BACKGROUND Recently,intestinal stenting combined with laparoscopic surgery has received increasing attention as a treatment option for acute intestinal obstruction.However,its safety and efficacy have not yet been est...BACKGROUND Recently,intestinal stenting combined with laparoscopic surgery has received increasing attention as a treatment option for acute intestinal obstruction.However,its safety and efficacy have not yet been established.AIM To assess the efficacy and safety of combining intestinal stenting with laparoscopic surgery for the management of acute intestinal obstruction.METHODS Clinical data from 74 patients with colorectal cancer and acute intestinal obstruction,who were admitted to the emergency department of the authors’hospital between October 2023 and November 2024,were collected and analyzed.Patients were divided into two groups based on the surgical intervention:A control group(emergency open surgery,n=37)and a study group(intestinal stent implantation combined with laparoscopic surgery,n=37).Observation indicators included stent placement rate,obstruction relief rate,and stent-related complications.RESULTS Intestinal stent placement was 100%successful in the study group,all of whom experienced relief from obstruction while exhibiting a significantly lower rate of ostomy creation and a higher rate of primary anastomosis than in the control group,as well as less intraoperative blood loss,shorter time to flatus,and shorter hospital stay.The complication rate was 5.41%(2/37;bleeding and re-obstruction),with no statistically significant difference between the two groups in terms of operative duration or perioperative mortality.The overall complication rates were 5.41%(2/37)and 21.62%(8/37)in the intervention and control groups,respectively.Tumor recurrence and overall survival rates were 2.70%and 97.30%in the study group and 13.51%and 91.89%in the control group,respectively.CONCLUSION Intestinal stenting relieved acute obstructions,reduced the number of emergency surgeries,and supported laparoscopic procedures while improving primary anastomosis rates,minimizing ostomy occurrence,surgical trauma,and complications,and accelerating recovery.展开更多
BACKGROUND:Intestinal mucosa injury in cases of severe acute pancreatitis(SAP) or obstructive jaundice(OJ) is one of the main reasons for the accelerated aggravation of these diseases.Besides being an organ to digest ...BACKGROUND:Intestinal mucosa injury in cases of severe acute pancreatitis(SAP) or obstructive jaundice(OJ) is one of the main reasons for the accelerated aggravation of these diseases.Besides being an organ to digest and absorb nutrients,the intestine is also a unique immune organ.When SAP and OJ develop,the destruction of the intestinal mucosa barrier is an important contributing factor for the development of bacterial translocation,systemic inflammatory response syndrome,and multiple organ dysfunction syndrome.It is important to protect the intestinal mucosa in the therapy for SAP and OJ.In this study,we determined the effect of Radix Salviae Miltiorrhizae(Danshen) injection on apoptosis and NF-κB P65 protein expression in the intestinal mucosa of rats with SAP or OJ,and explored the protective mechanism of Danshen in their mucosa.METHODS:Sprague-Dawley rats were used in the SAP and OJ experiments.These rats were randomly divided into shamoperated,model control,and treated groups.At various times after operation,the mortality rates were calculated.Subsequently,the rats were killed to assess the pathological changes,the expression levels of Bax and NF-κB proteins,and the apoptosis indices in the intestinal mucosa.RESULTS:Compared to the corresponding model control group,the number of SAP or OJ rats that died in the treated group decreased but showed no statistically significant difference.At all time points after operation,there was no significant difference between the treated and model control groups in the staining intensity as well as the product of staining intensity and positive staining rate of Bax protein in the intestinal mucosa of SAP and OJ rats.At 3 hours after operation,the apoptosis index of the intestinal mucosa of SAP rats in the treated group was lower than that in the model control group(P【0.01).At 12 hours after operation in SAP rats and 28 days after operation in OJ rats,the staining intensity as well as the product of staining intensity and positive staining rate of NF-κB protein of the intestinal mucosa in the treated group were lower than those in the model control group(P【0.01).CONCLUSION:Danshen exerts protective effects on the intestinal mucosa of SAP and OJ rats perhaps by inhibiting apoptosis and down-regulating NF-κB protein.展开更多
Intestinal malrotation occurs when there is a disruption in the normal embryological development of the bowel. The majority of patients present with clinical features in childhood, though rarely a first presentation c...Intestinal malrotation occurs when there is a disruption in the normal embryological development of the bowel. The majority of patients present with clinical features in childhood, though rarely a first presentation can take place in adulthood. Recurrent bowel obstruction in patients with previous abdominal operation for midgut malrotation is mostly due to adhesions but very few reported cases have been due to recurrent volvulus. We present the case of a 22-year-old gentleman who had laparotomy in childhood for small bowel volvulus and then presented with acute bowel obstruction. Preoperative computerised tomography scan showed small bowel obstruction and features in keeping with midgut malrotation. Emergency laparotomy findings confirmed midgut malrotation with absent appendix, abnormal location of caecum, ascending colon and small bowel. In addition, there were small bowel volvulus and a segment of terminal ileal stricture. Limited right hemicolectomy was performed with excellent postoperative recovery. This case is presented to illustrate a rare occurrence and raise an awareness of the possibility of dreadful recurrent volvulus even several years following an initial Ladd's procedure for midgut malrotation. Therefore, one will need to exercise a high index of suspicion and this becomes very crucial in order to ensure prompt surgical intervention and thereby preventing an attendant bowel ischaemia with its associated high fatality.展开更多
Introduction: Acute intestinal obstruction is a serious pathology, a surgical emergency for which medical imaging plays an important role in the management. We initiated this work in order to study the contribution of...Introduction: Acute intestinal obstruction is a serious pathology, a surgical emergency for which medical imaging plays an important role in the management. We initiated this work in order to study the contribution of imaging in the diagnosis of acute intestinal obstruction at the Point-G University Hospital. Patients and Methods: This was a prospective, descriptive and analytical study of 96 patients collected at the radiology and medical imaging department of CHU Point-G from January 2018 to January 2019. Results: The age of our patients varied from 11 to 86 years, with an average of 36 years old. There was a male predominance of 64.6% against 35.4% for women, i.e., a sex ratio of 1.82. Previous surgery was found in 61.5% of our patients. The pain was present in all patients. An unprepared abdominal X-ray was performed in 89.6% of patients. Hydroaerobic levels were found in 96.5% of patients. Abdominopelvic CT scans were performed on 12 patients, all of whom were diagnosed with occlusion. These positive diagnostic findings were consistent with intraoperative findings in 92% of cases. The causes were dominated by bridges in 46 patients and tumors in 9 patients. Signs of severity on CT were dominated by signs of distress of the upstream bile ducts in 8.3%. Exactly 8% of our patients spontaneously resumed transit, 91% received surgical treatment and 1% died before surgery. The outcome was favorable in 80 patients (83.3%) and poor with death in 16 patients (16.7%). Conclusion: Acute intestinal obstruction remains a serious pathology for which the X-ray of the PSA is often the only radiological examination performed in an emergency. However, abdominopelvic CT seems to us to be widely indicated thanks to its contribution both to the positive diagnosis and to the diagnosis of severity and etiology. However, this imaging technique is widely underused in our practice because of its high cost and lack of availability.展开更多
Objective: We initiated this work with the aim of studying the contribution of imaging in the diagnosis of acute intestinal obstruction at CIMED. Patients and methods: This was a prospective, descriptive and analytica...Objective: We initiated this work with the aim of studying the contribution of imaging in the diagnosis of acute intestinal obstruction at CIMED. Patients and methods: This was a prospective, descriptive and analytical study involving 96 patients collected at the radiology and medical imaging department of CIMED, from January 2022 to January 2023. Result: The age of our patients varied between 11 and 86 years with an average age of 36 years. There was a male predominance of 64.6% compared to 35.4% for women, i.e. a sex ratio of 1.82. The notion of previous surgery was found in 61.5% of our patients. Pain was present in all patients. Radiography of the ASP was performed in 89.6% of patients. It showed hydro-aerial levels in 96.5% of patients. Abdominopelvic CT was performed in 12 patients and made it possible to make the diagnosis of occlusion in all patients. The results of the positive diagnosis were concordant with those intraoperatively in 92% of cases. 8% of our patients, compared to the treatment, spontaneously resumed their transit, 91% benefited from surgical treatment and 1% died before surgery. The outcome was favorable in 80 patients or 83.3%, poor with death in 16 patients or 16.7% of cases. Conclusion: Acute intestinal obstruction remains a serious pathology for which ASP radiography often remains the only radiological examination performed urgently. However, abdominopelvic CT seems widely indicated thanks to its contribution both for the positive diagnosis and for the serious and etiological diagnoses. However, this imaging technique is largely underused in our practice due to its high cost and lack of availability.展开更多
Objective: to analyze the effect of different operation time on the treatment of acute intestinal obstruction. Methods: 60 patients with acute intestinal obstruction admitted to our hospital were selected as research ...Objective: to analyze the effect of different operation time on the treatment of acute intestinal obstruction. Methods: 60 patients with acute intestinal obstruction admitted to our hospital were selected as research objects (the time range was from April 2019 to April 2020), and then they were equally included into the control group and the observation group according to the order of admission time. Conservative treatment and intervention were carried out in both groups, and appropriate therapeutic methods were selected according to the specific etiology, symptoms and signs of the patients. The operation time of the control group and the observation group were 48 hours after onset and 48 hours after onset, respectively. The clinical indexes and complications after treatment were compared between the two groups. Results: after treatment, compared with the control group, the gastrointestinal function recovery time, ambulation time and hospitalization time of the observation group were shorter, P < 0.05;The total incidence and mortality rate of postoperative complications were lower (P < 0.05). Conclusion: surgical treatment for acute intestinal obstruction patients within 48 hours of onset is effective, which can significantly speed up the prognosis and rehabilitation, reduce the incidence of postoperative complications and mortality, and is worthy of promotion and application.展开更多
Acute intestinal obstructions are defined as a complete and persistent cessation of materials and gases in a segment of the digestive tract. They constitute a medical-surgical emergency. Our work aimed to study acute ...Acute intestinal obstructions are defined as a complete and persistent cessation of materials and gases in a segment of the digestive tract. They constitute a medical-surgical emergency. Our work aimed to study acute intestinal obstructions, to determine the hospital frequency, to describe the aspects (epidemiological, clinical and therapeutic), to analyze the surgical consequences and to evaluate the cost of the management of obstructions. acute intestinal infections in the general surgery department of the reference health center of commune I of Bamako in Mali. Our retrospective, longitudinal and descriptive study took place from January 1, 2015 to December 31, 2019 in the general surgery department of the reference health center in commune I of Bamako. The average age was 47.72 years with extremes of 15 and 78 years and a standard deviation of 16.07. Our sex ratio (56 men/15 women) was 3.38. The clinical signs were dominated by abdominal pain (100%), vomiting (52.9%), cessation of materials and gases (25.4%) and meteorism (35.3%). The main etiologies found intraoperatively were strangulated hernia (54.9%), bands and/or adhesions (21.1%), sigmoid volvulus (12.7%), colorectal tumor (7%), small bowel volvulus (2.8%) and acute intestinal intussusception (1.4%). Hernia repair was the most performed surgical procedure, i.e. 54.9%. The overall mortality rate was 1.4%.展开更多
To critically review the literature addressing the definition, epidemiology, aetiology and pathophysiology of acute colonic pseudo-obstruction (ACPO). METHODSA systematic search was performed to identify articles inve...To critically review the literature addressing the definition, epidemiology, aetiology and pathophysiology of acute colonic pseudo-obstruction (ACPO). METHODSA systematic search was performed to identify articles investigating the aetiology and pathophysiology of ACPO. A narrative synthesis of the evidence was undertaken. RESULTSNo consistent approach to the definition or reporting of ACPO has been developed, which has led to overlapping investigation with other conditions. A vast array of risk factors has been identified, supporting a multifactorial aetiology. The pathophysiological mechanisms remain unclear, but are likely related to altered autonomic regulation of colonic motility, in the setting of other predisposing factors. CONCLUSIONFuture research should aim to establish a clear and consistent definition of ACPO, and elucidate the pathophysiological mechanisms leading to altered colonic function. An improved understanding of the aetiology of ACPO may facilitate the development of targeted strategies for its prevention and treatment.展开更多
BACKGROUND Bezoars are conglomerates of indigestible foreign material that can be found in the gastrointestinal tract.Gastric ulcer,gastrointestinal perforation,and intestinal obstruction are the main complications.Ac...BACKGROUND Bezoars are conglomerates of indigestible foreign material that can be found in the gastrointestinal tract.Gastric ulcer,gastrointestinal perforation,and intestinal obstruction are the main complications.Acute pancreatitis secondary to bezoar is rare.Here,we present a rare case of a migratory gastric bezoar complicated by acute pancreatitis and small bowel obstruction after dissolution therapy.CASE SUMMARY A-65-year-old woman underwent gastroscopy because of epigastric pain,which revealed a huge bezoar and a gastric ulcer 10 d prior.The patient was discharged with a prescription of drinking 1 L Coca-Cola daily for 6 d,without repeat gastroscopy.However,she suddenly developed epigastric pain,nausea and vomiting for 3 d.Abdominal computed tomography(CT)revealed mild inflammation of the pancreas.Magnetic resonance cholangiopancreatography showed no abnormalities in the pancreatic duct or common bile duct.The nasogastric tube still showed drainage of more than 1.6 L of dark fluid each day after symptomatic treatment.Abdominal CT re-examination suggested intestinal obstruction.Esophagogastroduodenoscopy revealed a huge yellowish hard mass in the jejunal lumen,and we used the basket and net to fragment the bezoar.She was discharged with a good outcome.CONCLUSION Endoscopic therapy is the first choice for gastric bezoars.When mechanical disintegration cannot be achieved,timing of repeat endoscopy is important during Coca-Cola dissolution therapy.展开更多
The nasogastric tube(NGT) has become a frequently used device to alleviate gastrointestinal symptoms. Nasogastric tube syndrome(NTS) is an uncommon but potentially life-threatening complication of an indwelling NGT. N...The nasogastric tube(NGT) has become a frequently used device to alleviate gastrointestinal symptoms. Nasogastric tube syndrome(NTS) is an uncommon but potentially life-threatening complication of an indwelling NGT. NTS is characterized by acute upper airway obstruction due to bilateral vocal cord paralysis. We report a case of a 76-year-old man with NTS, induced by an indwelling long intestinal tube. He was admitted to our hospital for treatment of sigmoid colon cancer. He underwent sigmoidectomy to release a bowel obstruction, and had a long intestinal tube inserted to decompress the intestinal tract. He presented acute dyspnea following prolonged intestinal intubation, and bronchoscopy showed bilateral vocal cord paralysis. The NGT was removed immediately, and tracheotomy was performed. The patient was finally discharged in a fully recovered state. NTS be considered in patients complaining of acute upper airway obstruction, not only with a NGT inserted but also with a long intestinal tube.展开更多
AIM To investigate the epidemiology,treatment and outcomes of acute appendicitis(AA)in a large population study.METHODS This is a retrospective cohort study derived from the administrative dataset of the Bergamo distr...AIM To investigate the epidemiology,treatment and outcomes of acute appendicitis(AA)in a large population study.METHODS This is a retrospective cohort study derived from the administrative dataset of the Bergamo district healthcare system(more than 1 million inhabitants)from 1997 to 2013.Data about treatment,surgery,length of stay were collected.Moreover for each patients were registered data about relapse of appendicitis and hospital admission due to intestinal obstruction.RESULTS From 1997 to 2013 in the Bergamo district we collected 16544 cases of AA,with a crude incidence rate of 89/100000 inhabitants per year;mean age was 24.51±16.17,54.7%were male and the mean Charlson's comorbidity index was 0.32±0.92.Mortality was<0.0001%.Appendectomy was performed in 94.7%of the patients and the mean length of stay was 5.08±2.88 d;the cumulative hospital stay was 5.19±3.36 d and 1.2%of patients had at least one further hospitalization due intestinal occlusion.Laparoscopic appendectomy was performed in 48%of cases.Percent of 5.34 the patients were treated conservatively with a mean length of stay of 3.98±3.96 d;the relapse rate was 23.1%and the cumulative hospital stay during the study period was 5.46±6.05 d.CONCLUSION The treatment of acute appendicitis in Northern Italy is slowly changing,with the large diffusion of laparoscopic approach;conservative treatment of non-complicated appendicitis is still a neglected option,but rich of promising results.展开更多
BACKGROUND Cases of severe pneumonia complicated with acute myocardial infarction(AMI)with good prognosis after percutaneous coronary intervention(PCI)are rare,especially those with postoperative pericarditis and inte...BACKGROUND Cases of severe pneumonia complicated with acute myocardial infarction(AMI)with good prognosis after percutaneous coronary intervention(PCI)are rare,especially those with postoperative pericarditis and intestinal obstruction.CASE SUMMARY A 53-year-old male patient was admitted to the emergency department of our hospital because of paroxysmal chest tightness for 4 d,aggravated with chest pain for 12 h.The symptoms,electrocardiography,biochemical parameters,echocardiography and chest computed tomography confirmed the diagnosis of severe pneumonia complicated with AMI.The patient was treated with antiplatelet aggregation,anticoagulation,lipid regulation,vasodilation,anti-infective agents and direct PCI.The patient was discharged after 3 wk of treatment.Follow-up showed that the patient was asymptomatic without recurrence.CONCLUSION For patients with severe pneumonia complicated with AMI,PCI and antibiotic therapy is a life-saving strategy.展开更多
Background:Conservative therapy for Crohn’s disease(CD)-related acute bowel obstruction is essential to avoid emergent surgery.The present study aimed to evaluate the efficacy of using a long intestinal decompression...Background:Conservative therapy for Crohn’s disease(CD)-related acute bowel obstruction is essential to avoid emergent surgery.The present study aimed to evaluate the efficacy of using a long intestinal decompression tube(LT)in treatment of CD with acute intestinal obstruction.Methods:This is a prospective observational study.Comparative analysis was performed in CD patients treated with LT(the LT group)and nasogastric tube(the GT group).The primary outcome was the avoidance of emergent surgery.Additionally,predictive factors for failure of decompression and subsequent surgery were investigated.Results:There were 27 and 42 CD patients treated with LT and GT,respectively,in emergent situations.Twelve(44.4%)patients using LT were managed conservatively without laparotomy,while only nine(21.4%)patients in the GT group were spared from emergent surgery(P<0.05).Both in surgery-free and in surgery patients,the time to alleviation of symptoms was significantly shorter in the LT groups than in the GT groups(both P<0.01).C-reactive protein decrease after intubation and 48-hour drainage volume>500mL were predictors of unavoidable surgery(both P<0.05).The rate of temporary stoma and incidence of incision infection in the LT surgery group were significantly lower than those in the GT group(both P<0.05).No significant differences were observed in the frequency of medical and surgical recurrences between the LT and GT groups(all P>0.05).Conclusions:Endoscopic placement of LT could improve the emergent status in CD patients with acute bowel obstruction.The drainage output and changes in C-reactive protein after intubation could serve as practical predictive indices for subsequent surgery.Compared to traditional GT decompression,LT decompression was associated with fewer short-term complications and did not appear to affect long-term recurrence.展开更多
Background We created and validated a computed tomography(CT)-based radiomic model using both clinical factors and the radiomic signature for assessing the strangulation risk of acute intestinal obstruction.This would...Background We created and validated a computed tomography(CT)-based radiomic model using both clinical factors and the radiomic signature for assessing the strangulation risk of acute intestinal obstruction.This would assist surgeons in accurately predicting intestinal ischemia and strangulation in patients with intestinal obstruction.Methods We recruited 289 patients with acute intestinal obstruction admitted in the Affiliated Hospital of Qingdao University from January 2019 to February 2022.The patients were allocated to a training(n=226)and validation cohort(n=63).Radiomic features were collected from CT images,and the radiomic signature was extracted and used to calculate a radiomic score(Rad-score).A nomogram was constructed using the clinical features and the Rad-score,and the performance of the clinical,radiomics,and nomogram models was assessed in the two cohorts.Results Six robust features were used to construct the radiomic signature.The nomogram incorporating hemoglobin levels,C-reactive protein levels,American Society of Anesthesiologists score,time of obstruction,CT image of mesenteric fluid(P<0.05),and the signature demonstrated good predictive ability for intestinal ischemia in patients with acute intestinal obstruction,with areas under the curve of 0.892(95%confidence interval,0.837–0.947)and 0.781(95%confidence interval,0.619–0.944)for the training and validation sets,respectively.The decision curve analysis showed that this model outperformed the clinical and radiomic signature models.Conclusion The radiomic nomogram may effectively predict intestinal ischemia in patients with acute intestinal disease and may assist clinical decision-making。展开更多
Context: Generally in Africa, BO remains the leading cause of acute abdomen. We therefore sought to study the current etiological factors of intestinal obstruction on a virgin abdomen or unhealed abdomen at the centra...Context: Generally in Africa, BO remains the leading cause of acute abdomen. We therefore sought to study the current etiological factors of intestinal obstruction on a virgin abdomen or unhealed abdomen at the central hospital of Yaoundé in order to better understand the main causes and to better anticipate and improve the diagnosis, management and the evolution of intestinal obstruction on a virgin abdomen. Method: The patients were prospectively included from June 2021 to May 2022, these patients were recruited from the digestive and emergency surgery units of the Yaoundé Central Hospital during the study period and who met the inclusion criteria, with suspicion of partial or total intestinal obstruction or those with an intraoperative confirmed diagnosis were enrolled. Results: We recruited 73 patients including 43 (60.3%) men and 29 (39.7%) women whose mean age was 42.5 years with extremes ranging from 16 to 70 years. Most of them consulted after 72 hours, i.e. 65.2% of cases due to self-medication or even prior consultations in the lower level center at the Central Hospital of Yaoundé. The patients retained for this work presented in majority the symptoms according to the abdominal pains, the stop of the materials and gases;meteorism and vomiting. Abdominal wall hernias with incarcerated intestinal loops were the most common cause of intestinal obstruction in an unscarred abdomen in adults at 38.4% of cases, followed by digestive tumors 23.3% and adhesions 17.8%. Exceptionally, a cluster of roundworms was found as the cause of intestinal obstruction in two of our patients. Complications occurred in 25 patients or 31.5% of cases and were dominated respectively by nausea and hematoma (36%), local infections (24%) and malaria (24%). Death occurred in 5 of our patients, or 6.8% of cases, and was mostly caused by hypovolemic shock (40%) and pulmonary embolism (40%). Conclusion: Intestinal obstructions on the abdomen without scarring remain the prerogative of young adults and are caused by strangulated hernias with incarcerated intestinal loops, tumors and adhesions. The rate of complications remains high and they are dominated by infectious pathology. Their mortality is clearly improving.展开更多
文摘BACKGROUND Recently,intestinal stenting combined with laparoscopic surgery has received increasing attention as a treatment option for acute intestinal obstruction.However,its safety and efficacy have not yet been established.AIM To assess the efficacy and safety of combining intestinal stenting with laparoscopic surgery for the management of acute intestinal obstruction.METHODS Clinical data from 74 patients with colorectal cancer and acute intestinal obstruction,who were admitted to the emergency department of the authors’hospital between October 2023 and November 2024,were collected and analyzed.Patients were divided into two groups based on the surgical intervention:A control group(emergency open surgery,n=37)and a study group(intestinal stent implantation combined with laparoscopic surgery,n=37).Observation indicators included stent placement rate,obstruction relief rate,and stent-related complications.RESULTS Intestinal stent placement was 100%successful in the study group,all of whom experienced relief from obstruction while exhibiting a significantly lower rate of ostomy creation and a higher rate of primary anastomosis than in the control group,as well as less intraoperative blood loss,shorter time to flatus,and shorter hospital stay.The complication rate was 5.41%(2/37;bleeding and re-obstruction),with no statistically significant difference between the two groups in terms of operative duration or perioperative mortality.The overall complication rates were 5.41%(2/37)and 21.62%(8/37)in the intervention and control groups,respectively.Tumor recurrence and overall survival rates were 2.70%and 97.30%in the study group and 13.51%and 91.89%in the control group,respectively.CONCLUSION Intestinal stenting relieved acute obstructions,reduced the number of emergency surgeries,and supported laparoscopic procedures while improving primary anastomosis rates,minimizing ostomy occurrence,surgical trauma,and complications,and accelerating recovery.
文摘BACKGROUND:Intestinal mucosa injury in cases of severe acute pancreatitis(SAP) or obstructive jaundice(OJ) is one of the main reasons for the accelerated aggravation of these diseases.Besides being an organ to digest and absorb nutrients,the intestine is also a unique immune organ.When SAP and OJ develop,the destruction of the intestinal mucosa barrier is an important contributing factor for the development of bacterial translocation,systemic inflammatory response syndrome,and multiple organ dysfunction syndrome.It is important to protect the intestinal mucosa in the therapy for SAP and OJ.In this study,we determined the effect of Radix Salviae Miltiorrhizae(Danshen) injection on apoptosis and NF-κB P65 protein expression in the intestinal mucosa of rats with SAP or OJ,and explored the protective mechanism of Danshen in their mucosa.METHODS:Sprague-Dawley rats were used in the SAP and OJ experiments.These rats were randomly divided into shamoperated,model control,and treated groups.At various times after operation,the mortality rates were calculated.Subsequently,the rats were killed to assess the pathological changes,the expression levels of Bax and NF-κB proteins,and the apoptosis indices in the intestinal mucosa.RESULTS:Compared to the corresponding model control group,the number of SAP or OJ rats that died in the treated group decreased but showed no statistically significant difference.At all time points after operation,there was no significant difference between the treated and model control groups in the staining intensity as well as the product of staining intensity and positive staining rate of Bax protein in the intestinal mucosa of SAP and OJ rats.At 3 hours after operation,the apoptosis index of the intestinal mucosa of SAP rats in the treated group was lower than that in the model control group(P【0.01).At 12 hours after operation in SAP rats and 28 days after operation in OJ rats,the staining intensity as well as the product of staining intensity and positive staining rate of NF-κB protein of the intestinal mucosa in the treated group were lower than those in the model control group(P【0.01).CONCLUSION:Danshen exerts protective effects on the intestinal mucosa of SAP and OJ rats perhaps by inhibiting apoptosis and down-regulating NF-κB protein.
文摘Intestinal malrotation occurs when there is a disruption in the normal embryological development of the bowel. The majority of patients present with clinical features in childhood, though rarely a first presentation can take place in adulthood. Recurrent bowel obstruction in patients with previous abdominal operation for midgut malrotation is mostly due to adhesions but very few reported cases have been due to recurrent volvulus. We present the case of a 22-year-old gentleman who had laparotomy in childhood for small bowel volvulus and then presented with acute bowel obstruction. Preoperative computerised tomography scan showed small bowel obstruction and features in keeping with midgut malrotation. Emergency laparotomy findings confirmed midgut malrotation with absent appendix, abnormal location of caecum, ascending colon and small bowel. In addition, there were small bowel volvulus and a segment of terminal ileal stricture. Limited right hemicolectomy was performed with excellent postoperative recovery. This case is presented to illustrate a rare occurrence and raise an awareness of the possibility of dreadful recurrent volvulus even several years following an initial Ladd's procedure for midgut malrotation. Therefore, one will need to exercise a high index of suspicion and this becomes very crucial in order to ensure prompt surgical intervention and thereby preventing an attendant bowel ischaemia with its associated high fatality.
文摘Introduction: Acute intestinal obstruction is a serious pathology, a surgical emergency for which medical imaging plays an important role in the management. We initiated this work in order to study the contribution of imaging in the diagnosis of acute intestinal obstruction at the Point-G University Hospital. Patients and Methods: This was a prospective, descriptive and analytical study of 96 patients collected at the radiology and medical imaging department of CHU Point-G from January 2018 to January 2019. Results: The age of our patients varied from 11 to 86 years, with an average of 36 years old. There was a male predominance of 64.6% against 35.4% for women, i.e., a sex ratio of 1.82. Previous surgery was found in 61.5% of our patients. The pain was present in all patients. An unprepared abdominal X-ray was performed in 89.6% of patients. Hydroaerobic levels were found in 96.5% of patients. Abdominopelvic CT scans were performed on 12 patients, all of whom were diagnosed with occlusion. These positive diagnostic findings were consistent with intraoperative findings in 92% of cases. The causes were dominated by bridges in 46 patients and tumors in 9 patients. Signs of severity on CT were dominated by signs of distress of the upstream bile ducts in 8.3%. Exactly 8% of our patients spontaneously resumed transit, 91% received surgical treatment and 1% died before surgery. The outcome was favorable in 80 patients (83.3%) and poor with death in 16 patients (16.7%). Conclusion: Acute intestinal obstruction remains a serious pathology for which the X-ray of the PSA is often the only radiological examination performed in an emergency. However, abdominopelvic CT seems to us to be widely indicated thanks to its contribution both to the positive diagnosis and to the diagnosis of severity and etiology. However, this imaging technique is widely underused in our practice because of its high cost and lack of availability.
文摘Objective: We initiated this work with the aim of studying the contribution of imaging in the diagnosis of acute intestinal obstruction at CIMED. Patients and methods: This was a prospective, descriptive and analytical study involving 96 patients collected at the radiology and medical imaging department of CIMED, from January 2022 to January 2023. Result: The age of our patients varied between 11 and 86 years with an average age of 36 years. There was a male predominance of 64.6% compared to 35.4% for women, i.e. a sex ratio of 1.82. The notion of previous surgery was found in 61.5% of our patients. Pain was present in all patients. Radiography of the ASP was performed in 89.6% of patients. It showed hydro-aerial levels in 96.5% of patients. Abdominopelvic CT was performed in 12 patients and made it possible to make the diagnosis of occlusion in all patients. The results of the positive diagnosis were concordant with those intraoperatively in 92% of cases. 8% of our patients, compared to the treatment, spontaneously resumed their transit, 91% benefited from surgical treatment and 1% died before surgery. The outcome was favorable in 80 patients or 83.3%, poor with death in 16 patients or 16.7% of cases. Conclusion: Acute intestinal obstruction remains a serious pathology for which ASP radiography often remains the only radiological examination performed urgently. However, abdominopelvic CT seems widely indicated thanks to its contribution both for the positive diagnosis and for the serious and etiological diagnoses. However, this imaging technique is largely underused in our practice due to its high cost and lack of availability.
文摘Objective: to analyze the effect of different operation time on the treatment of acute intestinal obstruction. Methods: 60 patients with acute intestinal obstruction admitted to our hospital were selected as research objects (the time range was from April 2019 to April 2020), and then they were equally included into the control group and the observation group according to the order of admission time. Conservative treatment and intervention were carried out in both groups, and appropriate therapeutic methods were selected according to the specific etiology, symptoms and signs of the patients. The operation time of the control group and the observation group were 48 hours after onset and 48 hours after onset, respectively. The clinical indexes and complications after treatment were compared between the two groups. Results: after treatment, compared with the control group, the gastrointestinal function recovery time, ambulation time and hospitalization time of the observation group were shorter, P < 0.05;The total incidence and mortality rate of postoperative complications were lower (P < 0.05). Conclusion: surgical treatment for acute intestinal obstruction patients within 48 hours of onset is effective, which can significantly speed up the prognosis and rehabilitation, reduce the incidence of postoperative complications and mortality, and is worthy of promotion and application.
文摘Acute intestinal obstructions are defined as a complete and persistent cessation of materials and gases in a segment of the digestive tract. They constitute a medical-surgical emergency. Our work aimed to study acute intestinal obstructions, to determine the hospital frequency, to describe the aspects (epidemiological, clinical and therapeutic), to analyze the surgical consequences and to evaluate the cost of the management of obstructions. acute intestinal infections in the general surgery department of the reference health center of commune I of Bamako in Mali. Our retrospective, longitudinal and descriptive study took place from January 1, 2015 to December 31, 2019 in the general surgery department of the reference health center in commune I of Bamako. The average age was 47.72 years with extremes of 15 and 78 years and a standard deviation of 16.07. Our sex ratio (56 men/15 women) was 3.38. The clinical signs were dominated by abdominal pain (100%), vomiting (52.9%), cessation of materials and gases (25.4%) and meteorism (35.3%). The main etiologies found intraoperatively were strangulated hernia (54.9%), bands and/or adhesions (21.1%), sigmoid volvulus (12.7%), colorectal tumor (7%), small bowel volvulus (2.8%) and acute intestinal intussusception (1.4%). Hernia repair was the most performed surgical procedure, i.e. 54.9%. The overall mortality rate was 1.4%.
文摘To critically review the literature addressing the definition, epidemiology, aetiology and pathophysiology of acute colonic pseudo-obstruction (ACPO). METHODSA systematic search was performed to identify articles investigating the aetiology and pathophysiology of ACPO. A narrative synthesis of the evidence was undertaken. RESULTSNo consistent approach to the definition or reporting of ACPO has been developed, which has led to overlapping investigation with other conditions. A vast array of risk factors has been identified, supporting a multifactorial aetiology. The pathophysiological mechanisms remain unclear, but are likely related to altered autonomic regulation of colonic motility, in the setting of other predisposing factors. CONCLUSIONFuture research should aim to establish a clear and consistent definition of ACPO, and elucidate the pathophysiological mechanisms leading to altered colonic function. An improved understanding of the aetiology of ACPO may facilitate the development of targeted strategies for its prevention and treatment.
文摘BACKGROUND Bezoars are conglomerates of indigestible foreign material that can be found in the gastrointestinal tract.Gastric ulcer,gastrointestinal perforation,and intestinal obstruction are the main complications.Acute pancreatitis secondary to bezoar is rare.Here,we present a rare case of a migratory gastric bezoar complicated by acute pancreatitis and small bowel obstruction after dissolution therapy.CASE SUMMARY A-65-year-old woman underwent gastroscopy because of epigastric pain,which revealed a huge bezoar and a gastric ulcer 10 d prior.The patient was discharged with a prescription of drinking 1 L Coca-Cola daily for 6 d,without repeat gastroscopy.However,she suddenly developed epigastric pain,nausea and vomiting for 3 d.Abdominal computed tomography(CT)revealed mild inflammation of the pancreas.Magnetic resonance cholangiopancreatography showed no abnormalities in the pancreatic duct or common bile duct.The nasogastric tube still showed drainage of more than 1.6 L of dark fluid each day after symptomatic treatment.Abdominal CT re-examination suggested intestinal obstruction.Esophagogastroduodenoscopy revealed a huge yellowish hard mass in the jejunal lumen,and we used the basket and net to fragment the bezoar.She was discharged with a good outcome.CONCLUSION Endoscopic therapy is the first choice for gastric bezoars.When mechanical disintegration cannot be achieved,timing of repeat endoscopy is important during Coca-Cola dissolution therapy.
文摘The nasogastric tube(NGT) has become a frequently used device to alleviate gastrointestinal symptoms. Nasogastric tube syndrome(NTS) is an uncommon but potentially life-threatening complication of an indwelling NGT. NTS is characterized by acute upper airway obstruction due to bilateral vocal cord paralysis. We report a case of a 76-year-old man with NTS, induced by an indwelling long intestinal tube. He was admitted to our hospital for treatment of sigmoid colon cancer. He underwent sigmoidectomy to release a bowel obstruction, and had a long intestinal tube inserted to decompress the intestinal tract. He presented acute dyspnea following prolonged intestinal intubation, and bronchoscopy showed bilateral vocal cord paralysis. The NGT was removed immediately, and tracheotomy was performed. The patient was finally discharged in a fully recovered state. NTS be considered in patients complaining of acute upper airway obstruction, not only with a NGT inserted but also with a long intestinal tube.
文摘AIM To investigate the epidemiology,treatment and outcomes of acute appendicitis(AA)in a large population study.METHODS This is a retrospective cohort study derived from the administrative dataset of the Bergamo district healthcare system(more than 1 million inhabitants)from 1997 to 2013.Data about treatment,surgery,length of stay were collected.Moreover for each patients were registered data about relapse of appendicitis and hospital admission due to intestinal obstruction.RESULTS From 1997 to 2013 in the Bergamo district we collected 16544 cases of AA,with a crude incidence rate of 89/100000 inhabitants per year;mean age was 24.51±16.17,54.7%were male and the mean Charlson's comorbidity index was 0.32±0.92.Mortality was<0.0001%.Appendectomy was performed in 94.7%of the patients and the mean length of stay was 5.08±2.88 d;the cumulative hospital stay was 5.19±3.36 d and 1.2%of patients had at least one further hospitalization due intestinal occlusion.Laparoscopic appendectomy was performed in 48%of cases.Percent of 5.34 the patients were treated conservatively with a mean length of stay of 3.98±3.96 d;the relapse rate was 23.1%and the cumulative hospital stay during the study period was 5.46±6.05 d.CONCLUSION The treatment of acute appendicitis in Northern Italy is slowly changing,with the large diffusion of laparoscopic approach;conservative treatment of non-complicated appendicitis is still a neglected option,but rich of promising results.
文摘BACKGROUND Cases of severe pneumonia complicated with acute myocardial infarction(AMI)with good prognosis after percutaneous coronary intervention(PCI)are rare,especially those with postoperative pericarditis and intestinal obstruction.CASE SUMMARY A 53-year-old male patient was admitted to the emergency department of our hospital because of paroxysmal chest tightness for 4 d,aggravated with chest pain for 12 h.The symptoms,electrocardiography,biochemical parameters,echocardiography and chest computed tomography confirmed the diagnosis of severe pneumonia complicated with AMI.The patient was treated with antiplatelet aggregation,anticoagulation,lipid regulation,vasodilation,anti-infective agents and direct PCI.The patient was discharged after 3 wk of treatment.Follow-up showed that the patient was asymptomatic without recurrence.CONCLUSION For patients with severe pneumonia complicated with AMI,PCI and antibiotic therapy is a life-saving strategy.
基金This study was supported by the National Natural Science Foundation of China(81770556).
文摘Background:Conservative therapy for Crohn’s disease(CD)-related acute bowel obstruction is essential to avoid emergent surgery.The present study aimed to evaluate the efficacy of using a long intestinal decompression tube(LT)in treatment of CD with acute intestinal obstruction.Methods:This is a prospective observational study.Comparative analysis was performed in CD patients treated with LT(the LT group)and nasogastric tube(the GT group).The primary outcome was the avoidance of emergent surgery.Additionally,predictive factors for failure of decompression and subsequent surgery were investigated.Results:There were 27 and 42 CD patients treated with LT and GT,respectively,in emergent situations.Twelve(44.4%)patients using LT were managed conservatively without laparotomy,while only nine(21.4%)patients in the GT group were spared from emergent surgery(P<0.05).Both in surgery-free and in surgery patients,the time to alleviation of symptoms was significantly shorter in the LT groups than in the GT groups(both P<0.01).C-reactive protein decrease after intubation and 48-hour drainage volume>500mL were predictors of unavoidable surgery(both P<0.05).The rate of temporary stoma and incidence of incision infection in the LT surgery group were significantly lower than those in the GT group(both P<0.05).No significant differences were observed in the frequency of medical and surgical recurrences between the LT and GT groups(all P>0.05).Conclusions:Endoscopic placement of LT could improve the emergent status in CD patients with acute bowel obstruction.The drainage output and changes in C-reactive protein after intubation could serve as practical predictive indices for subsequent surgery.Compared to traditional GT decompression,LT decompression was associated with fewer short-term complications and did not appear to affect long-term recurrence.
基金the National Natural Science Foundation of China(Grant No.82000482).
文摘Background We created and validated a computed tomography(CT)-based radiomic model using both clinical factors and the radiomic signature for assessing the strangulation risk of acute intestinal obstruction.This would assist surgeons in accurately predicting intestinal ischemia and strangulation in patients with intestinal obstruction.Methods We recruited 289 patients with acute intestinal obstruction admitted in the Affiliated Hospital of Qingdao University from January 2019 to February 2022.The patients were allocated to a training(n=226)and validation cohort(n=63).Radiomic features were collected from CT images,and the radiomic signature was extracted and used to calculate a radiomic score(Rad-score).A nomogram was constructed using the clinical features and the Rad-score,and the performance of the clinical,radiomics,and nomogram models was assessed in the two cohorts.Results Six robust features were used to construct the radiomic signature.The nomogram incorporating hemoglobin levels,C-reactive protein levels,American Society of Anesthesiologists score,time of obstruction,CT image of mesenteric fluid(P<0.05),and the signature demonstrated good predictive ability for intestinal ischemia in patients with acute intestinal obstruction,with areas under the curve of 0.892(95%confidence interval,0.837–0.947)and 0.781(95%confidence interval,0.619–0.944)for the training and validation sets,respectively.The decision curve analysis showed that this model outperformed the clinical and radiomic signature models.Conclusion The radiomic nomogram may effectively predict intestinal ischemia in patients with acute intestinal disease and may assist clinical decision-making。
文摘Context: Generally in Africa, BO remains the leading cause of acute abdomen. We therefore sought to study the current etiological factors of intestinal obstruction on a virgin abdomen or unhealed abdomen at the central hospital of Yaoundé in order to better understand the main causes and to better anticipate and improve the diagnosis, management and the evolution of intestinal obstruction on a virgin abdomen. Method: The patients were prospectively included from June 2021 to May 2022, these patients were recruited from the digestive and emergency surgery units of the Yaoundé Central Hospital during the study period and who met the inclusion criteria, with suspicion of partial or total intestinal obstruction or those with an intraoperative confirmed diagnosis were enrolled. Results: We recruited 73 patients including 43 (60.3%) men and 29 (39.7%) women whose mean age was 42.5 years with extremes ranging from 16 to 70 years. Most of them consulted after 72 hours, i.e. 65.2% of cases due to self-medication or even prior consultations in the lower level center at the Central Hospital of Yaoundé. The patients retained for this work presented in majority the symptoms according to the abdominal pains, the stop of the materials and gases;meteorism and vomiting. Abdominal wall hernias with incarcerated intestinal loops were the most common cause of intestinal obstruction in an unscarred abdomen in adults at 38.4% of cases, followed by digestive tumors 23.3% and adhesions 17.8%. Exceptionally, a cluster of roundworms was found as the cause of intestinal obstruction in two of our patients. Complications occurred in 25 patients or 31.5% of cases and were dominated respectively by nausea and hematoma (36%), local infections (24%) and malaria (24%). Death occurred in 5 of our patients, or 6.8% of cases, and was mostly caused by hypovolemic shock (40%) and pulmonary embolism (40%). Conclusion: Intestinal obstructions on the abdomen without scarring remain the prerogative of young adults and are caused by strangulated hernias with incarcerated intestinal loops, tumors and adhesions. The rate of complications remains high and they are dominated by infectious pathology. Their mortality is clearly improving.
