scholarly journals Serum CRP: A Marker of Bowel Gangrene in Acute Intestinal Obstruction

2018 ◽  
Vol 6 (4) ◽  
Author(s):  
Dr Dileep Singh Thakur M.S. ◽  
Keyword(s):  
Intestinal Obstruction ◽  
Acute Intestinal Obstruction ◽  
Bowel Gangrene ◽  
Serum Crp

scholarly journals Ileosigmoid knotting: an unusual cause of acute intestinal obstruction with bowel gangrene

2019 ◽  
Vol 12 (5) ◽  
pp. e226663
Author(s):  
Raj Kumar ◽  
Pavan Kumar Shamanur Kenchappa ◽  
Kusum Meena ◽  
Brijesh Kumar Singh
Keyword(s):  
Intestinal Obstruction ◽  
Sigmoid Colon ◽  
Bowel Obstruction ◽  
Exploratory Laparotomy ◽  
Large Bowel Obstruction ◽  
Acute Intestinal Obstruction ◽  
Haemodynamic Instability ◽  
Ileocolic Anastomosis ◽  
Bowel Gangrene

Ileosigmoid knotting (ISK) is a rare cause of intestinal obstruction rapidly progressing to bowel gangrene. It is characterised by the wrapping of loops of ileum and sigmoid colon around each other. The condition often remains undiagnosed preoperatively; however, it can be suspected by the triad of small bowel obstruction, radiographic features suggestive of predominately large bowel obstruction and inability to deflate the intestine by a sigmoidoscope. We are reporting a case of 56-year-old man who presented with features of acute intestinal obstruction and compensated shock within 24 hours of onset of symptoms. Exploratory laparotomy revealed ISK resulting in gangrene of ileum and sigmoid colon. In view of haemodynamic instability, end ileostomy was done after excising gangrenous segments. The patient improved and stoma closure and ileocolic anastomosis were done after 3 months in follow-up.

scholarly journals A Study on Raised Serum LDH Level in Acute Intestinal Obstruction – A Marker of Bowel Gangrene

2020 ◽  
Vol 3 (1) ◽  
pp. 120-123
Author(s):  
Anantha Kumar Nateson ◽  
Suresh Nayak Basavanayak ◽  
Sudarsan Srikanth
Keyword(s):  
Intestinal Obstruction ◽  
Venous Blood ◽  
Cost Effective ◽  
Abdominal Distension ◽  
Serum Levels ◽  
Acute Intestinal Obstruction ◽  
Number Of Patients ◽  
Study Results ◽  
Bowel Gangrene ◽  
Aseptic Conditions

Background: Bowel gangrene is a major abdominal catastrophe associated with high mortality rate. Intestinal obstruction accounts for 20%   of all surgical emergencies around the world. The present study aims to estimate the LDH levels in patients with acute intestinal obstruction and correlate with bowel viability. Subjects and Methods: In this study, the estimation of serum LDH was conducted in 45 cases of acute intestinal obstruction who were admitted in surgical wards. After fulfilling the inclusion and exclusion criteria the study subjects were recruited. All the cases were thoroughly examined. Time of presentation and onset of symptoms were noted. Under aseptic conditions, 3 ml venous blood samples were collected from the study subjects, centrifuged at 3000 rpm and separated serum sample was used for the estimation of lactate dehydrogenase (LDH) and the estimated value of serum LDH is compared with the viability of the bowel intra operatively. Results: The total number of patients presented with obstruction is 45 out of which 25 were found to have elevated LDH which is about 55.56%. Out of 25 patients presented with elevated LDH, 20 patients found to have gangrenous bowel. 60% presented with abdominal pain and 40% had irreducible swelling. Most commonly associated symptoms are vomiting (84%) followed by abdominal distension (40%), obstipation (36%), pyrexia (24%), blood in stools (8%) and diarrhoea (4%). Per rectal examination showed 76% had normal faecal staining, 12% blood stained faeces and 8% empty. Complications observed were anastomotic leak 8%, wound infection 16%, wound gaping 8%, burst abdomen 8%. Conclusion: The present study results indicate that ischemic changes in any part of the bowel can cause elevation in the serum levels of LDH and a higher value of >1000 IU/L strongly indicates an underlying gangrenous change. It is a less invasive, cost effective and easily available diagnostic tool to diagnose bowel ischemia/gangrene. Hence it is more useful in centres where the diagnostic facilities are limited.

scholarly journals Surgical Management of Intussusception in Children: A Retrospective Review of 212 Cases

2021 ◽  
Author(s):  
Rajendra K. Ghritlaharey
Keyword(s):  
Intestinal Obstruction ◽  
Surgical Procedures ◽  
Bowel Resection ◽  
Bowel Perforation ◽  
Primary Objective ◽  
Acute Intestinal Obstruction ◽  
Perforation Peritonitis ◽  
Bowel Gangrene ◽  
Gangrenous Bowel ◽  
Infants And Young Children

Abstract Objectives The primary objective of this study was to analyze and review the demographics of children operated upon for intussusception. Secondary objectives were to review the clinical characteristics, surgical procedures performed, postoperative complications, and outcome. Materials and Methods It is a single-institution, retrospective study and consists of children below the age of 12 years. This study was conducted at the author’s department of pediatric surgery for the past 21 years, from January 1, 2000 to December 31, 2020. Results During the study period, 212 children were operated upon for intussusceptions and included 146 (68.86%) boys and 66 (31.13%) girls. This review consisted of infants 158 (74.52%), and children of 1 to 5 years of age (30; 14.15%), and 6 to 12 years of age (24; 11.32%). Clinically, 177 (83.49%) children presented with the features of acute intestinal obstruction, and the remaining 35 (16.5%) presented with features of perforation peritonitis. Primary (idiopathic) intussusception was documented in 188 (88.67%) of the cases. Gangrenous bowel was evident in 98 (46.22%) children. Sixty-two percent of the cases required bowel resection. Surgical procedures were executed in children for intussusception in the following order of frequency: (1) operative reduction with or without serosal tear/bowel perforation repair, n = 81 (38.2%); (2) resection of diseased ileum and ileoileal anastomosis, n = 52 (24.52%); (3) resection of diseased ileum ± part of colon and an ileostomy, n = 36 (16.98%); and (4) resection of diseased ileum, cecum, part of colon, and ileocolic (ileo-ascending or ileo-transverse) anastomosis, n = 43 (20.28%). Postoperatively, 9 (4.24%) children required reexploration for the management of their complications. Twenty-one (9.9%) children died during the postoperative period. Conclusion Intussusception remains the most common cause of acute intestinal obstruction in infants and young children. Delay in the referral, diagnosis, and seeking treatment were significantly associated with bowel gangrene, required bowel resection during the surgical therapy, and also culminated in significantly higher mortalities.

scholarly journals Role of procalcitonin in predicting the bowel gangrene and ischemia in acute intestinal obstruction

2021 ◽  
Vol 8 (3) ◽  
pp. 852
Author(s):  
Harindranath H. R. ◽  
Praveen K. H. ◽  
Lakshmi Vijaykumar
Keyword(s):  
Intestinal Obstruction ◽  
Statistical Tests ◽  
Acute Intestinal Obstruction ◽  
P Value ◽  
Mesenteric Ischaemia ◽  
Good Tool ◽  
Bowel Ischaemia ◽  
Midline Laparotomy ◽  
Bowel Gangrene

Background: Acute intestinal obstruction being the most common presentation on intestinal ischaemia and bowel gangrene. This study mainly concentrated on need for new marker for early prediction mesenteric ischaemia. Procalcitonin as a marker for stoppage of conservative management in intestinal obstruction.  Methods: Out 70 patients 45 underwent conservative and 25 eventually underwent surgery (midline laparotomy). Procalcitonin levels in both are observed at regular intervals and compared and analysis done using appropriate statistical tests. Results: Level of procalcitonin was found to be higher in patients who need surgery consistantly when compared with those who were in conservative line of management with mean PCT level 2.19 and 2.23 in conservative line with mean PCT of 3.68 and 6.58 for surgical need at presentation and after 48 hrs respectively with p value <0.0001 which is significant.  Conclusions: PCT at presentation can be a very good tool for predicting the bowel ischaemia and gangrene as an early indicator and also it can be used as a marker for need for surgery in patients managing conservatively for intestinal obstruction.  

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

2016 ◽  
Vol 5 (3) ◽  
pp. 134-139 ◽  
Author(s):  
Ajay K Pal ◽  
Maulana M Ansari ◽  
Najmul Islam
Keyword(s):  
Intestinal Obstruction ◽  
Bowel Obstruction ◽  
Acute Intestinal Obstruction ◽  
Emergency Setting ◽  
C Reactive Protein ◽  
Predictive Values ◽  
Cutoff Value ◽  
Reactive Protein ◽  
Sensitivity Specificity ◽  
Serum Crp

ABSTRACT 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. How to cite this article Pal AK, Ansari MM, Islam N. Combination of Serum C-reactive Protein and D-lactate: Predictors of Strangulation in Intestinal Obstruction. Panam J Trauma Crit Care Emerg Surg 2016;5(3):134-139.

Acute intestinal obstruction : an unusual cause

2020 ◽  
Vol 41 (4) ◽  
pp. 231-234
Author(s):  
M Tarchouli ◽  
M Essarghini ◽  
A El Kharras
Keyword(s):  
Intestinal Obstruction ◽  
Acute Intestinal Obstruction

CHANGES IN SMALL INTESTINE MICROFLORA IN PATIENTS WITH ACUTE INTESTINAL OBSTRUCTION

2020 ◽  
pp. 16-18
Author(s):  
V. M. Lykhman ◽  
O. M. Shevchenko ◽  
Ye. O. Bilodid ◽  
Igor Vladimirovich Volchenko ◽  
I. A. Kulyk ◽  
...  
Keyword(s):  
Small Intestine ◽  
Gastrointestinal Tract ◽  
Species Composition ◽  
Intestinal Obstruction ◽  
Bacterial Flora ◽  
Anaerobic Bacteria ◽  
Acute Intestinal Obstruction ◽  
Gram Positive ◽  
Mechanical Intestinal Obstruction ◽  
Facultative Anaerobic Bacteria

Among urgent surgical diseases of abdominal cavity, an acute intestinal obstruction is the most difficult to be diagnosed and treated. Leading factor, determining the development of pathophysiological processes is considered to be the progressive manifestations of enteric insufficiency syndrome, resulting in intestinal barrier impairment, negative changes in ecology of intestinal flora, increased endotoxins. To identify the small intestine microflora in acute intestinal obstruction and determine the role of dysbiotic disorders in clinical manifestations of main pathological process, a study was conducted in 60 patients with mechanical intestinal obstruction. The small intestine has a relatively rare microflora, consisting mainly of gram−positive facultative aerobic microorganisms, streptococci, lactobacilli. The distal ileum in nearly 30−55 % of healthy people contains scanty microflora, and yet the flora of this area differs from the microbial population of the higher gastrointestinal tract due to higher concentration of gram−negative bacteria. Optional−anaerobic coliform bacilli, anaerobic bifidobacteria and fusobacteria, bacteroids, the number of which starts exceeding the one of gram−positive species, are presented in significant quantities. Distal to the ileocecal valve there are significant changes in the microflora quantitative and species composition. Obligatory anaerobic bacteria become the predominant part of microflora, exceeding the number of aerobic and facultative anaerobic bacteria. The bacterial flora in different parts of gastrointestinal tract has its own specifics and is quite constant, as a result of the interaction of many factors, regulating the bacterial population in small intestine. The most important among them are: acidity of gastric juice, normal peristaltic activity of the intestine, bacterial interactions and immune mechanisms. Disorders of the intestine motor and evacuation function with its obstruction lead to slow passage of the chyme and contamination of the upper gastrointestinal tract with new types of microbes. There is a syndrome of small intestine excessive colonization, which means an increased concentration of bacterial populations in it, similar in species composition to the colon microflora. Pathological intra−intestinal contents become a source of endogenous infection and re−infection of the patient, leads to internal digestive disorders, which is manifested by syndrome of malabsorption of proteins, carbohydrates and vitamins. Key words: acute intestinal obstruction, small intestinal microflora, conditionally pathogenic microorganisms, intestinal biocenosis.

Acute Intestinal Obstruction

BMJ ◽  
1926 ◽  
Vol 2 (3422) ◽  
pp. 275-275
Author(s):  
J. O'Conor
Keyword(s):  
Intestinal Obstruction ◽  
Acute Intestinal Obstruction
Sign in / Sign up

Export Citation Format

Share Document