Xiaheng DengXiaheng Deng More articles by this author , and Jun TaoJun Tao More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1396AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoscopic radical cystectomy has been widely used by urologists as a minimally invasive treatment for bladder cancer. Delayed bowel function recovery and postoperative ileus are more concerned complications post operation. Our study was aimed to introduce an improved technique of pelvic peritonealization to reduce these complications. METHODS Fifty-five consecutive patients with localized bladder cancer underwent laparoscopic radical cystectomy with or without pelvic peritonealization in our institute between January 2015 and September 2016. The differences in surgery time, estimated blood loss, the time of bowl function recovery, the complications of intestinal and blood vessels injury and incidence of postoperative ileus were analyzed between the two groups. RESULTS All the patients were successfully received laparoscopic radical cystectomy with (26 cases) or without (29 cases) pelvic peritonealization. There was no significantly difference in surgery time (P = 0.072), estimated blood loss ((P = 0.717), the incidence of intestinal obstruction (P =0.469) between the two groups. Interestingly, patients received pelvic peritonealization had more rapid bowl function recovery than those did not receive (2.79 d vs. 3.72 d, P=0.001). Besides, the hospitalization stay of patients with peritonealization was also significantly shorter than those without (5.46 d vs. 6.68 d, P = 0.029). CONCLUSIONS Laparoscopic radical cystectomy with pelvic peritonealization described in the presents study had comparable perioperative complications, but was associated with rapid gastrointestinal recovery and short hospitalization stay. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e575 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Qiang Lu More articles by this author Pengchao Li More articles by this author Qiang Cao More articles by this author Jian Qian More articles by this author Xiao Yang More articles by this author Rui Zhou More articles by this author Wenbo Yuan More articles by this author Xiaheng Deng More articles by this author Jun Tao More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Single center retrospective study of 184 children with inflammatory bowel disease seen from 2000-2014

Objective: To investigate the clinical data of children with inflammatory bowel disease (IBD) retrospectively, including Crohn's disease (CD) and ulcerative colitis (UC) and identify the clinical characteristics and trends of change. Method: Clinical data of hospitalized patients diagnosed as IBD in Beijing Children's Hospital from January 2000 to December 2014 were collected and retrospectively analyzed. Patients were divided into six groups based on type of disease and year of admission: Group A1(CD, 2000-2004) included 12 patients, Group B1(CD, 2005-2009) included 11, Group C1(CD, 2010-2014) included 51; Group A2(UC, 2000-2004) included 17, Group B2(UC, 2005-2009) included 25, Group C2(UC, 2010-2014) included 68. Result: A total of 184 IBD patients were included in the study, 74 had CD and 110 had UC. The hospitalization constituent ratio of CD increased from 0.6/10 000 in Year 2000 to 2.9/10 000 in Year 2014. The hospitalization constituent ratio of UC increased from 0.5/10 000 in Year 2001 to 3.9/10 000 in Year 2014. The hospitalization constituent ratios of CD and UC both increased gradually(P<0.05). Up to 61.4%(113/184) of IBD patients belong to early onset IBD, furthermore the very early onset IBD and infantile IBD accounted for 41.8%(77/184) and 26.6%(49/184) respectively. For CD, ileocolonic type(47.3%, 35/74) and non-structuring, non-penetrating type (67.6%, 50/74) were more common. Perianal disease occured in 31.1%(23/74) of CD patients; 81.1%(60/74) of CD patients had moderate/severe activity. For UC, pancolitis type(59.1%, 65/110) was more common. There were no significant changes for location of pathological change, disease behavior, activity degree of CD, extent of UC lesion and incidence of surgery, intestinal perforation and hemorrhage of gastrointestinal tract for IBD in the past 15 years(P>0.05). Severe UC(S3) was more common in Group A2(64.7%, 11/17), but moderate UC(S2) was more common in Group C2(48.5%, 33/68), the difference was statistically significant (P=0.001 7). Conclusion: During the past 15 years, the hospitalization constituent ratio for IBD in our hospital showed a growing trend. The ratio of infantile IBD and very early onset IBD was high. For CD, perianal disease was commonly seen and most patients had moderate/severe activity. The surgery rate and incidence of intestinal obstruction and perforation were higher in the CD patients than UC patients. For UC, the lesions were more extensively combined with higher disease activity.

Intestinal obstruction in appendicitis: A retrospective cohort study

Appendicitis as a cause of intestinal obstruction is an infrequent condition. The purpose of this study was to define the incidence and frequency of intestinal obstruction, according to the classification of intestinal obstruction secondary to appendicitis, and to characterise their severity. A retrospective cohort study analysing all patients operated on for intestinal obstruction secondary to appendicitis within a 15-year period was designed. Continuous and categorical variables including age, gender, time interval between onset of symptoms and diagnosis, C-reactive protein and white blood cells values, type of intestinal obstruction and WSES Sepsis Severity Score, were included. During the period of study 3626 patients were operated on for appendicitis and 44 cases had associated intestinal obstruction (1.2%). According to the classification of intestinal obstruction in appendicitis, most patients had a mechanical ileus with strangulation (48%) and a WSES Sepsis Severity Score of 3 or less points (77%). The incidence of intestinal obstruction in appendicitis was higher than expected. These patients have a severe inflammatory response with a WSES Sepsis Severity Score of 3 points. According to the classification of intestinal obstruction in appendicitis, most patients had a mechanical obstruction with strangulation.

Continuous tube feeding versus intermittent oral feeding for intermediate position enterostomy in infants.

The stoma of intermediate position enterostomy (IPE) often leads to high output, which is related to electrolyte abnormalities, and prolongs patient recovery post-operatively. The continuous nasogastric tube feeding method has the advantage of reducing the risk of feeding intolerance, and improves nutrient absorption. In the current study, we review our experience with continuous tube feeding and compare the clinical outcomes with intermittent oral feeding in patients with an IPE post-operatively. This was a retrospective review of 118 infants with IPEs in our hospital. The infants were categorized into two groups (intermittent oral feeding [OF] group [n=68 infants, 1-14 days of age] and continuous tube feeding [TF] group [n=50 infants, 1-14 days of age]). Differences in stool volume, daily intravenous fluid infusion, weight gain, nutrition indices, and post-operative complications were reviewed. The stool volume and intravenous fluid infusion in the TF group were less than the OF group from week 2. The weight gain was higher in the TF group than the OF group from week 3. The pre-albumin and retinol binding protein levels were significantly higher in the TF group than the OF group in weeks 3-4 post-operatively. The incidence of cholestasis and waterelectrolyte disturbances in the TF group was significantly lower than the OF group, and the incidence of intestinal obstruction was lower than the control group, but the differences were not significant. Continuous tube feeding had better clinical outcomes than intermittent oral feeding in IPE patients.

Efficacy of primary tumor resection for metastatic colorectal cancer with unresectable metastases: a Meta analysis

Objective To evaluate the efficacy and safety of primary tumor resection for metastatic colorectal cancer with unresectable metastases. Methods Database including PubMed, Cochrane Library, China National Knowledge Infrastructure (CNKI), China Biomedicine and Wanfang Database were searched with the key words of asymptomatic, primary, resection, metastatic, stage Ⅳ, cancer, colon, colorectal, rectal, 无症状性, 原发灶切除, 转移性, 4期(Ⅳ期), 结直肠癌, 结肠癌, 直肠癌between the database establishment and August 2015. Literatures about primary tumor resection or systemic treatment as first-line treatment for asymptomatic patients with unresectable metastatic colorectal cancer were retrieved, and data were extracted and evaluated by 2 independent researchers. Patients with primary tumor resection as first-line treatment were allocated to the primary tumor resection group and patients with systemic treatment as first-line treatment were allocated into the systemic treatment group. The overall survival rate and median survival time were compared between the 2 groups. The incidence of perioperative complications and mortality in the primary tumor resection group as well as the incidences of intestinal obstruction and emergency operation in the systemic treatment group were evaluated. Survival data were presented by the odds ratio (OR) and 95% confidence interval (CI). Single rate data were presented as rate (r) and 95%CI. The median survival time was analyzed using the mean difference (MD) and 95%CI. Heterogeneity of the publication was analyzed using the I2 test. Results Ten retrospective control studies including 1 434 patients were retrieved. There were 770 patients in the primary tumor resection group and 664 patients in the systemic treatment group. The results of Meta analysis showed that overall survival rate of patients in the primary tumor resection group was better than that in the systemic treatment group (OR=1.35, 95 %CI: 1.01-1.79, P<0.05), and there was a longer median survival time of 3.8 months in the primary tumor resection group (MD=3.78, 95% CI: 3.60-3.97, P<0.05). The incidence of perioperative complications and mortality in the primary tumor resection group were 22% (95%CI: 0.13-0.30) and 1% (95%CI: 0.00-0.03), respectively. The incidences of intestinal obstruction and emergency surgery were 18% (95%CI: 0.14-0.21) and 11% (95%CI: 0.06-0.16) in the systemic treatment group, respectively. Conclusions For asymptomatic patients with unresectable metastatic colorectal cancer, resection of the primary tumor is safe and feasible, and it can improve the overall survival rate of patients and median survival time. The incidence of intestinal obstruction is higher among asymptomatic patients who do not receive primary tumor resection. Key words: Colorectal neoplasms; Unresectable metastases; Primary tumor resection; Meta-analysis

Clinical research of intraperitoneal implantation of sustained-release 5-fluorouracil in advanced colorectal cancer.

BackgroundThe objective of this study was to investigate the safety and long-term clinical effect of intraperitoneal implantation of sustained-release 5-fluorouracil in patients with advanced colorectal cancer during radical resection.MethodsA total of 202 patients with advanced colorectal cancer undergoing radical operations were randomly divided into an experimental group (98 cases, intraoperative intraperitoneal implantation of sustained-release 5-fluorouracil 600 mg as local chemotherapy) and a control group (104 cases, without local chemotherapy). The clinical data of the two groups was compared including toxicity, complications, local recurrence rate, distant metastasis, disease-free survival, and 1-, 3-, and 5-year survival rates.ResultsBoth groups of patients were followed up for more than 5 years, the longest follow-up time was 7.5 years. Bone marrow suppression, hepato-renal function, postoperative anastomotic leakage, pelvic effusion, incision infection, the incidence of intestinal obstruction, venting time, and hospital stay after operation (days) between two groups had no statistical significant difference. Locoregional recurrence and liver metastasis rate were decreased significantly in experimental group (P = 0.04 and 0.04). Extensive peritoneal metastasis and other organ metastasis rates had no significant difference between two groups. In the experimental group, 1-, 3-, and 5-year survival rates were higher than in the control group (95.92 vs 87.50 %, 77.55 vs 64.42 %, and 56.12 vs 40.38 %), which had significant difference. Disease-free survival (DFS) of the experimental group was higher than that of the control group (χ2 = 5.00, P = 0.025).ConclusionsIntraperitoneal implantation of sustained-release 5-fluorouracil is safe for advanced colorectal cancer during radical resection, which can reduce locoregional recurrence rate and liver metastasis rate. The long-term efficacy was reliable, and long-term survival and disease-free survival rate can be improved.

Analysis of predictive factors of intestinal obstruction in acute myocardial infraction patients afterprimary percutaneous coronary intervention

Objective to determine predictive factors of intestinal obstruction in acute myocardial infraction (AMI) patients after primary percutaneous coronary intervention (PCI) and to establish predictive model. Methods A total of 1220 AMI patients underwent primary PCI in Jiangxi provincial people's hospitalfrom June2004 toJune 2014were retrospectively analyzed. And 1025 cases of them whichall met the inclusion and exclusion criteriawere randomlydivided by using random number generated by SPSS 17.0 into two cohorts: model derivation cohort (MDC) and model validation cohort (MVC). MDC was divided into intestinal obstruction group and control group. predictive factors were identified using univariable andmultivariable logistic regression analysis in MDC. Interger point values were assigned to each predictor based upon their coefficient in multivariable logistic regression model to establish scoring model. The summed scores of each case in MVC were calculated to test predictive ability of the model by ROC cure. Results Total of 1 025 patients, 103 patients were diagnosed with different types of intestinal obstruction and the incidence of intestinal obstruction was 10.0%. Low position intestinal obstruction, incomplete intestinal obstruction and simple intestinal obstructionwere main characteristics in these patients. logistic regression analysis identified ten risk factorscan predict the appearance of intestinal obstruction: age >65 years old (OR =1.44, 95%CI∶1.26-4.63, P =0.000) , diabetes mellitus (OR =3.37, 95% CI∶2.39- 9.47, P =0.000) , habitual constipation (OR =4.75, 95% CI∶3.58-11.24, P =0.024) , inferior and extensive anterior wall myocardial infarction (OR =2.16, 95% CI∶1.94-4.79, P =0.017) , cardiac function grade≥3 class (Killip classification) (OR =2.86, 95% CI∶1.98-5.67, P=0.002) , femoral approach (OR =2.76, 95%CI∶1.38-6.12, P =0.002) , K+<3.5 mmol/L (OR=1.86, 95%CI∶1.11- 5.47, P=0.005) , taking laxative (OR =3.59, 95% CI∶2.99-10.21, P =0.000) , using morphine (OR=1.98, 95%CI∶1.07-3.12, P=0.021) and estimated glomerular filtration rate (eGFR) <60 mL·min-1·1.73m-2 (OR=1.19, 95%CI∶1.10-3.22, P=0.031). and areas under the ROC cure was 0.815 (95% CI∶0.802-0.883, P =0.000) and indicating the accuracy of predicting intestinal obstruction. Conclusions age> 65 years old, diabetes mellitus, habitual constipation, inferior and extensive anterior parts of myocardial infarction, cardiac functiongrade≥3class (Killip classification), femoral approach, K+<3.5mmol/L, taking laxative, using morphine and eGFR <60 ml. min-1.1.73m-2 were important predictive factors for intestinal obstruction in AMI patients after underwent 0 and the scoring model can predict accurately intestinal obstruction in such patients. Key words: Acute myocardial infraction; Primary percutaneous coronary intervention; Intestinal obstruction; Forecasting

Clinical efficacy of Daikenchuto for gastrointestinal dysfunction following colon surgery: a randomized, double-blind, multicenter, placebo-controlled study (JFMC39-0902)

ObjectiveThis exploratory trial was performed to determine whether Daikenchuto accelerates recovery of gastrointestinal function in patients undergoing open colectomy for colon cancer.MethodsA total of 386 patients undergoing colectomy at 1 of the 51 clinical trial sites in Japan from January 2009 to June 2011 were registered for the study (JFMC39-0902). Patients received either placebo or Daikenchuto (15.0 g/day, t.i.d) between post-operative day 2 and post-operative day 8. Primary end-points included time to first bowel movement, frequency of bowel movement and stool form. The incidence of intestinal obstruction was evaluated post-operatively. The safety profile of Daikenchuto until post-operative day 8 was also evaluated.ResultsThe results for 336 patients (Daikenchuto, n = 174; placebo, n = 162) were available for statistical analysis. The time to first bowel movement did not differ significantly between the two groups. All patients reported having diarrhea or soft stools immediately after surgery, and the time until stool normalization (50th percentile) in the Daikenchuto and placebo groups was 6 days and 7 days, respectively. The placebo group had a significantly greater number of hard stools at post-operative day 8 (P = 0.016), and bowel movement frequency continued to increase until post-operative day 8 as well. In contrast, bowel movement frequency in the Daikenchuto group increased until post-operative day 6, however decreased from post-operative day 7 and was significantly lower at post-operative day 8 compared with the placebo group (P = 0.024).ConclusionThe moderate effects of Daikenchuto were observed ∼1 week after the operation. Although Daikenchuto had an effect on gastrointestinal function after open surgery in patients with colon cancer, this study did not show its clinical benefits adequately.

Intraventricular hemorrhage as a comorbid factor for intestinal obstruction in very low-birthweight infants.

In very low-birthweight infants (VLBWI), intestinal obstruction (IO) tends to increase in severity due to the immaturity of the intestine and perinatal events. We examined the clinical comorbid factors related to IO in VLBWI. Clinical data of 160 VLBWI admitted to the neonatal intensive care unit in 2006-2011 were retrospectively reviewed. Patients were divided into two groups: IO group (n = 62) and non-IO group (n = 98). IO was defined as bile excretion via the mouth or nasogastric tube within 30 days after birth. The relationship between clinical factors and the incidence of IO was analyzed. On univariate analysis, gestational age, birthweight, and the incidence of chronic lung disease, patent ductus arteriosus, intraventricular hemorrhage (IVH), retinopathy of prematurity, and the postnatal use of mechanical ventilation, catecholamines, steroids, and sedatives were associated with IO. On multivariate analysis, only IVH was strongly associated with IO (OR, 4.74; P < 0.01). IVH is a significant comorbid factor of IO in VLBWI.