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
OBJECTIVE:To explore the treatment efficacy of integrated Chinese medicine(Chaihu Shugan San,柴胡疏肝散,CSS)and western therapy in the treatment of adhesive intestinal obstruction(AIO),to provide new ideas for the man...OBJECTIVE:To explore the treatment efficacy of integrated Chinese medicine(Chaihu Shugan San,柴胡疏肝散,CSS)and western therapy in the treatment of adhesive intestinal obstruction(AIO),to provide new ideas for the management of the disease.METHODS:In our single-blind randomized controlled study,120 patients with AIO who were hospitalized in The Affiliated Hospital of China West Normal University Nan Chong Gaoping District People's Hospital from January 2021 to June 2022 and met the inclusion criteria were categorized into the treatment group and the control group.Patients from the control group were administered basic Western Medicine therapy,whereas patients from the treatment group were administered basic Western Medicine therapy plus CSS by gastric tube injection.Subsequently,the time to first anal exhaustion and defecation,time to relief of abdominal distension and pain,days of hospitalization,Traditional Chinese Medicine(TCM)symptom scores,interleukin-6(IL-6),C-reactive protein(CRP)and procalcitonin(PCT)levels in the 2 groups were recorded and compared.RESULTS:The comparison of clinical efficacy of the treatment group were better than the control group.The TCM symptom score was considerably lower in the treatment group;the inflammation indicators CRP,IL-6,and PCT also decreased statistically when comparing the control group.Furthermore,there were significantly reduced in the time to first exhaustion,time to first defecation,time to relief of abdominal pain and distension,and days of hospitalization in the treatment group versus the control group.CONCLUSION:CSS could suppress the inflammatory reaction,reduce days of hospitalization,relieve clinical symptoms in AIO patients with reliable efficacy and high safety and is worthy of clinical application.展开更多
Lithopedion is a rare clinical situation characterised by the calcification of a foetus that has died during an ectopic pregnancy, usually in the abdominal cavity. It occurs in 1.5 to 2% of ectopic pregnancies. It can...Lithopedion is a rare clinical situation characterised by the calcification of a foetus that has died during an ectopic pregnancy, usually in the abdominal cavity. It occurs in 1.5 to 2% of ectopic pregnancies. It can be asymptomatic for several years. However, various complications can occur that lead to diagnosis. The authors report a case of lithopedion complicated by acute intestinal obstruction in a 24-year-old woman in her first pregnancy. This complication occurred after 12 months of amenorrhoea. A mass containing a calcified foetus was removed by laparotomy.展开更多
BACKGROUND Colon cancer is one of the most common malignancies of the digestive tract,often complicated by intestinal obstruction,which can significantly impact patient outcomes.While traditional laparotomy is the sta...BACKGROUND Colon cancer is one of the most common malignancies of the digestive tract,often complicated by intestinal obstruction,which can significantly impact patient outcomes.While traditional laparotomy is the standard treatment,it is associated with large wounds,slower recovery,and higher complication rates.Laparoscopic surgery,a minimally invasive approach,may offer better outcomes for these patients.AIM To evaluate the clinical effects and prognosis of laparoscopic surgery in patients with colon cancer complicated by intestinal obstruction compared to traditional laparotomy.METHODS A retrospective analysis was conducted on 100 patients diagnosed with colon cancer and intestinal obstruction who underwent surgical treatment between January 2020 and December 2022.Patients were divided into two groups:The control group(CG),treated with traditional laparotomy,and the observation group(OG),treated with laparoscopic surgery.Clinical effects,surgical indicators,postoperative pain,inflammatory response,complication rates,quality of life,and prognosis were assessed and compared between the two groups.RESULTS The OG showed superior clinical outcomes compared to the CG(P<0.05).Patients in the OG had shorter operation times,reduced intraoperative blood loss,faster recovery of intestinal function,earlier mobilization,and shorter hospital stays(P<0.05).Postoperative pain(numerical rating scale scores)and inflam-matory markers[tumor necrosis factor-alpha(TNF-α),interleukin-6(IL-6),C-reactive protein(CRP)]were lower in the OG(P<0.05).The incidence of complic-ations was significantly reduced in the OG(6.00%vs 22.00%,P<0.05).Quality of life scores,including physical function,psychological state,social communication,and self-care ability,were significantly higher in the OG(P<0.05).There were no significant differences between groups in abdominal drainage volume,1-year tumor recurrence or metastasis rates,or 1-and 3-year survival rates(P>0.05).CONCLUSION The OG showed superior clinical outcomes compared to the CG(P<0.05).Patients in the OG had shorter operation times,reduced intraoperative blood loss,faster recovery of intestinal function,earlier mobilization,and shorter hospital stays(P<0.05).Postoperative pain(NRS scores)and inflammatory markers(TNF-α,IL-6,CRP)were lower in the OG(P<0.05).The incidence of complications was significantly reduced in the OG(6.00%vs 22.00%,P<0.05).Quality of life scores,including physical function,psychological state,social communication,and self-care ability,were significantly higher in the OG(P<0.05).There were no significant differences between groups in abdominal drainage volume,1-year tumor recurrence or metastasis rates,or 1-and 3-year survival rates(P>0.05).展开更多
BACKGROUND Ileum adenocarcinoma(IA),a type of small bowel adenocarcinoma,is a rather uncommon factor associated with obstruction in small bowel.Owing to its location and indefinite clinical symptoms,the diagnosis of I...BACKGROUND Ileum adenocarcinoma(IA),a type of small bowel adenocarcinoma,is a rather uncommon factor associated with obstruction in small bowel.Owing to its location and indefinite clinical symptoms,the diagnosis of IA is difficult,and survival is usually poor.With respect to the rarity of this disease,very few studies have reported such cases to provide a reference for treatment.CASE SUMMARY In this manuscript,a case of a 48-year-old man presented with chronic right lower abdominal pain and distention,queasiness and emesis.A computed tomography scan revealed intestinal wall thickening and an intestinal obstruction in the terminal ileum.He was diagnosed with inflammatory bowel disease.However,his symptoms were not relieved after conservative treatment.The patient sub-sequently underwent exploratory laparotomy,and a tumour in the ileum measuring approximately 2.0 cm×2.0 cm that was located 20 cm from the ileocolic valve was discovered incidentally and was operatively resected along with the enlarged lymph nodes.Pathological examination revealed a stage IIA(T3N0M0)ulcerative IA.Along with imaging examinations,a diagnosis of primary IA with no lymph or distant metastases was considered.The patient was discharged and recovered well as of the writing of this manuscript.CONCLUSION IA should be considered as a differential diagnosis in cases of intestinal obstruction,and the recommended method for local disease treatment is surgery.展开更多
Background:Intestinal obstruction is a prevalent complication in patients with colorectal cancer following surgery,with a significant impact on health outcomes.Dachengqi decoction(DCQD)is a traditional Chinese medicin...Background:Intestinal obstruction is a prevalent complication in patients with colorectal cancer following surgery,with a significant impact on health outcomes.Dachengqi decoction(DCQD)is a traditional Chinese medicine(TCM)that is employed in clinical settings for the treatment of intestinal obstruction.However,the pharmacological mechanisms and active components of this medicinal preparation remain to be fully elucidated.The objective of this study was to examine the possible mechanisms and active constituents of DCQD in addressing intestinal obstruction subsequent to colorectal cancer surgery.Methods:A comprehensive search was conducted on the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform and the Traditional Chinese Medicine Integrated Database for the active chemical constituents of DCQD.In addition,the PubChem,Swiss Target Prediction and Uniprot databases were utilised to predict the drug targets.The possible target genes associated with intestinal obstruction were obtained from the GeneCards,Online Mendelian Inheritance in Man,PharmGKB,and Therapeutic Target Database databases,and were analysed using the Database for Annotation,Visualisation and Integrated Discovery platform for Gene Ontology(GO)functional enrichment analysis and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analysis.Cytoscape was utilised to visualise key components,targets,and pathways,and molecular docking technology was employed to verify the binding of core targets and key components.Results:A total of 41 active chemical components and 141 intersecting targets were screened,and it was determined that the intersecting targets of TCM and disease were significantly enriched in 44 GO entries and 93 KEGG pathways.Subsequent screening identified 3 key components(isosinensetin,tetramethoxyluteolin,and 5,7,4’-trimethylapigenin)and 9 core targets(TP53,STAT3,ESR1,SRC,EGFR,AKT1,CTNNB1,BCL2,and PIK3CA).The molecular docking results demonstrated that all 3 key components exhibited strong binding to the core targets.Conclusions:The present study identified the pharmacological basis by which DCQD exerts beneficial effects against intestinal obstruction and provided insights into its mechanism of action,providing scientific evidence for precise clinical utilisation and areas for new drug development.展开更多
BACKGROUND Intestinal obstruction(IO)in pregnancy,though rare(1:1500-1:66000),carries high maternal(6%-10%)and fetal mortality(26%).Adhesions from prior surgery are the leading cause.Diagnosis is often delayed due to ...BACKGROUND Intestinal obstruction(IO)in pregnancy,though rare(1:1500-1:66000),carries high maternal(6%-10%)and fetal mortality(26%).Adhesions from prior surgery are the leading cause.Diagnosis is often delayed due to symptom overlap with nor-mal pregnancy,increasing risks of perforation and sepsis.CASE SUMMARY A 25-year-old gravida 2 para 1 woman at 28 weeks of gestation presented with 1-week constipation,feculent vomiting,and abdominal distension.She had a history of exploratory laparotomy in 2015 for blunt abdominal trauma.The diagnosis of IO in pregnancy was confirmed via abdominopelvic ultrasound and clinical findings.Interventions included conservative measures(nasogastric tube decompression,enemas)followed by emergency laparotomy with bowel resec-tion/anastomosis.Despite surgical management,the patient succumbed to septic shock.CONCLUSION High clinical suspicion,expedited cross-sectional imaging(computed tomogra-phy/Magnetic resonance imaging),and emergent surgery are critical to reduce mortality.展开更多
BACKGROUND The gut-vascular barrier(GVB)is critical for maintaining intestinal homeostasis,but its involvement in intestinal obstruction(IO)remains unclear.AIM To investigate GVB disruption in patients with IO and its...BACKGROUND The gut-vascular barrier(GVB)is critical for maintaining intestinal homeostasis,but its involvement in intestinal obstruction(IO)remains unclear.AIM To investigate GVB disruption in patients with IO and its association with perioperative infection,organ injury,and clinical prognosis.METHODS Intestinal tissues from surgical patients with IO(IO group)and without obstruction(control group)were analyzed for PV1,a biomarker of GVB disruption.In the IO group,PV1 expression correlated with clinical data.Patients were further stratified into PV1-high and PV1-low subgroups,and clinical parameters were compared.RESULTS PV1 expression was significantly elevated in the IO group.In the IO group,PV1 levels were positively correlated with perioperative infection markers,liver and kidney injury indices,and adverse prognostic indicators,including prolonged hospitalization,antibiotic use,fever duration,and postoperative complications.Several of these outcomes were significantly worse in the PV1-high subgroup than in the PV1-low subgroup,although severe postoperative complications and mortality did not differ.CONCLUSION Our findings demonstrate that IO induces GVB damage,and the extent of impairment is closely associated with infection,organ injury,and adverse clinical outcomes in surgical patients,suggesting a pathogenic role for GVB disruption in IO.展开更多
AIM:To investigate different methods of creating incomplete intestinal obstruction in a rat model and to compare their electrophysiologic,morphologic and histologic characteristics. METHODS:Rat ileum was partially obs...AIM:To investigate different methods of creating incomplete intestinal obstruction in a rat model and to compare their electrophysiologic,morphologic and histologic characteristics. METHODS:Rat ileum was partially obstructed by the respective application of:braided silk(penetrated the mesentery and surrounded intestine);half ligation (penetrated directly and ligated 1/2 cross-section of the intestine);wide pipe(6 mm in width,surrounded the intestine);narrow pipe(2 mm in width,surrounded the intestine).A control was also included(no obstruction). Various behavioral and electrophysiologic variables, as well as morphologic and immunohistochemical observations were recorded by blinded investigators at different time points(12,24,48,72 h),including daily general condition,ileal wet weight and circumference, macromorphous and micromorphous intestine,bowel movement capability in vivo and in vitro,slow wave and neural electrical activity,and the number of c-Kit positive interstitial cells of Cajal(ICC). RESULTS:Despite being of a similar general condition, these methods resulted in different levels of obstruction in each group compared with the control at different time points(12,24,48,72 h).However,these fields of the wide pipe rat showed significantly differences when compared with the other three obstructed groups at 12 to 72 h,including macroscopic and histological presentation,intestinal transit ratio and contractility,circumference and wet weight,amplitude and frequency of nerve electrical discharge and slow wave,and ICC numbers(all P<0.01). CONCLUSION:The wide pipe rat method is significantly more reliable and stable than the other methods of obstruction,demonstrating that use of the wide pipe method can be a useful model of incomplete intestinal obstruction.展开更多
Abdominal cocoon syndrome is a rare cause of intestinal obstruction with unknown etiology. Diagnosis of this syndrome, which can be summarized as the small intestine being surrounded by a fibrous capsule not containin...Abdominal cocoon syndrome is a rare cause of intestinal obstruction with unknown etiology. Diagnosis of this syndrome, which can be summarized as the small intestine being surrounded by a fibrous capsule not containing the mesothelium, is difficult in the preoperative period. A 47-year-old male patient was referred to the emergency department with complaints of abdominal pain, nausea, and vomiting for two days. The abdominal computed tomography examination detected dilated small intestinal loops containing air-fluid levels clustered in the left upper quadrant of the abdomen and surrounded by a thick, saclike, contrast-enhanced membrane. During exploratory surgery, a capsular structure was identified in the upper left quadrant with a regular surface that was solid-fibrous in nature. Ab-dominal cocoon syndrome is a rarely seen condition, for which the preoperative diagnosis is difficult. The combination of physical examination and radiological signs, and the knowledge of "recurrent characteristics of the complaints" that can be learned by a careful history, may be helpful in diagnosis.展开更多
Objective:To investigate the clinical efficacy of acupuncture and moxibustion for incomplete adhesive intestinal obstruction.Methods:A total of 100 patients with incomplete adhesive intestinal obstruction were randoml...Objective:To investigate the clinical efficacy of acupuncture and moxibustion for incomplete adhesive intestinal obstruction.Methods:A total of 100 patients with incomplete adhesive intestinal obstruction were randomly divided into an observation group and a control group,and there were 50 patients in each group.The control group was treated with routine western medicine treatment,while the observation group was treated with acupuncture and moxibustion therapy on the foundation of the routine western medicine treatment of the control group.Zhongwan(中脘CV12),Tianshu(天枢ST25),Zusanli(足三里ST36),Shangjiuxu(上巨虚ST37),Zhigou(支沟TE6),Dachangshu(大肠俞BL25),and Xiaochangshu(小肠俞BL27)were taken when acupuncture was performed.Moxibustion was performed with moxibustion box on abdomen after acupuncture.The time of abdominal pain relief,the first anal exhausting,the first defecation and intestines sound recovery,surgery conversion rate and clinical efficacy were observed in the two groups.Results:The time of abdominal pain relief,the first anal exhausting,the first defecation and intestines sound recovery in the observation group were all shorter than those of the control group.There were statistically significant differences between the two groups(all P<0.01).The surgery conversion rate of the observation group was lower than that of the control group,there was statistically significant difference between the two groups(P<0.01).The clinical efficacy of the observation group was superior to that of the control group,the difference between the two groups was statistically significant(P<0.05).Conclusions:Acupuncture and moxibustion therapy on the foundation of the routine western medicine treatment,which can reduce the surgical conversion rate and cut down the time of treatment,was superior to routine western medicine treatment on the clinical efficacy of incomplete adhesive intestinal obstruction.展开更多
Small intestinal obstruction is a common complication of primary gastrointestinal cancer or metastatic cancers. Patients with this condition are often poor candidates for surgical bypasses, and placement of self-expan...Small intestinal obstruction is a common complication of primary gastrointestinal cancer or metastatic cancers. Patients with this condition are often poor candidates for surgical bypasses, and placement of self-expanding metal stent(SEMS) can be technically challenging. In this study, we examined the feasibility of combined application of single-balloon enteroscope(SBE) and colonoscope for SEMS placement in patients with malignant small intestinal obstruction. Thirty-four patients were enrolled in this study, among which 22 patients received SEMS placement by using SBE and colonoscope, while the other 12 patients received conservative medical treatment. The patients were followed up for one year. Stent placement was technically feasible in 95.5%(21/22). Clinical improvement was achieved in 86.4%(19/22). For the 19 clinical success cases, the average time of benefits from a gastric outlet obstruction scoring system(GOOSS) increase ≥1 was 111.9±89.5 days. For the 12 patients receiving conservative medical treatment, no significant improvement in GOOSS score was observed. Moreover, a significant increase of Short-Form-36 health survey score was observed in the 19 patients at time of 30 days after stent placement. By Kaplan-Meier analysis, a significant survival improvement was observed in patients with successful SEMS placement, compared with patients receiving conservative medical treatment. Taken together, combined use of SBE and colonoscope makes endoscopic stent placement feasible in patients with malignant small intestinal obstruction, and patients can benefit from it in terms of prolonged survival and improved quality of life.展开更多
Duplication of alimentary tract(DAT) presenting as an ileoileal intussusception is a very rare clinical entity.Herein,a case of an ileoileal intussusception due to DAT is presented.A 32-year-old woman was hospitalized...Duplication of alimentary tract(DAT) presenting as an ileoileal intussusception is a very rare clinical entity.Herein,a case of an ileoileal intussusception due to DAT is presented.A 32-year-old woman was hospitalized due to diffuse,intermittent abdominal pain,vomiting and constipation for 3 d associated with abdominal distention.Plain abdominal X-ray revealed dilated small bowel.Abdominal computed tomography showed grossly dilated small bowel with "sausage" and "doughnut" signs of small bowel intussusception.She underwent laparotomy,with findings of ileoileal intussusception due to a cystic lesion adjacent to the mesenteric side.Resection of the cystic lesion along with the affected segment of intestine,with an end to end anastomosis was performed.The histopathology was consistent with enteric duplication cyst.This case highlights the DAT,although,an uncommon cause of adult ileoileal intussusception should be considered in the differential diagnosis of intussusception in adults,particularly when the leading point is a cystic lesion.展开更多
AIM: To determine the value of bowel sounds analysis using an electronic stethoscope to support a clinical diagnosis of intestinal obstruction. METHODS: Subjects were patients who presented with a diagnosis of possibl...AIM: To determine the value of bowel sounds analysis using an electronic stethoscope to support a clinical diagnosis of intestinal obstruction. METHODS: Subjects were patients who presented with a diagnosis of possible intestinal obstruction based on symptoms, signs, and radiological findings. A 3MTH Littmann Model 4100 electronic stethoscope was used in this study. With the patients lying supine, six 8-second recordings of bowel sounds were taken from each patient from the lower abdomen. The recordings were analysed for sound duration, soundto-sound interval, dominant frequency, and peak frequency. Clinical and radiological data were reviewed and the patients were classified as having either acute, subacute, or no bowel obstruction. Comparison of bowel sound characteristics was made between these subgroups of patients. In the presence of an obstruction, the site of obstruction was identified and bowel calibre was also measured to correlate with bowel sounds. RESULTS: A total of 71 patients were studied during the period July 2009 to January 2011. Forty patientshad acute bowel obstruction (27 small bowel obstruction and 13 large bowel obstruction), 11 had subacute bowel obstruction (eight in the small bowel and three in large bowel) and 20 had no bowel obstruction (diagnoses of other conditions were made). Twenty-five patients received surgical intervention (35.2%) during the same admission for acute abdominal conditions. A total of 426 recordings were made and 420 recordings were used for analysis. There was no significant difference in sound-to-sound interval, dominant frequency, and peak frequency among patients with acute bowel obstruction, subacute bowel obstruction, and no bowel obstruction. In acute large bowel obstruction, the sound duration was significantly longer (median 0.81 s vs 0.55 s, P = 0.021) and the dominant frequency was significantly higher (median 440 Hz vs 288 Hz, P = 0.003) when compared to acute small bowel obstruction. No significant difference was seen between acute large bowel obstruction and large bowel pseudoobstruction. For patients with small bowel obstruction, the sound-to-sound interval was significantly longer in those who subsequently underwent surgery compared with those treated non-operatively (median 1.29 s vs 0.63 s, P < 0.001). There was no correlation between bowel calibre and bowel sound characteristics in both acute small bowel obstruction and acute large bowel obstruction. CONCLUSION: Auscultation of bowel sounds is nonspecific for diagnosing bowel obstruction. Differences in sound characteristics between large bowel and small bowel obstruction may help determine the likely site of obstruction.展开更多
Intraperitoneal foreign bodies such as retained surgical instruments can cause intestinal obstruction.However,intestinal obstruction due to transmural migration of foreign bodies has rarely been reported.Here,we repor...Intraperitoneal foreign bodies such as retained surgical instruments can cause intestinal obstruction.However,intestinal obstruction due to transmural migration of foreign bodies has rarely been reported.Here,we report a case of intestinal obstruction due to a clinical thermometer which migrated from the bladder into the abdominal cavity.A 45-year-old man was admitted to our hospital with a one-year history of recurrent lower abdominal cramps.Two days before admission,the abdominal cramps aggravated.Intestinal obstruction was confirmed with upright abdominal radiography and computerized tomography scan which showed dilation of the small intestines and a thermometer in the abdominal cavity.Then laparotomy was performed.A scar was observed at the fundus of the bladder and a ther-mometer was adhering to the small bowels and mesentery which resulted in intestinal obstruction.Abdominal cramps were eliminated and defecation and flatus recovered soon after removal of the thermometer.展开更多
Objective: To explore the mechanism of action of Radix et Rhizoma Rhei (Dahuang)(RERR) and Semen Persicae (Taoren)(SP) on adhesive intestinal obstruction (AIO). Methods: The main targets of the active ingredients of R...Objective: To explore the mechanism of action of Radix et Rhizoma Rhei (Dahuang)(RERR) and Semen Persicae (Taoren)(SP) on adhesive intestinal obstruction (AIO). Methods: The main targets of the active ingredients of RERR and SP were filtered based on the traditional Chinese medicine system pharmacology analysis platform. Cytoscape 3.2.1 was applied to build the ingredient-target network of RERR and SP for AIO. Results: Fifteen active components were predicted from the RERR and SP herb pair, such as aloe-emodin, catechin, rhein, gibberellin (GA) 119, GA120 and GA121. These components were applied to 59 targets mainly involved in many biological processes such as signal transduction, anti-apoptosis, and inflammatory response involved in activating the immune effect. Conclusion: This study proposes the system pharmacology method and identifies the potent combination therapeutic mechanism of RERR and SP for AIO. This strategy will provide a new insight to the study of herb combinations.展开更多
BACKGROUND Enterocutaneous fistula(ECF)is an abnormal connection between the gastrointestinal tract and the skin.ECF can lead to massive body fluid loss,hypercatabolism,and malnutrition.Therefore,nutritional support p...BACKGROUND Enterocutaneous fistula(ECF)is an abnormal connection between the gastrointestinal tract and the skin.ECF can lead to massive body fluid loss,hypercatabolism,and malnutrition.Therefore,nutritional support plays a crucial role in managing ECFs and promoting the healing of fistulas.For nutritional support,enteral nutrition(EN)is the preferred method when gastrointestinal function is recovering.Currently,various EN approaches have been applied for different anatomical positions of the ECF.However,the effectiveness of administering EN support for treating lower ECFs still needs further exploration and improvement.CASE SUMMARY We present the case of a 46-year-old male who underwent gastrointestinal stromal tumour resection.Six days after the surgery,the patient presented with fever,fatigue,severe upper abdominal pain,and septic shock.Subsequently,lower ECFs were diagnosed through laboratory and imaging examinations.In addition to symptomatic treatment for homeostasis,total parenteral nutrition support was administered in the first 72 h due to dysfunction of the intestine.After that,we gradually provided EN support through the intestinal obstruction catheter in consideration of the specific anatomic position of the fistula instead of using the nasal jejunal tube.Ultimately,the patient could receive optimal EN support via the catheter,and no complications were found during the treatment.CONCLUSION Nutritional support is a crucial element in ECF management,and intestinal obstruction catheters could be used for early EN administration.展开更多
[Objectives]To investigate the effect and mechanism of Dachengqi Decoction and separated decoction on incomplete intestinal obstruction in rats.[Methods]80 healthy SD rats were selected to establish incomplete intesti...[Objectives]To investigate the effect and mechanism of Dachengqi Decoction and separated decoction on incomplete intestinal obstruction in rats.[Methods]80 healthy SD rats were selected to establish incomplete intestinal obstruction model by silk ligation.The dosage was 20 mL/kg for 3 d,and the damage index of ileocecal mucosa was analyzed;the morphology of ileocecal mucosa was observed by HE staining;the serum levels of IL-1α,IL-1β,IL-6,IL-18,Ach,NO,ET,IL-1,TNF-αand ultra-micro Na+-K+-ATPase were detected by ELISA.[Results]Compared with the model group,the mucosal damage index of Dachengqi Decoction and each separated decoction group decreased significantly(P<0.05);compared with the normal group and sham operation group,the serum level of IL-1,IL-6,TNF-αand other factors in the model group increased significantly(P<0.05);compared with the model group,the serum IL-1,IL-6 and TNF-αsecretion levels of rats in Dachengqi Decoction group and separated decoction group decreased(P<0.01).[Conclusions]Dachengqi Decoction and each separated decoction can effectively improve intestinal tissue pathological damage in the incomplete intestinal obstruction model rats,and reduce the inflammatory reaction in the rat body.展开更多
The authors report an observation of a 20-year-old patient, who was referred by the medical emergency department for abdominal distention. The disease would have started with the appearance of abdominal pain, a stop o...The authors report an observation of a 20-year-old patient, who was referred by the medical emergency department for abdominal distention. The disease would have started with the appearance of abdominal pain, a stop of materials without stopping gases appeared gradually and evolving for 4 months. The patient was chronically constipated. She administered daily enemas with homemade products to have a bowel movement. She never had rectal bleeding, there was no alteration diarrhea—constipation. Mother of 3 children alive and apparently healthy. On clinical examination the abdomen was enlarged in size, painless but of firm consistency. The hernial orifices were free. Hard and abundant stools were noted on digital rectal examination. The abdominal CT scan revealed a large endorectal fecal impaction going up into the left colon, an absence of abdominal mass. We retained the diagnosis of giant fecal impaction. The patient was hospitalized and we instituted paraffin oil therapy combined with an evacuator enema with glycerin. The evolution was marked by a resumption of transit in the form of stool and gas (3 to 4 stools per day). At Day 8 of hospitalization the abdomen had decreased in volume the transit was regular and the patient was discharged on Day 10. Reviewed 3 months later, she maintained a regular transit made of one bowel movement a day. After a setback of 3 years the transit is still preserved. The authors discuss the etiologies of fecal impaction and their respective treatments.展开更多
Objective:To study the effect of nutritional support + intravenous chemotherapy on anti-tumor immunity and cancer cell proliferation in patients with colon cancer complicated by incomplete intestinal obstruction.Metho...Objective:To study the effect of nutritional support + intravenous chemotherapy on anti-tumor immunity and cancer cell proliferation in patients with colon cancer complicated by incomplete intestinal obstruction.Methods: Patients with colon cancer complicated by incomplete intestinal obstruction who were treated in Midi Branch, Pangang Group General Hospital between March 2015 and October 2017 were selected and randomly divided into the nutrition group who accepted nutritional support + FOLFOX4 intravenous chemotherapy and the control group who accepted FOLFOX4 intravenous chemotherapy alone, and they underwent surgery after two cycles of chemotherapy. The contents of immune cells in peripheral blood and the contents of immune cytokines in serum were determined before chemotherapy and two cycles after chemotherapy;the expression levels of proliferation genes in colon cancer lesions were determined after surgical resection.Results:Compared with those of same group before chemotherapy, peripheral blood Treg, Th9, Th17 and Th22 contents as well as serum IL-4, IL-9, IL-10, TGF-β1, IL-17 and IL-22 contents of nutrition group were decreased significantly after chemotherapywhereas peripheral blood Treg, Th9, Th17 and Th22 contents as well as serum IL-4, IL-9, IL-10, TGF-β1, IL-17 and IL-22 contents of control group did not change significantly after chemotherapy, and compared with those after chemotherapy between groups, peripheral blood Treg, Th9, Th17 and Th22 contents as well as serum IL-4, IL-9, IL-10, TGF-β1, IL-17 and IL-22 contents of nutrition group were significantly lower than those of control group, and CyclinD1, Bcl-2, USP22, VEGF and N-cadherin mRNA expression were not different from those of control group.Conclusion:Nutritional support + intravenous chemotherapy can improve the anti-tumor immune response without affecting the proliferation of cancer cells in the lesion of patients with colon cancer complicated by incomplete intestinal obstruction.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.
基金Nanchong City Science and Technology Plan Project:the Application of Tongli Shugan Liqi Method in the Treatment of Adhesive Intestinal Obstruction and its Effect on Inflammatory Indicators Interleukin-6,C-reactive protein and Procalcitonin(21YFZJ0108)。
文摘OBJECTIVE:To explore the treatment efficacy of integrated Chinese medicine(Chaihu Shugan San,柴胡疏肝散,CSS)and western therapy in the treatment of adhesive intestinal obstruction(AIO),to provide new ideas for the management of the disease.METHODS:In our single-blind randomized controlled study,120 patients with AIO who were hospitalized in The Affiliated Hospital of China West Normal University Nan Chong Gaoping District People's Hospital from January 2021 to June 2022 and met the inclusion criteria were categorized into the treatment group and the control group.Patients from the control group were administered basic Western Medicine therapy,whereas patients from the treatment group were administered basic Western Medicine therapy plus CSS by gastric tube injection.Subsequently,the time to first anal exhaustion and defecation,time to relief of abdominal distension and pain,days of hospitalization,Traditional Chinese Medicine(TCM)symptom scores,interleukin-6(IL-6),C-reactive protein(CRP)and procalcitonin(PCT)levels in the 2 groups were recorded and compared.RESULTS:The comparison of clinical efficacy of the treatment group were better than the control group.The TCM symptom score was considerably lower in the treatment group;the inflammation indicators CRP,IL-6,and PCT also decreased statistically when comparing the control group.Furthermore,there were significantly reduced in the time to first exhaustion,time to first defecation,time to relief of abdominal pain and distension,and days of hospitalization in the treatment group versus the control group.CONCLUSION:CSS could suppress the inflammatory reaction,reduce days of hospitalization,relieve clinical symptoms in AIO patients with reliable efficacy and high safety and is worthy of clinical application.
文摘Lithopedion is a rare clinical situation characterised by the calcification of a foetus that has died during an ectopic pregnancy, usually in the abdominal cavity. It occurs in 1.5 to 2% of ectopic pregnancies. It can be asymptomatic for several years. However, various complications can occur that lead to diagnosis. The authors report a case of lithopedion complicated by acute intestinal obstruction in a 24-year-old woman in her first pregnancy. This complication occurred after 12 months of amenorrhoea. A mass containing a calcified foetus was removed by laparotomy.
文摘BACKGROUND Colon cancer is one of the most common malignancies of the digestive tract,often complicated by intestinal obstruction,which can significantly impact patient outcomes.While traditional laparotomy is the standard treatment,it is associated with large wounds,slower recovery,and higher complication rates.Laparoscopic surgery,a minimally invasive approach,may offer better outcomes for these patients.AIM To evaluate the clinical effects and prognosis of laparoscopic surgery in patients with colon cancer complicated by intestinal obstruction compared to traditional laparotomy.METHODS A retrospective analysis was conducted on 100 patients diagnosed with colon cancer and intestinal obstruction who underwent surgical treatment between January 2020 and December 2022.Patients were divided into two groups:The control group(CG),treated with traditional laparotomy,and the observation group(OG),treated with laparoscopic surgery.Clinical effects,surgical indicators,postoperative pain,inflammatory response,complication rates,quality of life,and prognosis were assessed and compared between the two groups.RESULTS The OG showed superior clinical outcomes compared to the CG(P<0.05).Patients in the OG had shorter operation times,reduced intraoperative blood loss,faster recovery of intestinal function,earlier mobilization,and shorter hospital stays(P<0.05).Postoperative pain(numerical rating scale scores)and inflam-matory markers[tumor necrosis factor-alpha(TNF-α),interleukin-6(IL-6),C-reactive protein(CRP)]were lower in the OG(P<0.05).The incidence of complic-ations was significantly reduced in the OG(6.00%vs 22.00%,P<0.05).Quality of life scores,including physical function,psychological state,social communication,and self-care ability,were significantly higher in the OG(P<0.05).There were no significant differences between groups in abdominal drainage volume,1-year tumor recurrence or metastasis rates,or 1-and 3-year survival rates(P>0.05).CONCLUSION The OG showed superior clinical outcomes compared to the CG(P<0.05).Patients in the OG had shorter operation times,reduced intraoperative blood loss,faster recovery of intestinal function,earlier mobilization,and shorter hospital stays(P<0.05).Postoperative pain(NRS scores)and inflammatory markers(TNF-α,IL-6,CRP)were lower in the OG(P<0.05).The incidence of complications was significantly reduced in the OG(6.00%vs 22.00%,P<0.05).Quality of life scores,including physical function,psychological state,social communication,and self-care ability,were significantly higher in the OG(P<0.05).There were no significant differences between groups in abdominal drainage volume,1-year tumor recurrence or metastasis rates,or 1-and 3-year survival rates(P>0.05).
文摘BACKGROUND Ileum adenocarcinoma(IA),a type of small bowel adenocarcinoma,is a rather uncommon factor associated with obstruction in small bowel.Owing to its location and indefinite clinical symptoms,the diagnosis of IA is difficult,and survival is usually poor.With respect to the rarity of this disease,very few studies have reported such cases to provide a reference for treatment.CASE SUMMARY In this manuscript,a case of a 48-year-old man presented with chronic right lower abdominal pain and distention,queasiness and emesis.A computed tomography scan revealed intestinal wall thickening and an intestinal obstruction in the terminal ileum.He was diagnosed with inflammatory bowel disease.However,his symptoms were not relieved after conservative treatment.The patient sub-sequently underwent exploratory laparotomy,and a tumour in the ileum measuring approximately 2.0 cm×2.0 cm that was located 20 cm from the ileocolic valve was discovered incidentally and was operatively resected along with the enlarged lymph nodes.Pathological examination revealed a stage IIA(T3N0M0)ulcerative IA.Along with imaging examinations,a diagnosis of primary IA with no lymph or distant metastases was considered.The patient was discharged and recovered well as of the writing of this manuscript.CONCLUSION IA should be considered as a differential diagnosis in cases of intestinal obstruction,and the recommended method for local disease treatment is surgery.
基金funded by the Jining Key Research and Development Plan(No.2024YXNS267).
文摘Background:Intestinal obstruction is a prevalent complication in patients with colorectal cancer following surgery,with a significant impact on health outcomes.Dachengqi decoction(DCQD)is a traditional Chinese medicine(TCM)that is employed in clinical settings for the treatment of intestinal obstruction.However,the pharmacological mechanisms and active components of this medicinal preparation remain to be fully elucidated.The objective of this study was to examine the possible mechanisms and active constituents of DCQD in addressing intestinal obstruction subsequent to colorectal cancer surgery.Methods:A comprehensive search was conducted on the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform and the Traditional Chinese Medicine Integrated Database for the active chemical constituents of DCQD.In addition,the PubChem,Swiss Target Prediction and Uniprot databases were utilised to predict the drug targets.The possible target genes associated with intestinal obstruction were obtained from the GeneCards,Online Mendelian Inheritance in Man,PharmGKB,and Therapeutic Target Database databases,and were analysed using the Database for Annotation,Visualisation and Integrated Discovery platform for Gene Ontology(GO)functional enrichment analysis and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analysis.Cytoscape was utilised to visualise key components,targets,and pathways,and molecular docking technology was employed to verify the binding of core targets and key components.Results:A total of 41 active chemical components and 141 intersecting targets were screened,and it was determined that the intersecting targets of TCM and disease were significantly enriched in 44 GO entries and 93 KEGG pathways.Subsequent screening identified 3 key components(isosinensetin,tetramethoxyluteolin,and 5,7,4’-trimethylapigenin)and 9 core targets(TP53,STAT3,ESR1,SRC,EGFR,AKT1,CTNNB1,BCL2,and PIK3CA).The molecular docking results demonstrated that all 3 key components exhibited strong binding to the core targets.Conclusions:The present study identified the pharmacological basis by which DCQD exerts beneficial effects against intestinal obstruction and provided insights into its mechanism of action,providing scientific evidence for precise clinical utilisation and areas for new drug development.
文摘BACKGROUND Intestinal obstruction(IO)in pregnancy,though rare(1:1500-1:66000),carries high maternal(6%-10%)and fetal mortality(26%).Adhesions from prior surgery are the leading cause.Diagnosis is often delayed due to symptom overlap with nor-mal pregnancy,increasing risks of perforation and sepsis.CASE SUMMARY A 25-year-old gravida 2 para 1 woman at 28 weeks of gestation presented with 1-week constipation,feculent vomiting,and abdominal distension.She had a history of exploratory laparotomy in 2015 for blunt abdominal trauma.The diagnosis of IO in pregnancy was confirmed via abdominopelvic ultrasound and clinical findings.Interventions included conservative measures(nasogastric tube decompression,enemas)followed by emergency laparotomy with bowel resec-tion/anastomosis.Despite surgical management,the patient succumbed to septic shock.CONCLUSION High clinical suspicion,expedited cross-sectional imaging(computed tomogra-phy/Magnetic resonance imaging),and emergent surgery are critical to reduce mortality.
基金Supported by National Natural Science Foundation of China,No.82072204 and No.81701874Natural Science Foundation of Guangdong Province,China,No.2021A1515010990 and No.2025A1515012493.
文摘BACKGROUND The gut-vascular barrier(GVB)is critical for maintaining intestinal homeostasis,but its involvement in intestinal obstruction(IO)remains unclear.AIM To investigate GVB disruption in patients with IO and its association with perioperative infection,organ injury,and clinical prognosis.METHODS Intestinal tissues from surgical patients with IO(IO group)and without obstruction(control group)were analyzed for PV1,a biomarker of GVB disruption.In the IO group,PV1 expression correlated with clinical data.Patients were further stratified into PV1-high and PV1-low subgroups,and clinical parameters were compared.RESULTS PV1 expression was significantly elevated in the IO group.In the IO group,PV1 levels were positively correlated with perioperative infection markers,liver and kidney injury indices,and adverse prognostic indicators,including prolonged hospitalization,antibiotic use,fever duration,and postoperative complications.Several of these outcomes were significantly worse in the PV1-high subgroup than in the PV1-low subgroup,although severe postoperative complications and mortality did not differ.CONCLUSION Our findings demonstrate that IO induces GVB damage,and the extent of impairment is closely associated with infection,organ injury,and adverse clinical outcomes in surgical patients,suggesting a pathogenic role for GVB disruption in IO.
基金Supported by Higher Education Quality Project of Sichuan Province:Innovative Scientific Experiment Project of SichuanProvince,Grant No.SJCX201110Chengdu Medical College Innovative Scientific Experiment Project,Grant No.CX201220and CX201115
文摘AIM:To investigate different methods of creating incomplete intestinal obstruction in a rat model and to compare their electrophysiologic,morphologic and histologic characteristics. METHODS:Rat ileum was partially obstructed by the respective application of:braided silk(penetrated the mesentery and surrounded intestine);half ligation (penetrated directly and ligated 1/2 cross-section of the intestine);wide pipe(6 mm in width,surrounded the intestine);narrow pipe(2 mm in width,surrounded the intestine).A control was also included(no obstruction). Various behavioral and electrophysiologic variables, as well as morphologic and immunohistochemical observations were recorded by blinded investigators at different time points(12,24,48,72 h),including daily general condition,ileal wet weight and circumference, macromorphous and micromorphous intestine,bowel movement capability in vivo and in vitro,slow wave and neural electrical activity,and the number of c-Kit positive interstitial cells of Cajal(ICC). RESULTS:Despite being of a similar general condition, these methods resulted in different levels of obstruction in each group compared with the control at different time points(12,24,48,72 h).However,these fields of the wide pipe rat showed significantly differences when compared with the other three obstructed groups at 12 to 72 h,including macroscopic and histological presentation,intestinal transit ratio and contractility,circumference and wet weight,amplitude and frequency of nerve electrical discharge and slow wave,and ICC numbers(all P<0.01). CONCLUSION:The wide pipe rat method is significantly more reliable and stable than the other methods of obstruction,demonstrating that use of the wide pipe method can be a useful model of incomplete intestinal obstruction.
文摘Abdominal cocoon syndrome is a rare cause of intestinal obstruction with unknown etiology. Diagnosis of this syndrome, which can be summarized as the small intestine being surrounded by a fibrous capsule not containing the mesothelium, is difficult in the preoperative period. A 47-year-old male patient was referred to the emergency department with complaints of abdominal pain, nausea, and vomiting for two days. The abdominal computed tomography examination detected dilated small intestinal loops containing air-fluid levels clustered in the left upper quadrant of the abdomen and surrounded by a thick, saclike, contrast-enhanced membrane. During exploratory surgery, a capsular structure was identified in the upper left quadrant with a regular surface that was solid-fibrous in nature. Ab-dominal cocoon syndrome is a rarely seen condition, for which the preoperative diagnosis is difficult. The combination of physical examination and radiological signs, and the knowledge of "recurrent characteristics of the complaints" that can be learned by a careful history, may be helpful in diagnosis.
文摘Objective:To investigate the clinical efficacy of acupuncture and moxibustion for incomplete adhesive intestinal obstruction.Methods:A total of 100 patients with incomplete adhesive intestinal obstruction were randomly divided into an observation group and a control group,and there were 50 patients in each group.The control group was treated with routine western medicine treatment,while the observation group was treated with acupuncture and moxibustion therapy on the foundation of the routine western medicine treatment of the control group.Zhongwan(中脘CV12),Tianshu(天枢ST25),Zusanli(足三里ST36),Shangjiuxu(上巨虚ST37),Zhigou(支沟TE6),Dachangshu(大肠俞BL25),and Xiaochangshu(小肠俞BL27)were taken when acupuncture was performed.Moxibustion was performed with moxibustion box on abdomen after acupuncture.The time of abdominal pain relief,the first anal exhausting,the first defecation and intestines sound recovery,surgery conversion rate and clinical efficacy were observed in the two groups.Results:The time of abdominal pain relief,the first anal exhausting,the first defecation and intestines sound recovery in the observation group were all shorter than those of the control group.There were statistically significant differences between the two groups(all P<0.01).The surgery conversion rate of the observation group was lower than that of the control group,there was statistically significant difference between the two groups(P<0.01).The clinical efficacy of the observation group was superior to that of the control group,the difference between the two groups was statistically significant(P<0.05).Conclusions:Acupuncture and moxibustion therapy on the foundation of the routine western medicine treatment,which can reduce the surgical conversion rate and cut down the time of treatment,was superior to routine western medicine treatment on the clinical efficacy of incomplete adhesive intestinal obstruction.
基金supported by grants from the National Key Research and Development Program of China(No.2016YFC0107005)National Natural Science Foundation of China(No.81470818)+1 种基金Beijing Municipal Science&Technology Commission(No.D101100050010037)Research Project of the General Hospital of Air Force,PLA(No.kz2014020 and No.kz2015026)
文摘Small intestinal obstruction is a common complication of primary gastrointestinal cancer or metastatic cancers. Patients with this condition are often poor candidates for surgical bypasses, and placement of self-expanding metal stent(SEMS) can be technically challenging. In this study, we examined the feasibility of combined application of single-balloon enteroscope(SBE) and colonoscope for SEMS placement in patients with malignant small intestinal obstruction. Thirty-four patients were enrolled in this study, among which 22 patients received SEMS placement by using SBE and colonoscope, while the other 12 patients received conservative medical treatment. The patients were followed up for one year. Stent placement was technically feasible in 95.5%(21/22). Clinical improvement was achieved in 86.4%(19/22). For the 19 clinical success cases, the average time of benefits from a gastric outlet obstruction scoring system(GOOSS) increase ≥1 was 111.9±89.5 days. For the 12 patients receiving conservative medical treatment, no significant improvement in GOOSS score was observed. Moreover, a significant increase of Short-Form-36 health survey score was observed in the 19 patients at time of 30 days after stent placement. By Kaplan-Meier analysis, a significant survival improvement was observed in patients with successful SEMS placement, compared with patients receiving conservative medical treatment. Taken together, combined use of SBE and colonoscope makes endoscopic stent placement feasible in patients with malignant small intestinal obstruction, and patients can benefit from it in terms of prolonged survival and improved quality of life.
文摘Duplication of alimentary tract(DAT) presenting as an ileoileal intussusception is a very rare clinical entity.Herein,a case of an ileoileal intussusception due to DAT is presented.A 32-year-old woman was hospitalized due to diffuse,intermittent abdominal pain,vomiting and constipation for 3 d associated with abdominal distention.Plain abdominal X-ray revealed dilated small bowel.Abdominal computed tomography showed grossly dilated small bowel with "sausage" and "doughnut" signs of small bowel intussusception.She underwent laparotomy,with findings of ileoileal intussusception due to a cystic lesion adjacent to the mesenteric side.Resection of the cystic lesion along with the affected segment of intestine,with an end to end anastomosis was performed.The histopathology was consistent with enteric duplication cyst.This case highlights the DAT,although,an uncommon cause of adult ileoileal intussusception should be considered in the differential diagnosis of intussusception in adults,particularly when the leading point is a cystic lesion.
文摘AIM: To determine the value of bowel sounds analysis using an electronic stethoscope to support a clinical diagnosis of intestinal obstruction. METHODS: Subjects were patients who presented with a diagnosis of possible intestinal obstruction based on symptoms, signs, and radiological findings. A 3MTH Littmann Model 4100 electronic stethoscope was used in this study. With the patients lying supine, six 8-second recordings of bowel sounds were taken from each patient from the lower abdomen. The recordings were analysed for sound duration, soundto-sound interval, dominant frequency, and peak frequency. Clinical and radiological data were reviewed and the patients were classified as having either acute, subacute, or no bowel obstruction. Comparison of bowel sound characteristics was made between these subgroups of patients. In the presence of an obstruction, the site of obstruction was identified and bowel calibre was also measured to correlate with bowel sounds. RESULTS: A total of 71 patients were studied during the period July 2009 to January 2011. Forty patientshad acute bowel obstruction (27 small bowel obstruction and 13 large bowel obstruction), 11 had subacute bowel obstruction (eight in the small bowel and three in large bowel) and 20 had no bowel obstruction (diagnoses of other conditions were made). Twenty-five patients received surgical intervention (35.2%) during the same admission for acute abdominal conditions. A total of 426 recordings were made and 420 recordings were used for analysis. There was no significant difference in sound-to-sound interval, dominant frequency, and peak frequency among patients with acute bowel obstruction, subacute bowel obstruction, and no bowel obstruction. In acute large bowel obstruction, the sound duration was significantly longer (median 0.81 s vs 0.55 s, P = 0.021) and the dominant frequency was significantly higher (median 440 Hz vs 288 Hz, P = 0.003) when compared to acute small bowel obstruction. No significant difference was seen between acute large bowel obstruction and large bowel pseudoobstruction. For patients with small bowel obstruction, the sound-to-sound interval was significantly longer in those who subsequently underwent surgery compared with those treated non-operatively (median 1.29 s vs 0.63 s, P < 0.001). There was no correlation between bowel calibre and bowel sound characteristics in both acute small bowel obstruction and acute large bowel obstruction. CONCLUSION: Auscultation of bowel sounds is nonspecific for diagnosing bowel obstruction. Differences in sound characteristics between large bowel and small bowel obstruction may help determine the likely site of obstruction.
文摘Intraperitoneal foreign bodies such as retained surgical instruments can cause intestinal obstruction.However,intestinal obstruction due to transmural migration of foreign bodies has rarely been reported.Here,we report a case of intestinal obstruction due to a clinical thermometer which migrated from the bladder into the abdominal cavity.A 45-year-old man was admitted to our hospital with a one-year history of recurrent lower abdominal cramps.Two days before admission,the abdominal cramps aggravated.Intestinal obstruction was confirmed with upright abdominal radiography and computerized tomography scan which showed dilation of the small intestines and a thermometer in the abdominal cavity.Then laparotomy was performed.A scar was observed at the fundus of the bladder and a ther-mometer was adhering to the small bowels and mesentery which resulted in intestinal obstruction.Abdominal cramps were eliminated and defecation and flatus recovered soon after removal of the thermometer.
基金National Natural Science Foundation Youth Project (81804098)Jiangsu Natural Science Foundation Youth Project (BK20180219).
文摘Objective: To explore the mechanism of action of Radix et Rhizoma Rhei (Dahuang)(RERR) and Semen Persicae (Taoren)(SP) on adhesive intestinal obstruction (AIO). Methods: The main targets of the active ingredients of RERR and SP were filtered based on the traditional Chinese medicine system pharmacology analysis platform. Cytoscape 3.2.1 was applied to build the ingredient-target network of RERR and SP for AIO. Results: Fifteen active components were predicted from the RERR and SP herb pair, such as aloe-emodin, catechin, rhein, gibberellin (GA) 119, GA120 and GA121. These components were applied to 59 targets mainly involved in many biological processes such as signal transduction, anti-apoptosis, and inflammatory response involved in activating the immune effect. Conclusion: This study proposes the system pharmacology method and identifies the potent combination therapeutic mechanism of RERR and SP for AIO. This strategy will provide a new insight to the study of herb combinations.
基金the Guangxi Popularization and Application Program of Appropriate Medical Care and Public Health Technology,No.S2021043 and No.S2022002the Science and Technology Research Project of the Health Commission of Guangxi Zhuang Autonomous Region No.Z-A20230002.
文摘BACKGROUND Enterocutaneous fistula(ECF)is an abnormal connection between the gastrointestinal tract and the skin.ECF can lead to massive body fluid loss,hypercatabolism,and malnutrition.Therefore,nutritional support plays a crucial role in managing ECFs and promoting the healing of fistulas.For nutritional support,enteral nutrition(EN)is the preferred method when gastrointestinal function is recovering.Currently,various EN approaches have been applied for different anatomical positions of the ECF.However,the effectiveness of administering EN support for treating lower ECFs still needs further exploration and improvement.CASE SUMMARY We present the case of a 46-year-old male who underwent gastrointestinal stromal tumour resection.Six days after the surgery,the patient presented with fever,fatigue,severe upper abdominal pain,and septic shock.Subsequently,lower ECFs were diagnosed through laboratory and imaging examinations.In addition to symptomatic treatment for homeostasis,total parenteral nutrition support was administered in the first 72 h due to dysfunction of the intestine.After that,we gradually provided EN support through the intestinal obstruction catheter in consideration of the specific anatomic position of the fistula instead of using the nasal jejunal tube.Ultimately,the patient could receive optimal EN support via the catheter,and no complications were found during the treatment.CONCLUSION Nutritional support is a crucial element in ECF management,and intestinal obstruction catheters could be used for early EN administration.
基金2023 Young and Middle-aged University Teachers Basic Scientific Research Ability Improvement Project in Guangxi(2023KY0299)High-level Key Discipline Construction Project of Traditional Chinese Medicine of National Administration of Traditional Chinese Medicine(zyyzdxk-2023165)+3 种基金Talent Training Project of Guangxi International Zhuang Medicine Hospital—"Young Seedling Project"(2022001)Guangxi Traditional Chinese Medicine Multidisciplinary and Interdisciplinary Innovation Team Project(GZKJ2309)High-level Talent Cultivation Innovation Team Funding Project of Guangxi University of Chinese Medicine(2022A008)2023 Three-Year Action Plan Project for High-Level Talent Team Construction of Guangxi International Zhuang Medicine Hospital(GZCX20231203,GZCX20231202).
文摘[Objectives]To investigate the effect and mechanism of Dachengqi Decoction and separated decoction on incomplete intestinal obstruction in rats.[Methods]80 healthy SD rats were selected to establish incomplete intestinal obstruction model by silk ligation.The dosage was 20 mL/kg for 3 d,and the damage index of ileocecal mucosa was analyzed;the morphology of ileocecal mucosa was observed by HE staining;the serum levels of IL-1α,IL-1β,IL-6,IL-18,Ach,NO,ET,IL-1,TNF-αand ultra-micro Na+-K+-ATPase were detected by ELISA.[Results]Compared with the model group,the mucosal damage index of Dachengqi Decoction and each separated decoction group decreased significantly(P<0.05);compared with the normal group and sham operation group,the serum level of IL-1,IL-6,TNF-αand other factors in the model group increased significantly(P<0.05);compared with the model group,the serum IL-1,IL-6 and TNF-αsecretion levels of rats in Dachengqi Decoction group and separated decoction group decreased(P<0.01).[Conclusions]Dachengqi Decoction and each separated decoction can effectively improve intestinal tissue pathological damage in the incomplete intestinal obstruction model rats,and reduce the inflammatory reaction in the rat body.
文摘The authors report an observation of a 20-year-old patient, who was referred by the medical emergency department for abdominal distention. The disease would have started with the appearance of abdominal pain, a stop of materials without stopping gases appeared gradually and evolving for 4 months. The patient was chronically constipated. She administered daily enemas with homemade products to have a bowel movement. She never had rectal bleeding, there was no alteration diarrhea—constipation. Mother of 3 children alive and apparently healthy. On clinical examination the abdomen was enlarged in size, painless but of firm consistency. The hernial orifices were free. Hard and abundant stools were noted on digital rectal examination. The abdominal CT scan revealed a large endorectal fecal impaction going up into the left colon, an absence of abdominal mass. We retained the diagnosis of giant fecal impaction. The patient was hospitalized and we instituted paraffin oil therapy combined with an evacuator enema with glycerin. The evolution was marked by a resumption of transit in the form of stool and gas (3 to 4 stools per day). At Day 8 of hospitalization the abdomen had decreased in volume the transit was regular and the patient was discharged on Day 10. Reviewed 3 months later, she maintained a regular transit made of one bowel movement a day. After a setback of 3 years the transit is still preserved. The authors discuss the etiologies of fecal impaction and their respective treatments.
文摘Objective:To study the effect of nutritional support + intravenous chemotherapy on anti-tumor immunity and cancer cell proliferation in patients with colon cancer complicated by incomplete intestinal obstruction.Methods: Patients with colon cancer complicated by incomplete intestinal obstruction who were treated in Midi Branch, Pangang Group General Hospital between March 2015 and October 2017 were selected and randomly divided into the nutrition group who accepted nutritional support + FOLFOX4 intravenous chemotherapy and the control group who accepted FOLFOX4 intravenous chemotherapy alone, and they underwent surgery after two cycles of chemotherapy. The contents of immune cells in peripheral blood and the contents of immune cytokines in serum were determined before chemotherapy and two cycles after chemotherapy;the expression levels of proliferation genes in colon cancer lesions were determined after surgical resection.Results:Compared with those of same group before chemotherapy, peripheral blood Treg, Th9, Th17 and Th22 contents as well as serum IL-4, IL-9, IL-10, TGF-β1, IL-17 and IL-22 contents of nutrition group were decreased significantly after chemotherapywhereas peripheral blood Treg, Th9, Th17 and Th22 contents as well as serum IL-4, IL-9, IL-10, TGF-β1, IL-17 and IL-22 contents of control group did not change significantly after chemotherapy, and compared with those after chemotherapy between groups, peripheral blood Treg, Th9, Th17 and Th22 contents as well as serum IL-4, IL-9, IL-10, TGF-β1, IL-17 and IL-22 contents of nutrition group were significantly lower than those of control group, and CyclinD1, Bcl-2, USP22, VEGF and N-cadherin mRNA expression were not different from those of control group.Conclusion:Nutritional support + intravenous chemotherapy can improve the anti-tumor immune response without affecting the proliferation of cancer cells in the lesion of patients with colon cancer complicated by incomplete intestinal obstruction.
