Volvulus with intestinal malrotation hiding a near-total intestinal aganglionosis: Case report.

Total colonic aganglionosis occurring together with malrotation is a rare occurrence and may pose diagnostic and management dilemmas for the pediatric surgeon. We report the case of a new born, who was operated at the age of three days for malrotation with volvulus, treated by Ladd procedure. Postoperatively, we noticed persistent abdominal distension and emission of a small amount of meconium every 4 to 5 days. The barium enema showed a non-functional microcolon. Surgical exploration on the 24th day found an ileo-ileal transition zone located 60 cm distal to the ligament of Treitz. Extemporaneous biopsies from the colon and mid-ileum confirmed the absence of ganglion cells. We performed an ileostomy at 50 cm from duodeno-jejunal flexure. Unfortunately, the patient succumbed to nosocomial infection at 33 days of age.This case was a challenging scenario for us where a diagnosis of complicated malrotation had obscured the Hirschsprung's disease.

Electro-acupuncture attenuates inflammatory responses and intraabdominal pressure in septic patients: A randomized controlled trial.

BACKGROUND: A pathological increase in intraabdominal pressure (IAP) and inflammatory responses have negative effects on splanchnic, respiratory, cardiovascular, renal, and neurological function in septic patients with intestinal dysfunction. Electro-acupuncture (EA) has been evidenced to have a bidirectional neuron-endocrine-immune system regulating effect in patients with intestinal dysfunction. The purpose of current study was to evaluate the effects of EA at "Zusanli" (ST36) and "Shangjuxu" (ST37) on inflammatory responses and IAP in septic patients with intestinal dysfunction manifested syndrome of obstruction of the bowels Qi. METHODS: Eighty-two septic patients with intestinal dysfunction manifested syndrome of obstruction of the bowels Qi were randomly assigned to control group (n = 41) and EA group (n = 41). Patients in control group were given conventional therapies including fluid resuscitation, antiinfection, vasoactive agents, mechanical ventilation (MV), supply of enteral nutrition, and glutamine as soon as possible. In addition to conventional therapies, patients in EA group underwent 20-minutes of EA at ST36-ST37 twice a day for 5 days. At baseline, posttreatment 1, 3, and 7 days, serum levels of tumor necrosis factor-α (TNF-α) and interleukin-1ß (IL-1ß) and IAP levels, were measured, respectively. And days on MV, length of stay in intensive care unit (ICU) and 28 days mortality were recorded. RESULTS: The serum levels of TNF-α and IL-1ß and IAP levels at posttreatment 1, 3, and 7 days were lower significantly in the EA group compared with the control group (mean [SD]; 61.03 [20.39] vs 79.28 [20.69]; P < .005, mean [SD]; 35.34 [18.75] vs 66.53 [30.43]; P < .005 and mean [SD]; 20.32 [11.30] vs 32.99 [20.62]; P = .001, respectively, TNF-α. Mean [SD]; 14.11 [5.21] vs 16.72 [5.59]; P = .032, mean [SD]; 9.02 [3.62] vs 12.10 [4.13]; P = .001 and mean [SD]; 5.11 [1.79] vs 8.19 [2.99]; P < .005, respectively, IL-1ß. Mean [SD]; 14.83 [5.58] vs 17.55 [3.37]; P = .009, mean [SD]; 11.20 [2.57] vs 14.85 [3.01]; P < .005 and mean [SD]; 8.62 [2.55] vs 11.25 [2.72]; P < .005, respectively, IAP). There were no significant differences in the duration of MV, length of stay in ICU, and 28d mortality between the groups. CONCLUSION: EA at ST36-ST37 attenuated inflammatory responses through reduction in serum levels of TNF-α and IL-1ß and IAP in septic patients with intestinal dysfunction manifested syndrome of obstruction of the bowels Qi.

Saline Enemas versus Glycerin Suppositories to Promote Enteral Feeding in Premature Infants: A Pilot Randomized Controlled Trial.

BACKGROUND: Meconium retention is associated with feeding intolerance. Trials using glycerol and Gastrografin to expedite the evacuation of meconium have failed to generate clinically valid results for efficacy and safety. OBJECTIVE: We assessed the feasibility of aggressive meconium evacuation with saline rectal washout (RW) in very-low-birth-weight infants to reduce the time it took them to reach full enteral feeds. METHODS: We conducted an open-label, pilot, randomized controlled trial (RCT) (birth weight stratified, i.e., to 750-999 g and 1,000-1,500 g) of early aggressive meconium evacuation with twice-daily normal saline RW compared to conventional management with glycerin suppositories (GS), until full enteral feeds (110 mL/kg/day) were reached. Primary outcome was time to reach full enteral feeds. Safety, process, and secondary efficacy outcomes were also evaluated. RESULTS: Sixty-one infants were randomized, 28 to RW and 33 to GS. The process and feasibility outcomes were met. RW was found to be safe; none of the RW-randomized infants developed necrotizing enterocolitis (≥ stage II) or complications secondary to RW. Evidence of efficacy was supported: in the 750-999 g stratum (n = 15), the median time to full enteral feeds was shorter with RW (11.0 days, 95% CI: 10.4-11.6) than with GS (15.6 days, 95% CI: 13.0-18.2) by a reduction of 4.6 days (p = 0.027). In the 1,000-1,500 g stratum (n = 46), there was no evidence of benefit: RW 10.2 days (95% CI 8.3-12.1) and GS 10.1 days (95% CI 9.3-10.9, p = 0.304). CONCLUSION: Our protocol was feasible and an adequately powered RCT is required to confirm the findings of this trial.

Successful use of pregabalin by the rectal route to treat chronic neuropathic pain in a patient with complete intestinal failure.

Pregabalin is widely used for treatment of neuropathic pain and is only approved for oral use. This is the first reported case of using pregabalin by the rectal route for treatment in a 70-year-old patient with chronic neuropathic pain and complete intestinal failure. Therapies used in an attempt to manage his chronic pain have included a variety of doses and strengths of opioid preparations and cannabinoids, plus topical and alternative therapies. These were not effective, so it was decided to start a trial of pregabalin administered by the rectal route. Serum levels were measured to assess absorption. Within a few weeks of starting the treatment, the patient had improved pain control and appeared more comfortable and calm.

[Pelvic floor and anal incontinence. Conservative therapy]. / Beckenboden und anale Inkontinenz. Konservative Therapie.

Conservative treatment of fecal incontinence and obstructive defecation can be treated by many conservative treatment modalities. This article presents the options of medication therapy, spincter exercises, electric stimulation, transcutaneous tibial nerve stimulation, anal irrigation and injection of bulking agents. These methods are presented with reference to the currently available literature but the evidence-based data level for all methods is low. For minor disorders of anorectal function these conservative methods can lead to an improvement of anorectal function and should be individually adapted.

Primary carcinoma of jejunum--a case report.

A 73 years old male presented with features of acute intestinal obstruction. At exploratory laparotomy, a mass was felt in jejunum. The growth with adequate margin and mesenteric lymph nodes were removed. The jejunal growth was diagnosed as adenocarcinoma on histopathology, which is a rare tumour of small intestine. He was planned adjuvant chemotherapy. He is in complete remission 6 months after follow-up.

Transanal repair for treatment of rectocele in obstructed defaecation: manual or stapled.

AIM: Our aim is to evaluate the results of transanal repair of rectocele, either manual or stapled, considering the anatomic, manometric and symptomatic improvement. METHODS: Forty-five female patients with obstructed defaecation due to anterior rectocele were operated on in the Colorectal Surgery Unit, Mansoura University Hospital, after history taking, detailed questionnaire analysis, barium enema, anorectal manometric studies, EMG studies, anal endosonography, balloon expulsion test, colonic transit time and defaecographic studies. Transanal manual repair was performed for 23 patients (group 1), and transanal stapled repair (group 2) was performed for 22 patients. Postoperative complications were recorded, and the patients were followed up for 1 year. Functional results were evaluated at 3, 6 and 12 months after surgery by questionnaire, anorectal manometry and evacuation proctography. RESULTS: Time of operation and hospital stay were significantly shorter in group 2. Postoperatively, there was no mortality or major morbidity. Two patients in group 1 experienced temporary anal incontinence (A3 and B1 stages). There were no reported adverse effects on sexual life, but significant clinical improvement was observed in both groups after surgery. Manometrically, there was a significant improvement in MARP, FLAC, RS, UTDV and MTV in both groups (significantly better in the early postoperative period in the stapled group). Also, follow-up defaecographic findings showed a significant decrease in the rectocele size in all the patients. CONCLUSION: Transanal repair of rectocele is a safe and effective technique in improving symptomatic rectocele. Stapled repair offers the advantage of short operative time, no comorbidity, and shorter hospital stay.

Usefulness of psyllium in rehabilitation of obstructed defecation.

BACKGROUND: Rehabilitation is the first therapeutic step of obstructed defecation, after failure of conservative therapy with high-fiber diet and laxatives. This study evaluates the usefulness of psyllium, a bulk-forming agent, when used during rehabilitation of obstructed defecation. METHODS: Between January 2008 and December 2010, 45 patients affected by obstructed defecation were included in the study. Two randomized groups were selected. Group 1 (21 women; age range 25-67 (mean, 51.8) years) continued to consume a high-fiber diet (approximately 30 g fiber per day) during rehabilitation. Group 2 (24 women; age range 46-71 (mean, 59.8) years) consumed only psyllium (3.6 g × 2/day; Psyllogel(®) Fibra, Nathura, Montecchio Emilia, Italy) during the rehabilitative cycle. After a preliminary clinical evaluation, including the obstructed defecation syndrome (ODS) score, patients underwent defecography and anorectal manometry as well as rehabilitative treatment according to the "multimodal rehabilitative program" for obstructive defecation. At the end of the program, patients were reassessed by clinical evaluation and anorectal manometry. Post-rehabilitative ODS scores were used for an arbitrary schedule of patients divided into three classes: Class I, good (score ≤ 4); Class II, fair (score > 4 to ≤ 8); Class III, poor (score > 8). RESULTS: The number of bowel movements per week did not increase significantly after rehabilitation. Both groups had a significantly better Bristol stool form scale score (Group 1: P < 0.034; Group 2: P < 0.02). The overall mean ODS score from Groups 1 and 2 showed significant improvement after treatment (P < 0.001). Twenty-eight patients (82.3%) were Class I (good results) without significant differences between groups. Nine women were symptom-free. Significant differences were found between pre-rehabilitative and post-rehabilitative manometric data from the straining test (P < 0.001) and duration of maximal voluntary contraction (Group 1: P < 0.004; Group 2: P < 0.02). A significant difference was found between the pre-rehabilitative and post-rehabilitative conscious rectal sensitivity threshold (CRST) in Group 2 women (P < 0.02). The Group 2 women who underwent volumetric rehabilitation (11 patients) had significantly lower post-rehabilitative CRST values than pre-rehabilitative values (P < 0.002); the length of volumetric rehabilitation was also significantly shorter in Group 2 patients (P < 0.04) than in Group 1 patients. CONCLUSIONS: After rehabilitation of obstructed defecation, some patients became symptom-free and many had an improved ODS score. Psyllium is helpful for volumetric rehabilitation: patients who consumed psyllium had lower post-rehabilitative CRST values than subjects were on high-fiber diet.

The impact of arginine on bacterial translocation in an intestinal obstruction model in rats.

BACKGROUND & AIMS: Arginine has been shown to have multiple beneficial metabolic and immunologic effects in stress situations. Supplementation of arginine has been shown to promote wound healing and intestinal mucosal recovery after trauma, ischemia or intestinal resection. Bacterial translocation has also been evaluated although with conflicting results and using different assessing techniques. Therefore, the aim of this study was to evaluate the effects of arginine on bacterial translocation in an intestinal obstruction model in rats using Escherichia coli labeled with 99mTechnetium. METHODS: Male Wistar rats (250-350 g) were randomized to receive conventional chow, diet supplemented with pure arginine or diet supplemented with an immunonutrition enteral formula, enriched with arginine, omega-3 fatty acid and RNA. After 7 days, the animals were anesthetized. Terminal ileum was isolated and a ligature was placed around it. E. coli labeled with 99mTechnetium (99mTc-E. coli) was inoculated into the intestinal lumen (terminal ileum). After 24 h, the animals were sacrificed. Blood, mesenteric lymph nodes (MLN), liver, spleen and lungs were removed for radioactivity determination. RESULTS: Arginine supplementation (300 mg/day, 600 mg/day or present in the enteral formula) reduced the level of bacterial translocation when compared with the control group (p<0.05). This was shown by significantly decrease uptake of 99mTc-E. coli in blood, MLN, liver, spleen and lungs of the animals in the experimental groups (p < 0.05). CONCLUSIONS: These results have shown that arginine was able to decrease bacteria translocation despite intestinal obstruction. There are several mechanisms which might explain the role of arginine and these will be the subject of future studies.

Involvement of superoxide anion in the pathogenesis of simple mechanical intestinal obstruction.

BACKGROUND: Mechanism underlying the pathogenesis of mechanical intestinal obstruction has been suggested to be closely associated with bowel inflammatory response in which reactive oxygen metabolites might play an important role. This study was designed to examine the involvement of superoxide anion in the obstruction-induced intestinal injury. MATERIALS AND METHODS: Rats were randomly aasigned to four groups: sham, obstruction, obstruction with polyethylene glycol (PEG), and obstruction with polyethylene glycol-superoxide dismutase (PEG-SOD) groups. A ligation at the ileum 20 cm proximal to the cecum was created under anesthesia. The superoxide anion production and the pathological manifestations in the obstructed intestine were measured after 24 h of ligation. RESULTS: There were significant intestinal shortening, distension, fluid accumulation and mucosal damage in the segment proximal to the ligation site. Pronounced generation of superoxide anion was found in the obstructed intestinal segment. Supplement of SOD, a superoxide free radicals scavenger, ameliorated obstruction-induced bowel distension, fluid accumulation and mucosal damage. CONCLUSION: These data suggest superoxide anion is one of the important mediators in the pathophysiologic changes of simple mechanical intestinal obstruction.

[Effect of shenfu injection on recovery of intestinal function, cellular immunity, serum interleukin-2 and tumor necrosis factor-alpha in children with intestinal obstruction after operation].

OBJECTIVE: To observe the effect of Shenfu injection (SFI) on recovery of intestinal function, T-lymphocyte subsets (CD4, CD8 and CD4/CD8), interleukin-2 (IL-2) and tumor necrosis factor-alpha (TNF-alpha) in children with intestinal obstruction after surgical operation. METHODS: Ninety-eight children suffering from intestinal obstruction after emergent surgical operation were divided into the SFI group (n = 50, treated with SFI after operation) and the control group (n = 48, treated with surgical operation alone). The intestinal function recovery rate (IFRR), T-lymphocyte subsets, serum levels of IL-2 and TNF-alpha in them were observed. RESULTS: After being treated for 7 days, the IFRR in the SFI group was 84.0%, which was significantly higher than that in the control group (62.5%, P < 0.05). CD4, CD4/CD8 levels increased in the SFI group after treatment (P < 0.05), while in the control group, CD8 increased significantly after treatment (P < 0.05) and higher than that in SFI group (P < 0.01). IL-2 level was much higher in the SFI group after treatment than that in the control group (P < 0.05). TNF-alpha level significantly lowered in both groups (P < 0.01), and the level in the SFI group was lower than that in the control group (P < 0.05). CONCLUSION: SFI could promote the recovery of intestinal function, improve and regulate the immune function of the children after operation for intestinal obstruction.

Intestinal obstruction and perforation--the role of the gastroenterologist.

Intestinal obstruction belongs to highly severe conditions in gastroenterology, namely from the viewpoint of quick and correct diagnosis as well as at determining rational and effective therapy. Etiological multifactorial characteristics leading to processes resulting in mechanical or dynamic obstruction of the intestine, often referred to as paralytic ileus, are undoubtedly serious factors influencing the accuracy of diagnosis and therapeutic approach. Digestive endoscopy is a mandatory method in the diagnosis of intestinal obstructions. Diagnostic endoscopy, colonoscopy in the involvement of the large intestine or enteroscopy in the case of incomplete obstruction of the small intestine are the methods indicated in the majority of obstructive intestinal lesions. Besides their diagnostic importance, they also enable an effective therapeutic approach which may immediately follow the diagnostic intervention. Besides endoscopy that--due to the nature of performance--belongs to invasive methods, the diagnosis of obstructive intestinal processes is unthinkable without the use of non-invasive imaging methods. Abdominal ultrasound examination, a widely applied method, provides--under optimal examination conditions--information, e.g., about the width of the intestinal lumen or about the intestinal wall thickness; however, the specificity of investigation is not always sufficient. Both specificity and sensitivity of exploration are increased by a plain X-ray of the abdomen supplementing the ultrasound examination. Better results are achieved when the abdominal cavity is inspected by means of spiral CT examination that is nowadays not fashionable but highly effectively applied in the modification of the so-called CT enteroclysis or CT colonography. The usage of magnetic resonance (e.g. virtual colonography) is similar, but its efficacy is lower than that of CT examination. From a gastroenterologist's perspective, endoscopic examination is the fundamental diagnostic and therapeutic method. However, endoscopic examination is initially limited by the cardiopulmonary state of the patient--in a number of cases, first the cardiopulmonary condition must be stabilized, dysbalance of water and mineral state must be restored, and only then can endoscopic investigation be carried out. The application of enteroscopy in small intestine disorders is only suitable in cases where air must be aspirated from the region of the stomach and mainly small intestine as it happens, for example, in acute intestinal pseudo-obstruction. The success of complex conservative therapy in these states is reached in 80% of the cases. In acute and complete intestinal obstruction, a surgical treatment performed in time is the only method. In these cases, the importance of identification of obstruction and timing of the intervention performance from the viewpoint of the patient's survival is explicitly the principal and life-saving concern. In acute intestinal obstructions developing in patients with malignant affection of the intestine, it is necessary to choose--according to the obstruction location and general state of the patient--either urgently performed surgery or palliative endoscopic intervention which is the reduction of the intestinal lumen of the growing tumor mass and following insertion of a drain. This method also concerns lesions localized in the left half of the abdominal cavity, i.e. in the region of the rectosigmoid and descending part of the colon. Most patients in whom acute intestinal obstruction developed on the basis of malignant disease are risk and polymorbid subjects, and acute surgical intervention may be either impracticable or highly stressing. In such cases it is therefore helpful to insert a drain and to bridge the obstructed area after restoring the cardiopulmonary state including adjustment of the aqueous and mineral environment. Later, the performance of an elective surgical intervention is safer. Another alternative before inserting a drain is the dilatation of the stenotic site by means of a balloon, followed by stenting. Up until today, various types of intestinal drains have been introduced--they have always been self-expanding metallic stents. Just the application of self-expanding stents in patients with malignant intestinal obstruction and the endoscopic possibility of dilatations of benign intestinal obstructions with dilatation balloons are the most significant therapeutic contributions of digestive endoscopy in these states.

Effect of inositol-trisphosphate on fluid transport and protein extravasation in the obstructed small bowel.

BACKGROUND: Small-bowel obstruction is characterized by accumulation of fluid in the obstructed intestine. A pronounced inflammation in the obstructed gut wall has been shown to play an important role in the pathogenesis of the profuse fluid losses. alpha-Trinositol (D-myo-inositol-1,2,6-trisphosphate; PP56) has potent anti-inflammatory as well as antisecretory properties. The effects of alpha-Trinositol on inflammation and fluid losses in the obstructed small intestine are examined. METHODS: A total obstruction of the proximal part of the rat jejunum was induced during 18 h by thread ligation. A small segment of the obstructed intestine, with intact vascular and nervous supply, was placed in a chamber suspended from a force displacement transducer allowing for continuous registration of net fluid transport on a Grass polygraph. Three groups were included. One group (n = 12) received low-dose alpha-Trinositol (bolus: 2 mg kg(-1); IV infusion: 10 mg kg(-1) min(-1)), a second group (n = 10) received high-dose alpha-Trinositol (bolus: 12 mg kg(-1); IV infusion: 60 mg kg(-1) min(-1)), while a control group (n = 9) received corresponding volumes of isotonic saline (bolus: 0.5 ml; IV infusions 15 microl min(-1)). Quantitative measurement of extra-vasated Evans blue albumin in the obstructed jejunum was used as a marker of inflammation. RESULTS: High-dose alpha-Trinositol induced a significant (P < 0.001) inhibition of net fluid secretion, while low-dose alpha-Trinositol had no significant effect versus saline. In contrast, both doses of alpha-Trinositol induced significant inhibition of EB-albumin leakage (P < 0.05). CONCLUSION: High-dose alpha-Trinositol is a potent inhibitor of fluid secretion in obstructive ileus, most probably involving an anti-inflammatory mechanism.

[Diagnostic evaluation of the rectum and pelvic floor in chronic constipation]. / Diagnostik des Rektums und Beckenbodens bei chronischer Obstipation.

In outlet constipation an exact diagnostic evaluation is always necessary because of the different etiologies, multiple combinations in primary and secondary lesions and the number of therapeutic alternatives. Basic diagnostics start with the very important, structured evaluation of the patient's history, colorectal examination including inspection, palpation, procto-, recto-, sigmoidoscopy and anorectal manometry. Depending on the results of this primary evaluation the following methods are indicated: neurophysiologic evaluation (basic neurological examination, EMG, PNTML), defecography ev. including colon contrast enema and gastrointestinal transit time studies. If the complete problem could not be ruled out till that point, the following examinations might be helpful: dynamic pelvic floor MRI, anorectal endosonography, rectal motility studies, fecoflowmetry, colonoscopy, urological und gynecological examinations.

Megacystis microcolon intestinal hypoperistalsis syndrome.

Megacystis microcolon intestinal hypoperistalsis syndrome (MMIHS) is a rare cause of intestinal obstruction mainly affecting female neonates. We present a case of a newborn female infant with a history of abdominal distension, bilious vomiting and decreased urine output. Barium enema showed a microcolon. Patient died soon after admission and the autopsy revealed a shortened bowel, a microcolon with abundant ganglion cells in the myenteric plexus, and an enlarged urinary bladder. An interesting finding in this case was the presence of enlarged nerve bundles containing several large ganglion cells on the lateral wall of the cervix. The salient clinical and autopsy findings in this case are presented.

Management and causes of acute large-bowel obstruction.

Acute LBO has many possible causes. In the United States, the most common cause is colorectal carcinoma. Mechanical obstruction should be differentiated from pseudo-obstruction by contrast enema or colonoscopy because the treatments differ. The high postoperative mortality and morbidity of LBO compared with elective resection are explained by the multiple associated pathophysiologic changes of obstruction. Management of this condition requires careful assessment, awareness, and expertise in the current modalities of treatment. Gangrene and perforation should be avoided because they limit treatment options and are associated with an increase in mortality. We prefer, in most instances, to perform a single-stage procedure, which has the advantages of reduced hospital stay (and cost) and avoidance of a stoma. However, the appropriate treatment needs to be tailored to the individual situation. Recent developments in nonoperative decompressing procedures may demonstrate advantages in the future.

Ileo postoperatorio: su diagnóstico diferencial / Postoperative ileus: differential diagnosis

Se realiza una revisión de la clínica y fisiopatología del ileo postoperatorio adinámico y obstructivo, en atención a su diagnóstico diferencial. La dificultad de éste, nos lleva a plantear el uso de métodos auxiliares básicamente iconográficos. De estos, la radiología, el más frecuentemente usado, requeriría en un 20 a 30 por ciento de los casos, completarse con otros métodos, tales como la ecografía y la tomografía axial computada, muy utilizados en el exterior, estandarizados, altamente sensibles y específicos y bien tolerados por el paciente. En nuestra realidad clínica asistencial, la radiología con contraste bario/hypaque es capaz de proporcionar la certeza de una obstrucción mecánica, sin la necesidad de movilizar a un paciente, usando para ello un equipo de rayos portátil. La ecografía por otra parte, surge como una herramienta ideal, que debemos empezar a utilizar en nuestros pacientes, por cuestión de costos, disponibilidad, nula invasividad y extrema certeza en menos entrenadas

Recovery of gastrointestinal motility from post-operative ileus in dogs: effects of Leu13-motilin (KW-5139) and prostaglandin F2 alpha.

Cyclical motor activity of the gastrointestinal tract, normally occurring during the interdigestive period in several mammals, is disrupted in the post-operative ileus. We determined the recovery from the disappearance of cyclical motor activity, from the stomach to the colon, in dogs after laparotomy with the force transducers. Moreover, we examined the effects of Leu13-motilin (KW-5139) and prostaglandin F2 alpha (PGF2 alpha), administered in the early post-operative period, on the gastrointestinal motility. Following laparotomy, the cyclical motor activity reappeared firstly in the ileum and the colon, then in the jejunum and the duodenum, and finally in the stomach. The reappearance time of the phase III contractions in the stomach was 105.8 +/- 10.6 h (n = 4). In the early post-operative period, KW-5139 (0.5 microgram kg-1, i.v.) induced phase-III-like contractions, whereas PGF2 alpha (50 micrograms kg-1, i.v.) induced simultaneously occurring contractions over the whole gastrointestine. The treatment with KW-5139 (0.5 microgram kg-1, i.v.) four times (twice daily on the first and the second post-operative day) significantly (P < 0.05) shortened the time required to recover the phase III contractions in the stomach (64.2 +/- 2.2 h, n = 4), whereas that with PGF2 alpha (50 micrograms kg-1, i.v.) four times did not (111.3 +/- 17.2 h, n = 4). The present results indicate that, after laparotomy, the cyclical motor activity recovers faster in the distal intestine than in the proximal intestine and the stomach, and that KW-5139, but not PGF2 alpha, shortens the reappearance time of the phase III activity in the stomach.