Intestinal Obstruction In Patients Research Articles

A Prospective Study on Lactate Dehydrogenase Levels in Acute Intestinal Obstruction as a Marker of Bowel Gangrene.

Background Intestinal obstruction continues to be one of the most common causes of emergencies presenting to the surgical department. A thorough clinical examination along with relevant investigations continue to be best modality for timely management and prompt decision-making in such cases. Objectives The aim of this study was to identify patients of intestinal obstruction with elevated levels of serum lactate dehydrogenase (LDH) and correlate elevated LDH levels with bowel viability. Materials and methods The study comprised 46 cases of intestinal obstruction and their serum LDH values measured prior to surgical intervention/first day of admission. The intra-operative bowel viability was noted and compared with LDH values obtained, and their correlation was studied along with other variables of the patient. Results In our study, it was found that a serum LDH level of >800 IU/L signified an abnormal bowel with increased risk of bowel gangrene, as indicated by a sensitivity of 75% and a specificity of 94%. Gangrenous bowel was found to be more associated with causes such as superior mesenteric artery/vein thrombosis, volvulus, and habits such as alcoholism and tobacco consumption. Elevated LDH levels, however, do not correlate with the length of the affected gangrenous bowel, with the duration of presentation of symptoms, or as a predictor of mortality. Conclusion Serum LDH can be used as a good predictor of gangrenous bowel in cases of intestinal obstruction.

Effect of rapid rehabilitation nursing on improving clinical outcomes in postoperative patients with colorectal cancer.

Surgical resection is the cornerstone treatment for colorectal cancer. Rapid rehabilitation care predicated on evidence-based medical theory aims to improve postoperative nursing care, subsequently reducing the physical and mental traumatic stress response and helping patients who undergo surgery recover rapidly. To assess the effect of rapid rehabilitation care on clinical outcomes, including overall postoperative complications, anastomotic leaks, wound infections, and intestinal obstruction in patients with colorectal cancer. We searched the PubMed, Web of Science, Embase, Elsevier Science Direct, and Springer Link databases from January 1, 2010, to January 1, 2024, to screen eligible studies on rapid rehabilitation care among patients who underwent colorectal cancer surgery. Patients were screened based on the inclusion and exclusion criteria. RevMan 5.4 software was used for statistical analysis of the data. Twelve studies were enrolled, which included 2420 patients. The results showed that rapid rehabilitation care decreased the incidence of overall postoperative complications (OR: 0.44, 95%CI: 0.26-0.74, P = 0.002), anastomotic leaks (OR: 0.68, 95%CI: 0.41-1.12, P = 0.13), wound infections (OR: 0.45, 95%CI: 0.29-0.72, P = 0.0007), and intestinal obstruction (OR: 0.54, 95%CI: 0.34-0.86, P = 0.01) compared to conventional care. Further trials and studies are needed to confirm these results. Rapid rehabilitation care decreased the occurrence of postoperative complications, anastomotic leaks, wound infections, and intestinal obstruction compared to conventional care in patients who underwent colorectal surgery. Therefore, promoting the application of rapid rehabilitation care in clinical practice cannot be overemphasized.

One-step approach by enterolithotomy as surgical treatment of biliary ileus associated with bridle: case report and literature review

Gallstone ileus is a rare cause of intestinal obstruction, more common in adults and in the context of late complications due to gallbladder stones. The pathophysiology describes long-term inflammatory processes of the gallbladder, with biliodigestive fistula development and passage of the gallstone into the intestine, impacting the terminal ileum in most cases. It manifests with data of intestinal obstruction in patients with a chronic history of gallbladder lithiasis. The ideal imaging study is a computed tomography (CT) scan of the abdomen to identify pneumobilia, intestinal obstruction and the lithiasis impacting on the bowel. The surgical approach depends on the context of each patient through laparoscopy or laparotomy in order to perform enterotomy and extraction of the stone or by performing also the management of the fistula and cholecystectomy at the same surgical time. Management must be individualized for each patient. We present the case of a patient in her tenth decade of life with a history of recurrent biliary colic without management, who was admitted to the general surgery department with data of probable intestinal occlusion. Imaging studies were performed, with radiographic evidence of distension of the small bowel loops and tomography with findings suggestive of biliary ileus. Due to the clinical context and comorbidities of the patient, laparotomy with enterotomy and extraction of the stone was performed.

Atezolizumab monotherapy versus chemotherapy in untreated locally advanced or metastatic urothelial carcinoma (IMvigor130): final overall survival analysis from a randomised, controlled, phase 3 study

The primary analysis of IMvigor130 showed a significant progression-free survival benefit with first-line atezolizumab plus platinum-based chemotherapy (group A) versus placebo plus platinum-based chemotherapy (group C) in patients with locally advanced or metastatic urothelial cancer. However, this finding did not translate into significant overall survival benefit for group A versus group C at the final analysis, precluding formal statistical testing of outcomes with atezolizumab monotherapy (group B) versus group C. Here we report the final overall survival results for group B versus group C; this report is descriptive and should be considered exploratory due to the study's statistical design. In this global, partially blinded, randomised, controlled, phase 3 study, patients (aged ≥18 years) who had locally advanced or metastatic urothelial cancer previously untreated in the metastatic setting and Eastern Cooperative Oncology Group performance status of 0-2 were enrolled at 221 hospitals and oncology centres in 35 countries. Patients were randomly assigned (1:1:1), using a permuted block method (block size of six) and an interactive voice and web response system, stratified by PD-L1 status, Bajorin score, and investigator's choice of platinum-based chemotherapy, to receive either atezolizumab plus platinum-based chemotherapy (group A), atezolizumab alone (group B), or placebo plus platinum-based chemotherapy (group C). Sponsors, investigators, and patients were masked to assignment to atezolizumab or placebo in group A and group C; atezolizumab monotherapy in group B was open label. For groups B and C, atezolizumab (1200 mg) or placebo was administered intravenously every 3 weeks. Chemotherapy involved 21-day cycles of gemcitabine (1000 mg/m2 body surface area on day 1 and day 8 of each cycle) plus the investigator's choice of carboplatin (area under the curve 4·5 mg/mL per min or 5 mg/mL per min) or cisplatin (70 mg/m2 body surface area), administered intravenously. Co-primary endpoints were progression-free survival and overall survival in group A versus group C, and overall survival in group B versus group C, tested hierarchically, in the intention-to-treat (ITT) population, and then the populations with high PD-L1 tumour expression (immune cell [IC] expression score of IC2/3) if the results from group A versus group C were significant. Here, we report the co-primary endpoint of overall survival for group B versus group C in the ITT and IC2/3 populations. The ITT population for this analysis comprised concurrently enrolled patients in groups B and C who were randomly assigned to treatment. For the safety analysis, all patients enrolled in group B and group C who received any study treatment were included. The trial is registered with ClinicalTrials.gov, NCT02807636, and is active but no longer recruiting. Between July 15, 2016, and July 20, 2018, 1213 patients were enrolled and randomly assigned to treatment, of whom 362 patients were assigned to group B and 400 to group C, of whom 360 and 359, respectively, were enrolled concurrently (ITT population). 543 (76%) of 719 patients were male, 176 (24%) were female, and 534 (74%) were White. As of data cutoff (Aug 31, 2022), after a median follow-up of 13·4 months (IQR 6·2-30·8), median overall survival was 15·2 months (95% CI 13·1-17·7; 271 deaths) in group B and 13·3 months (11·9-15·6; 275 deaths) in group C (stratified hazard ratio 0·98 [95% CI 0·82-1·16]). The most common grade 3-4 treatment-related adverse events were anaemia (two [1%] in patients who received atezolizumab monotherapy vs 133 [34%] in those who received placebo plus chemotherapy), neutropenia (one [<1%] vs 115 [30%]), decreased neutrophil count (0 vs 95 [24%]), and decreased platelet count (one [<1%] vs 92 [24%]). Serious adverse events occurred in 163 (46%) patients versus 196 (50%). Treatment-related deaths occurred in three (1%; n=1 each, pneumonia, interstitial lung disease, large intestinal obstruction) patients who received atezolizumab monotherapy and four (1%; n=1 each, diarrhoea, febrile neutropenia, unexplained death, toxic hepatitis) who received placebo plus chemotherapy. The final analysis from IMvigor130 did not show a significant improvement in overall survival with first-line atezolizumab monotherapy compared with platinum-based chemotherapy in the intention-to-treat population. The safety profile of atezolizumab monotherapy remained acceptable after extended follow-up, with no new safety signals. F Hoffmann-La Roche.

Lower Risks of Gastrointestinal Perforation and Intestinal Obstruction in Patients with Atypical Antipsychotics in Comparison with Typical Antipsychotics Based on Real-World Data from the MID-NET® in Japan

Intestinal perforation and obstruction are known to be one of the adverse events caused by antipsychotics; however, warning information on package inserts varies among antipsychotics. To investigate the risks of gastrointestinal perforation and intestinal obstruction in patients prescribed atypical antipsychotics compared with those in patients prescribed typical antipsychotics, a nested case–control study was conducted utilizing real-world data from the MID-NET® medical information database in Japan. The study period spanned from January 1, 2009, to December 31, 2018. We found that the risks of gastrointestinal perforation and intestinal obstruction in patients prescribed atypical antipsychotics were significantly lower than those in patients prescribed typical antipsychotics (adjusted odds ratio, 0.48; 95% confidence interval, 0.29–0.80). This finding was supported with prolonged periods for the exposure definition in the sensitivity analyses. In addition, no major differences in the risks of atypical antipsychotics, such as risperidone, quetiapine, olanzapine, and aripiprazole, were identified in this study. The safety profile regarding the lower risks of gastrointestinal perforation and intestinal obstruction in patients prescribed atypical antipsychotics should be considered when choosing antipsychotics in clinical practice in terms of the proper use of such drugs.

Possible role of features of the intestinal microbiome in patients with colorectal cancer as a cause of anastomotic leak

Aim. Following the analysis of literature data, to determine significant factors of intestinal obstruction in patients with colorectal cancer.Materials and methods. We analyzed 84 literature sources from the Scopus, Web of Science, Google Scholar, and PubMed databases, as well as open access articles on Google.Results. The predominant causes of anastomotic leaks after operations for colorectal cancer are discussed, the role of the microbiome in the development of postoperative complications is analyzed. The intestinal microbiome of patients with colorectal cancer contains bacteria that are not normally found under physiological conditions. These bacteria contribute to the development of disease, suture failure after surgery for intestinal obstruction, and progression of carcinogenesis. This effect is due to the production of bacterial metabolites, the effect on the human immunity, and competition with obligate intestinal microflora. On the other hand, the use of drug therapy, including antibiotics, leads to mass death of obligate bacteria. Therefore, it is important to search for drugs and treatment methods that, if possible, do not have a significant negative impact on the microbiome, but are capable of destroying pathogenic microorganisms. The concept of Russian authors was proposed, which consists in the intraluminal use of rifaximin-α for the prevention of purulent and septic complications and anastomotic leaks during reconstructive surgeries on the distal colon.

Surgical management outcome and its associated factors among intestinal obstruction patients admitted to adult surgical ward of Wollega University Referral Hospital, Ethiopia

BackgroundGlobally, bowel obstruction is the most common cause of surgical emergencies. It remains a challenge to healthcare workers in spite of improvements in management techniques. There is a lack of the study to determine the surgical management outcome and its associated factors in the area of study. Hence, this study aimed to determine management outcome and its associated factors among surgically treated intestinal obstruction patients at Wollega University Referral Hospital, 2021.MethodsFacility-based cross-sectional study was conducted among all cases surgically managed for intestinal obstruction between September 1, 2018 and September 1, 2021. Data were collected using a structured checklist. The collected data were checked for completeness and entered into data entry software and then exported to SPSS version 24 for data cleaning and analysis. Both bi-variable and multivariable logistic regressions were run. P-value < 0.05 was used to declare a statistically significant association in multivariable logistic regression. The odds ratio along with 95%CI was estimated to measure the strength of the association.Result116 (59.2%) patients had favorable surgical management outcome for intestinal obstruction. Male sex (AOR = 3.694;95%CI:1.501,9.089), absence of fever (AOR = 2.636; 95%CI:1.124,6.18), ≤ 48 h duration of illness before operation (AOR = 3.045; 95%CI:1.399,6.629), viable intraoperative bowel condition (AOR = 2.372; 95%CI:1.088, 5.175), having bowel resection and anastomosis (AOR = 0.234; 95%CI:0.101,0.544) were the significantly associated factors of the favorable surgical management outcome for intestinal obstruction.Conclusion and recommendationThe favorable management outcome of patients with intestinal obstruction who were treated surgically in this study was low. Factors like sex, fever, short duration of illness, viable intraoperative bowel condition, and bowel resection and anastomosis were found to influence the surgical management outcome of patients with intestinal obstruction. The patient with intestinal obstruction should seek health care on time. Health professionals have to be skilled and provide appropriate care for the patients to reduce the risk of complications.

Magnitude and predictors of unfavorable management outcome in surgically treated patients with intestinal obstruction in Ethiopia: a systematic review and meta-analysis

BackgroundUnless an emergency surgical intervention is conducted, intestinal obstruction may result in high morbidity and mortality. In Ethiopia, the magnitude and predictors of unfavorable management outcomes in surgically treated patients with intestinal obstruction are highly variable and inconsistent. The aim of this study was; therefore, to estimate the overall prevalence of unfavorable management outcome and its predictors among surgically treated patients with intestinal obstruction in Ethiopia.MethodWe searched articles from databases from June 1, 2022, to August 30, 2022. Cochrane Q test statistics and I2 tests were applied. We used a random-effect meta-analysis model to overcome the impact of heterogeneity among the included studies. In addition, the association between risk factors and unfavorable management outcome in surgically treated patients with intestinal obstruction was investigated.ResultsThis study included a total of twelve articles. The pooled prevalence of unfavorable management outcome in surgically treated patients with intestinal obstruction was 20.22% (95% CI: 17.48–22.96). According to a sub-group analysis by region, Tigray region had the highest prevalence of poor management outcome, which was 25.78% (95% CI: 15.69–35.87). Surgical site infection was the most commonly reported symptom of poor management outcome (8.63%; 95% CI: 5.62, 11.64). The length of postoperative hospital stays (95% CI: 3.02, 29.08), duration of illness (95% CI: 2.44, 6.12), presence of comorbidity (95% CI: 2.38, 10.11), dehydration (95% CI: 2.07, 17.40), and type of intraoperative procedure (95% CI: 2.12, 6.97) were all significantly associated with unfavorable management outcome of intestinal obstruction among surgically treated patients in Ethiopia.ConclusionAccording to this study, the magnitude of unfavorable management outcome was high among surgically treated patients in Ethiopia. Unfavorable management outcome was significantly associated with the length of postoperative hospital stays, duration of illness, comorbidity, dehydration, and type of intraoperative procedure. Medical, surgical and public health measures are pivotal to reduce unfavorable management outcome in surgically treated intestinal obstruction patients in Ethiopia.

Surgical management of acute intestinal obstruction study of 50 cases operated in emergency

Background: Intestinal obstruction is one the major cause that patients underwent emergency operations and which might lead to complications that could be turn fatal. Prompt evaluation and treatment prevents mortality and morbidity of post-operative patients. Methods: Prospective study conducted between 01 April 2020 to 31 March 2022 in 50 patients of intestinal obstruction operated in emergency according to inclusion criteria. Pre-operative, intraoperative, and post-operative assessment and recording of data done. Results: In 50 cases of intestinal obstruction, commonest age group is 41 to 60 years, pain and obstipation remains major presenting symptoms and tenderness, guarding and rigidity were most common signs. The commonest cause of intestinal obstruction in the adults in this study was postoperative adhesions (44%) followed by Koch’s abdomen (30%). Malignancy of the large bowel was seen in 6 cases constituting 12% of cases, obstructed hernia in 5 cases (10%), intussusception in 3 cases (6%) and gut malrotation in 1 case (2%). Comorbidity like hypertension and diabetes were main causes of post-operative complications. Conclusions: Maximum incidence of intestinal obstructions were reported in Age group 41-60 years with male predominance. Abdominal pain was the consistent symptoms followed by obstipation. Post-operative adhesion were the most common cause of the intestinal obstruction. Malignancy and multiple comorbidity remains the major risk factor for the post-operative complications and mortality.

Short-term outcomes of deeper intubation technique of ileus tube for different types of acute intestinal obstruction patients: A retrospective multicenter study.

Our previous research reported a novel deeper intubation technique (DIT) of the ileus tube for acute bowel obstruction patients. The present study was designed to evaluate the effect of this novel technique on the clinical outcomes of patients with obstruction using a large cohort. The detailed clinical data were analyzed retrospectively from 496 obstruction patients who underwent intubation technique from 2014 to 2019 in five hospitals. The patients were divided into either the DIT group or the traditional intubation technique (TIT) group. The groups were matched in a 1:1 ratio using propensity scores, and the primary outcome was the short-term clinical outcomes for patients. The baseline characteristics were similar between the DIT group and the TIT group after matching. Compared with the TIT group, the DIT group had a significantly deeper intubation depth, with shorter hospital days, shorter time to first flatus and defecation, lower pain score, increased drainage volume, and lower emergency surgery rate. Importantly, the inflammatory factors such as white blood cell, C-reactive protein, and procalcitonin levels were significantly lower in the DIT group. In addition, the DIT treatment was significantly useful for adhesive obstruction patients. The DIT procedure led to better short-term clinical outcomes compared with the TIT procedure, indicating that DIT is a safe and feasible technique for the treatment of intestinal obstruction that is worthy of further popularization and clinical application.

Serum homocysteine is a valuable marker for predicting aggravation of infection in intestinal obstruction patients.

The aim of this study was to investigate the expression of serum homocysteine (HCY), procalcitonin (PCT), and C-reactive protein (CRP) in abdominal infectious disease and analyze their relationship with the degree of abdominal infection. We conducted a retrospective study involving 157 patients with abdominal infections at Xuzhou Central Hospital between January 2016 and October 2019. The patients were composed of intestinal obstruction (73 cases), appendicitis (45 cases), perforation of the digestive tract (25 cases), and cholecystitis (14 cases). The HCY, PCT, and CRP levels of patients with abdominal infections were detected using enzyme-linked immunosorbent assay (ELISA), and correlation analysis between the HCY, PCT, and CRP levels and abdominal infection was performed using Pearson's correlation analysis. Compared with before treatment, the HCY, PCT, and CRP levels in the four groups decreased significantly after treatment. The levels in the patients in the intestinal obstruction group decreased more markedly than in those in the other groups. There were positive correlations among the HCY level, PCT, and CRP before treatment only in patients with intestinal obstruction (P < 0.001). The difference was statistically significant in the HCY level between the non-operation and the operation groups in patients with intestinal obstruction (P < 0.001). Serum HCY may be a valuable marker for predicting aggravation of infection in patients with intestinal obstruction.

Colonoscopic Evaluation of Patients Treated Conservatively for Intestinal Obstruction: An Observational Study

Background: Acute intestinal obstruction occurs when there is an interruption in the forward flow of intestinal contents. This interruption can occur at any point along the length of the gastrointestinal tract, and clinical symptoms often vary based on the level of obstruction. Objectives: To evaluate the causes of obstruction of patients who were treated conservatively for acute intestinal obstruction. Materials &amp; Method: A cross-sectional observational study. The study was carried out in the Surgery In-patient Department of Comilla Medical College Hospital, Comilla, from 01.07.2013 to 31.12.2013. A total of 246 patients got admitted to the surgery in-patient department and diagnosed as a case of intestinal obstruction. 101 patients of both sex, aged 23-79 responded to initial conservative treatment and were recruited for the study. The remaining 145 patients underwent emergency surgery for intestinal obstruction and were excluded from the study. All data gathered from the data collection sheet was compiled manually. After compilation, these data were shifted to statistical analysis software for further analysis. Results: Out of 246 intestinal obstruction patients, we recorded 101 patients who responded to conservative management. 59 (58.4%) patients were male, and the remaining were female. Peak Incidence (45.5%) was in 51-66 years age group. 54(53.4%) patients presented with large bowel obstruction, the remaining with small bowel obstruction. Most of the patients 68 (67.3%), presented with sub-acute obstruction, followed by acute 28 (27.7%) and chronic 5 (4.9%) obstruction, respectively. 12(11.8%) patients were diagnosed with colorectal carcinoma, 5(4.9%) patients with intestinal TB, and 1(0.9%) patient with diverticulosis. 10(83.3%) of the patients with Colorectal carcinoma were in the elderly age group (&gt;50 years) whereas two patients were below 80 years of age. The cause of obstruction could not be detected in 83 (82.2%) patients by colonoscopy. ..............

A CLINICAL STUDY AND MANAGEMENT OF ACUTE INTESTINAL OBSTRUCTION

Aims And Objectives: The current study aims to review the various causes, clinical features and the outcome of surgical procedures in relation to etiological factors in 50 intestinal obstruction patients admitted at Government general hospital ,Kurnool july2020 –july2022. This study was done on 50 cases of acute intestinal obstruction Materials And Methods: that presented to emergency department of government general hospital,Kurnool(july 2020-july2022).All patients with provisional diagnosis of acute intestinal obstruction were assessed clinically in detail after admission. Investigations done included Hb, Blood counts including TC, DC, ESR, serum electrolytes ,X-ray Chest PA view, Plain X-ray abdomen erect lm &amp; Ultrasonography abdomen, CECT abdomen. . The commonest Results: age group affected was 31-40 years. M:F ratio is 2.6:1. In our patients, the main cause of obstruction was obstructed hernia (36%). Adhesions and bands (26%) were the second most common cause of intestinal obstruction followed by sigmoid volvulus (12%), TB abdomen (8%) and malignant obstruction (6%). Surgery was the mainstay of treatment, with herniorraphy, adhesiolysis and resection - anastomosis being the most commonly performed procedures. Post-operative complications noted were wound infection (12%), respiratory infection (6%) and prolonged ileus (6%). In the present study of 50 cases, 5 patients (10%) died due to septicemia,leak and MODS. The incidence of intestinal Conclusion: obstruction is more common in males, Mode of presentation also differs in different levels of intestinal obstruction, Adhesions accounted for majority of small bowel obstruction (26%),Malignancies are common causes of large bowel obstruction.Early recognition and timely intervention is important to prevent the bowel going for gangrenous changes.Morbidity was due to anastomotic leak, would infection, chest infection. Prognosis was poor in elderly patients and , in patients with co-morbid conditions, presence of strangulated bowel that required resection &amp; anastomosis and those whose presentation to hospital was late

The endoscopic prediction model of simple endoscopic score for Crohn's disease (SES-CD) as an effective predictor of intestinal obstruction in Crohn's disease: A multicenter long-term follow-up study.

The simple endoscopic score for Crohn's disease (SES-CD) is a widely used index to evaluate clinical and endoscopic activity. However, the association and predictive value of SES-CD for intestinal obstruction in Crohn's disease (CD) remains unclear. We aimed to establish the best cut-off indicators of SES-CD for early clinical intervention and subsequent prevention of intestinal obstruction in CD. Data on patients with CD evaluated at our institute from January 2016 to January 2022 were retrospectively collected. The SES-CD and Crohn's Disease Activity Index scores used in the analysis indicated the results of the first clinical and colonoscopy evaluations after hospitalization. The primary outcome was the occurrence of intestinal obstruction during admission and follow-up. A total of 248 patients with a median follow-up time of 2years [interquartile range: 1.0-4.0] were enrolled, of which 28.2% developed intestinal obstruction. An SES-CD score of 8 was the most significant threshold evaluation, and SES-CD ≥8 had the largest area under the receiver operating characteristic curve (0.705), with a sensitivity of 52.9% and specificity of 88.2% in predicting intestinal obstruction. Furthermore, SES-CD ≥8 had the greatest risk factor for intestinal obstruction (odds ratio: 7.731; 95% confidence interval: 3.901-15.322; p < 0.001) and significantly decreased the overall intestinal obstruction-free survival (p < 0.001). The SES-CD endoscopic prediction model could be an effective predictor of intestinal obstruction in patients with CD. More frequent follow-up and colonoscopic surveillance should be considered in patients with SES-CD score ≥8 to prevent the development of intestinal obstruction.

Co-Morbidities and Post-Operative Complications in Patients of Acute Intestinal Obstruction at Tertiary Care Institute of North India

Background: There is limited information on the post operative complications and associated co-morbidities for bowel obstruction. Present study was done to evaluate the Co-Morbidities and Post operative complications in Patients of acute intestinal obstruction at IGMC Shimla. Material and Methodology: This cross sectional study was done among total of 50 patients admitted with features of acute intestinal obstruction in the general surgery department of Indira Gandhi Medical College Shimla, randomly selected during the period from 15 June 2019 to 15 June 2020. Data regarding Socio-demographic Characteristics, Co-Morbidities and Post operative complications was extracted and analysed using Epi Info Software v7. Results: The study showed the peak incidence of Intestinal obstruction in the age group 51-60 (11) and 61-70(10) years .Mean age in our current study was 53 years and male to female ratio was 3:1. In present study diabetes (18%) was the most common co-morbidity followed by hypertension (10%). Surgical site infection (SSI) was the most common post-operative complication (33%) followed by respiratory tract infection (17%) and septicemia (7%). This study shows that major complications occurred in patients having both hypertension and diabetes. Patients with diabetes are more liable to complications than hypertension. Conclusion: Our study concluded that diabetes and hypertension were the most common co-morbidities while Surgical site infection, respiratory tract infection and septicemia (SSI) were the most common post-operative complication among patients of Acute Intestinal Obstruction.

Management and Outcomes among Acute Intestinal Obstruction Patients Admitted At Tertiary Care Institute of North India

Background: Acute intestinal obstruction continues to be one of the commonest surgical emergencies. Present study was done to evaluate the Management and outcomes among acute intestinal obstruction patients admitted at IGMC Shimla. Material and Methodology: This cross sectional study was done among total of 50 patients admitted with features of acute intestinal obstruction in the general surgery department of Indira Gandhi Medical College Shimla, randomly selected during the period from 15 June 2019 to 15 June 2020. Data regarding Socio-demographic Characteristics, Management and outcomes was extracted and analysed using Epi Info Software v7. Results: The study showed the peak incidence of Intestinal obstruction in the age group 51-60 (11) and 61-70(10) years .Mean age in our current study was 53 years and male to female ratio was 3:1. In our study patients of intestinal obstruction were managed more commonly surgically 30 (60%) than conservative 20 (40%). Among the 30 patients managed surgically, Adhesiolysis was done in 8 patients, Resection and anastomosis in 7 patients, Resection anastomosis and stoma creation in 5 patients, Hemicolectomy in 6 patients, Appendicectomy in 2 patients, Transverse loop Colostomy in 1 patient and De-rotation with sigmoidopexy in 1 patient. In the present study of 50 patients, 2 patients died. All death were due to Septicaemia and ARDS. Conclusion: Our study concluded that most of cases of Acute Intestinal Obstruction were managed surgically. Adhesiolysis, Resection and anastomosis, Resection anastomosis and stoma creation and Hemicolectomy were the common mode of surgical management. All death occurred due to Septicaemia and ARDS.

Molecular characterization of vascular intestinal obstruction using whole-exome sequencing.

BackgroundVascular intestinal obstruction is a rare intestinal disease with a rapid progression, poor prognosis, and high mortality. This study aimed to identify several mutations associated with vascular intestinal obstruction.MethodsWhole-exome sequencing (WES) was performed on the peripheral blood of 9 sporadic patients with acute vascular intestinal obstruction. The mutation genes in each patient and the mutation genes shared by all 9 patients were identified. Next, a functional annotation analysis and a protein-protein interaction (PPI) analysis of the shared mutation genes in the 9 patients were performed. Copy number variations (CNVs) were identified using the open-source software CNV kit.ResultsIn total, all 9 patients shared 112 mutation genes. The Reactome database revealed 2 significantly enriched pathways, the O-linked glycosylation of the mucins (MUCs), and the termination of the O-glycan biosynthesis. MUC5AC was the protein with the highest degree in the PPI network. After searching the TiGER database, the keratin 18 (KRT18), MUC4, and MUC3A genes were found to be significantly more highly expressed in the colon tissues than the other tissues. Additionally, ArfGAP with dual PH domains 1 (ADAP1), cytochrome P450 family 2 subfamily W member 1 (CYP2W1), and transmembrane protein 184A (TMEM184A) were found to be highly expressed in colon tissues. The expression levels of several candidate genes between the vascular intestinal obstruction and normal control patients were measured by quantitative real-time polymerase chain reaction (qRT-PCR).ConclusionsOur study identified multiple mutations in 4 genes (i.e., MUC3A, MUC5AC, MUC16, and KRT18), and the CYP2W1 deletion. Our findings extend understandings of the potential pathological mechanism of vascular intestinal obstruction.

CLINICAL STUDY AND MANAGEMENT OF ACUTE INTESTINAL OBSTRUCTION

Background: The etiology of acute intestinal obstruction, which is one of the commonest surgical emergencies, varies between countries, and has also changed over the decades'.The current study aims to review the various causes, clinical features and the outcome of surgical procedures in relation to etiological factors in 50 intestinal obstruction patients admitted at Government General Hospital, Kurnool (Oct 2019 to Oct 2021). Methods: This was a prospective study of 50 patients admitted with a diagnosis of acute intestinal obstruction at GGH, Kurnool between Oct 2019- Oct 2021. Data related to the objectives of the study were collected and analysed by comparing with various standard studies. Results: Acute intestinal obstruction was the diagnosis in 3% of all patients admitted, with a M: F ratio of 1.38:1. The commonest age group affected was 31-40 years. In our patients, the main cause of obstruction was obstructed hernia (36%), due to lack of awareness among the rural population. Adhesions and bands (26%) were the second most common cause of intestinal obstruction followed by sigmoid volvulus (12%), TB abdomen (8%) and malignant obstruction (6%). Surgery was the mainstay of treatment, with herniorraphy, adhesiolysis and resection - anastomosis being the most commonly performed procedures. Post-operative complications noted were wound infection (12%), respiratory infection (6%) and prolonged ileus (6%). In the present study of 50 cases, 5 patients (10%) died due to septicemia and MODS. Conclusion: This study demonstrates that the pattern of intestinal obstruction differs from the Western world with obstructed hernias rather than adhesions being the most common cause. Majority of the patients need timely surgical relief of obstruction to avoid the development of peritonitis, sepsis and multi-organ failure.

Computed tomography in intestinal obstruction: a tertiary care perspective from Northern India

Background: Intestinal obstruction is a very common surgical emergency faced today in surgical ERs (emergency rooms) all around the globe. With the advent of newer technology, management of intestinal obstruction has changed significantly. Today computed tomography (CT) employs both intravenous as well as oral contrast for determining the cause and the level of obstruction. It also gives additional information regarding any malignancy causing the obstruction, its staging and status of vessels. Thus, a surgeon can go in the procedure with a plan already in mind which can be discussed in detail with experienced surgeons beforehand.Methods: This was a prospective observational study that was done in department of surgery at GMC Jammu over a period of two years. Patients of intestinal obstruction who presented to our department were enrolled in this study. They were subjected to a contrast enhanced CT after due preparation and managed accordingly. Data was recorded in a tabulated fashion and evaluated.Results: After implementing the exclusion criteria’s, a total of 163 patients were included in this study, majority being males in the age group of 20-40 years. Major cause of intestinal obstruction was attributed to post-operative adhesions followed by band obstruction due to various cause. CT findings were seen to be quite significant in evaluation and management of intestinal obstruction. About 30 % of the patients enrolled in our study were treated conservatively while 70 % required operative intervention in form of exploratory laparotomy.Conclusions: Computed tomography is widely available now a days at a cheaper cost. It greatly increases the armamentarium of the surgeon in dealing with this condition. A lot many cases today are dealt conservatively due to high utilisation of CT scan. It also helps the surgeon to preoperatively plan a proper surgical approach

S225 Cannabis Use Is Associated With an Increased Risk of Intestinal Obstruction in Patients Hospitalized With Diverticulitis

S225 Cannabis Use Is Associated With an Increased Risk of Intestinal Obstruction in Patients Hospitalized With Diverticulitis