Indications and Therapeutic Strategy for Intestinal Obstruction Due to Intra-abdominal Adhesions

Background: Intestinal obstruction continues to be a common surgical emergency throughout the world and its management protocol has evolved over years. In our study we aimed to provide a complete epidemiological description of intestinal obstruction in adult age group patients in a tertiary care hospital in Northern India.Methods: This is a prospective study of patients belonging to age group more than 12 years admitted in our unit with clinical features suggestive of intestinal obstruction from September 2011 to December 2013 at R. N. T. Medical College, Udaipur. The study comprised of 134 patients.Results: Intestinal obstruction contributed to 6.5% of all surgical admissions. It was nearly twice more common in males. 43% patients presented with features of acute intestinal obstruction in comparison to 57% who presented with features of sub-acute intestinal obstruction. Most common cause observed was obstruction due to intra-abdominal adhesions followed by abdominal tuberculosis 48 and 29 percent respectively. Features of intestinal obstruction resolved in 60% patients with conservative management. Adhesions, abdominal tuberculosis and malignancy counted for majority of patients with sub-acute obstruction. Emergency surgery was done in 32% of patients and 36.5 % of patients were discharged non-operatively. Planned Surgery after successful expectant management was done in 24 % patients. Most frequently seen complication was wound site collection (72.5%) followed by respiratory tract infections (49%). Total mortality in our study was 12.6% of which 41% was post-operative mortality and 59% mortality seen in patients who expired during conservative management. Conclusions: This study demonstrates that intra-abdominal adhesions and abdominal tuberculosis account for most cases of intestinal obstruction in countries like India. A watchful expectant management can be tried in patients with prior operative history and those with history of tuberculosis.

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A clinical study on the surgical management of intestinal obstruction

International Surgery Journal ◽

10.18203/2349-2902.isj20195961 ◽

2019 ◽

Vol 7 (1) ◽

pp. 150

Author(s):

Jyotsna Choudary Gogineni ◽

Trupti Tonape ◽

V. S. Athavale ◽

Sree Kumar ◽

Shweta Achuthan Kutty ◽

...

Keyword(s):

Intestinal Obstruction ◽

Surgical Management ◽

Signs And Symptoms ◽

Abdominal Distension ◽

Abdominal Adhesions ◽

Medical College ◽

Common Causes ◽

General Surgeons ◽

The Common ◽

A Prospective Study

Background: Intestinal obstruction remains one of the common emergencies encountered by general surgeons all over the world. Acute intestinal obstruction occurs when there is a disruption in the frontward flow of intestinal contents.Methods: This study is a prospective study conducted in Dr. D Y Patil Medical College and Hospital, Pimpri, Pune. Patients coming to the hospital with signs and symptoms suggestive of intestinal obstruction and willing for surgical management in our hospital were included after taking written and informed consent.Results: In our study, pain abdomen and abdominal distension was the most common presenting complaints in 90% and 92% of the patients respectively. On palpation, 96% of the patients had abdominal tenderness, 72% of the patients had guarding and 12% of the patients had rigidity. On auscultation, all patients had some abnormality with regard to bowel sounds. It has been noted that intestinal strictures and abdominal adhesions were amongst the most common causes of intestinal obstruction in our study.Conclusions: Prompt clinical assessment aided by radiological imaging is of crucial importance in reaching the diagnosis of intestinal obstruction. Decision regarding surgical intervention is taken based on the initial presentation of the patient, and his/her response to first line conservative management and fluid resuscitation

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HOSPITAL EPIDEMIOLOGY OF ABDOMINAL ADHESIONS

Бюллетень Восточно-Сибирского научного центра Сибирского отделения Российской академии медицинских наук ◽

10.12737/22982 ◽

2016 ◽

Vol 1 (4) ◽

pp. 115-118 ◽

Cited By ~ 1

Author(s):

Аюшинова ◽

Natalya Ayushinova ◽

Шурыгин ◽

Mikhail Shurygin ◽

Шурыгина ◽

...

Keyword(s):

Intestinal Obstruction ◽

Clinical Symptoms ◽

Abdominal Cavity ◽

Abdominal Adhesions ◽

Hospital Epidemiology ◽

Surgical Interventions ◽

Adhesive Intestinal Obstruction ◽

Intestinal Fistulas ◽

Regional Hospitals ◽

Methods Of Treatment

The purpose of the research was to establish main causes of development and outcomes of adhesive obstruction.We analyzed the outcomes of treatment of 154 patients with acute intestinal obstruction. The following data were taken into consideration: age, gender, surgeries in past medical history, terms of adhesions manifestations, clinical symptoms, findings of additional examinations, methods of treatment, outcome. It has been established, that the most frequent causes of adhesions were appendectomy (23%), stomach operations (21 %) and gynecological interventions (14 %). After surgeries performed in conditions of regional hospitals, adhesions developed after appendectomy, gynecological operations and interventions on the intestine. In patients operated in city hospitals intestinal obstruction more often occurred after extensive operations on the stomach, appendix, and after gynecological interventions. Urgent surgical interventions more often led to adhesive process in the abdominal cavity (63 %). Mortality made 5.8 %. Causes of death were intestinal fistulas and abdominal sepsis.Thus, acute adhesive intestinal obstruction as an extreme form of abdominal adhesions continues to be an urgent medical issue.

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Intestinal Obstruction: An Overview of Aetiology, Evaluation and Management

Journal of Surgical Sciences ◽

10.3329/jss.v17i2.43783 ◽

2019 ◽

Vol 17 (2) ◽

pp. 89-95

Author(s):

ABM Khurshid Alam ◽

Kazi Lsrat Jahan ◽

Mohammad Ali

Keyword(s):

Intestinal Obstruction ◽

Clinical Symptoms ◽

Abdominal Distension ◽

Initial Study ◽

Abdominal Adhesions ◽

Radiologic Imaging ◽

Vascular Compromise ◽

Intestinal Decompression ◽

Bowel Rest ◽

Bowel Decompression

Intestinal obstruction occurs when there is an interruption in the forward flow of intestinal contents. This interruption can occur at any point along the length of the gastrointestinal tract, and clinical symptoms often depend on the level of obstruction. Intestinal obstruction is most commonly caused by intra-abdominal adhesions, malignancy, or intestinal herniation. The clinical presentation generally includes colicky abdominal pain, vomiting, abdominal distension and constipation. Radiologic imaging can confirm the diagnosis. Although radiography is often the initial study, non-contrast computed tomography is recommended if the index of suspicion is high or if suspicion persists despite negative radiography. Management of uncomplicated obstructions includes fluid resuscitation with correction of metabolic derangements, intestinal decompression, and bowel rest. Evidence of vascular compromise or perforation, or failure to resolve with adequate bowel decompression is an indication for surgical intervention. Journal of Surgical Sciences (2013) Vol. 17 (2): 89-95

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Abdominal adhesions: intestinal obstruction, pain, and infertility

Surgical Endoscopy ◽

10.1007/s00464-002-9208-9 ◽

2003 ◽

Vol 17 (7) ◽

pp. 1017-1022 ◽

Cited By ~ 102

Author(s):

W. W. Vrijland ◽

J. Jeekel ◽

H. J. van Geldorp ◽

D. J. Swank ◽

H. J. Bonjer

Keyword(s):

Intestinal Obstruction ◽

Abdominal Adhesions

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Abdominal adhesions causing intestinal obstruction following cytoreductive surgery and early postoperative intraperitoneal chemotherapy

European Surgery ◽

10.1007/bf02602252 ◽

1995 ◽

Vol 27 (2) ◽

pp. 92-95 ◽

Cited By ~ 13

Author(s):

P. Jacquet ◽

P. H. Sugarbaker

Keyword(s):

Intestinal Obstruction ◽

Intraperitoneal Chemotherapy ◽

Cytoreductive Surgery ◽

Abdominal Adhesions ◽

Early Postoperative Intraperitoneal Chemotherapy

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Adhesive disease of the abdominal cavity

Vestnik of Experimental and Clinical Surgery ◽

10.18499/2070-478x-2017-10-4-320-326 ◽

2017 ◽

Vol 10 (4) ◽

pp. 320-326 ◽

Cited By ~ 4

Author(s):

Alexandr Alexeevich Andreev ◽

Anton Petrovich Ostroushko ◽

Elena Sergeevna Sotnikova ◽

Daria Vladimirovna Kiryanova ◽

Vladislav Nikolaevich Britikov

Keyword(s):

Conservative Treatment ◽

Intestinal Obstruction ◽

Body Position ◽

Intestinal Anastomosis ◽

Abdominal Cavity ◽

Adhesion Formation ◽

Protective Film ◽

Abdominal Adhesions ◽

Surgical Interventions ◽

Protein Components

After operations on the abdominal adhesions occur in 80-90% of cases, adhesive disease develops in 12-64% of cases. First about the causes of adhesions said George Punter in 1793. For the first time in the Russian literature on intraperitoneal adhesions mentioned V.P. Dobrovolsky in 1838. According to modern notions, adhesive disease is a separate nosological form, characterized by the formation of intra-abdominal adhesions, as a rule, manifested by recurrent episodes of intestinal obstruction or pain. The basis for the development of peritoneal commissures in abdominal cavity are a complex, diverse violations of the functions of various body systems. Trigger in the development of adhesion formation in abdominal cavity considered: mechanical, physical, infectious, implant, chemical factors and congenital anomalies (bands of lane, membranes of Jackson and others). As a result of inflammation of the peritoneum dystrophic process, accompanied by desquamation of the mesothelium and other connective tissue layers of the peritoneum, there is an allocation of exudate, coagulation of protein components and formation of fibrinous adhesions, which under normal fibrinolytic activity within 24-72 hours lysed. There are four degrees of prevalence of adhesions: grade I – local adhesions, occupying not more than 1/3 of one floor; II degree – additionally determined by single spikes in other areas. III and IV degree – adhesions, occupying 1/3 and 2/3 of the abdominal cavity, respectively. The clinical picture of adhesive disease is expressed aching pain in the abdomen, changing its character with the change of body position; periodic bloating, unstable chair; vomiting during exercise or after violation of the diet, the phenomena of complete or partial adhesive intestinal obstruction. Diagnostic informativeness of traditional x-ray methods is only 50-60%. The most informative is the use of contrast enterography and ultrasound examination of the abdomen with a directed study of problem areas of the abdomen. Prevention of adhesions is an important problem of practical surgery. Methods of preventing the formation of adhesions are the following: reduction of abdominal trauma, reducing inflammation in the area of operations, reducing the likelihood of deposition of fibrin in the free abdominal cavity, the suppression of postoperative paresis of the intestine, delimitation of the damaged serosal surfaces and interfere with adhesion by applying a protective film on the mesothelium. Application drugs does not negate the careful attitude to the tissues and accurate surgical interventions. Conservative treatment includes: electrophoresis lidazy, hydrocortisone, application of paraffin, ozokerite on the anterior abdominal wall, injection antispasmodics, nasogastric drainage, staging of hypertension and cleansing enemas and others. Indications for operative intervention are: absence of effect of conservative treatment, the deterioration of the patient, the symptoms of acute intestinal obstruction. The following types of surgery: enteroclysis, the imposition of intestinal anastomosis with or without bowel resection laparoscopic lysis of adhesions, entropicalia.

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PREDICTING THE RISK OF DEVELOPING ABDOMINAL ADHESIONS IN CHILDREN DEPENDING ON ACETYLATION GENOTYPE

Novosti Khirurgii ◽

10.18484/2305-0047.2021.5.573 ◽

2021 ◽

Vol 29 (5) ◽

pp. 573-580

Author(s):

M.G. Melnychenko ◽

◽

A.A. Kvashnina ◽

P.B. Antonenko ◽

K.A. Antonenko ◽

...

Keyword(s):

Risk Factors ◽

Genetic Polymorphism ◽

Intestinal Obstruction ◽

Single Case ◽

Point Mutations ◽

Mutant Gene ◽

Main Group ◽

Wild Type ◽

Abdominal Adhesions ◽

Adhesive Intestinal Obstruction

Objective. To determine the predictive value of the genetic polymorphism of the N-arylacetyltransferase-2 (NAT-2) gene for assessing the risk of postoperative adhesive intestinal obstruction in children. Methods. In all children (36 children with adhesive intestinal obstruction (main group) and 35 planned patients (comparative group)) the acetylation genotype was studied by detecting point mutations of the NAT-2 gene using allele-specific amplification method with analysis of apolymerase chain reaction-restrictionfragmentlengthpolymorphism. Results. The study of the frequency of mutations at position 481 revealed the greatest diversity of the studied variants of genotypes: 33.3% of the children of the main group were homozygous for the wild-type gene, 44.4% were heterozygotes, 22.2% of patients had a homozygous mutant gene. According to the NAT-2 * 6A genotype (G 590 - A), the majority of patients (55.6%) were heterozygotes, 44.4% were homozygotes with the wild-type of the gene. Not a single case of mutation at position 857 has been identified. Among the children of the main group, the share of «fast» acetylators was 69.4%, in the comparison group - 40.0% (χ<sup>2</sup>=6.215; p=0.013). The development of postoperative adhesive intestinal obstruction in children with the “fast” acetylation genotype occurred in the absence of clinical and anamnestic risk factors and was characterized by a greater severity and prevalence of intra-abdominal adhesive process (PAI was (14.8±1.8) and (8.1±2.4 ), respectively). Conclusion. The risk of developing postoperative adhesive complications in children can be done preventively by determining the genetic polymorphism of the N-acetyltransferase-2 gene. The risk group for developing adhesive intestinal obstruction is made up of children who are the carriers of NAT-2 alleles and correspond to the genotype of «fast» and «moderate» acetylation. Children who are «fast» acetylators have a more pronounced intra-abdominal adhesion process and a higher risk of complications associated with excessive adhesion even in the absence of other risk factors. What this paper adds N-acetyltransferase 2 (NAT2) gene polymorphism as a prognostic risk factor for the development of adhesive intestinal obstruction in children has been studied. Children as the carriers of the «fast» acetylator genotype have a higher risk of developing intra-abdominal adhesions and therefore require more comprehensive preventive measures at all stages of possible influence.

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