Treatment Of Acute Intestinal Obstruction Research Articles

The role of obstructive resection in the treatment of acute intestinal obstruction complicated by bowel necrosis

Methods of surgical intervention in acute intestinal obstruction with necrosis of the strangulated area of the intestine are the subject of ongoing discussions. There is no doubt that every patient with this disease should undergo emergency surgery. However, diagnosing necrosis of the strangulated area is not easy. For this reason, a number of authors recommend refraining from emergency surgery for all patients with intestinal obstruction during dynamic follow-up, which can last up to 14 days. Over the past century, the etiology of intestinal obstruction has shifted from strangulated hernia to postoperative adhesive disease, which has led to a paradigm shift in methodological approaches. In order to successfully manage acute intestinal obstruction with suspected strangulation, the clinician today must be able to distinguish between patients requiring urgent surgery and those who should receive conservative therapy.In this paper, we consider the surgical approach of delayed anastomosis formation on significant clinical material, including tactical approaches, timing and necessary conditions for anastomosis formation in patients with intestinal obstruction complicated by necrosis of the strangulated area.The complex of therapeutic measures in the treatment of patients with acute intestinal obstruction complicated by necrosis of the strangulated area of the intestine, intraoperative perforation of the intestine during separation of adhesions, both in conditions of peritonitis and without it, should include obstructive resection of the intestine in combination with the formation of an anastomosis in a delayed order, as well as or planned sanitation of the abdominal cavity. All this makes it possible to reduce the incidence of interintestinal anastomosis failure from 86.7 to 0.96% of cases, and postoperative mortality from 41.8 to 14.4%.

EXPERIENCE OF STAGED SURGICAL TREATMENT OF ACUTE OBSTRUCTIVE INTESTINAL OBSTRUCTION OF TUMOR ORIGIN

Summary. Objective: to improve the results of surgical treatment of patients with acute intestinal obstruction of tumor origin.
 Materials and methods of research. During the period from 2014 to 2020 in the surgical clinics of the Military Medical Clinical Center of the Southern Region (Odessa) 186 patients were treated with acute obstructive colonic obstruction of tumor origin.
 Research results and their discussion. In 34 (18.3 %) patients with GOKN during the applied conservative measures positive dynamics was observed, which allowed to examine patients in detail and prepare for surgery. In 6 (3.2 %) elderly patients with severe comorbidities, tumor recanalization and stent placement were performed. In 146 (78.5 %) patients, conservative measures were unsuccessful and were operated on according to vital signs, the first stage of which was intestinal fatigue.
 Conclusions. Step-by-step tactics of surgical treatment of acute intestinal obstruction of tumor origin with the use of laparoscopic colostomy in the first stage were used in 60.3 % of patients, which allowed final verification of the diagnosis, safe compensation of electrolyte and nutritional disorders in the patient and further treatment and correction.

A study on the trends and patterns of intestinal obstruction and surgical outcome based on APACHE score II in a tertiary care centre

Background: One of the most common intra-abdominal problems faced by general surgeons in their practice remains bowel obstruction. It is important to identify and analyse the clinical presentation and etiology of patients with acute intestinal obstruction. With its multiple etiologies, intestinal obstruction of either the small or large bowel continues to be a major cause of morbidity and mortality.Methods: An observational study was carried out at Narayana Hrudayalaya Hospital, Bangalore between July 2016 and June 2019 involving 190 patients, after approval from Institutional ethics Committee. Predicted mortality rates were calculated using the APACHE II scoring system by linear analysis method. It was then compared with the actual outcomes. Univariate and multivariate analysis was carried to analyze the collected data.Results: The commonest cause in this study was postoperative adhesions [82 patients (43.2%)]. Frequency of mortality in our study was 7.9%. ROC curve analysis to predict the mortality using APACHE score showed sensitivity (80%), specificity (81.14%) and AUROC=0.796. P value was <0.001 which is highly significant. A positive correlation was found between deaths and complications with higher APACHE scores.Conclusions: Successful treatment of acute intestinal obstruction depends upon early diagnosis, skilful management and treating the pathological effects of the obstruction just as much as the cause itself. The APACHE II score allows for direct comparison between the observed and expected adverse outcome rates. They can also be used to determine prognosis and help family members make informed decisions about the aggressiveness of care.

Clinical study and surgical management of acute intestinal obstruction in the adults

Background: The aim of this study was to evaluate the treatment protocol of intestinal obstruction in adults.Methods: A total of 60 patients diagnosed with intestinal obstruction were included in the study. All the patients with the provisional diagnosis of the intestinal obstruction were assessed clinically after the admission. Appropriate surgical procedures were implemented on the patients with clear signs and symptoms of acute abdominal obstruction. Surgery adopted and criteria for deciding the procedure were noted.Results: For the management of small bowl obstruction. Adhesiolysis was done in 14 patients, resection and anastomsis was done in 8 patients, in 4 patients the band release procedure was performed, hernia repair was done in 8 patients, followed by resection, hernia repair, volvulus derotation and Mekels diverticulectomy was done in 2 patients respectively. For the management of large bowl obstruction the Colostomy was done in 8 cases, resection and anastomosis in 4 cases, intussusception milking in two cases, volvulus derotation was done in 2 cases and right hemicolectomy was done in 4 cases of CA ascending colon.Conclusions: Success in the treatment of acute intestinal obstruction depends largely upon early diagnosis skilful management and treating the pathological effects of the obstruction just as much as the cause itself. Postoperative adhesions are the common cause to produce intestinal obstruction. Clinical radiological and operative findings put together can diagnose the intestinal obstruction. Mortality is still significantly high in acute intestinal obstruction.

Clinical Study of Acute Intestinal Obstruction

Background: Acute intestinal obstruction is one of the most common surgical emergencies. There are many causes of acute intestinal obstruction like bands and adhesions, neoplasms, strictures etc. Aims and Objectives: In this study we have tried to find out common clinical presentation, aetiology and treatment of acute intestinal obstruction. Materials and Methods: This is a prospective study conducted at department of General Surgery, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik, Maharashtra in which we have studied 45 cases of acute intestinal obstruction to find out the clinical presentation, aetiology and treatment of acute intestinal obstruction. Conclusions: Acute intestinal obstruction is more common in females than in males. Small intestinal obstruction is more common than large intestinal obstruction. The commonest cause of intestinal obstruction is adhesions. The next most common cause is Tubercular stricture. Malignancy is most common cause of large intestinal obstruction. Most of the patients having large bowel obstruction required laparotomy.

Diagnosis and surgical treatment of acute intestinal obstruction caused by extragenital form of endometriosis

Damage to the gastrointestinal tract with extragenital endometriosis is a very rare pathology. According to the literature, the frequency of damage to the gastrointestinal tract in endometriosis, after previously performed gynecological operations, is less than 1%. At the same time, involvement in the pathological process of the intestine is noted in 337% of women of childbearing age with diagnosed genital endometriosis. In most clinical cases extragenital endometriosis occurs intraoperatively due to the complexity of early diagnosis.
 This article presents a clinical case of successful surgical treatment of a 43-year-old patient admitted to a surgical department with signs of intestinal obstruction. According to the anamnesis the patient had been suffering from recurrent pains in the lower abdomen in the right mesogastrium and constipation. The day before hospitalization, the above mentioned symptoms become worse with additional nausea, vomiting, lack of gases and feces. Based on the clinical laboratory and instrumental data the diagnosis of acute intestinal obstruction was established; and the urgent surgical treatment was carried out. Two formations were revealed intraoperatively (in the terminal ileum and in the elongated loop of the sigmoid colon). Both formations circularly narrowed the intestinal lumen, however the ileum was the cause of obstruction. Due to the lack of histological verification and the inability to exclude the malignant nature of the formation, the surgical treatment was carried out taking into account oncological standard in the amount of ileum resection and obstructive resection of the sigmoid colon with lymphadenectomy and small intestine intubation. Pathohistological examination confirmed intestinal endometriosis. The course of the postoperative period revealed no complications. The patient was discharged on the 12th day for outpatient treatment under the supervision of a surgeon and a gynecologist at the place of residence with recommendations and subsequent planned hospitalization in order to conduct reconstructive surgery to restore intestinal patency.

ХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ ОСТРОЙ КИШЕЧНОЙ НЕПРОХОДИМОСТИ, ОБУСЛОВЛЕННОЙ НЕЙРОЭНДОКРИННОЙ ОПУХОЛЬЮ ТОНКОЙ КИШКИ, НА ФОНЕ ИНФИЦИРОВАНИЯ ПАЦИЕНТА НОВОЙ КОРОНОВИРУСНОЙ ИНФЕКЦИЕЙ COVID-19

A clinical case of successful surgical treatment of acute intestinal obstruction due to a neuroendocrine tumor of the small intestine in a patient against a new coronovirus infection COVID-19 is described.

Clinical Effectiveness of Endoscopic Stent Placement in Treatment of Acute Intestinal Obstruction Caused by Colorectal Cancer

BackgroundEmergency endoscopic intestinal stenting has been applied with increasing frequency in colorectal cancer patients with acute intestinal obstruction. However, its clinical effectiveness as compared to emergency surgery remains controversial.Material/MethodsThe clinical data of 96 patients with acute intestinal obstruction caused by colorectal cancer from April 2012 to April 2018 were retrospectively collected. Statistical technique success rate, clinical success rate, operative time, average indwelling time of stent, complications, transition time to second-stage surgery, postoperative hospital stay, sputum rate, and postoperative infection rate were studied.ResultsEndoscopic colonoscopy was successfully performed in 94 patients. The success rate of stent placement was 97.9%, and the average operative time was 35 minutes (range, 25–85 minutes). Forty-two patients underwent stage I colectomy after relief of the obstruction. The average stent retention time was 7 days (range, 5–15 days). Two patients suffered from anastomotic infection. Their intestinal preparation time, hospital stay, fistula rate, and infection rate were lower than those of patients undergoing emergency operation for colon cancer intestinal obstruction. A total of 52 patients with colon cancer underwent palliative stent placement. Three patients had complications, including 1 case of stent displacement in the palliative care group and 2 cases with perforation in the bridge surgery group.ConclusionsEmergency endoscopic placement of an intestinal stent is safe and effective in the treatment of patients with acute intestinal obstruction caused by colorectal cancer. It is also a safe and simple procedure for patients receiving advanced palliative treatment, which greatly improves their quality of life and is easy for patients’ families to accept.

A clinical study of aetiology of acute intestinal obstruction

Background: Acute intestinal obstruction is one of common abdominal emergency and is associated with significant morbidity and mortality especially if it progresses to bowel ischemia. The diagnosis and management of the patient with intestinal obstruction is one of the more challenging emergencies that a general surgeon can come across. Although the mortality due to acute intestinal obstruction is decreasing with better understanding of pathophysiology and improvement in diagnostic techniques, fluid and electrolyte correction, much potent anti-microbials but still mortality ranges from 10-15% and more so in developing countries.Methods: The study will be conducted in the department of general surgery with symptoms and signs of acute intestinal obstruction admitted in the surgical ward. Fifty cases of intestinal obstruction have been studied. Patients belonged to all the age groups except infants are included in present study. The criteria for selection of cases was based on clinical history, physical findings, radiological and haematological investigations. The study was divided into clinical study, investigations and treatment. The results are tabulated stressing on following points age, sex, symptoms examination findings, investigations, abnormalities, probable causative factors, operative findings and operative procedure adopted and complications if any.Results: The commonest cause of intestinal obstruction in the adults in this study series was postoperative adhesions (36%) followed by obstructed/strangulated hernia (26%). Malignancy of the large bowel was seen in 9 cases constituting 18% of cases where as incidence of Volvulus of bowel was 4% in this series. Although pulmonary tuberculosis is more prevalent in India due to advent in use of antitubercular drugs incidence of abdominal tuberculosis is becoming less. In present study incidence of ileocaecal tuberculosis was 10%. One case of mesenteric ischaemia was present in our study.Conclusions: Acute intestinal obstruction remains an important surgical emergency in the surgical field. Success in the treatment of acute intestinal obstruction depends largely upon its early diagnosis, skilful management and treating the pathological effects of the obstruction just as much as the cause itself.

Экспериментальное обоснование применения синтетического пептида в комплексном хирургическом лечении острой кишечной непроходимости

Высокая смертность при хирургическом лечении острой кишечной непроходимости (ОКН) определила поиск новых методов сопутствующей терапии. Обнаруженная ранее высокая эффективность опиоидных пептидов в стимулировании лимфотока в микрососудах брыжейки тонкой кишки у крыс, восстановлении нарушенной микроциркуляцию и снижении смертности при ряде заболеваний, определила цель данного исследования: изучить роль фармакологической стимуляции лимфотока в динамике ОКН. В работе использовали методы: биомикроскопия, лазерная допплеровская флоуметрия брыжейки и стенки тонкой кишки крысы, регистрация сократительной активности лимфатических микрососудов ЛМ методом фотометрии, морфометрия микрососудов, видео- и фотосъемка. Полученные результаты предполагают наличие адаптационной роли у активатора микролимфоциркуляции (опиоидного пептида-171 прямого действия) в комплексном хирургическом лечении ОКН. Однократное орошение пептидом межкишечного анастомоза (после удаления) и поврежденного лигатурой фрагмента кишки (перед зашиванием операционной раны) увеличивало выживаемость животных с ОКН на 23%. У всех выживших животных отмечено восстановление: проходимости кишки, микроциркуляции в кровеносных и лимфатических микрососудах, а также структуры стенки кишки. High mortality in the surgical treatment of acute intestinal obstruction (AIO) has warranted the search for new methods of concomitant therapy. Opioid peptides have proved highly effective in stimulating the lymphatic flow in rat small intestinal mesenteric microvessels, restoring the impaired microcirculation, and reducing mortality in many diseases. This had determined this study objective: to investigate the role of lymphatic stimulation in the dynamics of AIO. The study used methods of biomicroscopy, laser Doppler flowmetry, and histological examination of the mesentery and the small intestinal wall in rats; recording the contractile activity of lymphatic microvessels using photometry; microvessel morphometry; video and photography. The study results suggested an adaptive role of the lymphatic microcirculation activator (direct-action opioid-171) in the complex surgical treatment of AIO. A one-time peptide irrigation of the intestinal anastomosis (after removal) and the intestinal injuried by the ligature (before the surgical wound was sutured) increased the survival of animals with AIO by 23%. In all surviving animals, recovery of the intestinal patency, blood and lymphatic microcirculation, and the intestinal wall structure was observed.

Determining the level of resection of the intestine in experimental acute intestinal obstruction using bioimpedance

Актуальность. Определение границ необратимого повреждения кишки в условиях острой кишечной непроходимости является одной из важнейших задач, выполняемых в ходе оперативного лечения данной патологии.Цель исследования: улучшение результатов хирургического лечения острой кишечной непроходимости путем уменьшения объема резекции кишки при ее некрозе.Материалы и методы. Исследование выполнено на 64 белых крысах линии «Вистар» массой 180-230 г. Под наркозом проводили срединную лапаротомию и моделировали острую странгуляционную тонкокишечную непроходимость путем наложения толстой лигатуры на петлю тонкой кишки (длиной 1,5-2 см) вместе с брыжейкой. Моделирование патологического процесса было произведено на сроки 1 час (n=11), 3 часа (n=13) и 6 часов (n=12). На 13 животных были исследованы показатели импеданса тонкой кишки в норме. Отдельную группу (n=15) составили животные, которым произведено моделирование острой кишечной непроходимости сроком на 3 часа с последующей резекцией кишки на различных уровнях и формированием кишечных анастомозов. Инвазивную биоимпедансометрию (БИМ) кишечной стенки производили с помощью устройства для измерения импеданса биологических тканей БИМ-II (Патент РФ №2366360). В качестве калибровки прибора перед исследованием in vitro измеряли импеданс физиологического раствора. Исследуемые участи кишки подвергались гистологическому исследованию.Результаты и их обсуждение. Величина импеданса физиологического раствора составила 0,46 кОм. При изучении изменений показателей БИМ приводящего и отводящего отделов тонкой кишки выявлено, что значения уменьшаются по направлению к зоне странгуляции, наиболее низкие величины регистрировались на границе с зоной странгуляции. По данным гистологического исследования тонкой кишки в зонах, где регистрировали показатели биоимпедансометрии ниже 2 кОм в условиях острой кишечной непроходимости, выявлены признаки некроза различной выраженности. При этом максимальное значение импеданса в этих участках было равно 1,99 кОм. В зонах кишки, где регистрировали показатели импеданса выше 2 кОм, независимо от сроков патологического процесса, признаков некроза обнаружено не было. При определении границ резекции кишки ориентиром служила величина импеданса выше 2 кОм.Гистологическое исследование кишечных анастомозов, выполненных при резекции кишки в условиях острой кишечной непроходимости с учетом данных биоимпедансометрии, и анастомозов, выполненных при резекции органа в пределах заведомо жизнеспособных тканей, не выявило существенных различий в гистоморфологической картине заживления.Выводы. Значение биоимпедансометрии участков приводящего и отводящего отделов кишки выше 2 кОм является критерием при определении границ резекции органа.Ключевые слова: эксперимент, острая кишечная непроходимость, жизнеспособность кишки, биоимпедансометрия.

Enteral Detoxication in Complex Treatment of Acute Intestinal Obstruction

Enteral Detoxication in Complex Treatment of Acute Intestinal Obstruction

Decision Making in Bowel Obstruction: A Review

Over the last century there have not been significant changes in the anatomical location of obstruction. The age of presentation has increased along with age related co-morbidity. Management has consequently been challenging as risks keep on increasing with advanced age. Hence, clear decision making has become essential in its management. A selective review of the literature pertaining to common age related aetiologies, diagnosis methods leading to standard decision making and treatment of acute intestinal obstruction was done. The same is obtained from randomized controlled studies, meta-analysis and other related evidence based publications. Predicting the conservative or operative management of Bowel Obstruction (BO) is difficult. BO in young age, in unscarred abdomen and Large Bowel Obstruction (LBO) needs early surgery. Decision on surgery should be taken in paediatric patient by second day and preferably between 3-5 days of admission in adults. Higher American Society of Anaesthesiologists (ASA) grade correlates well with the mortalities. In this article, the timing of surgery, methods to avoid bowel resection and type of surgery in various causes are stressfully analysed and discussed.

Severity of hepatic dysfunction and its correction in the complex treatment of acute intestinal obstruction

The article describes the role that could play a hepatoprotective therapy in the treatment of patients with acute intestinal obstruction. The study involved 128 patients with mechanical acute intestinal obstruction, accompanied by the syndrome of enteral insufficiency. Hepatoprotective drugs have been added in the scheme of treatment. It has been proven beneficial therapeutic effect of this measure on the dynamics of the development of hepatorenal syndrome, syndrome of enteral insufficiency.

COMPARISON OF CHANGES IN THE SMALL INTESTINE DURING THE TREATMENT OF SEVERE OBTURATIVE INTESTINAL OBSTRUCTION IN THE EXPERIMENT

The article presents results of the study of morphological changes in the small intestine during simulated surgical treatment of acute intestinal obstruction without using the sorbent Silard P. and with it.

Different operation timing in the treatment of acute intestinal obstruction

Objective To explore the effect of different operation timing in the treatment of acute intestinal obstruction.Methods 74 patients with acute intestinal obstruction admitted to our hospital from Oct.2009 to Sep.2012 were selected as study objects and then were divided into an A group and a B group according to the operation timing.The A Group underwent operation within 48 h after the attack,and the B group were surgically treated 48 h after the attack.The differences of complication incidence and mortality after the operation were compared between the two groups.Results The complication incidence and mortality were lower in the A group than in the B group,with statistical differences(P ＜ 0.05).Conclusions Early surgery for acute intestinal obstruction can effectively prevent intestinal necrosis,reduce the patients' mortality,and has clinical significance for the patients prognosis Key words: Operation timing; Acute intestinal obstruction; Treatment effect

The surgical treatment of acute intestinal obstruction caused by colon cancer

Objective To analyse the clinical effects on colon cancer with acute intestinal obstruction.Methods 56 patients with acute intestinal obstruction caused by colon cancer were studied retrospectively.The experience of diagnosis was summarized.Results 47 patients with acute intestinal obstruction caused by colon cancer received Stage Ⅰ tumor resection and the other 9 patients received different stages.54 patients healed (96.4％) and 1perioperative deaths (1.8 ％).Postoperative complications occurred in 18 cases (32.1％) including incision infection,intraperitoneal infection and intestinal fistula.Conclusion Stage Ⅰ tumor resection is feasible and safe surgical procedures for acute intestinal obstruction caused by colon cancer. Key words: Colonic neoplasms ; Intestinal obstruction; Surgical treatment

AN IMPACT OF INTRAABDOMINAL HYPERTENSION ON BLOOD BIOCHEMICAL AND RHEOLOGICAL CHANGES AFTER SURGICAL TREATMENT OF ACUTE INTESTINAL OBSTRUCTION IN AN EXPERIMENT

The paper has presented the results of an experimental research on an impact of intraabdominal hypertension on changes of the biochemical characteristics of blood and the state of its coagulation system after a simulation and surgical treatment of acute intestinal obstruction. The obtained results testify that prolonged intraabdominal hypertension results in a trustworthy increase of blood urea transaminases and the blood serum creatinine levels, proving its negative impact on the development of hepatonephric dysfunction in case of acute intestinal obstruction during an early postoperative period. This particular complication is also characterized by a significant increase of fibrinogen in the blood plasma, a prolongation of the prothrombin time a reduction of the prothrombin index and activated partial thromboplastin time that is indicative of the development of the process of false hypocoagulation.

7079 A new modality treatment of acute intestinal obstruction due to rectosigmoid cancer by metal stents.

Acute intestinal obstruction is a not rare complication of rectosigmoid cancer and the majority of these cases are usually treated by colostomy in emergency surgery. Insertion of metal prosthesis has the theoretical advantage to allow stool passage, and wait for a surgical elective treatment. We have considered for this temporary palliative treatment 12 patients presented with acute intestinal occlusion due to distal colorectal cancer They were admitted in the emergency department of our hospital, and they have undergone to endoscopy without intestinal washing, after a routine premedication with midazolam (5 mg i.v.). In all cases we have used a gastroscope to rule out the cancer and pass the stricture. On a guide wire a metal stent has been inserted across the stricture and then released by introduction device with full endoscopic control of distal end of the prosthesis. In 9 cases we used an UltraflexTM (Boston Scientific) with diameter 23 to 28 mm, 100 mm long, and proximal release. In the other 3 cases we used a PlacehitTM (Schneider) with diameter of 22 mm and 100 mm in length. No failure was suffered, and in all cases the stent has been correctly inserted. No complications were noted, related to endoscopic maneuver. In 11/12 patients the stool passage has been immediately effective, and they have undergone to radical left colectomy within a week after stenting. One patient required a colostomy the day after stenting for persistent obstruction. In conclusion metal stents seem to be useful in temporary treatment of acute intestinal obstruction, and they allow an elective surgical treatment in safe condition and with a radical purpose.

Experience in the diagnosis and treatment of acute intestinal obstruction

The results of treatment of acute intestinal obstruction in Tatarstan for 30 years were analyzed. A direct dependence of the outcomes of the operation on the timing of admission of patients to the hospital from the moment of the disease was revealed.