A Current Appraisal of Problems with Gangrenous Bowel

Barnett, William O.; Petro, Anthony B.; Williamson, Johnnie W.

doi:10.1097/00000658-197606000-00006

Cited by 44 publications

(11 citation statements)

References 8 publications

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“…Mortality rate of 15-30% has been reported in most series, and this is substantially higher than mortality rate of 5-8% after simple, nonstrangulated obstruction (4)(5)(6)(7)(8). In approximately 30% of cases with strangulation, reversible ischemia may be present (9), and early diagnosis and operation may be vital in such situation.…”

Section: Introductionmentioning

confidence: 95%

The role of D-dimer in the diagnosis of strangulated small-bowel obstruction

Boguševičius¹,

Grinkevičius²,

Maleckas³

et al. 2007

Medicina

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Section: Introductionmentioning

confidence: 95%

The role of D-dimer in the diagnosis of strangulated small-bowel obstruction

Boguševičius¹,

Grinkevičius²,

Maleckas³

et al. 2007

Medicina

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“…Unfortunately, a nonselective, nonoperative plan can be dangerous [5, 6]. When embarking on an initial nonoperative approach, surgeons must be flexible to manage those patients properly with persistence or progression of their symptoms because late recognition of a strangulation obstruction is associated with markedly increased morbidity and mortality [7, 8]. …”

Section: Introductionmentioning

confidence: 99%

Small Bowel Obstruction—Who Needs an Operation? A Multivariate Prediction Model

et al. 2010

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Background Proper management of small bowel obstruction (SBO) requires a methodology to prevent nontherapeutic laparotomy while minimizing the chance of overlooking strangulation obstruction causing intestinal ischemia. Our aim was to identify preoperative risk factors associated with strangulating SBO and to develop a model to predict the need for operative intervention in the presence of an SBO. Our hypothesis was that free intraperitoneal fluid on computed tomography (CT) is associated with the presence of bowel ischemia and need for exploration. Methods We reviewed 100 consecutive patients with SBO, all of whom had undergone CT that was reviewed by a radiologist blinded to outcome. The need for operative management was confirmed retrospectively by four surgeons based on operative findings and the patient’s clinical course. Results Patients were divided into two groups: group 1, who required operative management on retrospective review, and group 2 who did not. Four patients who were treated nonoperatively had ischemia or died of malignant SBO and were then included in group 1; two patients who had a nontherapeutic exploration were included in group 2. On univariate analysis, the need for exploration (n = 48) was associated (p < 0.05) with a history of malignancy (29% vs. 12%), vomiting (85% vs. 63%), and CT findings of either free intraperitoneal fluid (67% vs. 31%), mesenteric edema (67% vs. 37%), mesenteric vascular engorgement (85% vs. 67%), small bowel wall thickening (44% vs. 25%) or absence of the “small bowel feces sign” (so-called fecalization) (10% vs. 29%). Ischemia (n = 11) was associated (p < 0.05 each) with peritonitis (36% vs. 1%), free intraperitoneal fluid (82% vs. 44%), serum lactate concentration (2.7 ± 1.6 vs. 1.3 ± 0.6 mmol/l), mesenteric edema (91% vs. 46%), closed loop obstruction (27% vs. 2%), pneumatosis intestinalis (18% vs. 0%), and portal venous gas (18% vs. 0%). On multivariate analysis, free intraperitoneal fluid [odds ratio (OR) 3.80, 95% confidence interval (CI) 1.5–9.9], mesenteric edema (OR 3.59, 95% CI 1.3–9.6), lack of the “small bowel feces sign” (OR 0.19, 95% CI 0.05–0.68), and a history of vomiting (OR 4.67, 95% CI 1.5–14.4) were independent predictors of the need for operative exploration (p < 0.05 each). The combination of vomiting, no “small bowel feces sign,” free intraperitoneal fluid, and mesenteric edema had a sensitivity of 96%, and a positive predictive value of 90% (OR 16.4, 95% CI 3.6–75.4) for requiring exploration. Conclusion Clinical, laboratory, and radiographic factors should all be considered when making a decision about treatment of SBO. The four clinical features—intraperitoneal free fluid, mesenteric edema, lack of the “small bowel feces sign,” history of vomiting—are predictive of requiring operative intervention during the patient’s hospital stay and should be factored strongly into the decision-making algorithm for operative versus nonoperative treatment.

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“…Small bowel ischaemia is a potentially fatal complication of small bowel volvulus: mortality in non-infarcted bowel is 5–8%5 and in infarcted bowel 40–100% 6 , 7. Ischaemia is notoriously challenging to diagnose in that bowel enhancement can be normal, increased, decreased or even absent.…”

Section: Discussionmentioning

confidence: 99%

A rare case of adult primary jejunal volvulus

Takatsuka

Shah²,

Dharmarajah³

et al. 2010

Case Reports

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Jejunal volvulus is a rare and life threatening presentation of intestinal ischaemia. Clinical features, laboratory investigations and plain abdominal films are non-specific and so computed tomography (CT) scanning is useful in reaching a timely diagnosis. Rapid recourse to surgical intervention is typical and life saving. We report a rare case of primary jejunal volvulus which, after diagnosis on emergency CT scanning, was successfully treated by laparotomy and resection of infarcted bowel.

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A Current Appraisal of Problems with Gangrenous Bowel

Cited by 44 publications

References 8 publications

The role of D-dimer in the diagnosis of strangulated small-bowel obstruction

The role of D-dimer in the diagnosis of strangulated small-bowel obstruction

Small Bowel Obstruction—Who Needs an Operation? A Multivariate Prediction Model

A rare case of adult primary jejunal volvulus

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