Ileus
Intestinal Obstruction
Intestinal Pseudo-Obstruction
Meconium
Gallstones
Postoperative Complications
Gastrointestinal Transit
Tyrphostin AG 126 inhibits development of postoperative ileus induced by surgical manipulation of murine colon. (1/151)
Manipulation of the bowel during abdominal surgery leads to a period of ileus, which is most severely manifested after procedures that directly involve the colon. Ileus is associated with the increased expression of proinflammatory cytokines and chemokines, a leukocytic infiltration into the muscularis, and the release of mediators from resident and infiltrating leukocytes that directly inhibit intestinal smooth muscle contractility. Phosphorylation of tyrosine residues on regulatory proteins by protein tyrosine kinases (PTKs) occurs at multiple steps in the signaling cascades that regulate the expression of proinflammatory genes. The purpose of this study was to determine whether inhibition of PTK activity will attenuate the inflammatory response associated with colonic ileus and lead to improved function. Using a rodent model of colonic postoperative ileus, we demonstrate that a single bolus injection of the PTK inhibitor tyrphostin AG 126 (15 mg/kg sc) before surgery significantly attenuates the surgically induced impairment of colonic contractility both in vivo and in vitro. Improvement in function was associated with a reduction in magnitude of inflammatory cell infiltrate and with a decrease in transcription of genes encoding proinflammatory mediators IL-1beta and monocyte chemoattractant protein (MCP)-1, inducible nitric oxide synthase, and cyclooxygenase-2. Furthermore, tyrphostin AG 126 pretreatment significantly inhibited activation of multifactorial transcription factor NF-kappaB, which could form the basis for reduction in proinflammatory mediator expression. These data demonstrate for the first time that inhibition of PTK activity may represent a novel approach for management of ileus in the clinical setting. (+info)Bouveret's syndrome complicated by a distal gallstone ileus. (2/151)
AIM: Gastric outlet obstruction caused by duodenal impaction of a large gallstone migrated through a cholecystoduodenal fistula has been referred as Bouveret's syndrome. Endoscopic lithotomy is the first-step treatment, however, surgery is indicated in case of failure or complication during this procedure. METHODS: We report herein an 84-year-old woman presenting with features of gastric outlet obstruction due to impacted gallstone. She underwent an endoscopic retrieval which was unsuccessful and was further complicated by distal gallstone ileus. Physical examination was irrelevant. RESULTS: Endoscopy revealed multiple erosions around the cardia, a large stone in the second part of the duodenum causing complete obstruction, and wide ulceration in the duodenal wall where the stone was impacted. Several attempts of endoscopic extraction by using foreign body forceps failed and surgical intervention was mandatory. Preoperative ultrasound evidenced pneumobilia whilst computerized tomography showed a large stone, 5 cm x 4 cm x 3 cm, logging at the proximal jejunum and another one, 2.5 cm x 2 cm x 2 cm, in the duodenal bulb causing a closed-loop syndrome. She underwent laparotomy and the jejunal stone was removed by enterotomy. Another stone reported as located in the duodenum preoperatively was found to be present in the gallbladder by intraoperative ultrasound. Therefore, cholecystoduodenal fistula was broken down, the stone was retrieved and cholecystectomy with duodenal repair was carried out. She was discharged after an uneventful postoperative course. CONCLUSION: As the simplest and the least morbid procedure, endoscopic stone retrieval should be attempted in the treatment of patients with Bouveret's syndrome. When it fails, surgical lithotomy consisting of simple enterotomy may solve the problem. Although cholecystectomy and cholecystoduodenal fistula breakdown is unnecessary in every case, conditions may urge the surgeon to perform such operations even though they carry high morbidity and mortality. (+info)Induced nitric oxide promotes intestinal inflammation following hemorrhagic shock. (3/151)
In hemorrhagic shock (HS), increased cytokine production contributes to tissue inflammation and injury through the recruitment of neutrophils [polymorphonuclear cells (PMN)]. HS stimulates the early expression of inducible nitric oxide synthase (iNOS) that modulates proinflammatory activation after hemorrhage. Experiments were performed to determine the contribution of iNOS to gut inflammation and dysmotility after HS. Rats subjected to HS (mean arterial pressure 40 mmHg for 2.5 h followed by resuscitation and death at 4 h) demonstrated histological signs of mucosal injury, impairment of intestinal smooth muscle contractility, extravasation of PMN, and increased gut mRNA levels of ICAM-1, IL-6, and granulocyte colony-stimulating factor (G-CSF). In addition, DNA binding activity of NF-kappaB and Stat3, an IL-6 signaling intermediate, was significantly increased. In shocked rats treated with the selective iNOS inhibitor l-N(6)-(1-iminoethyl)lysine at the time of resuscitation, histological signs of intestinal injury and PMN infiltration were reduced and muscle contractility was almost completely restored. Selective iNOS inhibition in shocked animals reduced the binding activity of NF-kappaB and Stat3 and reduced mRNA levels of ICAM-1, IL-6, and G-CSF. The results of studies using iNOS knockout mice subjected to HS were similar. We propose that early upregulation of iNOS contributes to the inflammatory response in the gut wall and participates in the activation of signaling cascades and cytokine expression that regulate intestinal injury, PMN recruitment, and impaired gut motility. (+info)A comparison of two surgical strategies for the emergency treatment of gallstone ileus. (4/151)
INTRODUCTION: Debate currently exists regarding the appropriate surgical strategy for emergency treatment of gallstone ileus. This relates to the need for definitive biliary tract surgery after relief of mechanical obstruction. Our study reviews treatment by enterolithotomy alone and enterolithotomy combined with definitive biliary tract surgery and fistula closure to determine if there is advantage of one treatment option over the other. METHODS: The clinical, operative and follow-up data on 19 consecutive patients treated by emergency surgery for gallstone ileus from January 1992 to December 2000 was retrospectively reviewed. RESULTS: There were 15 women and four men, with a mean age of 74.6 (range 62-91) years. Pre-operative diagnosis was made in only nine of 19 patients. Enterolithotomy alone (E group) was performed in seven patients and enterolithotomy with cholecystectomy and fistula closure (E+C group) in 12 patients. In the E group, more patients had significant co-morbidity as identified by poorer American Society of Anesthesiologists (ASA) status, poorer pre-operative status (shock at presentation) than in the E+C group. Operative time was significantly shorter in the E group. However, there were no significant differences in morbidity, and both groups had zero mortality. CONCLUSION: Both procedures can be carried out safely and with zero mortality. Relief of obstruction remains the mainstay of treatment. The better surgical option in our series is enterolithotomy alone. It is safe in both low and high-risk patients, and requires a shorter operating time as it is technically less demanding. In the longer term, the remnant fistula also does not appear to lead to further complications. (+info)A prospective randomized study of laparoscopy and minilaparotomy in the management of benign adnexal masses. (5/151)
BACKGROUND: Recent prospective and randomized studies have demonstrated that laparoscopy is better than laparotomy in the treatment of benign adnexal masses. The aim of this study is to analyse the perioperative outcomes of laparoscopy and minilaparotomy in these patients, in a prospective and randomized manner. METHODS: Between January 2003 and August 2003, 100 consecutive women with a diagnosis of presumed benign adnexal mass and requiring surgical treatment were randomly assigned to minilaparotomy and laparoscopy. Randomization was centralized and computer-based. RESULTS: All operative procedures were performed without conversion to laparotomy. In the group of patients submitted to minilaparotomy, a shorter operating time than patients submitted to operative laparoscopy (mean+/-SD: 71.9+/-31.8 versus 87.0+/-44.8 min; P<0.05) was found. On the other hand, there were significant differences in terms of postoperative ileus (1.1+/-0.4 days in laparoscopy and 1.4+/-0.6 in minilaparotomy P<0.023), without affecting the day of discharge. No intraoperative or early complications were registered in either group. CONCLUSIONS: Taking into account that laparoscopy has to be considered the first choice for benign adnexal surgery, our data suggest that minilaparotomy could offer the gynaecology surgeon a valid alternative in the minimally invasive surgery field, especially in specific settings. (+info)Mechanisms of polymicrobial sepsis-induced ileus. (6/151)
Sepsis frequently occurs after hemorrhage, trauma, burn, or abdominal surgery and is a leading cause of morbidity and mortality in severely ill patients. We performed experiments to delineate intestinal molecular and functional motility consequences of polymicrobial sepsis in the clinically relevant cecal ligation and puncture (CLP) sepsis model. CLP was performed on male Sprague-Dawley rats. Gastrointestinal transit, colonic in vivo pressure recordings, and in vitro muscle contractions were recorded. Histochemistry was performed for macrophages, monocytes, and neutrophils. Inflammatory gene expressions were quantified by real-time RT-PCR. CLP delayed gastrointestinal transit, decreased colonic pressures, and suppressed in vivo circular muscle contractility of the jejunum and colon over a 4-day period. A leukocytic infiltrate of monocytes and neutrophils developed over 24 h. Real-time RT-PCR demonstrated a significant temporal elevation in IL-6, IL-1beta, monocyte chemoattractant protein-1, and inducible nitric oxide synthase, with higher expression levels of IL-6 and inducible nitric oxide synthase in colonic extracts compared with small intestine. Polymicrobial CLP sepsis induces a complex inflammatory response within the intestinal muscularis with the recruitment of leukocytes and elaboration of mediators that inhibit intestinal muscle function. Differences were elucidated between endotoxin and CLP models of sepsis, as well as a heterogeneous regional response of the gastrointestinal tract to CLP. Thus the intestine is not only a source of bacteremia but also an important target of bacterial products with major functional consequences to intestinal motility and the generation of cytokines, which participate in the development of multiple organ failure. (+info)Churg-Strauss syndrome (allergic granulomatous angiitis) associated with T lymphoblastic lymphoma. (7/151)
We report a rare case of Churg-Strauss syndrome in a 37-year-old man, presented as ileus intestinal and associated with Tlymphoblastic lymphoma, that was located in the retroperitoneal space and infiltrated the suprarenal gland. The T lymphoblasts, with the immunohistochemical method, disclosed positivity for CD3 and CD8, while they were negative for Pan B and CD20. (+info)Alvimopan, a novel, peripherally acting mu opioid antagonist: results of a multicenter, randomized, double-blind, placebo-controlled, phase III trial of major abdominal surgery and postoperative ileus. (8/151)
OBJECTIVE: To demonstrate that alvimopan (6 or 12 mg) accelerates recovery of gastrointestinal (GI) function in patients undergoing laparotomy for bowel resection or radical hysterectomy. SUMMARY BACKGROUND DATA: Postoperative ileus (POI) following laparotomy may increase morbidity and extend hospitalization. Opioids can contribute to the duration of POI. Alvimopan is a novel opioid receptor antagonist in development for the management of POI. METHODS: A total of 510 patients scheduled for bowel resection or radical hysterectomy were randomized (1:1:1) to receive alvimopan 6 mg, alvimopan 12 mg, or placebo orally > or =2 hours before surgery, then twice a day (b.i.d.) until hospital discharge or for up to 7 days. The primary efficacy end point was a composite of time to recovery of upper and lower GI function. An associated secondary end point was time to hospital discharge order written. RESULTS: The modified intent-to-treat population included 469 patients (451 bowel resection and 18 radical hysterectomy patients). Time to recovery of GI function was accelerated for the alvimopan 6 mg (hazard ratio [HR] = 1.28; P < 0.05) and 12 mg (HR = 1.54; P < 0.001) groups with a mean difference of 15 and 22 hours, respectively, compared with placebo. The time to hospital discharge order written was also accelerated in the alvimopan 12 mg group (HR = 1.42; P = 0.003) with a mean difference of 20 hours compared with placebo. The incidence of adverse events was similar among treatment groups. CONCLUSIONS: Alvimopan accelerated GI recovery and time to hospital discharge order written compared with placebo in patients undergoing laparotomy and was well tolerated. (+info)Ileus is a condition characterized by a lack of intestinal motility or paralysis of the bowel, leading to obstruction of the digestive tract. It is not caused by a physical blockage but rather by a disruption of the normal muscular contractions (peristalsis) that move food through the intestines. This can result in abdominal distention, vomiting, and absence of bowel movements or gas passage. Ileus can be a complication of various surgical procedures, intra-abdominal infections, or other medical conditions. It is essential to diagnose and treat ileus promptly to prevent further complications such as tissue damage, sepsis, or even death.
Intestinal obstruction, also known as bowel obstruction, is a medical condition characterized by a blockage that prevents the normal flow of contents through the small intestine or large intestine (colon). This blockage can be caused by various factors such as tumors, adhesions (scar tissue), hernias, inflammation, or impacted feces.
The obstruction can be mechanical, where something physically blocks the intestinal lumen, or functional, where the normal muscular contractions of the bowel are impaired. Mechanical obstructions are more common than functional ones.
Symptoms of intestinal obstruction may include abdominal pain and cramping, nausea and vomiting, bloating, inability to pass gas or have a bowel movement, and abdominal distention. If left untreated, intestinal obstruction can lead to serious complications such as tissue death (necrosis), perforation of the intestine, and sepsis. Treatment typically involves hospitalization, intravenous fluids, nasogastric decompression, and possibly surgery to remove the obstruction.
Intestinal pseudo-obstruction, also known as paralytic ileus or functional obstruction, is a gastrointestinal motility disorder characterized by the absence of mechanical obstruction in the intestines, but with symptoms mimicking a mechanical small bowel obstruction. These symptoms may include abdominal distention, cramping, nausea, vomiting, and constipation or difficulty passing stools.
The condition is caused by impaired intestinal motility due to dysfunction of the nerves or muscles that control the movement of food and waste through the digestive system. It can be a chronic or acute condition and may occur as a primary disorder or secondary to other medical conditions, such as surgery, trauma, infections, metabolic disorders, neurological diseases, or certain medications.
Diagnosis of intestinal pseudo-obstruction typically involves imaging studies, such as X-rays or CT scans, to rule out mechanical obstruction and confirm the presence of dilated bowel loops. Manometry and other specialized tests may also be used to assess intestinal motility. Treatment options include medications to stimulate intestinal motility, dietary modifications, and in severe cases, surgery or intravenous nutrition.
Meconium is the first stool passed by a newborn infant, typically within the first 48 hours of life. It is composed of materials ingested during fetal development, including intestinal epithelial cells, lanugo (fine hair), amniotic fluid, mucus, bile, and water. The color of meconium is usually greenish-black, and its consistency can range from a thick paste to a liquid. Meconium staining of the amniotic fluid can occur when the fetus has passed meconium while still in the uterus, which may indicate fetal distress and requires careful medical attention during delivery.
Ileal diseases refer to conditions that primarily affect the ileum, which is the final portion of the small intestine. The ileum plays a crucial role in nutrient absorption, particularly vitamin B12 and bile salts. Ileal diseases can cause various symptoms, including diarrhea, abdominal pain, weight loss, and malnutrition, depending on their nature and extent. Some common ileal diseases include:
1. Crohn's disease: A type of inflammatory bowel disease (IBD) that can affect any part of the gastrointestinal tract, including the ileum. Crohn's disease causes chronic inflammation, which can lead to symptoms such as diarrhea, abdominal pain, and fatigue.
2. Celiac disease: An autoimmune disorder triggered by gluten ingestion in genetically susceptible individuals. In celiac disease, the immune system attacks the lining of the small intestine, including the ileum, causing inflammation and impaired nutrient absorption.
3. Intestinal tuberculosis: A bacterial infection caused by Mycobacterium tuberculosis that can affect any part of the gastrointestinal tract, including the ileum. Intestinal tuberculosis can cause symptoms such as abdominal pain, diarrhea, and weight loss.
4. Typhlitis: Also known as neutropenic enterocolitis, typhlitis is an inflammatory condition that affects the cecum and terminal ileum, typically in immunocompromised individuals. It can cause symptoms such as abdominal pain, fever, and diarrhea.
5. Meckel's diverticulum: A congenital condition characterized by a small pouch protruding from the wall of the ileum. While many people with Meckel's diverticulum do not experience symptoms, it can sometimes become inflamed or bleed, causing abdominal pain and rectal bleeding.
6. Lymphoma: A type of cancer that originates in the lymphatic system and can affect any part of the body, including the ileum. Ileal lymphoma can cause symptoms such as abdominal pain, diarrhea, and weight loss.
Gastrointestinal motility refers to the coordinated muscular contractions and relaxations that propel food, digestive enzymes, and waste products through the gastrointestinal tract. This process involves the movement of food from the mouth through the esophagus into the stomach, where it is mixed with digestive enzymes and acids to break down food particles.
The contents are then emptied into the small intestine, where nutrients are absorbed, and the remaining waste products are moved into the large intestine for further absorption of water and electrolytes and eventual elimination through the rectum and anus.
Gastrointestinal motility is controlled by a complex interplay between the autonomic nervous system, hormones, and local reflexes. Abnormalities in gastrointestinal motility can lead to various symptoms such as bloating, abdominal pain, nausea, vomiting, diarrhea, or constipation.
Gallstones are small, hard deposits that form in the gallbladder, a small organ located under the liver. They can range in size from as small as a grain of sand to as large as a golf ball. Gallstones can be made of cholesterol, bile pigments, or calcium salts, or a combination of these substances.
There are two main types of gallstones: cholesterol stones and pigment stones. Cholesterol stones are the most common type and are usually yellow-green in color. They form when there is too much cholesterol in the bile, which causes it to become saturated and form crystals that eventually grow into stones. Pigment stones are smaller and darker in color, ranging from brown to black. They form when there is an excess of bilirubin, a waste product produced by the breakdown of red blood cells, in the bile.
Gallstones can cause symptoms such as abdominal pain, nausea, vomiting, and bloating, especially after eating fatty foods. In some cases, gallstones can lead to serious complications, such as inflammation of the gallbladder (cholecystitis), infection, or blockage of the bile ducts, which can cause jaundice, a yellowing of the skin and eyes.
The exact cause of gallstones is not fully understood, but risk factors include being female, older age, obesity, a family history of gallstones, rapid weight loss, diabetes, and certain medical conditions such as cirrhosis or sickle cell anemia. Treatment for gallstones may involve medication to dissolve the stones, shock wave therapy to break them up, or surgery to remove the gallbladder.
Jejunal diseases refer to a range of medical conditions that affect the jejunum, which is the middle section of the small intestine. These diseases can cause various symptoms such as abdominal pain, diarrhea, bloating, nausea, vomiting, and weight loss. Some examples of jejunal diseases include:
1. Jejunal inflammation or infection (jejunitis)
2. Crohn's disease, which can affect any part of the gastrointestinal tract including the jejunum
3. Intestinal lymphoma, a type of cancer that can develop in the small intestine
4. Celiac disease, an autoimmune disorder that causes damage to the small intestine when gluten is consumed
5. Intestinal bacterial overgrowth (SIBO), which can occur due to various reasons including structural abnormalities or motility disorders of the jejunum
6. Meckel's diverticulum, a congenital condition where a small pouch protrudes from the wall of the intestine, usually located in the ileum but can also affect the jejunum
7. Intestinal strictures or obstructions caused by scarring, adhesions, or tumors
8. Radiation enteritis, damage to the small intestine caused by radiation therapy for cancer treatment.
The diagnosis and management of jejunal diseases depend on the specific condition and its severity. Treatment options may include medications, dietary modifications, surgery, or a combination of these approaches.
Postoperative complications refer to any unfavorable condition or event that occurs during the recovery period after a surgical procedure. These complications can vary in severity and may include, but are not limited to:
1. Infection: This can occur at the site of the incision or inside the body, such as pneumonia or urinary tract infection.
2. Bleeding: Excessive bleeding (hemorrhage) can lead to a drop in blood pressure and may require further surgical intervention.
3. Blood clots: These can form in the deep veins of the legs (deep vein thrombosis) and can potentially travel to the lungs (pulmonary embolism).
4. Wound dehiscence: This is when the surgical wound opens up, which can lead to infection and further complications.
5. Pulmonary issues: These include atelectasis (collapsed lung), pneumonia, or respiratory failure.
6. Cardiovascular problems: These include abnormal heart rhythms (arrhythmias), heart attack, or stroke.
7. Renal failure: This can occur due to various reasons such as dehydration, blood loss, or the use of certain medications.
8. Pain management issues: Inadequate pain control can lead to increased stress, anxiety, and decreased mobility.
9. Nausea and vomiting: These can be caused by anesthesia, opioid pain medication, or other factors.
10. Delirium: This is a state of confusion and disorientation that can occur in the elderly or those with certain medical conditions.
Prompt identification and management of these complications are crucial to ensure the best possible outcome for the patient.
Gastrointestinal transit refers to the movement of food, digestive secretions, and waste products through the gastrointestinal tract, from the mouth to the anus. This process involves several muscles and nerves that work together to propel the contents through the stomach, small intestine, large intestine, and rectum.
The transit time can vary depending on factors such as the type and amount of food consumed, hydration levels, and overall health. Abnormalities in gastrointestinal transit can lead to various conditions, including constipation, diarrhea, and malabsorption. Therefore, maintaining normal gastrointestinal transit is essential for proper digestion, nutrient absorption, and overall health.
A laparotomy is a surgical procedure that involves making an incision in the abdominal wall to gain access to the abdominal cavity. This procedure is typically performed to diagnose and treat various conditions such as abdominal trauma, tumors, infections, or inflammatory diseases. The size of the incision can vary depending on the reason for the surgery and the extent of the condition being treated. Once the procedure is complete, the incision is closed with sutures or staples.
The term "laparotomy" comes from the Greek words "lapara," which means "flank" or "side," and "tome," which means "to cut." Together, they describe the surgical procedure that involves cutting into the abdomen to examine its contents.
The digestive system is a series of organs that work together to convert food into nutrients and energy. Digestive system surgical procedures involve operations on any part of the digestive system, including the esophagus, stomach, small intestine, large intestine, liver, pancreas, and gallbladder. These procedures can be performed for a variety of reasons, such as to treat diseases, repair damage, or remove cancerous growths.
Some common digestive system surgical procedures include:
1. Gastric bypass surgery: A procedure in which the stomach is divided into two parts and the smaller part is connected directly to the small intestine, bypassing a portion of the stomach and upper small intestine. This procedure is used to treat severe obesity.
2. Colonoscopy: A procedure in which a flexible tube with a camera on the end is inserted into the rectum and colon to examine the lining for polyps, cancer, or other abnormalities.
3. Colectomy: A procedure in which all or part of the colon is removed, often due to cancer, inflammatory bowel disease, or diverticulitis.
4. Gastrostomy: A procedure in which a hole is made through the abdominal wall and into the stomach to create an opening for feeding. This is often done for patients who have difficulty swallowing.
5. Esophagectomy: A procedure in which all or part of the esophagus is removed, often due to cancer. The remaining esophagus is then reconnected to the stomach or small intestine.
6. Liver resection: A procedure in which a portion of the liver is removed, often due to cancer or other diseases.
7. Pancreatectomy: A procedure in which all or part of the pancreas is removed, often due to cancer or chronic pancreatitis.
8. Cholecystectomy: A procedure in which the gallbladder is removed, often due to gallstones or inflammation.
These are just a few examples of digestive system surgical procedures. There are many other types of operations that can be performed on the digestive system depending on the specific needs and condition of each patient.