Acute mechanical bowel obstruction: Clinical presentation, etiology, management and outcome

Markogiannakis, Haridimos; Messaris, Evangelos; Dardamanis, Dimitrios; Παραράς, Νικόλαος; Tzertzemelis, Dimitrios; Giannopoulos, Panagiotis; Larentzakis, Andreas; Lagoudianakis, Emmanuel; Manouras, Andreas; Bramis, Ioannis

doi:10.3748/wjg.v13.i3.432

Cited by 264 publications

(288 citation statements)

References 20 publications

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“…Ischemia, which complicates 7 to 42% of bowel obstructions, significantly increases mortality associated with bowel obstruction. 1 Time is an essence, with an earlier diagnosis of strangulation favoring increased patient's survival. The diagnosis of strangulation is primarily clinical, with a sudden onset of pain, i.e., continuous rather than colicky, the early appearance of shock, and the presence of fever, tachycardia, marked abdominal tenderness, guarding, rebound tenderness, and a tender abdominal mass are all in favor of the diagnosis of strangulation.…”

Section: Introductionmentioning

confidence: 99%

Combination of Serum C-reactive Protein and D-lactate: Predictors of Strangulation in Intestinal Obstruction

Pal¹,

Ansari²,

Islam³

2016

Panamerican Journal of Trauma, Critical Care &Amp; Emergency Surgery

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Introduction: Serum C-reactive protein (CRP) and D-lactate have been proposed as markers of intestinal ischemia. The purpose of this prospective observational study is to find whether serum CRP and serum D-lactate can help in predicting strangulation in cases of acute intestinal obstruction. Materials and methods:A total of 50 consecutive patients were included in the study after excluding patients of comorbid medical illness and patients with findings other than obstruction or strangulation. The serum values of CRP and D-lactate were measured and compared between obstruction with strangulation and obstruction without strangulation. Receiver operating characteristic (ROC) curve was drawn and cutoff values for the diagnosis of strangulation were calculated along with calculation of sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs).Results: A total of 14 patients who were diagnosed with strangulated bowel obstruction had significantly higher values of serum CRP and D-lactate when compared with 36 patients with simple bowel obstruction (116 vs 40 mg/L and 5.4 vs 2.7 mmol/L respectively, p < 0.05). Using ROC analysis, the area under the curve of serum CRP and D-lactate was found to be 0.785 and 0.775 respectively, for bowel strangulation. Using a cutoff value of 60 mg/L for CRP, the sensitivity, specificity, PPV, and NPV were 87.5, 58.3, 48.3, 91.3% respectively. Using a cutoff value of 4.5 mmol/L for D-lactate, the sensitivity, specificity, PPV, and NPV were 75.0, 69.4, 52.7, 86.2% respectively. Conclusion:Serum CRP and D-lactate can be useful and reasonable markers for predicting strangulation in cases of acute intestinal obstruction in an emergency setting.

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Section: Introductionmentioning

confidence: 99%

Combination of Serum C-reactive Protein and D-lactate: Predictors of Strangulation in Intestinal Obstruction

Pal¹,

Ansari²,

Islam³

2016

Panamerican Journal of Trauma, Critical Care &Amp; Emergency Surgery

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“…Todavia outros autores, que também estudaram pacientes idosos, assinalaram como causa mais comum de obstrução intestinal a hérnia inguinal, femoral ou umbilical 14,29 . Em casuística constituída de adultos, porém não exclusivamente de idosos, a brida pós-operatória tem sido apontada como a causa mais importante de obstrução intestinal 3,6,9,16,21,22,24,28 .…”

Section: Discussionunclassified

Obstrução intestinal no idoso

Henry

Lerco

Oliveira

et al. 2007

ABCD, arq. bras. cir. dig.

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A população brasileira vem apresentando nas últimas cinco décadas mudanças nos níveis de mortalidade e fecundidade, as quais vêm caindo a uma velocidade nunca vista anteriormente 19 . Essa mudança de comportamento populacional -à qual dá-se o nome de transição demográfica 19,27 -é a responsável pelo envelhecimento da população.A medida que o número de pessoas que atingem idade avançada continua a crescer, existe necessidade associada de prover cuidados médicos eletivos e de emergência a um número cada vez maior de pacientes idosos 13 .Dentre as causas de internação hospitalar, a obstrução intestinal ocupa posição de destaque, sendo responsável por 3% das admissões 2,22 .Com relação ao atendimento do paciente idoso com obstrução intestinal, existem questões importantes que devem ser elucidadas, tais como distinção entre obstrução funcional ou mecânica, simples ou estrangulada e deter- brida (38%), câncer de colon (24%), hérnias (12%), impactacão fecal (12%), carcinomatose (10%) e volvo da sigmóide (4%). A mortalidade foi de 18% associada à complicações infecciosas em todos os pacientes. Conclusões -a) A distinção entre a obstrução intestinal funcional e orgânica oferece dificuldade no idoso; b) o câncer do colon constitui-se em importante causa de obstrução intestinal com quadro obstrutivo já na primeira manifestação clínica desse tumor; c) bridas e hérnias são igualmente importantes na etiologia da obstrução intestinal; d) os sinais clínicos obstrutivos são poucos evidentes no idoso e a leucometria é mais fidedigna para este diagnóstico. DESCRITORES -Obstrução intestinal, idoso, tratamento. ABCDDV/564

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“…The most common aetiology is adhesions, while other causes include hernias, neoplasms, Crohn's disease, Meckel's diverticulum and gall stone ileus [59]. In the past, laparotomy had been the mainstay of treatment.…”

Section: Small Bowel Obstructionmentioning

confidence: 99%

Laparoscopic Surgery in Luminal Gastrointestinal Emergencies—a Review of Current Status

et al. 2014

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Laparoscopy has already established itself as the preferred surgical approach in a variety of elective surgical conditions. Along with its usual advantages of less tissue trauma and faster recovery, its diagnostic as well as therapeutic role is making it an attractive option in emergency surgery. In this paper, we have reviewed the current status of laparoscopic surgery in luminal gastrointestinal emergencies. Relevant papers were selected using Medline database from 2007 to the present. These were reviewed, and outcomes were stated under the headings of appendicitis, perforated peptic ulcer, colorectal emergencies and small bowel obstruction. The laparoscopic intervention was found to be of clear benefit in most of the patients with appendicitis. Its role, however, is not absolutely clear in managing perforated peptic ulcers. Laparoscopic lavage and drainage have been recommended in diverticular perforation with limited contamination. Small case series and studies have shown benefits of laparoscopic surgery in iatrogenic colonic perforations, colonic obstruction, emergency colectomy and small bowel obstruction. Laparoscopic surgery can be recommended in appendicitis and lowrisk cases of perforated peptic ulcers. Its definitive role in other conditions needs more evidence. The surgeon's experience and careful patient selection are very important to improve the outcome.

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Acute mechanical bowel obstruction: Clinical presentation, etiology, management and outcome

Cited by 264 publications

References 20 publications

Combination of Serum C-reactive Protein and D-lactate: Predictors of Strangulation in Intestinal Obstruction

Combination of Serum C-reactive Protein and D-lactate: Predictors of Strangulation in Intestinal Obstruction

Obstrução intestinal no idoso

Laparoscopic Surgery in Luminal Gastrointestinal Emergencies—a Review of Current Status

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