Paralytic Intestinal Obstruction Research Articles

Pathophysiology of the gastrointestinal tract in burn disease

The review of foreign publications resulted in a generalisation of medical reports on the pathological changes of the gastrointestinal tract in burn disease. Burn disease produces an immediate reaction in all organs and systems, which are not always able to maintain homeostasis and frequently suffer pathophysiological and morphological damage. One of those target systems is the gastrointestinal tract. Only in very rare cases do severe (mainly electrical) burns cause direct injury to the abdominal cavity organs, thus resulting in a very severe clinical course and high mortality. Patients of all ages who have experienced a burn injury have an increased overall risk of developing gastrointestinal diseases, which include pathology of the esophagus, stomach, and intestines, as well as lesions of the gallbladder, biliary tract, and pancreas. With a burn area of 40—95%, 5.7% of the victims were diagnosed with pathology of the abdominal organs. Among them, 26.0% had an abdominal catastrophe (infarction or perforation), 37.0% had bleeding from the upper parts of the gastrointestinal tract, 32.0% had paralytic intestinal obstruction, and 5.0% developed pancreatitis and acute necrotizing cholecystitis. Large burns are usually associated with a significant decrease in splanchnic perfusion. After severe burns, intestinal ischemia and hypoxia disrupt the intestinal epithelial barrier and enteric bacterial translocation, leading to serious complications such as systemic inflammatory response syndrome, sepsis, and multiple organ failure. Peritonitis or gastrointestinal bleeding accounted for 88.2% of deaths among patients with gastrointestinal dysfunction. In general, gastrointestinal dysfunction was more common in patients with inhalation injuries, burn shock, large burn areas, and high analgesic requirements.

Acute Necrotizing Pancreatitis Complicated With Sinistral Portal Hypertension And Mechanical Obstruction Of The Colon: A Case Report.

Acute necrotizing pancreatitis (ANP) is often associated with acute necrotic collection (ANC) or walled-off necrosis (WON). Due to the close anatomical connection between the pancreas, the spleen, and the transverse colon, necrotizing pancreatitis is often combined with spleen or colon involvement. Gastrointestinal dysfunction usually caused by pancreatitis leads to paralytic intestinal obstruction. However, pancreatitis combined with mechanical colonic obstruction is extremely rare. It can easily be misdiagnosed as malignant intestinal obstruction, and diagnosing the cause of intestinal obstruction becomes more critical when accompanied by Sinistral portal hypertension (SPH). Surgical resection is the primary method for the previous occurrence of colonic complications. In this case report, upon admission, a 37-year-old patient was diagnosed with acute necrotizing pancreatitis with sinistral portal hypertension. On the 6th day after admission, the patient developed a sudden colonic obstruction. After identifying the cause, the patient underwent a transanal decompression tube and minimally invasive necrosectomy, avoiding colon resection. In acute necrotizing pancreatitis combined with colonic mechanical obstruction, it is essential to clarify the etiology, and focus treatment on clearing the peripancreatic necrotic tissue, non-surgical treatment to deal with colonic obstruction is feasible, and the principle of individualized treatment should be used throughout the disease.

Association between Red Blood Cell Distribution Width and Short-Term Mortality in Patients with Paralytic Intestinal Obstruction: Retrospective Data Analysis Based on the MIMIC-III Database.

Elevated red cell distribution (RDW) has been reported to be associated with mortality in patients with acute pancreatitis and cholecystitis admitted to the intensive care unit (ICU). However, evidence for the relationship between RDW and paralytic intestinal obstruction is lacking. Therefore, the article aims to investigate the relationship between RDW and 28-day mortality of the patients with paralytic intestinal obstruction. Patients and Methods. This is a single-center retrospective study. Based on a particular screening criterion, 773 patients with paralytic intestinal obstruction were selected from the Medical Information Mart for Intensive Care III (MIMIC-III) database. Indicators of the first 24 h into the ICU were used to analyze the relationship between RDW and 28-day death from paralytic intestinal obstruction by Kaplan-Meier (K-M) analysis, logistic regression analysis, and stratification analysis. The curve fitting exhibited a nonlinear relationship. The K-M curve showed that groups with higher RDW values had lower survival rates. The logistic regression analysis revealed that RDW increased with 28-day mortality in patients with paralytic intestinal obstruction in the fully adjusted model. In the fully adjusted model, OR value and 95% CI from the second to the third quantiles compared to the first quartile (reference group) were 1.89 (1.04, 3.44) and 3.29 (1.82, 5.93), respectively. The results of stratified analysis of each layer had the same trend as those of regression analysis, and the interaction results were not significant. Elevated RDW was associated with increased 28-day mortality from paralytic intestinal obstruction in the ICU. This study can help to further explore the relationship between RDW and death in patients with paralytic intestinal obstruction.

Abdominal pain in pregnant women: modern possibilities differential diagnosis and relief

The article shows the main causes of functional and organic abdominal pain and its specific types during pregnancy. The author presents the tactics of patient management, the peculiarities of the interpretation of laboratory data in case of suspected acute surgical pathology and “alarm symptoms” in case of abdominal pain in pregnant women. She emphasized the importance of imaging techniques in the differential diagnosis of acute abdomen syndrome in the gestational period. Article also substantiates safety and the need for magnetic resonance imaging in patients with persistent abdominal pain. It discusses a clinical case of paralytic intestinal obstruction in a pregnant woman. It analyzes the drug therapy for abdominal pain, taking into account the prevalence of the expected benefit to the mother over the potential risk to the fetus. The author demonstrates that the management of abdominal pain relies on a conservative approach due to the lack of evidence base on the safety of drugs for the fetus and clinical guidelines for the management of pregnant women with abdominal pathology. Author also emphasizes the need for legal registration of the appointment of magnetic resonance imaging and computed tomography, as well as off-label pharmacotherapy the instructions during gestation.

Nonocclusive mesenteric ischemia caused by type B aortic dissection: a case report

BackgroundNonocclusive mesenteric ischemia (NOMI) is defined as acute intestinal ischemia because of decreased blood flow in mesenteric vessels. Only a few cases of NOMI that occur secondary to aortic dissection (AD) have been reported, resulting in the lack of sufficient knowledge of diagnosis and treatment.Case presentationWe aimed to report a case of NOMI caused by type B Aortic Dissection. A 26-year-old male patient was transferred to our hospital with the diagnose of NOMI and aortic dissection in April 2018. The abdominal computed tomography (CT) assists the diagnosis of paralytic intestinal obstruction, intestinal wall pneumatosis, and perforation. Emergency laparotomy revealed that the bowel wall supplied by the superior mesenteric artery (SMA) was pale with the palpable but weak pulsation of the parietal artery. The small intestine was extremely dilated with a paper-thin, fragile wall that was ruptured easily and could not be sutured. In this case, extensive resection and segmental drainage were done. Postoperatively, the digestive tract was reconstructed. However, the patient suffered from iron deficiency anemia and short bowel syndrome eight months later, and unfortunately died from long-term complications.ConclusionAortic dissection leads to continuous decrease in blood pressure and blood flow to the SMA, considering as a predisposing factor for NOMI. During the treatment, extensive resection and segmental drainage are the optimal surgical strategy, which can make benefit in emergencies especially.

Association between the clinical efficacy of fecal microbiota transplantation in recipients and the choice of donor

Objective: To examine the association between the clinical efficacy of fecal microbiota transplantation (FMT) in recipients and the choice of donor, and to observe the characteristics of intestinal flora and metabolites among different donors. Methods: A retrospective case-control study was conducted. Donor whose feces was administrated for more than 30 recipients was enrolled. Data of 20 FMT donors and corresponding recipients at Intestinal Microecology Diagnosis and Treatment Center of the Tenth People's Hospital from October 2018 to December 2019 were collected retrospectively. During follow-up, the efficacy of each recipient 8-week after FMT treatment was recorded and analyzed. Based on the efficacy of each donor, the donors were divided into three groups: high efficacy group (effective rate >60%, 10 donors), moderate efficacy group (effective rate 30%-60%, 6 donors) and low efficacy group (effective rate <30%, 4 donors). The structure of the bacterial flora and the content of fecal short-chain fatty acids in each group of donors were detected and compared among groups. Association of the efficacy of each donor group with the morbidity of complications, and association of efficacy of recipients with donors were analyzed. The evaluation indicators of FMT efficacy included objective clinical effectiveness and/or subjective effectiveness. Objective effectiveness indicated clinical cure plus clinical improvement, and subjective effectiveness indicated marked effectiveness plus medium effectiveness through questionnaire during follow-up. Results: A total of 1387 recipients were treated by 20 donors, including 749 cases of chronic constipation, 141 cases of chronic diarrhea, 107 cases of inflammatory bowel disease (IBD), 121 cases of irritable bowel syndrome (IBS), 83 cases of autism, and 186 cases of other diseases, such as radiation bowel injury, intestinal pseudo-obstruction, paralytic intestinal obstruction, functional bloating and allergic diseases. There were 829 cases, 403 cases, and 155 cases in high efficacy group, moderate efficacy group and low efficacy group respectively. Baseline data among 3 groups were not significantly different (all P> 0.05). In comparison of bacterial abundance (operational taxonomic unit, OTU) among different effective donor groups, the high efficacy group was the highest (330.68±57.28), the moderate efficacy group was the second (237.79±41.89), and the low efficacy group was the lowest (160.60±49.61), whose difference was statistically significant (F=16.910, P<0.001). In comparison of bacterial diversity (Shannon index), the high efficacy group and the moderate efficacy group were higher (2.96±0.36 and 2.67±0.54, respectively), and the low efficacy group was lower (2.09±0.55), whose difference was statistically significant (F=5.255, P=0.017). In comparison of butyric acid content among three groups, the high efficacy group had the highest [(59.20±9.00) μmol/g], followed by middle efficacy group [(46.92±9.48) μmol/g], and the low efficacy group had the lowest [(37.23±5.03) μmol/g], whose difference was statistically significant (F=10.383, P=0.001). The differences of acetic acid and propionic acid among three groups were not statistically significant (all P>0.05). A total of 418 cases developed complications (30.1%). Morbidity of complication in low efficacy group, moderate efficacy group and high efficacy group was 40.6% (63/155), 30.0% (121/403) and 28.2% (243/829) respectively, and the difference was statistically significant (χ(2)=9.568, P=0.008). The incidence of diarrhea in low efficacy group, moderate efficacy group and high efficacy group was 7.1% (11/155), 4.0% (16/403) and 2.8% (23/829) respectively, and the difference was statistically significant (χ(2)=7.239, P=0.027). Comparing the incidences of other types of complications, no statistically significant differences were found (all P>0.05). Follow up began 8 weeks after the FMT treatment. The total follow-up rate was 83.6% (1160/1387). The overall effective rate 58.3% (676/1160). Effective rates of various diseases were as follows: chronic constipation 54.3% (328/604), chronic diarrhea 88.5% (115/130), IBD 56.1% (55/98), IBS 55.1% (59/107), autism 61.6% (45/73), and other diseases 50.0% (74/148). Comparing the effective rate of three groups of donors for different diseases, there was no statistically significant difference in chronic diarrhea (P>0.05); there was a positive correlation trend in IBD, IBS and autism, but the differences were not statistically significant (all P>0.05). For chronic constipation and other diseases, high efficacy group had the highest effective rate [65.0% (243/374) and 63.2% (55/87)], followed by moderate efficacy group [49.4% (86/174) and 38.1% (16/42)], and low efficacy group had the lowest [16.1% (9/56) and 15.8% (3/19)], whose differences were significant (all P<0.05). Conclusions: Different donors have different efficacy in different diseases. Chronic constipation, radiation bowel injury, etc. need to choose donors with high efficacy. IBD, IBS and autism may also be related to the effectiveness of donors, while chronic diarrhea is not associated to the donor. The efficiency of the donor is negatively correlated to the morbidity of complications. The abundance and diversity of intestinal flora and the content of butyric acid may affect the efficacy of the donor.

Efficiency of the early surgery in acute biliary pancreatitis

Background. The evaluation of the effectiveness of active surgical tactics in patients with acute biliary pancreatitis was the purpose of our study. Materials and methods. A clinical examination and treatment of 126 patients with acute biliary pancreatitis has been performed. Among the examined patients, there were 32 men (25.4 %), and 94 women (74.6 %). Based on the causes of acute biliary pancreatitis, we identified three groups of patients: the first one — 65 individuals with isolated cholecystolithiasis (42 — with acute calculous cholecystitis, 23 — with chronic calculous cholecystitis), the second one — 35 patients with small concrements in different departments of the biliary tract, which did not cause obturation of the common bile duct, and the third one — 26 persons, who had torsion concretions of the common bile duct, including those wedged into major duodenal papilla. Patients in the first group underwent laparoscopic cholecystectomy, in the second and third groups — endoscopic transpapillary decompression of the common bile duct and, if necessary, laparoscopic cholecystectomy. In up to 48 hours, surgeries were performed in 78.6 % of patients in all groups. Results. During the analysis, it was found that the temperature response in patients, who were operated for 48 hours, was normal within 2.2 ± 0.8 days, whereas in patients, who had surgical intervention at a later date, — after 3.0 ± 0.7 days. Early operative intervention in all groups of patients positively influenced the regression of clinical signs of acute biliary pancreatitis and paralytic intestinal obstruction. Active surgical tactics allowed to reliably eliminate respiratory (p = 0.01; odds ratio (OR) = 4.0); hemodynamic (p = 0.02; OR = 5.69); enteral (p = 0.04; OR = 3.50) syndromes, systemic inflammation response syndrome (p = 0.04; OR = 3.50) and an increased level of enzymes in the blood (p = 0.07; OR = 4.79). We had not found significant differences in regression of clinical and laboratory manifestations of peritoneal (p = 0.6; OR = 1.74), metabolic (p = 0.3; OR = 2.29), hemocoagulation (p = 0.8; OR = 1.24) and liver syndrome (p = 0.1; OR = 2.54) and renal (p = 0.3; OR = 2.02) dysfunction, depending on the terms of the operation. Also, these patients noted a lower incidence of specific complications of acute biliary pancreatitis: acute peripancreatic uninfected fluid clusters (p = 0.03; OR = 0.15), peripancreatic abscesses, postnecrotic cysts of the pancreas (p = 0.05; OR = 0.18) and postcholecystectomy syndrome (p = 0.05; OR = 0.27). Conclusions. In patients with acute biliary pancreatitis, surgery on the bile duct system for up to 48 hours can significantly improve the regression of the main clinical manifestations of the disease, is pathogenetically substantiated and should be used more frequently.

Early diagnosis and treatment of 57 cases with colorectal cancer postoperative ileus

Objective To explore how to effectively prevent and detect cancer early postoperative intestinal obstruction and treatment methods and means. Methods This retrospective analysis of 13 years occurred in 57 patients with rectal cancer diagnosis and treatment of cases of early postoperative intestinal obstruction process, including fasting, gastrointestinal decompression, fluid therapy, liquid paraffin, diatrizoate and surgical treatment of oral contrast. Results In 57 cases, paralytic intestinal obstruction in 7 cases, conservative treatment was relieved, the success rate was 100.0%; early inflammatory intestinal obstruction in 37 cases after conservative treatment of 36 cases of remission, the success rate was 97.3%; mechanical intestinal obstruction in 13 cases after conservative treatment could not be alleviated, conservative success rate was 0.0% and was cured by reoperation.The first two groups of patients compared with mechanical intestinal obstruction patients, conservative success rate had statistical differences(χ2=40.08, 11.08, all P<0.01). Conclusion Cancer treatment lies in early postoperative intestinal obstruction effective prevention, early detection, close observation and timely and effective treatment, a good grasp of timing of surgery and surgical indications. Key words: Colorectal neoplasm; Intestinal obstruction; Treatment

Clinical analysis of colon cancer combined with abdominal abscess

Objective To summarize the clinical characteristics, preoperative examinations and therapeutic method of colon cancer combined with abdominal abscess. Methods The clinical data of 41 patients with colon cancer combined with abdominal abscess who were admitted to the First Hospital of Longyan between January 2008 and August 2014 were retrospectively analyzed. All the patients underwent laboratory tests and imaging examinations before operation. According to the principles of operative safety and radical resection of tumor, 41 patients underwent open operation and then received the fluid infusion, antibiotic treatment, parenteral nutrition support and symptomatic treatment after operation. Patients were followed up via telephone interview and outpatient examination till August 2014. Results All the 41 patients had different levels of obstruction and infection at admission, and concomitant diabetes mellitus were detected in 26 patients, essential hypertension in 21 patients, heart diseases in 19 patients and chronic obstructive pulmonary disease in 9 patients. The results of laboratory tests showed that there were 4 patients with hemoglobin (Hb) 90 g/L, 36 patients with albumin (Alb) <30 g/L, 18 patients with increased glycosylated hemoglobin (GHb) , 41 patients with increased serum procalcitonin and 10 patients with increased blood carcinoembryonic antigen (CEA) . Abdominal tumors and intestinal obstructions were detected in 41 patients by thoracic and abdominal enhanced CT, intraluminal tumors in 23 patients by colonoscopy because of unsuccessful placement of colonoscopy in 19 patients, the metal stent endoprosthesis was placed in 2 patients to relieve obstruction. Fifty-nine strains of bacteria were cultured from 41 copies of the pus (28 copies obtained from diagnosistic peritoneocentesis and 13 copies obtained from operation) , and most of them were escherichia coli with a percentage of 61.0% (36/59) and were sensitive to imipenem. All patients underwent open surgery including 33 patients combined wtih enterostomy. The operation time was 150-272 minutes with a median time of 221 minutes. The volume of intraoperative blood loss was 100-800 mL with a median volume of 370 mL. The tumor located at the ileocecal valve was detected in 6 patients and ascending colon in 9 patients, and then palliative or radical right hemicolectomy was performed. The tumor located at the hepatic flexure of colon was detected in 2 patients and then radical extended right hemicolectomy was performed. The tumor located at the splenic flexure was detected in 4 patients and descending colon in 7 patients, and then the radical resection and terminal ileostomy were performed. Among 13 patients with tumor located at the sigmoid colon, 12 patients received radical resection and 1 patient received palliative resection. Eleven patients were complicated with pulmonary infection, 6 patients with infection or dehiscence of incision, 5 patients with anastomotic leakage, 4 patients with ureteral injury, 4 patients with heart failure, 3 patients with paralytic intestinal obstruction, 2 patients with septicemia, 1 patient with renal failure, 1 patient with cerebral infarction and 1 patient with pulmonary embolism. Nine patients died after operation. The diameter of resected tumor was 4.5-15.0 cm with a median diameter of 9.4 cm. High-differentiated tumors were detected in 25 patients, moderate-differentiated tumors in 12 patients and low-differentiated tumors in 4 patients (signet-ring cell carcinoma in 1 patient) . There were 4 patients in the T3 stage of tumor and 37 patients in the T4 or T4b stage. The number of lymph node dissection was 23 (range, 15-35 ) with 18 positive lymph nodes. Six patients had lymph node metastasis. Twenty-eight patients were followed up for a median time of 27 months (range, 3-80 months) . During the follow-up, 16 patients died and 12 patients survived, 10 patients died of tumor recurrence and metastasis, 6 patients died of other diseases, 4 patients had tumor recurrence and metastasis and 8 patients had no recurrence and metastasis. Conclusions Patients with colon cancer combined with abdominal abscess are usually complicated with internal diseases, with a high mortality. Surgical treatment is the only curative treatment option, but an accurate preoperative evaluation is essential and the opportunity of operation should be evaluated before operation, the injury of ureteral , vascular and other surrounding important structures should be avoided during operation, meanwhile, intraoperative application of enterostomy could reduce anastomosis-related complications. After operation, routine peritoneal lavage and antibiotics according to the drug sensitive test are conducted for reducing the postoperative complications and mortality. Key words: Colonic neoplasms; Abdominal abscess; Surgical procedure, operative

Effect of da-cheng-qi decoction on pancreatitis-associated intestinal dysmotility in patients and in rat models.

The impairment of intestinal motility and related infectious complications are the predominant clinical phenomenon in patients with severe acute pancreatitis (SAP). We aimed to investigate the effects of Da-Cheng-Qi decoction (DCQD) on the gastrointestinal injury in SAP patients and the potential mechanism involved in rats. DCQD was enema administered to 70 patients for 7 days in West China Hospital. Mortality and organ failure during admission were observed and blood samples for laboratory analysis were collected. We also experimentally examined plasma inflammatory cytokines in rat serum and carried the morphometric studies of the gut. Intestinal propulsion index and serum and tissue vasoactive intestinal peptide (VIP) were also detected. Though DCQD did not affect the overall incidence of organ failure, it shortened the average time of paralytic intestinal obstruction and decreased the morbidity of infectious complications in patients with SAP. Compared with untreated rats, the DCQD lowered the levels of proinflammatory cytokine and decreased the mean pathological intestinal lesion scores. The VIP level in intestinal tissue or serum in DCQD group was obviously lowered and intestinal propulsion index was significantly improved. In conclusion, DCQD has good effect on pancreatitis-associated intestinal dysmotility in patients and in rat models.

Application of naso-intestinal decompression tubes in patients with acute paralytic intestinal obstruction

Application of naso-intestinal decompression tubes in patients with acute paralytic intestinal obstruction

The progress in clinical and basic research of the effect of acupuncture in treating disorders of gastrointestinal motility

Disorders of gastrointestinal motility are a group of diseases with abnormal gastrointestinal movement of various etiology. In clinical practice drugs with the activity of promoting gastrointestinal motility, such as domperidone and cisapride, were used as the major means of treatment. Acupuncture proved to have a good effect on the diseases. The clinical effect and basic research of acupuncture in treating irritable bowel syndrome, paralytic intestinal obstruction, gastroparesis, non-ulcerative dyspepsia and achalasia etc. were reviewed here in this report.

107. Die nichtocclusive ischämische Enteropathie — als seltene Ursache eines Ileuszustandes

The cause for a nonocclusive ischemic enteropathy seems to be a low cardiac output syndrome. There are often signs of a paralytic intestinal obstruction. Parameters of the blood chemistry offer no conclusive data. The angiogram of the mesenteric vessels demonstrates extensive arterial vasoconstriction as well as an obstructed venous outflow. Experimental findings disclose that this venous obstruction may be a result of an ischemic contracture in the course of a low flow state. This rigor initiates finally a thrombosis of the venoles. The rigor can be effectually mastered by energy-rich compounds.