LETHALITY ANALYSIS IN PATIENTS WITH ACUTE SMALL BOWEL OBSTRUCTION. ADVERSE FACTORS AND POSSIBLE WAYS TO ELIMINATE THEM.

OBJECTIVE: The aim: To determine obstruction factors that can lead to lethal consequences for patients with acute small intestine in order to develop possible directions for their prevention. PATIENTS AND METHODS: Materials and methods: During the retrospective analysis of 30 patients with acute small bowel obstruction, the causes and contributing factors of mortality were determined. RESULTS: Results: The cause of mortality in the $rst three days of the postoperative period was the progression of the phenomena of intoxication, which led to the appearance of the syndrome of enteric insu%ciency and the development of multiple organ dysfunction. Mortality in the later period was observed due to the decompensation of concomitant diseases that accompanied acute obstruction of the small intestine. In the process of the study it was determined that the possible reasons of the postoperative complications in the studied group of patients, apart from the elderly and senile age of the patients and delayed medical care, according to the results of our observation were: uncorrected hypotension and hypovolemia in the postoperative period, refusal of the intubation of the small intestine and permanent decompression of the gastrointestinal tract, early removal of the nasogastric tube, long-term anemia and hypoproteinemia, prevention of stress ulcers of the gastrointestinal tract in the elderly and senile age, refusal of early use of enteral nutrition and later restoration of motility of the gastrointestinal tract. CONCLUSION: Conclusions: Treatment of patients with acute small intestine obstruction requires the selection of a specially designed treatment program (optimal timing of preoperative preparation, selection of the minimum volume) at all stages of surgical care, taking into account the existing concomitant pathology, age and hospitalization period.

Role and place of ultrasonography in diagnostics of adhesive intestinal obstruction.

OBJECTIVE: The aim: To study the possibilities of ultrasound in adhesive ileus obstruction diagnosis and indications for surgical treatment determination. PATIENTS AND METHODS: Materials and methods: The results of diagnosis and treatment of 60 patients with acute adhesive intestinal obstruction with comparative use of X-ray and ultrasound methods were analyzed. RESULTS: Results: The use of a standard X-ray examination of the abdominal organs upon admission to the hospital allowed the diagnosis of acute adhesions of small bowel obstruction in only 32 (53.3%) patients. Transabdominal ultrasonography allowed the establishment of adhesive ileus during hospitalization in 53 (88.3%) patients and also in 7 (11.7%) during a dynamic examination 2-3 hours after admission. Due to the lack of positive effect from the conducted conservative therapy relying on the data of ultrasound studies, 33 (55%) patients were operated on. During X-ray examination, only 10 (30.3%) of these patients demonstrated negative X-ray dynamics, and with an ultrasound study, deterioration of echo pictures was observed in all 33 (100%) patients. CONCLUSION: Conclusions: Compared with the X-ray method, transabdominal ultrasonography is established to be safe, affordable, simpler, non-invasive and highly informative method for the study of acute adhesions of the small intestinal obstruction. The method allows the assessment of the ongoing conservative therapy dynamics and determination for surgical treatment indications.

Surgical Drain-Related Intestinal Obstruction After Robot-Assisted Laparoscopic Radical Prostatectomy in Two Cases.

Background: Drainage tubes are almost always routinely used after a laparoscopic or robot-assisted radical prostatectomy and pelvic lymphadenectomy to prevent urinoma formation and lymphoceles. They are seldom of any consequence. We present our unique experience of bowel obstruction resulting from the use of pelvic drains. Case Presentation: We are reporting on two prostate cancer cases with rare postoperative complications. Each of them received robot-assisted laparoscopic radical prostatectomy and bilateral pelvic lymph node dissection and subsequently developed ileus and bowel obstruction. Series follow-up images suggested the bowel obstruction was related to their drainage tube. No evidence of urine leakage or intestine perforation was found based on drainage fluid analysis. We performed exploratory laparotomy in the first patient and found drainage tube kinking with the terminal ileum and adhesion band. The drainage tube was removed and patient recovery occurred over the following days. In the second case, the patient experienced bowel obstruction for 4 days after surgery. Based on our experience in the first case, and a drainage fluid survey showing no evidence of urine leakage, we removed the drainage tube on the morning of the 4th day, giving the patient a dramatic recovery with flatus and stool passage occurring in the afternoon. Both of the patients recovered well in hospital and during regular follow-up. Conclusion: To best of our knowledge, despite there being certain case reports regarding drainage tube ileus in colorectal and bowel surgery, we have reported here on the first two cases of small bowel obstruction as a complication arising from the abdominal drainage tube used in robot-assisted urology surgery.

"Jodhpur bezoar": giant polyurethane bezoar.

Acute upper gastrointestinal obstruction due to foreign body ingestion is rare (<6 % of all small intestinal obstruction). Bezoars tend to grow slowly and only thereafter cause obstruction, if any. Rapid formation of a bezoar within hours of ingestion of the offending substance is a unique entity. Here, we present a case of a 22-year-old Indian male who was brought in the emergency department with history of ingesting chemicals used for refrigerator insulation, with suicidal intent. Within hours, he was operated for suspected perforation. And on the operation table, we came across surprisingly a cast extending from the whole of the esophagus to as far as 2 ft of proximal jejunum! Probably the first of its kind ever known! And no breach in the gut could be found in spite of free gas under the dome of diaphragm, probably due to the chemicals sealing the rent as it solidified!

Diagnostic Value of Plain and Contrast Radiography, and Multi-slice Computed Tomography in Diagnosing Intestinal Obstruction in Different Locations.

Early intestinal obstruction is easily misdiagnosed. Many physicians consider terminal bouton if computed tomography (CT) scan is done. However, different examinations provide diverse information and significance. This retrospective, randomized, clinical study investigated the diagnostic value of three imaging modalities for intestinal obstruction, supine and upright (or decubitus) plain abdominal radiography, contrast radiography using Gastrografin, and 64 multi-slice spiral CT (MSCT). A total 142 patients with intestinal obstruction were examined. The diagnostic accuracy of plain radiography, contrast radiography, and MSCT for detecting small bowel obstruction was 62.5, 85, and 77.5 %, for localizing the obstruction was 0, 90, and 78.75 %, and for determining the cause of obstruction was 0, 71, and 65 %, respectively. The diagnostic accuracy for detecting large bowel obstruction was 53.23, 73.17, and 92 %, and for localizing the obstruction was 38.17, 60.98, and 98 %, respectively. The diagnostic accuracy of MSCT in determining the cause of obstruction was 91 %. None of the patients administered Gastrografin experienced any adverse effects. In conclusion, MSCT has great diagnostic value in identifying the site and cause of intestinal obstruction, especially in cases of large bowel obstruction. Contrast radiography using Gastrografin was effective in diagnosing and treating small bowel obstruction, making it a beneficial adjunct to MSCT.

Síndrome de obstrucción intestinal distal en pacientes adultos con fibrosis quística: Casos clínicos / Distal intestinal obstruction syndrome: Report of two cases with cystic fibrosis

Distal Intestinal Obstruction Syndrome (DIOS) has a 16 percent incidence among patients with Cystic Fibrosis (CF). It is characterized by an intestinal obstruction secondary to fecal impaction in distal ileum or cecum. We report two adult patients with DIOS. A female with CF and subjected to lung transplantation at the age of 13 years old. Five years later, she consulted for an intestinal obstruction. She was treated conservatively with a good clinical evolution. She had a new episode of DIOS eight months later that was also treated conservatively. A 31 year-old mole, subjected to bilateral lung transplantation nine years before, that was admitted to the hospital for a bronchiolitis. Three days after admission he started with an intestinal obstruction that was diagnosed as a DIOS. He was managed conservatively with a good clinical response.

A Clinical analysis of Intestinal Obstruction in the Adult

Three hundred nine adult patients with the diagnosis of intestinal obstruction were treated at the Department of Surgery, Seoul National University Hospital during 5 years and three months from September 1989 to December 1994. A clinical analysis of those patients was done and the following results were obtained. The most prevalent age group was sixth decade in cases of 90(29%) and male to female ratio was 2.1:1. The etiologic factors included adhesions 206(66.7%), malignant disease 51(16.5%), hernia 10(3.2%), intussusception 9(2.9%), ischemic injury 7(2.3%), bezoar 6(1.9%), volvulus 6(1.9%), inflammatory disease 5(1.6%), intestinal tuberculosis 5(1.6%), and others 3(0.9%). Malignant obstructions increased and it may be caused by increased cases of cancer operation. The location of intestinal obstruction was small bowel in cases of 275(89%) and large bowel in the remained proportion. The frequency of strangulation was 14.2% and its causes were adhesion(56.8%), ischemic injury(15.9%), hernia(9.1%), malignant disease(6.8%), volvulus(6.8%), intestinal tuberculosis(2.3%), and intususception(2.3%). The main cardinal symptoms on admission were abdominal pain(93.9%), vomiting(79.3%), abdominal distension(72.8%), diarrhea(24.9%), obstipation(17.2%), bloody stool(11.7%) and the physical signs were abdominal tenderness(74.8%), abdominal distension(72.8%), altered bowel sound(55.0%), tachycardia(18.1%), fever(17.5%), rebound tenderness(8.4%) . Toxic signs such as fever, tachycardia, rebound tenderness with leukocytosis over 10,000/mm3 have the clinical significance in the strangulated obstruction. Operations were done in 196 cases and the types of operative procedures were resection (23.7%), bypass surgery (11.4%), adhesiolysis (11.1%), colostomy (8.4%), herniorrhaphy(1.8%), bezoar removal (1.8%), and others (0.6%). Operative complications occurred in 44 cases(22.4%) and among them, wound infection was the most common cause(7.7%).The overall mortality was 3.2% and sepsis was the most common cause(30%).