Accuracy of abdominal auscultation for bowel obstruction.

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

The risk of adverse pregnancy outcome after bariatric surgery: a nationwide register-based matched cohort study.

OBJECTIVE: The aim of this study was to describe the risk of adverse obstetric and neonatal outcome after bariatric surgery. STUDY DESIGN: Nationwide register-based matched cohort study of singleton deliveries after bariatric surgery during 2004-2010. Data were extracted from The Danish National Patient Registry and The Medical Birth Register. Each woman with bariatric surgery (exposed) was individually matched with 4 women without bariatric surgery (unexposed) on body mass index, age, parity, and date of delivery. Continuous variables were analyzed with the paired t test and binary outcomes were analyzed by logistic regression. RESULTS: We identified 339 women with a singleton delivery after bariatric surgery (84.4% gastric bypass). They were matched to 1277 unexposed women. Infants in the exposed group had shorter mean gestational age (274 vs 278 days; P < .001), lower mean birthweight (3312 vs 3585 g; P < .001), lower risk of being large for gestational age (adjusted odds ratio, 0.31; 95% confidence interval, 0.15-0.65), and higher risk of being small for gestational age (SGA) (adjusted odds ratio, 2.29; 95% confidence interval, 1.32-3.96) compared with infants in the unexposed group. No statistically significant difference was found between the groups regarding the risk of gestational diabetes mellitus, preeclampsia, labor induction, cesarean section, postpartum hemorrhage, Apgar score less than 7, admission to neonatal intensive care unit or perinatal death. CONCLUSION: Infants born after maternal bariatric surgery have lower birthweight, lower gestational age, 3.3-times lower risk of large for gestational age, and 2.3-times higher risk of SGA than infants born by a matched group of women without bariatric surgery. The impact on SGA was even higher in the subgroup with gastric bypass.

[Endoscopy-assisted sigmoidostomy]. / Endoskopisk assisteret sigmoideostomianlaeggelse.

INTRODUCTION: Formation of sigmoidostoma in order to establish temporary or permanent faecal diversion is a well-known procedure. In recent years an increasing number of centres have carried out laparoscopically-assisted stoma formation instead of the traditional laparotomy. Endoscopically-assisted sigmoidostoma formation is a less well-known and less technically challenging technique. MATERIALS AND METHODS: At the gastroenterology department (Gastroenheden), Hvidovre Hospital, Denmark, we have performed 24 endoscopically-assisted sigmoidostoma formations since June 2003. The study was done retrospectively. RESULTS: 24 patients were treated with endoscopically-assisted sigmoidostoma formation. The procedure was attempted in further 5 incidences without success, and conversion was necessary. In 3 cases stoma revision was needed afterwards and performed by local procedure without laparatomy. 1 patient with T3 rectal cancer died on the 6th postoperative day. CONCLUSION: Endoscopically-assisted sigmoidostoma formation is a minimal invasive procedure, which is technically simple. In our opinion, the procedure is at least equivalent to laparoscopically-assisted sigmoidostoma formation. We recommend endoscopically-assisted sigmoidostoma formation for patients where sigmoidostomy is necessary, and where there is no other need for laparotomy and the means of conversion to laparotomy or laparoscopy are available.