The Clinical Management of Intestinal Obstruction

Burdette, Walter J.; Stevens, Lawrence E.

doi:10.1001/archsurg.1961.01300130124015

Cited by 7 publications

(3 citation statements)

References 40 publications

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“…Therefore, even in those patients whose intestinal obstruction is due to progression of their neoplastic disease, significant relief of symptoms cannot be predictably expected from nonoperative modes of therapy. 3 No significant difference in results was noted between those patients who had short tube nasogastric intubation as compared to those who had a trial of treatment with long, intestinal tubes.g.10 At the present time, however, an attempt is always made to pass a long intestinal tube prior to surgery. The splinting action of this tube as it lies within multiple loops of small bowel during the postoperative period may serve to avoid subsequent episodes of obstruction by preventing acute angulations of the loops of small intestine during the formation of adhesions.1 No significant complications have been encountered in using the single lumen, long intestinal tube.4…”

mentioning

confidence: 99%

Delayed intestinal obstruction following treatment for cancer

Ketcham

Hoye

Pilch

et al. 1970

Cancer

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A review of 117 patients who have been treated for cancer and subsequently developed 173 episodes of intestinal obstruction has established guidelines for the management of the cancer patient with abdominal distress. Operative intervention is the treatment of choice for intestinal obstruction occurring in a patient previously treated for a malignant neoplasm. Approximately one fourth of such patients will have intestinal obstructions which are not caused by recurrence of, or metastases from, the neoplasm for which they had been previously treated. In these patients, obstruction may be due to a new primary cancer or to nonneoplastic disease. The prognosis for such patients is good, with a long‐term survival of 40%. When intestinal obstruction is due to recurrent or metastatic neoplasm, significant palliation may be expected by surgically relieving the intestinal obstruction even when multiple episodes are experienced. The interval of palliation following each subsequent obstruction is, however, of progressively shorter duration. Nonoperative management of these patients has been uniformly unsuccessful. Repeated exploration and bowel resection is indicated for palliation and, on occasion, may be curative even when intestinal obstruction is due to local recurrence of cancer.

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confidence: 99%

Delayed intestinal obstruction following treatment for cancer

Ketcham

Hoye

Pilch

et al. 1970

Cancer

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“…12,13 The common presenting symptom was abdominal pain 94% followed by constipation 72%, abdominal distention 68%,vomiting 62%, abdominal tenderness 68%, guarding 60% and obstipation 14% only. 14,15 The most frequent reason for requesting CT scan was to differentiate between adynamic ileus from obstruction, the second reason was find out the cause of obstruction and third reason for requesting CT pertained to patients in whom obstruction was definitely present, but cause could not be ascertained i.e. they had no history of surgery, hernia etc.…”

Section: Discussionmentioning

confidence: 99%

Role of multi-slice computed tomography in evaluation and management of intestinal obstruction

et al. 2019

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Background: The purpose of this study is to evaluate the role of multi-slice computed tomography (CT) with reference to presence or absence of intestinal obstruction, level of obstruction, the cause of obstruction, and correlating with their clinical diagnosis.Methods: Patients were admitted directly from Out Patient Department or emergency department with complaints suggestive of intestinal obstruction. Computed tomography scan interpretations performed by experienced radiologists were compared with the final diagnosis that was made on the basis of information obtained clinically, by investigations, and by surgical findings.Results: Majority of patients were males 62%. Mean age 51.62±17.46 years. Majority presents with abdominal pain 94% and constipation 72%.The most common cause of obstruction was adhesion bands 18%.The pre CT diagnosis was changed because of CT findings in 28 patients. Only in 50 (89.28%) patients CT findings matched with intra-operative and cause of obstruction was also found, and in 6 (10.71%) patients intra-operative findings are different from CT findings. In bowel obstruction, the CT sensitivity was 89.28%, specificity 90.90%, positive predictive value 92.59%, negative predictive value 86.95% and accuracy 92.59%.Conclusions: We concluded that multi-slice CT is highly sensitive and specific in determining the presence, the cause and site of bowel obstruction, the site of obstruction and cause of obstruction. We recommended the use of CT scan when diagnosis between ileus and obstruction on the basis of clinical and plain radiographic are difficult or in patients in whome small bowel obstruction is diagnosed when conservative management is contemplated.

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“…Prompt diagnosis and early operation both reduce the mortality of intestinal obstruction. However, a proportion of patients arrive in hospital in very poor general condition, and such patients should not be taken to the operating theatre too soon (Burdette and Stevens, 1961;Marcus, 1962). There is much to be said for allowing adequate time (2-4 hours) for replacement of fluid and electrolyte deficiencies, reducing abdominal distension, and ensuring that the stomach is kept empty.…”

Section: The Timing Of the Operationmentioning

confidence: 99%

Anaesthetic Problems of Intestinal Obstruction in Adults

Stevens

1964

British Journal of Anaesthesia

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The problems of anaesthetizing ill patients with intestinal obstruction arise from the possibility of aspirating stomach contents, and from attempts to produce adequate abdominal muscular relaxation. The hazards and mechanisms of both vomiting and regurgitation are discussed in detail. On this basis, the rationale of preventing aspiration is described. For the production of adequate abdominal relaxation, the muscle relaxants appear to be the method of choice, despite occasional abnormal responses in these patients. The nature of these responses and methods of rendering them even less common are discussed in detail. PRE-OPERATIVE PROBLEMS Fluid and electrolyte loss. Normally, about 8 litres of digestive juices are secreted every 24 hours, most of which is reabsorbed in the colon. If there is an obstruction proximal to the colon, large volumes of gas (mainly nitrogen) and fluid accumulate above it. Small bowel obstruction presents a more urgent problem than large bowel obstruction because the

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The Clinical Management of Intestinal Obstruction

Cited by 7 publications

References 40 publications

Delayed intestinal obstruction following treatment for cancer

Delayed intestinal obstruction following treatment for cancer

Role of multi-slice computed tomography in evaluation and management of intestinal obstruction

Anaesthetic Problems of Intestinal Obstruction in Adults

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