AIMS: This prospective controlled trial was undertaken to resolve the controversy over whether intestinal obstruction due to postoperative adhesions should be managed by immediate operation or by conservative care. METHODS: A randomized prospective controlled study was undertaken of all private and public sector patients admitted under the care of one surgeon with intestinal obstruction due to postoperative adhesions over a 15-year period. The patients were randomly allocated either to immediate operation or conservative care with nasogastric aspiration and intravenous fluids. Patients managed conservatively who had not settled after 5 days were operated on. The data were analysed by Student's t test and Fisher's exact test. RESULTS: There were 127 patients. The two groups were statistically identical regarding age, number of previous operations and time since last operation, and heart rate, blood pressure, haemoglobin concentration, white count and urea level on admission. Sixty-three patients were treated conservatively; 22 failed to settle and were operated on, of whom 11 required a bowel resection. There were two postoperative deaths. In 64 patients treated immediately by operation, the incidence of bowel resection was not significantly reduced (22 per cent; P > 0.05) but there were four postoperative deaths. There was no significant difference in the length of stay. CONCLUSIONS: Conservative management of postoperative adhesional intestinal obstruction is safe and 65 per cent settle. In those who fail to settle there is no significantly increased risk of bowel strangulation. There is no way of identifying those who will not settle from the history or initial investigations on admission.
Download full-text PDF |
Source |
---|---|
http://dx.doi.org/10.1046/j.1365-2168.2000.01383-17.x | DOI Listing |
Cureus
December 2024
Department of General Surgery, Uttar Pradesh University of Medical Sciences, Saifai, IND.
Enteroenteric fistula in the pediatric age group is an unusual presentation. It can create a diagnostic dilemma for the physician, particularly in the absence of any previous surgery, prolonged abdominal symptoms, or inflammatory bowel disease. The patient is a 10-year-old girl who presented with mild-grade fever, abdominal distension, scanty stool passage, and foul-smelling vomiting for the past 10 days.
View Article and Find Full Text PDFCureus
December 2024
General Surgery, Mediclinic City Hospital, Dubai, ARE.
Internal hernias are characterized by the protrusion of abdominal viscera through congenital or acquired apertures within the abdominal cavity and are a recognized etiology of intestinal obstruction. Internal hernias can cause symptoms ranging from mild abdominal discomfort to complete intestinal obstruction. Transomental hernias are often associated with postoperative anatomical changes and are rare in patients without prior abdominal surgeries.
View Article and Find Full Text PDFInt J Gen Med
January 2025
Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, Chennai, Tamilnadu.
Medicine (Baltimore)
January 2025
Department of Neonatology, Hangzhou Women's Hospital, Hangzhou, Zhejiang, China.
Rationale: Fetal intestinal volvulus, a rare and severe disorder, poses significant diagnostic challenges prenatally and can lead to intrauterine death or adverse neonatal outcomes if untreated in a timely manner. This study reports a case of fetal intestinal volvulus confirmed postoperatively, providing insights into its clinical manifestations, diagnostic methods, and treatment outcomes, thereby enhancing understanding of this rare condition.
Patient Concerns: A Chinese gravida 2, para 1 female presented at 32 weeks and 5 days of gestation with decreased fetal movements.
Tech Coloproctol
January 2025
Department of Colorectal Surgery, Peace Hospital Affiliated to Changzhi Medical College, 110 Yan'an South Road, Luzhou District, Changzhi City, 046000, Shanxi Province, China.
Objective: To investigate the efficacy of laparoscopic sigmoid extraperitoneal colostomy combined with pelvic peritoneal closure in abdominoperineal resection for low rectal cancer.
Methods: We retrospectively analyzed the clinical data of 162 patients with low rectal cancer, who underwent laparoscopic abdominoperineal resection from January 2015 to January 2019 at the Affiliated Peace Hospital of Changzhi Medical College. Extraperitoneal stoma construction was performed in 98 patients (study group), while 64 patients (control group) underwent the procedure without suturing the pelvic peritoneum.
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!