Water-soluble contrast agent in adhesive small bowel obstruction: a systematic review and meta-analysis of diagnostic and therapeutic value.

BACKGROUND: Adhesive small bowel obstructions are the most common postoperative causes of hospitalization. Several studies investigated the diagnostic and therapeutic role of water-soluble contrast agent (WSCA) in predicting the need for surgery, but there is no consensus. METHODS: A systematic review and meta-analysis was done of studies on diagnostic and therapeutic role of oral WSCA. RESULTS: WSCA had a sensitivity of 92% and a specificity of 93% in predicting resolution of obstruction without surgery; diagnostic accuracy increased significantly if abdominal X-rays were taken after 8 hours. The administration of oral WSCA reduced the need for surgery (odds ratio .55, P = .003), length of stay (weighted mean difference -2.18 days, P < .00001), and time to resolution (weighted mean difference -28.25 hours, P < .00001). No differences in terms of morbidity or mortality were recorded. CONCLUSIONS: The administration of WSCA is accurate in predicting the need for surgery; the test should be taken after at least 8 hours from administration. WSCA is a proven safe and effective treatment, correlated with a significant reduction in the need for surgery and in the length of hospital stay.

Specifics of diagnosis and treatment in synchronous colorectal cancers (SCC).

INTRODUCTION: SCC have an incidence of 1,8% up to 12,4% and could have more simultaneous localizations. MATERIAL AND METHOD: Between January 2004 and January 2011, 214 patients with CRC have been operated on in our ward; from those, eight patients had multiple colorectal neoplasms. RESULTS: The majority of SCC (six cases) was hospitalized under emergency status, with incomplete or complete bowel obstruction through colonic obstructive tumour. The favourite localizations were on the sigmoid (six tumours) and the transverse colon (four tumours). The diagnosis was preoperatively assessed in three cases by colonoscopy and barium enema, intraoperative in four cases, postoperative in one case. Curative operations were performed in five cases and palliative operations in three. Immediate postsurgical evolution was good, long time evolution was marked by the complications of the primary disease. Out of five patients that were long term monitored, three have a five year survival, one has survived for three years and one deceased within a nine month period after surgery, with multiple metastases. CONCLUSIONS: Preoperative diagnosis of synchronous lesions can be difficult (emergency hospitalized patient, incomplete bowel preparation, bowel obstruction or intestinal bleeding) and the colonoscopy exam can be incomplete. Rigorous intraoperative colonic examination is necessary in order to diagnose synchronous lesions and avoid surgical reintervention.

Modest benefit of total parenteral nutrition and chemotherapy after venting gastrostomy tube placement.

OBJECTIVE: The aim of the study is to review a single institution's experience with gastrostomy tubes (GTs) performed for malignant bowel obstruction from gynecologic cancers. METHODS: Women with gynecologic cancers who underwent venting GT placement from 2000 to 2008 were identified and clinical data were extracted. Logistic regression and spearman correlational coefficients were used to determine relationships between variables. Survival analysis was performed using the Kaplan-Meier method and a Cox proportional hazard model. RESULTS: We identified 115 women who underwent GT placement, the majority of whom were diagnosed with ovarian cancer (84%). Median time from cancer diagnosis to GT placement was 2.2 years. Median survival following GT placement was 5.6 weeks. A majority (56%) developed GT complications requiring GT revision. While burden of disease as assessed on CT scan by the validated peritoneal cancer index (PCI) was not associated with survival, low CA-125 within one week of GT placement was associated with improved survival (p<0.01). TPN was administered in 36% of women, was associated with concurrent chemotherapy (p<0.001) and a 5 week survival benefit (p<0.01). Chemotherapy after GT was administered in 40% of women and was associated with a 10 week survival benefit (p<0.001). Age-adjusted multivariate analysis identified chemotherapy as the only independent variable associated with survival. CONCLUSIONS: Women with malignant bowel obstructions from gynecologic cancers requiring palliative GT placement had a guarded prognosis measured in weeks. Gastrostomy tubes near the end of life had a high rate of complications requiring medical intervention. Chemotherapy after GT was associated with TPN administration, and both were associated with a modest extension in survival.

Etiological factors and mortality of acute intestinal obstruction: a review of 705 cases.

OBJECTIVE: To figure out the etiological factors and overall mortality of the patients with acute intestinal obstruction, and to explore the rational period of conservative therapy before operation. METHODS: Medical records of all the patients with acute intestinal obstruction admitted to West China Hospital from 1995 to 2002 were retrospectively reviewed. The etiology of the obstruction was categorized, and the correlation of mortality and time interval between conservative therapy and operation was analyzed. RESULTS: There were 705 patients with acute intestinal obstruction included. There were 71.1% of the obstruction lesions located on the small bowel, and 82.6% of the patients experienced simple obstruction. The most frequent cause was adhesions (62.0%), and next was neoplasms (23.7%). There were 57.6% of the patients underwent the surgical treatment. The overall mortality rate was 1.6%, and the mortality rates in conservative therapy and surgical intervention groups were 1.3% and 1.7% respectively. The intestinal necrosis rate was increased gradually with the prolongation of time interval between conservative therapy and operation, and the death might occur 24 hours after strangulation. CONCLUSION: The epidemiological transition to adhesive obstruction still exists in China, and it is similar to that in Western countries. In our experience, near half of the patients with simple obstruction may achieve palliation by conservative therapy. Surgical intervention is indicated for the patients with prolonged and non-palliated simple obstruction, or strangulation disease within the first 24 hours.

Safety and efficacy of gastrointestinal stents in cancer patients at a community hospital.

OBJECTIVE: Increasing scientific evidence supports the use of self-expanding metallic gastrointestinal (GI) stents. The commonly accepted primary indications are their usefulness as a bridge to surgery and for palliation to avoid surgery. These stents have been shown to have high technical success and low complication rates, leading to improved quality of life for patients. They have also been shown to be cost-effective when compared with alternative therapies. The objective of this study is to present a retrospective review of our local experience. METHODS: Attempts were made to place 23 GI stents in 16 patients for palliative cancer indications. RESULTS: Follow-up was 5-352 days (mean 81.9 d). Presenting symptoms included abdominal distention or pain (81%), nausea or vomiting (69%), constipation (31%) and weight loss (19%). Stents were placed in the colon (11 patients), duodenum (4 patients) or esophagus (1 patient). The technical success rate was 91.3%, the clinical success rate (defined as any improvement in symptoms in patients successfully receiving a stent) was 85.7%, and the complication rate was 21.4% among patients successfully receiving a stent, or 18.8% overall. Of 14 patients successfully receiving at least 1 stent, 10 (71%) were discharged home after a mean of 11.5 days (range 1-26 d). Of patients successfully receiving at least 1 stent, 12 (86%) had passed away at the time of last follow-up. Patients who successfully received a stent but who have since passed away (either in hospital or out of hospital) had their stent(s) in situ for a mean of 57 days (range 5-180 d). CONCLUSION: On the basis of our data, we believe that GI stents may be safely and effectively used in a community hospital setting and that they provide benefit in the palliative care population.

[Integrated therapeutic strategy in large bowel neoplastic occlusion. An innovative therapeutic protocol]. / Strategia terapeutica integrata nelle neoplasie occludenti del grosso intestino. Un protocollo terapeutico innovativo.

BACKGROUND: Occlusive complication is a common event in the colo-rectal cancer (20-30% of cases). Operative mortality and 5 yrs survival of not occlusive cancer vs occlusive cancer is 11% vs 23% and 45% vs 25% rispectively. In occlusive cancer the level of parietal infiltration affects considerably the local and peritoneal recurrence. 50% of all patients underwent a surgical re-operation for colo-rectal cancer have peritoneal neoplastic implant. AIM: The resolution of occlusive complication in immediate or delayed urgency with decompressive derivation, it allows to perform an integrated treatment of choice that it could guarantee the oncological radical procedure. RATIONALE-METHODS: The intraperitoneal hyperthermic chemotherapy (IPHC) combined with radical or cytoriductive surgery performs its action through sinergistic effects of high dosage and concentration of drugs and hyperthermia. These agents perform a cell killing with a direct contact against micro and/or macroscopic neoplastic residue. EXPECTED RESULTS: In radical surgery with curative intent, the association with IPHC ("preventive" adjuvant) has got as objective the distruction of microscopic local or peritoneal metastasis. In occlusive cancer with synchronous or metachronous peritoneal carcinomatosis, the performance of the cytoreductive surgery with IPHC ("therapeutic" adjuvant) is the only treatment that improves the survival and the quality of remainig life. CONCLUSIONS: The clinical results reported by many Istitutions indicates that the 2-5 yrs survivals are 45-60% and 20-30% rispectively. These data lead us to believe that an optimal eradication of micro and/or macroscopic peritoneal spreading could be optained also in occlusive colo-rectal cancer.

[Palliative treatment for colorectal cancer]. / Kolorektales Karzinom.

Over 50,000 new cases of colorectal cancer are diagnosed in Germany every year. About half of these patients will be cured by surgery. The other reoccur or present primarily with advanced disease. Recently, the survival of patients with metastasized disease has been prolonged from about 6 months with best supportive care alone to more than 20 months with combination chemotherapy. Therefore, adequate palliation is reasonable. Irresectable liver metastasis can be treated by locally ablative procedures such as radiofrequency ablation (RFA) or laserinduced thermotherapy (LITT). In the individual case resection of lung or brain metastasis should be discussed. Practitioners have to deal with plenty of supportive opportunities e.g. analgesics, bisphosphonates, central acting drugs, nutrition but also with drug side effects. In centers different endoscopic or interventional radiologic procedures are offered. Considering the variety of therapeutic options, it is prudent to discuss individual treatment plans in an interdisciplinary "tumor board" and involve the practitioners in the decision making.

Sigmoid volvulus in children and adolescents.

BACKGROUND: Sigmoid volvulus is an exceptionally rare and potentially life-threatening condition in the pediatric age group. STUDY DESIGN: We report our experience with three children treated for sigmoid volvulus and review the cases reported in the medical literature since 1940. RESULTS: Since 1940, 63 cases of sigmoid volvulus in children (including this series) have been reported. The median age was 7 years and the male to female ratio was 3.5:1. Two distinct presentations (acute and recurrent) were identified. Abdominal symptoms dominated the clinical picture. Barium enemas either confirmed or were highly suggestive of sigmoid volvulus. Reduction by barium enema was successful in 77% (10 of 13) of the attempts. Forty-nine patients underwent operative treatment, with sigmoidectomy (with or without primary anastomosis) being the most common. The overall mortality rate was 6%, operative mortality was 8.1%, and neonatal mortality was 14%. Associated conditions were frequent. Particular emphasis should be placed on ruling out Hirschsprung's disease (present in 11 of 63 patients). CONCLUSIONS: Sigmoid volvulus remains a rare occurrence in children, but it should be included in the differential diagnosis of pain in children when colonic distention is present. An algorithm for treatment is proposed.

[Rectal carcinoma. Optimizing the procedures in an emergency]. / Rektumkarzinom. Optimierung des Vorgehens in der Notfallsituation.

Emergency conditions in rectal cancer can happen pre-, intra-, and postoperatively. Preoperative emergencies are perforation and obstipation. Spontaneous intraperitoneal perforations have a mortality of 17 to 33% and a five year survival of only 7 to 10%. The site of the perforation is not identical with the the site of the tumor. Due to fecal peritonitis a defunctioning stoma and planned repeat laparotomies are indicated. Initial fecal diversion is followed by tumor resection with anastomosis when the peritonitis has subsided. Iatrogenic perforations from endoscopy or barium enema examination are rare (0.09 to 0.004%). Tumor obstruction occurs in 15% of colorectal cancers. Immediate resection with primary anastomosis is deemed to be feasible if preceded by on-table colonic lavage. Immediate resection has a lower mortality (13.6%) than two staged fecal diversion and resection (35.5%). Intraoperative emergency conditions are bleeding and tumor cell spillage. Bleeding from the presacral veins will be controlled with the hemorrhage occluder pin. Inadvertent perforation of the tumor leads to dissemination of tumor cells. In case of spillage local recurrence was seen in 39% of resections within five years. Multivisceral resection and precise preparation with respect to anatomical planes may prevent damage of the rectum. The leading postoperative emergency condition is anastomotic leak. The incidence of clinical leaks is 6%. In diffuse peritonitis the anastomosis should be taken down and planned repeat laparotomy should be performed. This concept reduces the mortality down to 18.7%.

Recurrent intraabdominal cancer with intestinal obstruction.

The objective of this study was to evaluate short and long term results of management of recurrent intraabdominal malignancy causing intestinal obstruction using surgery and intraperitoneal chemotherapy and determine the clinical features that suggest favorable outcome. Forty two consecutive patients who were treated by cytoreductive surgery with or without intraperitoneal chemotherapy were retrospectively analyzed. There were 20 patients with primary tumors of appendix, 13 with cancer of colon or rectum, and 9 patients with cancer of other origins. All 42 patients were explored and extensively evaluated intraoperatively. Surgery included bowel resections and peritonectomy procedures. In 30 patients early postoperative intraperitoneal chemotherapy was administered. The overall morbidity was 55% while mortality was 7.14%. The projected three year survival for this group of patients was 32.7%. Among the most significant clinical features that reflect favorable prognosis were low histologic grade of malignancy, recurrence 2 and more years after primary surgery, and cancer that could be completely surgically excised. As a result of treatment patients' performance status improved in 47.6% of cases. An aggressive reoperative approach may be considered for palliation of selected patients with recurrent cancer causing intestinal obstruction.

[Preparation of the large intestine for the surgical treatment of intestinal obstruction]. / Podgotovka tolstoi kishki k operatsii pri kishechnoi neprokhodimosti.

Obstruction of the large intestine of tumorous origin was treated by the traditional methods in 191 patients: an emergency operation in peritonitis or nonoperative management of the obstruction by cleansing enema, purgatives, and infusion-transfusion therapy. In another group of 341 patients emergency colonoscopy and ultrasonic diagnosis were resorted to and the "obstruction index" (Deltz et al. 1989) was used for objectification of the indications for an emergency operation. The method of fractional oral treatment with 30% solution of polyethelyne oxide-400 and 1% chloramphenicol was applied in this group. Traditional treatment caused resolution of the obstruction in 22.8% of patients in the control and in 28.3% of patients in the experimental group. Postoperative mortality was 24.1% and 16.4%, respectively. The obstruction index allowed correct evaluation of the indications for operation in 97% of cases, the number of forced operation reduced from 52.2% to 14.1%.

Puntaje de severidad de la gangrena intestinal por vólvulo de colon / A prognostic index gangrenous colonic volvulus

Este estudio retrospectivo evaluó a 50 pacientes con vólvulo de colon gangrenado-dos casos con vólvulo ileocecal, un caso con vólvulo de colon transverso y 47 casos con vólvulo del sigmoides-manejados con resección y anastomosis primaria (n=21) o con resección más colostomía (n=29) en el Hospital Belén, Trujillo, Perú, desde el 1§ de enero de 1967 al 31 de julio de 1993. El objetivo principal del estudio fue identificar por análisis univariado la combinación de factores de riesgo predictivos de mortalidad post-operatoria. Los siguientes factores estuvieron asociados con incremento de la mortalidad: presión arterial media menor de 70 mmHg (p=0.004), presencia de fluido peritoneal purulento o fecaloide (p=0.013) o evidencia de perforación intestinal macroscópica (p<0.001). Usando estos factores se describió un método de cuantificación del riesgo de mortalidad por gangrena intestinal. A cada factor se le otorgó un valor que osciló entre 0 y 2 (0=mayor, 1=moderada, 2=menor) de acuerdo a la severidad de la injuria. La suma de los valores de cada factor individual dió lugar al Puntaje de Severidad de Gangrena por vólvulo de Colon (PSGC). En esta serie la mortalidad global fue de 30 por ciento. Un PSGC mayor de cuatro se presentó en 34 (68 por ciento) de los pacientes. Este evento estuvo asociado con una mortalidad de 9 por ciento y contrastó a la de 75 por ciento encontrada cuando el PSGC fue igual o menor de 4. Se produjo un 33 por ciento de mortalidad en los pacientes operados con anastomosis inmediata (PSGC, 4.2 ñ 0.99) y fue de 28 por ciento en aquellos sometidos a resección y colostomía (PSGC, 3 ñ 0.87). Nosotros concluímos que el PSGC sería útil en predecir la mortalidad, la necesidad de medidas de soporte post-operatorias intensivas y en seleccionar el procedimiento quirúrgico en pacientes con gangrena intestinal por vólvulo de colon

[Volvulus of the colon. Apropos of 37 cases]. / Les volvulus du côlon. A propos de 37 cas.

A retrospective study of 37 case reports of patients with volvulus of the colon was carried out to define diagnostic and therapeutic strategies. The group comprised 22 men and 15 women, mean age 69 +/- 4 years (range 26-88 years), the volvulus being located in the sigmoid colon (n = 23), ascending colon (n = 13) or transverse colon (n = 1). The diagnosis, suggested by the straight abdominal film in almost all cases, was confirmed by a barium enema in 70% of cases. Treatment was surgical in 30 patients (81%) including 12 as emergency operations. Mortality was 5.4% (2 cases), and morbidity high (43% including fatal complications) the majority of adverse reactions being respiratory. Volvulus of the ascending colon was treated by hemicolectomy in 9 cases with no mortality or relapse. In patients with sigmoid volvulus, a "medical" reduction was performed in 7 patients, with success in 5 cases, one recurrence and no mortality, ideal sigmoidectomies in 14 cases resulting in one recurrence and no mortality. Right hemicolectomy appears to be the technique of choice even for urgent cases, there being no contraindications to a one-stage re-establishment of continuity. Inversely, an urgent intervention should at all costs be avoided in cases of sigmoid volvulus, a "medical" reduction (radiology, intubation, endoscopy) allowing preparation of the patient for a deferred ideal sigmoidectomy. Obviously, failure to reduce the volvulus or signs of colon necrosis require urgent surgery and raise the problem of whether or not to re-establish colon continuity.

Factores predisponentes, cuadro clínico y mortalidad en vólvulo de intestino delgado / Predisponent factors, clinical picture and mortality in small bowel volvulus

Este estudio retrospectivo evaluó factores predisponentes, cuadro clínico y los métodos de tratamiento en relación a la morbimortalidad de 19 casos de vólvulo de intestino delgado (VID) operados en el Hospital de Belén de Trujillo (Perú), durante los últimos 26 años (1966-1992). El VID constituyó el 11.6 por ciento de todos los casos de obstrucción intestinal en este períodod y el 10.8 por ciento de todos los vólvulos intestinales. El promedio de edad fue de 43 ñ 20.5 años (rango 6 a 78 años) y la mayoría estuvo entre los 38 y 40 años. Dieciséis casos (84.2 por ciento) fueron varones y tres (15.8 por ciento) mujeres. Todos fueron de raza mestiza y la mayoría procedió de la Sierra del Departamento de la Libertad y se dedicaba a la agricultura. Dos casos (10.5 por ciento)presentaron antecedentes operatorios no relacionados. El promedio del tiempo de enfermedad previo a la hospitalización fue de 19.3 días (rango, 17 horas a 94 días). Seis casos (31.6 por ciento) tuvieron una duración menor o igual a siete días y trece casos (68.4 por ciento) refirieron enfermedad mayor de 8 días con episodios recurrentes. La mayoría de casos presentó dolor abdominal súbito, vómitos y distensión abdominal. Los signos físicos más frecuentes fueron balonamiento y timpanismo abdominal. La localización del VID fue en ileon, 12 casos(63.2 por ciento), raíz del mesenterio, 4 casos (21 por ciento) y yeyuno, 3 casos (15.8 por ciento). Seis pacientes(31.5 por ciento ) presentaron gangrena intestinal y dos casos (10.5 por ciento) gangrena asociada a a perforación que requirieron resección. En este grupo un paciente (5.2 por ciento) falleció de sepsis y la incidencia de infección de herida operatoria fue de 37.5 por ciento. No hubo correlación estadísticamente significativa entre el tiempo de enfermedad y la presencia de gangrena intestinal y la mortalidad (p mayor que 0.05). Se efectuó desvolvulación simple a once pacientes (57.9 por ciento) con intestino viable no registrándose defunciones y la incidencia de infección de herida operatoria en este grupo fue de 27 por ciento. Otras complicaciones fueron neumonía (10.5 por ciento) y fístula enterocutánea (10.5 por ciento). Nosotros concluímos que el VID es una entidad clínica poco frecuente con baja mortalidad pero alta morbilidad especialmente cuando hay gangrena intestinal y se necesita resección. La destorción sin fijación del mesenterio es el procedimiento de elección cuando el intestino está viable

[Sixty-one cases of acute obstructions of the colon caused by cancer. Indications for emergency surgery]. / Soixante et une occlusions aiguës du côlon par cancer. Indications chirurgicales en urgence.

Sixty-one cases of acute malignant colonic obstruction were operated upon within 24 hours after the patient's admission, between 1979 and 1989: 10 for a right colon carcinoma, 51 for a left-sided lesion. Indications, for emergency operation were: complete clinical obstruction, iliac tenderness, radiologic ileal fluid levels and arrest on barium enema. The initial procedures consisted of 8 right hemicolectomies, and for the left-sided obstructions, 32 colostomies, 7 colectomies with immediate anastomosis, and 12 colectomies without anastomosis. Overall mortality was nil for the right side and 4% left-sided obstructions. The current surgical procedures of choice according to the authors are: right hemicolectomy for right-sided obstruction; elective colostomy for the left side. In case of doubt about the mechanism of obstruction or vitality of the colon, a midline approach for operative exploration, followed by colectomy without anastomosis is recommended. Colectomy with immediate anastomosis is possible in rare favourable cases. Subtotal colectomy is indicated in cases of ischemic lesions, caecal perforation or other colonic tumours. Intraoperative irrigation of the colon is rarely permitted in this particular variety of acute obstruction.

Malrotation of the intestines in children: the effect of age on presentation and therapy.

Because of the devastating consequences of midgut volvulus as a result of malrotation, we reviewed the charts of 70 consecutive children to define the spectrum of presentation. Although 27 patients (39%) had presenting symptoms within the first ten days of life, 35 (50%) were older than 2 months of age. In general, the older children had a longer course of vague, antecedent symptoms such as intermittent, nonbilious vomiting and chronic abdominal pain. Associated congenital anomalies were common, with 32 patients (46%) presenting with 56 anomalies, the most prevalent of which were intestinal atresia, imperforate anus, duodenal web, and cardiac and orthopedic anomalies. Upper gastrointestinal (GI) series revealed the diagnosis in 29 cases (41%), as did contrast enema in 24 (34%). It is important to note that volvulus, intestinal gangrene, and mortality occurred regardless of age or chronicity of symptoms. Fifteen patients (21%) were discovered serendipitously while being evaluated and treated for seemingly unrelated conditions. No morbidity of mortality occurred in those patients who underwent subsequent semielective Ladd's procedure. The majority of morbidity and all seven mortalities occurred in patients with volvulus and intestinal necrosis. This study emphasizes the need for consideration of Ladd's procedure for children of all ages. In addition, due to the broad range of initial symptoms, a high index of suspicion is required in evaluating children with possible malrotation. Because it remains impossible to predict which patients will have catastrophic complications (based on age or type of presentation), we urge that even incidentally discovered patients with intestinal malrotation undergo Ladd's procedure.

Changing patterns of treatment and survival in neonates with meconium ileus.

This report describes 51 neonates with meconium ileus and emphasizes a changing pattern of treatment and improved survival. Twenty-four neonates had uncomplicated meconium ileus due to inspissated meconium obstructing the distal ileum. Twenty-seven neonates had 41 complications of meconium ileus including volvulus (18), bowel atresia (13), perforation (5), and giant cystic meconium peritonitis (5). Nine patients with uncomplicated cases responded to nonoperative clearing of meconium using a meglumine diatrizoate (Gastrografin) enema. Six of 7 patients with enema failures underwent laparotomy, purse-string enterotomy, and intraluminal irrigation. The remaining 9 patients with uncomplicated meconium ileus had resection and enterostomy. Complicated cases were managed by resection and anastomosis (13) or enterostomy (14). Survival at 1 year was 92% in patients with uncomplicated meconium ileus and 85% for those with complicated meconium ileus. Nonoperative Gastrografin enema or enterotomy-irrigation can relieve obstruction in uncomplicated meconium ileus and avoid an enterostomy in most cases.

[Volvulus of the sigmoid colon]. / Volvulus du côlon sigmoïde.

The authors report of 34 cases of sigmoid colon volvulus occurring in young subjects (15%) and in elderly subjects (60% over the age of 75 years). The diagnosis is frequently suggested by the clinical features and the history (30% of patients have a history of a previous identical episode) and is confirmed by a plain abdominal x-ray and/or an opaque enema. Endoscopy is performed in every case, except in the presence of peritoneal signs, in an attempt to perform detorsion and colonic intubation under direct vision in order to avoid emergency surgery; this procedure is effective in 87% of cases. Emergency surgery has a high mortality rate (43.5%). Elective or deferred emergency surgery after preparation is much safer (6.6% mortality). In patients with multiple diseases, non-surgical conservative management after detorsion too frequently results in repeated complications, leading to decompensation of the concurrent illnesses and a mortality rate of 34%. Endoscopic detorsion followed by surgical resection after a short 3 to 4 day preparation seems to be the best guarantee of therapeutic success.

Paresis of peristalsis and ileus lead to death in lactating mice.

Based on the examination of 45 dead and 5 moribund female mice during a 2-year period, we are able to describe a new disease entity: ileus of the small intestine in lactating mice caused by a paresis of peristalsis. Diarrhoea was not observed and inflammation and infectious agents were not found. Females were affected during the 2nd week of their first lactation. The condition may have a mortality rate as high as 40%. It is assumed that exhaustion (calcium, glucose, etc.) is the cause of this condition. Consequently, the development of a dietary supplement or of a special diet for lactating mice may prove beneficial in preventing this disease. Endogenic (Clostridia) or exogenic toxic components may also play a role.