Suspected Bowel Obstruction Research Articles

Accuracy of abdominal auscultation for bowel obstruction.

To investigate the accuracy and inter-observer variation of bowel sound assessment in patients with clinically suspected bowel obstruction. Bowel sounds were recorded in patients with suspected bowel obstruction using a Littmann(®) Electronic Stethoscope. The recordings were processed to yield 25-s sound sequences in random order on PCs. Observers, recruited from doctors within the department, classified the sound sequences as either normal or pathological. The reference tests for bowel obstruction were intraoperative and endoscopic findings and clinical follow up. Sensitivity and specificity were calculated for each observer and compared between junior and senior doctors. Interobserver variation was measured using the Kappa statistic. Bowel sound sequences from 98 patients were assessed by 53 (33 junior and 20 senior) doctors. Laparotomy was performed in 47 patients, 35 of whom had bowel obstruction. Two patients underwent colorectal stenting due to large bowel obstruction. The median sensitivity and specificity was 0.42 (range: 0.19-0.64) and 0.78 (range: 0.35-0.98), respectively. There was no significant difference in accuracy between junior and senior doctors. The median frequency with which doctors classified bowel sounds as abnormal did not differ significantly between patients with and without bowel obstruction (26% vs 23%, P = 0.08). The 53 doctors made up 1378 unique pairs and the median Kappa value was 0.29 (range: -0.15-0.66). Accuracy and inter-observer agreement was generally low. Clinical decisions in patients with possible bowel obstruction should not be based on auscultatory assessment of bowel sounds.

Sa1392 Bad Prognosis Factors on Dilation Treatment of Post-Roux-en-Y Gastric Bypass Anastomotic Stenosis

Sa1392 Bad Prognosis Factors on Dilation Treatment of Post-Roux-en-Y Gastric Bypass Anastomotic Stenosis

Opioid Antagonists

Opioid Antagonists

Role of multislice computed tomography in evaluation and management of intestinal obstruction.

The aims and objectives of this study were: i) to evaluate the efficacy of computed tomography (CT) imaging in diagnosing the presence, level, degree, and cause of intestinal obstruction, and the role of CT in detecting presence of complications; ii) to assess impact of CT in decision making and management (surgical/conservative); iii) to correlate CT findings with intra operative findings whenever possible. A prospective study of 40 patients presented in outpatient/emergency department with features suggestive of intestinal obstruction. Multislice contrast enhanced computed tomography of whole abdomen was done in all patients after preliminary investigations. Whenever indicated, patients were explored. Statistical analysis was performed to determine the efficacy of multidetector computed tomography (MDCT) in diagnosing intestinal obstruction and its complications. Out of 40, 30 patients underwent exploratory laparotomy and it was found that MDCT was 85% sensitive and 70% specific in diagnosing bowel obstruction. Association between MDCT findings suggestive of obstruction and intra-operative findings turn out to be significant (P=0.003). MDCT findings were consistent with intraoperative findings in 22 out of 30 patients (73%). MDCT is sensitive and specific in determining the presence of bowel obstruction and should be recommended for patients with suspected bowel obstruction because it affects outcome in these patients.

Colopexy as a treatment option for the management of acute transverse colon volvulus: a case report

IntroductionTransverse colon volvulus is an uncommon acute surgical presentation associated with a higher rate of mortality than volvulae at other locations along the colon. Surgical resection or correction is the only treatment, and various methods have been described in case report literature to relieve the volvulus and prevent recurrence.Case presentationWe present the case of a 25-year-old Caucasian woman who was admitted with a three-day history of abdominal pain, absolute constipation and abdominal distension. Subsequent radiographic and computed tomography imaging revealed right-sided colonic dilatation suggestive of a volvulus. An emergency laparotomy was performed during which the dilated proximal bowel was decompressed and colopexy executed by using the greater omentum to fix the transverse colon at the hepatic and splenic flexures.ConclusionsVolvulus of the transverse colon is rare but must form part of the clinician's differential diagnosis when encountering a patient with suspected bowel obstruction, especially in younger patients with no previous surgical history. Laparotomy is the treatment of choice and the technique of using the greater omentum as a fixing point for redundant bowel to the lateral abdominal wall is an option that may be considered especially when the bowel appears viable.

Radiographic and Clinical Factors Associated with Improved Outcomes in Advanced Cancer Patients with Bowel Obstruction

The purpose of this study was to identify preoperative clinical and radiographic factors relevant to treatment selection and outcomes in patients with advanced cancer presenting with bowel obstruction. Clinical and radiographic data were retrospectively obtained from records of inpatients with suspected bowel obstruction referred for palliative surgical consultation (2000-2006). Patients were stratified according to site of obstruction: gastric outlet obstruction (GOO), small bowel obstruction (SBO), and large bowel obstruction (LBO). We utilized the Cox proportional hazards model to identify preoperative clinical and radiologic variables associated with overall survival (OS). Of 191 patients, the site of obstruction was classified as GOO in 41 (21%), SBO in 122 (64%), and LBO in 28 (15%). Almost half of the patients (47%) had received systemic therapy in the 6 weeks prior to evaluation. The most common sites of disease identified on imaging included abdominal visceral metastases (37%), carcinomatosis/sarcomatosis (46%), and an intact primary tumor or recurrence (31%). Most patients (62%) exhibited 2 or more sites of disease on imaging. Treatment strategies included nonoperative/nonprocedural management in 41% (n = 79), endoscopic/interventional radiology procedures in 25% (n = 48), and surgery in 34% (n = 64). Median OS for the cohort was 3.5 months (95% confidence interval [CI]: 2.7-4.6). Median OS for GOO, SBO, and LBO was 2.7 (95% CI: 1.7-4.1), 3.5 (95% CI: 2.5-4.9), and 7.0 (95% CI: 2.1-11) months, respectively (p = 0.17). Adverse prognostic factors for OS included endoscopic/interventional radiology procedures and ≥3 radiologically evident sites of disease. OS, although low, was not significantly different among GOO, SBO, and LBO. Single sites of disease identified on imaging were not associated with OS, although multiple sites of disease were associated with diminished OS.

Actinomycose pelvienne : est-ce prévisible ?

Objectives Pelvic actinomycosis is a rare disease that can be diagnosed before, during or after surgical treatment of a suspected ovarian tumor, a suspected bowel obstruction, or acute peritonitis. The possibility of early detection of pelvic or abdominal abscess related to was evaluated through a personal series and literature review. Patients and methods Our series of 11 cases of severe abdominal or pelvic actinomycosis is related and compared to 58 cases reported in the literature. Results Seven patients in this series were diagnosed with pelvic inflammatory disease and acute peritonitis with or without bowel obstruction, and four women were diagnosed after surgical treatment for suspected ovarian cancer. Fifty-two of the 58 cases of reproductive tract actinomycosis reported in the literature review and all our cases were associated with prolonged use of an intrauterine contraceptive device with a mean of eight years. The contribution of pelvic ultrasound and angioscanner in evaluating these patients should not be underestimated and MRI may be useful in some cases as well. Early diagnosis based on Actinomyces-positive cervical smears or abscess aspiration was accomplished only once in our series and was rare in literature. A histopathologic diagnosis during laparoscopy or laparotomy could avoid more difficult and extensive surgery. In our series of 11 patients, five women required abdominal surgery, five required salpingo-oophorectomy and three required hysterectomy. All women required surgical intervention. Effective treatment combined long antibiotic therapy with surgery. Correct preoperative diagnosis is rare but if achieved, long-term treatment with penicillin for at least two months and sometimes up to a year may completely eradicate the infection. Surgery may still be necessary to improve medical treatment or to resolve pelvic abscesses. Discussion and conclusion Any pelvic abscess occurring in a woman with a history of long-term use of an intrauterine device should be considered as possible pelvic actinomycosis. If there is no fever in association with an atypical adnexal tumor, frozen section should be obtained during surgery to rule out the diagnosis of actinomycosis.

Radiographic and clinical factors associated with improved outcomes in cancer patients with bowel obstruction

e20564 Background: The purpose of this study was to identify clinical and radiographic factors relevant to treatment outcomes in cancer patients presenting with bowel obstruction. Methods: Clinical and radiographic factors were retrospectively abstracted from records of inpatients referred for surgical consultation for suspected bowel obstruction (2000–2006). Patients were stratified by treatment: surgical treatment (ST), minimally invasive (percutaneous/endoscopic) procedures (MIP), or bowel rest (BR). Clinical outcomes such as status at discharge and median overall survival (OS) were examined. Results: Of 194 patients, 25% had a primary diagnosis of colorectal cancer. Computed tomography, plain radiographs, enteral contrast studies, and other modalities were used for diagnosis in 59%, 26%, 12%, and 3% of patients, respectively. 62% of obstructions were located in the small bowel, with the remaining 23% and 12% identified as gastric outlet and colon, respectively. Over 90% of patients treated with ST (n = 60) were discharged home and tolerated enteral feeding. In contrast, for patients treated with MIP and BR, 48% and 68% were discharged home, and 70% and 72% were able to tolerate enteral feeding, respectively. OS was similar for patients treated with ST (6.3 months) and for those whose bowel obstruction resolved with BR (6.4 months). For patients treated with MIP, however, OS was 1.4 months. Though significant differences in OS for patients treated with ST and MIP were observed (p<0.0001), 30-day readmission rates were similar across treatment groups. Radiographic images demonstrating low grade obstruction, absence of ascites, and the absence of peritoneal carcinomatosis were associated with improved OS. Additional relevant clinical factors affecting OS included serum albumin level; however, no association was observed for age, tumor type, site of obstruction, previous bowel obstruction, or abdominal exploration. Conclusions: Clinical and radiographic factors affect treatment outcomes for cancer patients with bowel obstruction. Given that factors such as ascites, peritoneal carcinomatosis and low serum albumin result in poor OS, non-invasive procedures should be considered. No significant financial relationships to disclose.

Prepartum sonographic demonstration of ‘to‐and‐fro’ motion in fetal intestinal obstruction: a novel sign for immediate postnatal surgery

Prepartum sonographic demonstration of ‘to‐and‐fro’ motion in fetal intestinal obstruction: a novel sign for immediate postnatal surgery

Comparison of two schedules (previous evening versus same morning) of bowel preparation for colonoscopy

Evening preparation for colonoscopy is often unsatisfactory and inconvenient. We performed this study to compare the efficacy of bowel preparation at two different timings: previous evening and same morning and to compare the loss of working hours and sleep between these groups. In this prospective, investigator blinded, randomized trial, 201 patients were enrolled from February to June 2005. Patients aged between 18 to 80 years needing colonoscopy were included. Patients with prior bowel surgery, suspected bowel obstruction or contraindications to phosphate preparation were excluded. Patients received a phosphate based preparation on the previous evening or morning of the procedure. The endoscopist and an observer scored bowel preparation using the Ottawa and Aronchick scales. Using the Ottawa scale right, middle and left colon were separately assessed. Loss of sleep and working hours were noted. One hundred and two patients received morning preparation and 99 patients received preparation on the previous evening. There was no significant difference in bowel preparation in both the groups using the Ottawa ( P = 0.87) or Aronchick ( P = 0.22) scales. Bowel preparation for right colon was significantly better in the morning group ( P = 0.008). More working hours were lost in the evening group (7.99 vs 10.17, P< 0.001). Sleep was disturbed in 15 patients in morning group and in 42 patients in evening group ( P< 0.001). Both preparations had similar efficacy. Right side preparation was significantly better in the morning group. Evening preparation was associated with loss of more working hours and sleep.

Three-Dimensional Computed Tomography Illustration of Small Bowel Obstruction Transition Points in Patients Receiving Oral Contrast

Computed tomography (CT) is often the first modality ordered in patients with suspected bowel obstruction. Three-dimensional (3D) CT imaging is now seen as a valuable tool for illustrating pathologic findings to clinicians and surgeons. Three cases are reported in which 3D CT volume rendering was used to demonstrate transition points in proximal small bowel obstructions in patients who had received oral contrast.

Bilateral Diaphragmatic Agenesis in an Adult Complicated by a Paraduodenal Hernia

Diaphragmatic agenesis is an extremely rare clinical entity and has only been reported five previous times in the English literature. We report a patient with bilateral diaphragmatic agenesis complicated by a paraduodenal hernia. Diaphragmatic agenesis is rarely diagnosed preoperatively. Most diagnoses will likely be made during exploration for suspected bowel obstruction or other gastrointestinal emergency. When they are found repair seems warranted if contamination from associated procedures such as bowel resection is minimal. Repair of diaphragmatic agenesis can be approached much like the creation of a neodiaphragm after diaphragmatic resection. The diagnosis of paraduodenal hernia can usually be confirmed radiologically. Many cases of paraduodenal hernias have been reported and repair is uniformly recommended.

Mechanical Small Bowel Obstruction due to Intraluminal Thrombus in a Patient with Acute Leukaemia: Ultrasonic Findings

Conventional plain film radiography is the primary imaging procedure in cases of suspected bowel obstruction. With improvement in ultrasound (US) technology, it can be used as part of the evaluation of patients with an acute abdomen [1–3]. US can detect the level of bowel obstruction accurately, particularly in the presence of a gasless, fluid-filled plain abdominal film [4]. We report an unusual case of gastrointestinal bleeding and subsequent small bowel obstruction caused by thrombus in a patient with acute leukaemia. The diagnosis was based on the US findings and confirmed at emergency surgery. To our knowledge, such a case has been not described previously.

The Utility of MR Imaging Using the HASTE and True FISP Sequences in Diagnosing Bowel Obstruction

Purpose: To determine the value of magnetic resonance imaging (MRI) using HASTE (half- Fourier single-shot turbo spin-echo) and true FISP (fast imaging with steady-state precession and heavy T2-weighting) sequences in diagnosing bowel obstruction. Materials and Methods: Thirty-one consecutive patients in whom suspected bowel obstruction was revealed at plain abdominal radiography, barium study, and computed tomography (CT) were admitted during an eight-month period. Eighteen of 27 in whom bowel obstruction was confirmed underwent MRI using HASTE and true FISP sequences. Results: At MRI, bowel obstruction was diagnosed in all patients. Using the HASTE sequence, the site of obstruction was correctly identified in 16 patients(89%) and the cause of obstruction was correctly diagnosed in 15(83%). Using the true FISP sequence, the corresponding figures were 16(89%) and 16(89%). Of the 18 patients with confirmed bowel obstruction, 33%(6/18) showed better lesion conspicuity at true FISP, for 39%(7/18), conspicuity was equal at both sequences, 28%(5/18) showed better conspicuity at HASTE. Conclusion: MRI can be useful for evaluation the presence, site and cause of bowel obstruction. On comparing the findings of HASTE and true FISP sequences, no significant differences were observed.

The abdominal radiographic series in children with suspected bowel obstruction--should the second view be abandoned?

To determine whether the addition of a second (horizontal beam) view to the supine abdominal radiograph improves diagnostic accuracy in the diagnosis of paediatric bowel obstruction. The abdominal radiographs of 72 paediatric patients were retrospectively evaluated for the presence of bowel obstruction by 22 independent observers (radiologists, surgeons and emergency physicians) of varying experience. Evaluation involved initial assessment of the supine radiograph alone, followed by reassessment with the addition of an upright or decubitus radiograph. When observers evaluated supine radiographs alone, their sensitivity was 66%, specificity 72% and accuracy 70%. With the addition of the second view sensitivity was 78%, specificity 75% and accuracy 76%. The mean change in accuracy was 6% with no statistically significant difference between radiologists, surgeons or emergency staff. The value of the routine second radiograph in the accuracy of diagnosis of bowel obstruction is limited, and its use should be restricted to selected cases in which diagnostic uncertainty persists.

Chronic intestinal pseudo-obstruction. Clinical symptomatology and course

Chronic intestinal pseudoobstruction (CIP) is a motility disorder clinically characterized by recurrent symptoms of small intestinal or large bowel obstruction without organic stenosis. The aim of the present study was to assess the clinical presentation and course of the disease. During a four year period all available data including the symptoms as assessed by the bowel disease questionnaire (BDQ) of all patients with newly established diagnosis of CIP were analyzed including duration of symptoms and previous surgical interventions due to the abdominal symptoms. Data of nine patients (five females, four males, age 20 - 64 years) with newly diagnosed CIP were available for analysis. Median age at initial onset of symptoms were 24 years. The final diagnosis of CIP was established after a median of 7 years (range 1 - 20). Initially, the majority of patients suffered from uncharacteristic symptoms such as abdominal fullness and abdominal pain. All patients had undergone repeated abdominal surgical interventions for suspected mechanical bowel obstruction. On average, the first surgical intervention was performed 5 years after the onset of symptoms and there was a median number of 10 treatments as in-patients. Suspected acute bowel obstruction occurred between 1 and 14 times and laparotomies were performed in 50 % of these events. The diagnosis of CIP is usually preceded by several years with uncharacteristic abdominal symptoms. During this time, most patients undergo multiple surgical interventions. Thus, in patients with repeated suspected acute bowel obstruction without definite proof of mechanical obstruction, CIP has to be taken into consideration as differential diagnosis. In this context, small bowel manometry is an important diagnostic tool.

Monokontrast-Distensions-untersuchung des Dünndarms - Vergleich mit der konventionellen MDP und dem Enteroklysma -

Development of a new monocontrast examination of the small bowel. The new examination was applied to 20 patients with suspected bowel obstruction or inflammatory bowel disease. A contrast mixture, containing gelatin, a water-soluble contrast medium (Peritrast) and water (GPW-mixture) was given over an intestinal tube. The viscosity of the new contrast mixture was measured by rotation and flow viscosimetry. The diagnostic value and the degree of small bowel distension were determined independently by 3 examiners. By comparison 20 randomized selected small bowel follow-through examinations (SBFT) and 20 small bowel enemas were examined. Special questionnaires were used to determine subjective compatibility and discomfort. Due to the viscosity of the new contrast medium and the administration over an intestinal tube, a good bowel distension was achieved with the GPW mixture. The bowel distension (p: < 0.01) and the diagnostic value (p: < 0.01) of the new examination in comparison to the SBFT was characterized as being significantly better. In comparison to the small bowel enema, distension was not significantly better (p: 0.31-1.0). The diagnostic value of the small bowel enema was characterized as significantly better by one of the three examiners in comparison to the new monocontrast-distenson examination (p-level < 0.01). The monocontrast-distension examination is a potential alternative in patients in whom a small bowel enema with barium sulfate is contraindicated.

3423 Pulsed irrigation evacuation: a better technique for colon cleansing?

Background: The first, and possible most critical, step in colonoscopy is to have an adequately prepared colon. Unfortunately, none of the currently used colon cleansing regimens are completely satisfactory both in terms of patient complaints of unpleasant side effects and in terms of failure to provide a clean colon. The failure rate with traditional preparation is typically 10 to 30%. We used the Pulsed Irrigation Evacuation (PIE) device for colon cleansing. This device administers warm tap water through a cuffed speculum with microprocessor timed pulses of inflow and outflow. The rehydrated fecal matter is collected in a closed system which is discarded. The PIE technique is FDA approved for the management of fecal impaction. We hypothesized that use of PIE should result in rapid colon cleansing for colonoscopy with minimal patient discomfort. Methods: Consecutive outpatients scheduled for colonoscopy were offered the opportunity to participate. Main exclusion criteria were suspected bowel obstruction, previous colon resection, and severe congestive heart failure. Patients were advised to take clear liquids after 1 PM on the day prior to examination, one bottle of magnesium citrate (165 mL) the evening prior to examination and were kept NPO after midnight. Upon arrival to endoscopy suite, PIE was performed until the return was clear, followed by colonoscopy. Endoscopic photographs were taken in each segment of the colon, and video recordings were made. Patient discomfort during colon cleansing was assessed by a questionnaire. The quality of colon cleansing was graded using a previously used scoring system during the procedure. Two endoscopists also independently graded the quality of colon cleansing based on the photographs/video. Results: 20 consecutive patients participated (mean age = 60 yr - range of 45-80 yr). PIE was well tolerated. The only side effect was mild abdominal cramps during large pulses. Colonoscopy was complete to the cecum or terminal ileum in all. Colon cleansing was graded as acceptable or better in all (100% success: excellent = 4 patients, good = 15 patients, acceptable = 1 patient). The average time for cleansing was 25 minutes (range 20 to 35) and typically, approximately 6 gallons of water was required. Five patients had previous colonoscopy with GoLYTELY preparation and all preferred PIE. Conclusions: PIE results in optimal and rapid colon cleansing while causing minimal patient discomfort. It could be used as a primary colon preparation or for same day cleansing of those with poor traditional preparation.

The use of prone films for suspected bowel obstruction in infants and children

Prone frontal and cross-table lateral views of the abdomen are recommended as most helpful in radiographic evaluation of infants and children suspected of having obstructive of nonobstructive ileus. A series of films in multiple projections is recommended to evaluate the gas in the large bowel, particularly the rectum. When studies must be limited, prone and left lateral decubitus views are recommended. In obstructive ileus, the collapsed rectum contains little or no air. Utilization of the prone view will often obviate the use of fluoroscopic contrast studies. The level of obstruction, as well as the cause, can often be determined by this plain film approach. Six cases are presented to illustrate these points.