Vigorous Peristalsis Research Articles

Small bowel knots.

Intertwining of bowel loops to form a knot is very rare cause of intestinal obstruction. Among intestinal knots, ileoileal knotting is the most rare, with only a handful of cases reported in literature. We present a rare case of ileoileal knotting and review of small bowel knots. The aim of this review was to summarise the existing evidence on small bowel knots and to postulate the possible mechanisms for knotting. A systematic search was conducted for literature published up to December 2019 using MEDLINE, PubMed and Google Scholar databases, together with the references of the full-text articles retrieved. Papers with case reports of small bowel knots were considered to be eligible for inclusion in the review. A total of 14 case reports were evaluated. There was no clear predilection for age or sex. Mostly cases were from Asia and Africa with no cases from the West. The presenting complaints were abdominal pain (93%), vomiting (64%), abdominal distention (57 %) and obstipation (43%). The bowel was gangrenous in 78% of cases. All underwent exploration, with the majority requiring resection and anastomosis of the involved segment. Ileoileal knotting is a very rare cause of intestinal obstruction. Possible mechanisms include loaded bowel with longer mesentery, vigorous peristalsis, single bulky meal, pregnancy and intussusception. The condition is extremely difficult to diagnose preoperatively and it is usually diagnosed intraoperatively. The standard of treatment is resection of gangrenous part and anastomosis.

Intestinal occlusion secondary to a retained surgical item

Abstract Background Retained surgical items after a surgical procedure is a real, existing, and preventable problem that affects the safety of the surgical patient. Its incidence is not exactly known due to under-reporting of occurrence, due to the potential risk of lawsuits. Clinical case A 31 year-old women that had an elective caesarean, apparently without complications. In the immediate post-operative period, clinical features appeared that were compatible with intestinal obstruction, such as inability to channel gas, bloating, abdominal pain and vigorous peristalsis. The diagnosis is made by the recent history of abdominal-pelvic surgery and the finding of a foreign body on a simple X-ray of the abdomen. The patient was operated upon, with a satisfactory outcome, and was discharged 5 days later. Conclusion A retained surgical instrument is an under-reported event that represents a medical-legal problem, leading to various complications, including death if it is not diagnosed and treated early. It is important to know the risk factors and adopt a culture of prevention through perioperative monitoring of equipment and instruments used during the surgical act.

Vigorous Peristalsis During Multiple Rapid Swallows Does Not Predict Acid Reflux by pH Impedance Testing

Vigorous Peristalsis During Multiple Rapid Swallows Does Not Predict Acid Reflux by pH Impedance Testing

Comparison of clinical and manometric parameters in Achalasia cardia between elderly and non-elderly patients in West Bengal.

Achalasia cardia, a primary esophageal motility disorder of unknown etiology involving lower two- third of esophagus and lower esophageal sphincter (LES), can be specifically diagnosed by gold standard method, manometry, which shows abnormal LES relaxation and absent or vigorous peristalsis. In our study, 125 patients were admitted with dysphagia, regurgitation of food, vomiting, chest pain, retrosternal discomfort, of which, 36 were detected as esophageal carcinoma and lye stricture, rest were non organic. These 89 patients were sent for esophageal manometry. Males were significantly affected than females. Other than dysphagia, common symptoms were regurgitation of food and chest pain. 59.55% patients demonstrated LES pressure 60 years). Incidence of duration of symptoms before diagnosis and vomiting were significant in elderly patients, but manometric parameters showed no significant difference. Basal LES pressure was above normal in our study.

Morphology and biology of Polysaccus japonicus (Crustacea, Rhizocephala, Akentrogonida, Polysaccidae, fam. n.), a parasite of the ghost‐shrimp Callianassa japonica

The morphology and biology of Polysaccus japonicus Høeg & Lützen, 1993 is described. Nearly all infected hosts are adults, the females of which become castrated. Each bears 4–50 (female) externae on the underside of the abdomen. The externae are interconnected via a root system within the host's perineural blood sinus. The externae pass through three moults. Cypris larvae inject spermatogonia into the immature externa's mantle cavity, which is where spermiogenesis occurs later. Multiplication of the male cells is probably supported by secretion from paired mantle cavity glands, presumably homologous to the receptacles of kentrogonid rhizocephalans. Late during the 2nd intermoult the visceral mass ruptures to release the ova into the mantle cavity where they become fertilized. The third moult results in opening of the mantle aperture which initiates a period of vigorous peristalsis of the muscular mantle. Following emission of the cypris larvae the externae perish leaving distinct scars. The root system always contains buds of various sizes and stage of development. When the scarred host moults, the most advanced buds emerge to give rise to a new generation of externae. This is thought to be repeated for the rest of the host's life.The antennule of the cyprid has a relatively very long and slender 3rd segment, a unique construction among Akentrogonida. Because of this and the presence of special mantle cavity glands, a new family, Polysaccidae, is erected, which in some characters is intermediate between the Kentrogonida and the Akentrogonida.

Motility changes associated with canine intestinal allografting

Intraluminal pressures in segments of normal resting jejunum were measured by small balloon-tipped catheters. In most animals, ischemia produced a hyperperistaltic response which subsided during perfusion with cold Ringer's solution. Within 5 min after revascularization, intraluminal pressures increased threefold, with wide fluctuations, reflecting vigorous peristalsis. Intramural electrical activity was monitored using Teflon coated stainless steel wire electrodes. Complete severance of extrinsic innervation resulted in definite increase in action potentials and in some cases slow waves became irregular and decreased slightly in amplitude. Initially, ischemia produced vigorous spiking which disappeared during a 60-min perfusion period. Revascularization resulted in reappearance of electrical activity and vigorous peristalsis. Action potentials were prominent, while slow waves were irregular, of diminished amplitude and reduced in frequency. Necrosis of the segment secondary to rejection was associated with loss of electrical activity; based on gross appearance smooth muscle appeared more resistant to rejection than mucosa. Alterations of motility did not appear to be useful in early prediction of rejection.

TIMING OF ATROPINE AND NEOSTIGMINE IN THE REVERSAL OF MUSCLE RELAXANTS

The antimuscarinic effects of atropine were studied in 46 patients to whom neostigmine had been given after operation to reverse the action of a muscle relaxant. Neostigmine was given to alternate patients three minutes after, or together with, atropine, and the effects of the two procedures were compared by measuring the secretions which collected in the buccal and oropharyngeal cavities and observing the heart rate. It was found that the glands of the oral cavity were stimulated to a greater extent when neostigmine was given with atropine than after atropine. Any dose of atropine sufficient to inhibit peristaltic movements of the bowel is more than enough to block completely secretion by the salivary glands, and the appearance of some secretion in all cases after the administration of neostigmine suggests that the bowel was at liberty to react to the neostigmine in every case, but perhaps particularly so when atropine and neostigmine were given mixed. The integrity of an anastomosis of the bowel could be endangered by vigorous peristalsis in the early postoperative period. Electrocardiograms in about half the patients from each group confirmed earlier work that the muscarinic effects of neostigmine on the heart can be prevented by giving the atropine either before or together with the neostigmine.

Primary megaloureter.

IN 1923 CAULK (1) introduced the term “megaloureter” to denote a congenitally dilated, unobstructed ureter. Unfortunately, since then the term has frequently been misused to describe the ureteral dilatation resulting from prolonged infection, neuromuscular vesical disorders, or urethral or vesical neck obstruction. Campbell (2) stated that most of the cases of nonobstructive ureterectasis cited in the literature fall into one of the above classifications and that isolated ureteral dilatation is rare. The terms hydroureter and megaloureter have often been used interchangeably in spite of the fact that the former tends to imply obstruction either in the ureter or distally. Atony of the ureter and idiopathic segmental dilatation of the ureter are other names, presumably descriptive, that have been used synonymously with megaloureter and have been abandoned by most authors. Hurst et al. (3) in 1931 used the term achalasia (4) to indicate a neurogenic basis for this disorder and likened the process to that which occurs in the lower end of the esophagus. Because of the plethora of names and their lack of specificity and interchangeable usages, most authors today have abandoned all nomenclature and refer to this disorder as nonobstructive or nonocclusive ureteral dilatation. In this report we will use the term megaloureter to mean primary nonocclusive ureteral dilatation, eliminating all obstructive and neuromuscular vesical disorders (paraplegia, myelodysplasia, tabes dorsalis) that secondarily produce ureterectasis. The etiology and pathogenesis of primary megaloureter are as confusing and disputed as its nomenclature. Most investigators now believe that a functional obstruction occurs at the ureterovesical orifice. Though of normal caliber and patency, the segment of ureter immediately below the dilated portion, often referred to as the “narrow segment,” is usually intravesical but occasionally supravesical in location and lacks adequate means of transporting the urine the final few centimeters into the urinary bladder. Cineradiology and fluoroscopy (5) reveal vigorous peristalsis in the dilated part of the ureter with the narrow segment atonic and failing to distend. A bolus of urine passes down the dilated ureter, strikes the narrow segment, and floods back up the ureter permitting only a small trickle of urine to pass distally. Also, reverse contractions occur, which start at the lower segment and progress upward. The cause of the atonic narrow segment is not clear. Swenson (6, 7) contends that there is a deficiency of parasympathetic, myenteric nerve endings in the adventitia of the urinary bladder, particularly in the area of the ureterovesical orifice, producing a phenomonon similar to megacolon (Hirschsprung's). This autonomic imbalance produces atony of the urinary bladder and intramural portion of the ureter.

Congenital Pyloric Antral Membranes in Infancy

IN THIS communication we will describe 2 cases of congenital pyloric antral membranes presenting in the neonatal period. In both instances a pylorectomy with endto- end anastomosis was performed. In the second case, a correct preoperative diagnosis was made radiologically. This is the first case believed to have been so diagnosed at this age; indeed, although the condition is now well known only one other case of incomplete pyloric membrane has been recorded in the neonatal period (6). Case Reports CASE I: In May 1965 a premature Negro 3-dayold female presented with repeated non-bile-stained vomiting. Normal stools were being passed. There was slight epigastric fullness. A plain radiograph showed a distended stomach with relatively little gas in the small intestine. The stomach was aspirated, and a contrast examination was performed with a water-soluble medium. There was no gastric emptying for forty-five minutes. Later, an elongated segment was demonstrated, and an erroneous diagnosis of hypertrophic pyloric stenosis was made (Figs. 1 and 2). At surgery a prepyloric membrane with a central aperture of 2 mm was found. The histology of the membrane was that of normal gastric mucosa. There was no evidence of muscle hypertrophy. CASE II: In June 1967, a 4-day-old Negro male was seen. The birth was normal, but the mother had hydramnios. The patient had been vomiting since birth, the vomiting becoming projectile in character during the last twenty-four hours. The vomiting was not bile-stained, and motions were normal. There was slight dyspnea. Plain films showed a fluid level in the stomach, the rest of the abdomen being relatively airless. There was slight bronchopneumonia in the chest. A limited amount of dilute barium sulfate suspension was instilled down an intragastric tube. Esophageal reflux occurred, and vigorous peristalsis was noted in the stomach. The pyloric region was round and blunted. There was marked delay in gastric emptying, and it was not until after one hour that a central linear streak of barium emerged from the pyloric region (Figs. 3 and 4). From these appearances a diagnosis of prepyloric membrane was made. At surgery the pyloric canal was opened, and a thin membrane with a small central aperture was found to be obstructing the pylorus. The histology of the membrane was that of normal gastric mucosa; no muscle hypertrophy was seen. Discussion The pyloric membranes described are congenital in origin and present as a neonatal emergency. The membranes may be incomplete (as in these two cases) or complete. In the neonatal period, the clinical features are of upper gastrointestinal obstruction. Dyspnea, cyanosis, excess salivation, and aspiration may also occur. In the diagnosis esophageal atresia can be excluded by passing a catheter. Bilestained vomiting excludes 85 per cent of duodenal atresias (those distal to the ampulla of Vater).

Timing of Atropine and Neostigmine in the Reversal of Muscle Relaxants

The antimuscarinic effects of atropine were studied in 46 patients to whom neostigmine had been given after operation to reverse the action of a muscle relaxant. Neostigmine was given to alternate patients three minutes after, or together with, atropine, and the effects of the two procedures were compared by measuring the secretions which collected in the buccal and oropharyngeal cavities and observing the heart rate.It was found that the glands of the oral cavity were stimulated to a greater extent when neostigmine was given with atropine than after atropine. Any dose of atropine sufficient to inhibit peristaltic movements of the bowel is more than enough to block completely secretion by the salivary glands, and the appearance of some secretion in all cases after the administration of neostigmine suggests that the bowel was at liberty to react to the neostigmine in every case, but perhaps particularly so when atropine and neostigmine were given mixed. The integrity of an anastomosis of the bowel could be endangered by vigorous peristalsis in the early postoperative period.Electrocardiograms in about half the patients from each group confirmed earlier work that the muscarinic effects of neostigmine on the heart can be prevented by giving the atropine either before or together with the neostigmine.

The effects of pressure and pharmacologically active substances on gastric peristalsis in a transmurally stimulated rat soomach-duodenum preparation.

1. A rat stomach-duodenum preparation in which pressures in the body and the antrum and flow through the pylorus could be recorded simultaneously has been used to study the effects of pressure and pharmacologically active substances on the peristalsis induced by transmural stimulation.2. Vagal and transmural stimulation produced vigorous peristalsis and episodic flow. Simultaneous stimulation of the peri-arterial nerves abolished peristalsis and relaxed the pylorus.3. After repeated stimulation the preparation lost tone and peristalsis failed. Peristalsis and tone could then be improved by lowering intragastric pressure. Vigorous peristalsis could be restored in an inactive preparation by eserine and more transiently by 5-HT.4. Drugs which increased smooth muscle tone improved peristalsis and, under the conditions used, they reduced flow. Eserine was more active in this respect than acetylcholine or 5-HT.5. Adrenaline and hyoscine abolished peristalsis and caused the stomach and the pylorus to relax.6. The results suggest that the peristaltic activity of the antrum is more important than the tone of the pylorus itself in controlling gastric emptying.

Function of the pylorus and pyloric antrum in gastric emptying 1

The function of the pylorus and the pyloric antrum in the control of gastric emptying has been studied in an isolated rat stomach-duodenum preparation. Pressures in the body and pyloric...

Experimental small-bowel homografts.

Small-bowel homografts were transplanted into 18 adult mongrel dogs. Immediately, the transplanted bowel assumed a normal color and exhibited vigorous peristalsis. Seven of the recipient animals died as a result of circulatory arrest involving the superior mesenteric vein, while the remainder of the animals (except 1) died as a result of changes associated with the homograft rejection phenomenon. The technic is sufficiently advanced to permit the successful homotrans-plantation of small bowel. Intestinal homotransplants satisfactorily withstood periods of ischemia of sufficient length to ensure the satisfactory execution of necessary technical details. Successful clinical utilization of small-bowel homotransplants will follow the solution of the complex problems associated with the rejection phenomenon.

Meconium peritonitis due to a hole in the foetal intestinal wall and without obstruction.

The presence of meconium in the foetal peritoneal cavity has long been recognized as a cause of intense chemical peritonitis. The visceral peritoneum becomes thickened to form a membrane encasing the intestines ; in it and in the thickened parietal peritoneum calcium is deposited, recognized radiologically (Neuhauser, 1944) and histologically (Falkenheim and Askanazy, 1892). In some cases there is a plastic peritonitis, in others gross ascites. Such changes are not infective, but infection is added when the normal intestinal bacteria appear on the third or fourth day of life. There is a mystery about the mechanism by which the meconium reaches the peritoneal cavity. Rupture of the intestinal wall does occur in both neonate and foetus in association with obstruction. Thelander (1939) has collected many reports of perforations at all levels of the gastro intestinal tract. At the end of the proximal segment, at the lowest part of the normally functioning gut, there may be dilatation with or without muscular hypertrophy, and this whether the cause of the obstruction be atresia, stenosis, bands or aberrant arteries, or MeckePs diverti culum, malrotation with kinking of the gut, inspissated meconium, or paralysis of Hirschsprung type (functional obstruction). Sooner or later, without relief of the obstruction this segment perforates. A neonatal perfora tion, occurring after the arrival of intestinal bacteria, causes bacterial peritonitis and pneumoperitoneum with signs of severe shock leading to death of the baby. Foetal perforation causing meconium peritonitis can be understood if it is accepted that the foetus swallows liquor amnii and the foetal intestinal wall moves in peristaltic waves. The statement made in 1915 by Rud new (quoted by Low et al, 1949), who collected 40 cases, is that in only half of them was there evidence of obstruction and, whether this proportion is accurate or not, a hole may be found without any obstruction. But why should there be a hole in the wall of what is appar ently a normally formed and normally acting intestine ? The mystery is further deepened by two more observa tions : cases of meconium peritonitis have been reported in newborn babies in whom the subsequent post mortem examination has failed to show any hole through which meconium could have escaped (Skiles, 1928) ; and in some cases, with a hole but without evidence of obstruc tion by inspissated meconium, pancreatic fibrosis is proved or suspected, as in Case 2 below. A full explana tion to account for all these observations is still lacking. It is possible that a foetus with meconium Heus may by vigorous peristalsis rupture the gut and relieve itself by passing the meconium into the peritoneal cavity, and that the perforation may even heal in some cases before birth.