Wertigkeit der oralen Gastrografin-Passage in der Ileus-Diagnostik

Janson, R; Christ, F.; Schneider, B.; Engel, Charles

doi:10.1055/s-2008-1056122

Cited by 17 publications

(4 citation statements)

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“…-taktik dar [12,17,23,24]. Besonders beim Diinndarmileus miissen jedoch diese diagnostischen Schritte innerhalb der ersten Stunde nach Klinikaufnahme realisiert werden.…”

Section: Diagnosestellungunclassified

Der operierte mechanische Ileus

Waclawiczek

1987

Langenbecks Arch Chiv

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Between 1972 and 1983 a total of 351 patients was operated suffering from mechanical occlusion of the small intestine (n = 256) and of the colon (n = 95). The surgical complication rate amounted to 28.1% in cases of small intestine ileus and to 24.3% in cases of colon ileus; the most frequent complications were anastomotic dehiscences following resections (small intestine 17.7%/colon 33.8%), enterotomies (5.8%/27.2%), abdominal wall ruptures (3.5%/4.2%) and re-ileus (5.5%/3.2%). The medical complication rate (postop. pneumonia, pulmonary embolism, cardial decompensation etc.) amounted to 17.7% resp. 22.1%. All these complications carried a mortality of 20.6% in small intestine ileus and of 30.4% in colon ileus. The consequences of this retrospective analysis resulted in: early intensive care treatment, general perioperative thrombosis-, pneumonia- and stress ulcer prophylaxis, exact preoperative radiological diagnosis, strict indications for enterotomies and resections, sole transversostomy in stage of ileus for the left-sided colon obstruction caused by carcinoma, discontinuity resection by Hartmann in cases of inflammatory or perforated large bowel stenoses and tube decompression of the small bowel in cases of peritonitis or wide-spread adhesions. Since 1984 we could prospectively decrease the complication resp. mortality rate of the small intestine ileus (n = 64) to 9.4% resp. 4.7% and of the colon ileus (n = 20) to 10% resp. 5%.

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“…-taktik dar [12,17,23,24]. Besonders beim Diinndarmileus miissen jedoch diese diagnostischen Schritte innerhalb der ersten Stunde nach Klinikaufnahme realisiert werden.…”

Section: Diagnosestellungunclassified

Der operierte mechanische Ileus

Waclawiczek

1987

Langenbecks Arch Chiv

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“…Die orale Gastrografin-Passage ist kaum schadlich, liefert in manchen Fallen von Dunndarrnileus eine recht genaue Lokalisation der Obstruktion, die verlangsamte Kontrastierung birgt aber auch die Gefahr der Diagnoseverschleppung in sich. Hilfreich ist sie vor allem beim inkompletten Darrnverschlufs und beim funktionellen Ileus [6].…”

Section: Klinik Und Pathophysiologieunclassified

Sonographische Ileusdiagnostik

Seitz¹,

Merz²

2008

Ultraschall in Med

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Bowel obstruction is an acute alarming situation with limited diagnostic conditions. Therapeutic decisions must be taken in time. Diagnostic differentiation between incomplete or complete bowel obstruction, intestinal obstruction and paralytic ileus is often uncertain and the underlying cause difficult to detect. Besides plain films in acute abdomen the ultrasound examination presents important additional informations: 1st Dilated intestinal loops and gas caps correlate with the characteristic x-ray finding, i.e. erected dilated intestinal loops with fluid levels. The location of the obstruction is defined in small bowel obstruction by differentiation between jejunum (with Kerckring folds) and ileum (without Kerckring folds). In large bowel obstruction the caecum is dilated and a collapse of the distal colon is detectable. 2nd Additional sonographical findings are: oedema of the intestinal walls, hyperpendulum peristalsis or absence of peristalsis, sedimentation of intestinal contents, pearlstring-like lined up gas bubbles under the ventral intestinal walls, and concomitant ascites. Duplex sonographical studies of the intestinal peristalsis may help to differentiate between mechanical obstruction and paralytic ileus. 3rd In bowel obstruction stenoses can be detected as a result of tumour, Crohn's disease diverticulitis, invagination, strangulated hernias or gall stone ileus. Intestinal adhesions cannot be found by ultrasound. Small and large bowel is dilated in paralytic ileus. Numerous causes like acute pancreatitis, ureteral colic, free gastrointestnal perforation and so on can be diagnosed. 4th In ileus of vascular disorder early diagnosis is high important, but inspite of colour flow imaging diagnostic possibilities are limited. 5th Sonographical diagnosis is of special interest when the x-ray plain films is "empty". The lack of massive fluid collection and meteorism allows an optimal ultrasound examination. In this early phase disorders of peristalsis and intestinal walls are reliably found, and it is easier to find the cause of bowel obstruction. In this way the definitive diagnosis can be arrived at earlier, because it still takes up to 6 hours to obtain the classical x-ray finding. There is a rule that the earlier ultrasound is done, the more findings one will get.

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“…Komplikationen der Kontrastmittelpassage sind selten: Neben der bereits erwähnten Aspiration sind gelegentliche Elektrolytstörungen [7] und Hypovolämien [6] beschrieben worden. 3).…”

Section: Strangulationsileusunclassified

Aktueller Stand zur Diagnostik und nichtoperativen Therapie des Dünndarmileus

Henne‐Bruns

Löhnert

2000

Chirurg

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In obstructed small bowel the number of stercoral bacteria increases due to stasis, inducing a liberation of mediators that are leading to ileus disease with facultative sepsis and breakdown of the circulatory system. The therapeutic procedures have to cure the stasis. In the case of mechanical obstruction cure is achieved by operation, while functional ileus may be healed by conservative treatment. Implantation of a gastric tube or Dennis' tube can evacuate the small intestine. Several peristalsis-inducing drugs are in use, although their clinical relevance remaines to be demonstrated. Clinical examination and anamnesis offer initial information; X-ray of the abdomen confirms the diagnosis of ileus and is the baseline examination. Addition of oral contrast medium, ultrasonography, CT and endoscopy may help to evaluate the underlying cause of small-bowel paralysis.

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Wertigkeit der oralen Gastrografin-Passage in der Ileus-Diagnostik

Cited by 17 publications

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Der operierte mechanische Ileus

Der operierte mechanische Ileus

Sonographische Ileusdiagnostik

Aktueller Stand zur Diagnostik und nichtoperativen Therapie des Dünndarmileus

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