Intestinal Obstruction Research Articles

S2999 True or False? A Case of Large Bowel Obstruction Secondary to Right-Sided Colonic Malignancy Initially Presenting as Ogilvie Syndrome

S2999 True or False? A Case of Large Bowel Obstruction Secondary to Right-Sided Colonic Malignancy Initially Presenting as Ogilvie Syndrome

S2864 The Womb Wanders to the Bowel: An Uncommon Case of Large Bowel Obstruction Secondary to Intestinal Endometriosis

S2864 The Womb Wanders to the Bowel: An Uncommon Case of Large Bowel Obstruction Secondary to Intestinal Endometriosis

S2979 An Unexpected Detour: Partial Large Bowel Obstruction Due to Rectal Carcinoma in a Young Adult

S2979 An Unexpected Detour: Partial Large Bowel Obstruction Due to Rectal Carcinoma in a Young Adult

Decreasing adverse events from concurrent Vinca-alkaloid and azole antifungals in a pediatric oncology population: Patient safety improvement process.

297 Background: Azole-antifungals like posaconazole and voriconazole have a documented significant risk of adverse drug events (ADE) when concomitantly administered with vinca-alkaloid chemotherapy (vincristine, vinblastine, vinorelbine) due to inhibition of vinca clearance. Potential ADE’s include paralytic ileus, severe, potentially permanent neuropathies, cranial nerve dysfunction, seizures, etc. Aim: Assess a standardized process to hold azole-antifungal around vinca-alkaloid drug administration to decrease the risk of adverse events associated with this drug-drug interaction in pediatric oncology patients. Intervention: Azole-antifungals (fluconazole*, voriconazole, posaconazole, itraconazole) will be held the day before, day of, and day after the vinca-alkaloid administration (with flexibility given provider discretion*) in the outpatient and inpatient setting at a single site. Methods: Development of a Standard Operating Procedure (SOP), informational technology (IT) processes such as Best Practice Advisory (BPA), nursing orders, Vinca Time-Out order and standard nursing note template for telephone encounter to remind patient/parents. Retrospective data was assessed in three 6-12 month phases, Pre-SOP (Phase 0), Post- SOP and Pre-IT support (Phase 1), and Full implementation (Phase 2). Study Outcomes: 1.Hold the azole-antifungal in 100% of encounters where vinca-alkaloid is due. 2. Decrease number of adverse events by 10%. 3. Maintain adequate fungal prophylaxis (or treatment) with a 0% incidence of breakthrough fungal infections. Results: Average number of concomitant azole/vinca administrations for each Phase was 39. A 97% improvement was seen in the number of vinca administrations dose reduced or held from 28 (Phase 0) to 1 (Phase 2). A 66% improvement in SOP compliance was observed (19 % in Phase 0, and 85% in Phase 2). Significant adverse effects were decreased by 33-50% between Phase 0, and Phase 1 and 2, respectively. Three patients in Phase 2 experienced fungal infection breakthrough; all had documented compliance issues prior to the study period. Conclusions: Implementation of the SOP and IT processes helped achieve a process to hold azole antifungals and led to significant decrease in the need to dose reduce or hold vinca-alkaloids thereby allowing less chemotherapy interruption/dose adjustments. Further modification of the SOP may be developed to exclude those patients on anti-fungal therapy for an active fungal infection.

Use of gastric point-of-care ultrasonography to evaluate postoperative ileus.

Use of gastric point-of-care ultrasonography to evaluate postoperative ileus.

S1557 Bowel Obstruction due to Enteral and Hepatobiliary Stent Migration: A Systematic Review

S1557 Bowel Obstruction due to Enteral and Hepatobiliary Stent Migration: A Systematic Review

S3079 Barium Contrast Induced Bowel Obstruction Treated With Endoscopic Retrieval

S3079 Barium Contrast Induced Bowel Obstruction Treated With Endoscopic Retrieval

Linear and discrete foreign body small intestinal obstruction outcomes, complication risk factors, and single incision red rubber catheter technique success in cats.

To compare survival and report perioperative complications in cats undergoing surgery for small intestinal (SI) linear (LFBO) and discrete (DFBO) foreign body obstructions (FBO). To report success of a red rubber catheter technique (RRCT) to remove LFBOs. Retrospective study. Client-owned cats (n = 169). Medical records of cats undergoing surgery for SI FBO from a veterinary teaching hospital between February 2012 and January 2023 were classified as LFBO, DFBO, or both linear and discrete FBO (BFBO). Signalment and perioperative data were collected. Preoperative hypoalbuminemia (LFBO: n = 1/6; DFBO: n = 5/6) and septic peritonitis (LFBO: n = 2/4; DFBO: n = 0/4; BFBO: n = 2/4) were rare. Intraoperative hypotension did not differ between LFBOs and DFBOs (p = .4756). RRCT was successful in 20/24 attempts of LFBO removal. Three cats were euthanized intraoperatively (LFBO: 1; DFBO: 1; BFBO: 1). Postoperatively, two cats (DFBO) experienced intestinal dehiscence and two cats (DFBO) died or were euthanized. Survival to discharge (p = 1.0000) and postoperative complications (p = .1386) did not differ between LFBOs and DFBOs. Postoperative complications and survival did not differ between cats with LFBOs and DFBOs. Intestinal dehiscence secondary to FBO in cats is rare. A RRCT can be successful in many cats with LFBOs. Cats with LFBOs and DFBOs have similar postoperative complication rates and survival to discharge when preoperative septic peritonitis is not present. Intestinal dehiscence is rare, which is important when discussing surgical prognosis with owners. A RRCT can be considered to remove LFBOs when there is concern for multiple enterotomies.

Chronic granulomatous intestinal disease: case report

Chronic intestinal granulomatous disease is a disorder that directly compromises the entire immune system. The estimated incidence is one in a million inhabitants. Among the associated risk factors, the presence of chronic and recurrent infections stands out. In the present case, it is a 39-year-old female patient with a history of intestinal obstruction and endometriosis, who presents abdominal pain in the left abdomen and recurrent abdominal pain without an identifiable cause. Laboratory tests revealed leukocytosis and mild neutrophilia. The tomography showed intestinal dilation at the jejunoileal level without transition zones, and the serological tests were negative. Exploratory laparoscopy was performed and the presence of tumor implants was found in the omentum, extending to the abdominal, uterine, intestinal, and peritoneal regions, as well as sallow fluid at the abdominal level. Tumor markers are normal. Histopathology details fungal colonization with eosinophilic necrosis and presence of granulomas, negative immunohistochemistry for Aspergillus and negative Lowestein-jensen culture. Antifungal and antituberculous treatment was started, with a decrease in symptoms and improvement in the clinical picture.

The treatment and short-term outcome of intestinal obstruction after digestive system malignancy affect the long-term survival of patients

The treatment and short-term outcome of intestinal obstruction after digestive system malignancy affect the long-term survival of patients

A Preliminary Phenomenological Exploration of Experiences of the Empty Pelvis Syndrome Derived From a Modified-Delphi: The Price of Survival Following Pelvic Exenteration for Advanced Pelvic Cancer.

The empty pelvis syndrome (EPS) is common after pelvic exenteration (PE), causing fluid collections, bowel obstruction, perineal sinuses, and fistulas. The best approach to fill the pelvis to mitigate this remains controversial, and the impact of EPS on health-related quality of life (HrQoL) is unknown. This study is the first to begin to explore lived-experiences of EPS complications. Unstructured EPS virtual focus group meetings were conducted with a convenience sample of patients who underwent PE, as an extension of a modified-Delphi study. Interpretative phenomenological analysis was conducted on verbatim transcripts to generate group experiential themes. Twelve patients (eight UK, one Dutch, and three Belgian) participated in four focus groups. Eight EPS complications were reported, (two pelvic collections, five chronic perineal sinuses, and one bowel obstruction). Group experiential themes were 'Out of Options', depicting patients forced to accept complications or limited survival; 'The New Normal', with EPS potentially delaying adaptation to post-PE HrQoL; 'Information Influencing Adaptation,' emphasising the significance of patients understanding EPS to cope with its effects; and 'Symptoms,' reporting manifestations of EPS, the resultant physical limitations, and an intangible feeling that patients lost part of themselves. EPS may influence patient decision-making, regret, adaptation, and information-seeking. It can cause a variety of unpleasant symptoms and physical limitations, which may include phantom phenomenon. This work supports ongoing purposeful HrQoL research to better define these themes.

The Therapeutic Potential of Metformin for Attenuating Postsurgical Adhesion Band Formation

Objectives: Intra-abdominal adhesions are the most frequently occurring postoperative complication following abdominopelvic surgery. Peritoneal adhesion formation can lead to infertility, chronic pelvic pain, and intestinal obstruction. Several studies have shown the potential role of metformin in reducing inflammation. Here, we explored the therapeutic potency of Metformin against postsurgical adhesion band formation. Methods: We adopted Animal Research: Reporting of In Vivo Experiments (ARRIVE) guidelines for the experimental protocol. Peritoneal adhesions were examined macroscopically .Metformin (100 mg/kg) was administered intraperitoneally in male albino Wistar rats. After 9 days, macroscopic evidence and score of fibrotic bands based on scaling methods were performed and evaluated by the Nair and Leach scoring system. Moreover, the anti-inflammatory and antifibrosis effects were investigated by using hematoxylin and eosin, Masson's trichrome staining, the enzyme-linked immunosorbent assay (ELISA), and reverse transcription polymerase chain reaction (RT-PCR). Results: Metformin inhibited the stabilization of adhesion bands and appeared to elicit antiinflammatory responses by attenuating submucosal edema, suppressing proinflammatory cytokines, decreasing proinflammatory cell infiltration, and inhibiting oxidative stress at the site of peritoneal surgery. We also showed that metformin prevents fibrotic adhesion band formation by reducing excessive collagen deposition and suppression of profibrotic gene expression at the peritoneum adhesion tissues via modulation of Col 1A1/A3. Conclusion: These results supported the potential application of metformin in preventing postsurgical adhesion band formation by inhibiting key pathologic responses of inflammation and fibrosis in patients post-surgery.

Assessment of tumor location in adjuvant treatment decision for stage II colon cancer

Aims: In stage II colon cancer, the aim is to evaluate the impact of tumor location and other clinicopathological factors on prognosis and survival. Methods: The study included a total of 93 patients diagnosed with stage II colon cancer between January 2018 and December 2022, comprising 41 females and 52 males. Clinicopathological factors related to the patients were retrospectively investigated. Factors found to be significant in univariate analysis were further evaluated through multivariate analysis to identify independent factors. Results: As a result of univariate analysis, variables such as tumor location (right-left colon), perineural invasion, surgical margin, intestinal obstruction, and lymph node dissection were found to be statistically significant for the risk of death (p

MINIMALLY INVASIVE TREATMENT OF ACUTE INTESTINAL OBSTRUCTION BY PERITONITIS

Acute commissural intestinal obstruction aggravated by peritonitis has been proved to be quite common and severe disease which requires urgent operations; death rate of this disease averages 10,2 – 56,9 %. Taking into consideration these facts the aim of this work is to decrease risk factors of disease’s recurrence, to improve the level of prophylaxis of commissural intestinal obstruction aggravated by peritonitis using modern therapeutic methods. Clinical evaluation of 81 patients with commissural intestinal obstruction aggravated by peritonitis (OIOAP) who have been treated in our department for the last 8 years has been carried out in this investigation. On the base of sufficient clinical material, the following conclusions have been made: treatment by the means of endovideolaparoscopic method gives the opportunity not only to eliminate the cause of the development of commissural intestinal obstruction aggravated by peritonitis; it proved to be effective method of prevention of commissural disease after surgical operation; besides, this method completely meets the requirements of esthetic and cosmetic surgery. Actually this method prevents the recurrence of commissure formation, it is very important for patients with the tendency to commissure formation.

Treating neonatal intestinal obstruction with ostomy in continuity: a single-center comparative study.

There is an array of surgical modalities available to treat neonatal intestinal obstruction, but there is no consensus on the optimal method. The study aims to evaluate the therapeutic efficacy of ostomy in continuity (OIC), providing a reference for surgeons to determine the appropriate surgical approach. The study involved a retrospective analysis of the clinical data of 46 neonates with intestinal obstruction hospitalized between June 2019 and February 2024. The types of intestinal injuries included in the study comprised atresia, necrotizing enterocolitis (NEC), meconium ileus and volvulus. Based on their surgical procedures, patients were divided into the OIC group and the control group. General information, as well as perioperative and postoperative complications, were compared between the two groups. There were 18 patients underwent OIC, and 28 patients underwent double-barrel or single-barrel enterostomies. There were no statistically significant differences between patients in the two groups in terms of general information, duration of the ostomy surgery (P=0.66), bleeding volume (P=0.25), length of post-ostomy hospital stay (P=0.08), and time to first defecation after surgery (P=0.23). Compared to the control group, neonates in the OIC group had a shorter duration of parenteral nutrition (P=0.02), a shorter interval between stoma creation and closure surgeries (P=0.02), a shorter duration of stoma closure surgery (P<0.001), and fewer postoperative complications (P<0.001). The weight-for-age Z-score before the stoma closure surgery was better in the OIC group than the control group (P=0.01). In this study, we found that OIC, as a treatment for neonatal intestinal obstruction, was effective in maintaining intestinal continuity, improving the nutritional status of neonates, and shortening the interval between the stoma creation and closure surgeries.

Small Bowel Obstruction Due to Food Bolus Impaction in a Post Gastrojejunostomy Patient: A Case Report

Small Bowel Obstruction Due to Food Bolus Impaction in a Post Gastrojejunostomy Patient: A Case Report

Global research trends in postoperative ileus from 2011 to 2023: A scientometric study.

Postoperative ileus (POI) is a common complication after abdominal surgery with high morbidity, which hinders patient recovery, prolongs hospitalization, and increases healthcare costs. Therefore, POI has become a global public health challenge. POI triggering is multifactorial. Autonomic and hormonal mechanisms are generally involved in POI pathogenesis. Recent studies have shown that beta adrenergic signaling of enteric glia is a POI trigger. Currently, the status quo, trends, and frontiers of global research on POI remain unclear. To explore the current status, trends, and frontiers of POI research from 2011 to the present based on bibliometric analysis. Publications published on POI research from 2011 to 2023 were retrieved on June 1, 2023, from the Web of Science Core Collection. CiteSpace 6.2.R2 and VOSviewer were used to conduct bibliometric visualization. In total, 778 POI records published from 2011 to 2023 were retrieved. Over the past few decades, the annual cumulative number of related articles has linearly increased, with China and the United States of America contributing prominently. All publications were from 59 countries and territories. China and the University of Bonn were the top contributing country and institution, respectively. Neurogastroenterology & Motility was the most prolific journal. The Journal of Gastrointestinal Surgery had the highest number of citations. Wehner Sven was the most productive author. Burst keywords (e.g., colon, prolonged ileus, acupuncture, paralytic ileus, pathophysiology, rectal cancer, gastrointestinal function, risk) and a series of reference citation bursts provided evidence for the research frontiers in recent years. This study demonstrates trends in the published literature on POI and provides new insights for researchers. It emphasizes the importance of multidisciplinary cooperation in the development of this field.

Effect of Probiotics on Improving Intestinal Mucosal Permeability and Inflammation after Surgery.

We explored the mechanisms underlying the improvement of postoperative ileus (POI) following probiotic pretreatment. We assessed intestinal permeability, inflammation, tight junction (TJ) protein expression in the gut epithelium, and plasma interleukin (IL)-17 levels in a guinea pig model of POI. Guinea pigs were divided into control, POI, and probiotic groups. The POI and probiotic groups underwent surgery, but the probiotic group received probiotics before the procedure. The ileum and proximal colon were harvested. Intestinal permeability was measured via horseradish peroxidase permeability. Inflammation was evaluated via leukocyte count in the intestinal wall muscle layer, and calprotectin expression in each intestinal wall layer was analyzed immunohistochemically. TJ proteins were analyzed using immunohistochemical staining, and plasma IL-17 levels were measured using an enzyme-linked immunosorbent assay. The POI group exhibited increased intestinal permeability and inflammation, whereas probiotic pretreatment reduced the extent of these POI-induced changes. Probiotics restored the expression of TJ proteins occludin and zonula occludens-1 in the proximal colon, which were increased in the POI group. Calprotectin expression significantly increased in the muscle layer of the POI group and was downregulated in the probiotic group; however, no distinct differences were observed between the mucosal and submucosal layers. Plasma IL-17 levels did not significantly differ among the groups. Probiotic pretreatment may relieve POI by reducing intestinal permeability and inflammation and TJ protein expression in the gut epithelium. These findings suggest a potential therapeutic approach for POI management.

Tertiary Care Center Trends in Colonic Stent Placement over the Past Decade.

Colonic endoluminal stent placement is a commonly utilized and effective endoscopic approach for the management of malignant large bowel obstruction and is an emerging approach for the management of some benign etiologies of large bowel obstruction. However, recent studies evaluating the evolution of clinical scenarios and patient populations for which stenting is performed in real-world practice are lacking. We assessed colonic stent utilization patterns in a tertiary care academic medical center over the past 10 years. We analyzed the demographics and patient and procedure characteristics of the initial (first half of study period) and latter (second half of the study period) procedures to assess trends over time using standard descriptive statistics. Our analysis was notable due to its provision of some novel insights. The frequency of colonic stent placement procedures increased significantly over time by comparison of the procedure volume for the initial 5-year interval (22 colonic stent procedures) relative to the latter 5-year interval (49 colonic stent procedures) (p = 0.03). The median age of patients who underwent colonic stent placement was significantly lower in the latter 5 years, compared with the initial 5 years of the study period (mean of 81.41 vs. 58.73 years, respectively, p < 0.001). The increased diversity of indications for colonic stent placement was also noted over time. Our data highlight the evolution of colonic stent placement in tertiary care practice over time and are notable for some interesting trends, including the increased utilization of colonic stent placement over time, the broadening of indications for colonic stent placement to include benign indications, and lower patient age at the time of colonic stent placement over time. These findings will help inform the clinical practice of colonic stent placement and provide a foundation to guide future research on the topic.

Unintended Upper Uterine Wall Extensions at the Time of Cesarean Delivery: Risk Factors and Associated Adverse Maternal and Neonatal Outcomes.

This study aims to estimate the frequency of unintended upper uterine wall extensions during cesarean delivery (CD) and identify associated risk factors and adverse outcomes. A multicenter retrospective cohort study was conducted, including patients who underwent CD between 2005 and 2021. Demographic factors, obstetric history, CD indications, delivery and surgical characteristics, adverse maternal and neonatal outcomes were compared between those with unintended upper uterine wall extensions during CD and those without extensions. Crude and adjusted estimates (odds ratios [ORs] and 95% confidence intervals [CIs]) were used. Among 30,517 patients meeting inclusion criteria, 117 (0.4%) had an unintended upper uterine wall extension. In univariate analysis, upper uterine wall extensions were associated with higher rates of intrapartum CD, second-stage CD, unplanned or emergency CD, CD following failed vacuum delivery or trial of labor after CD, chorioamnionitis, prolonged labor, increased vaginal exams, lower fetal head station, and higher birth weight. During surgery, higher rates of general anesthesia, significant intraperitoneal adhesion, fetal malpresentation, and fetal extraction by the leg were observed. Multivariable analysis identified fetal extraction not by head (adjusted OR [aOR]: 9.17, 95% CI: 5.35-15.73), vertex fetal presentation (aOR: 3.65, 95% CI: 1.81-7.35), second-stage CD (aOR: 3.07, 95% CI: 1.24-7.59), and trial of labor after cesarean (aOR: 2.04, 95% CI: 1.08-3.84) as significant risk factors for unintended upper uterine wall extensions. Additionally, upper uterine wall extensions were associated with higher rates of maternal and neonatal complications, including longer operating times, excessive bleeding, postpartum hemorrhage, intraperitoneal drainage, blood product transfusion, puerperal fever, paralytic ileus, Apgar score < 7 at 1 and 5 minutes, and fetal intracranial hemorrhage. Our study identifies risk factors for unintended upper uterine wall extensions during CD. While these extensions are infrequent, their occurrence is associated with increased maternal and neonatal morbidity. · Unintended upper uterine wall extensions occur in 0.4% of cesarean deliveries.. · Significant risk factors include fetal extraction not by head and second-stage CD.. · Extensions are associated with increased maternal complications like excessive bleeding and prolonged surgery.. · Neonatal complications include lower Apgar scores and intracranial hemorrhage.. · Awareness of these risks is critical for improving cesarean delivery outcomes..