51
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Liu C, Smerin D, Comba I, Bhatia L. Acute Colonic Pseudo-Obstruction After Ventriculoperitoneal Shunt Placement for Normal Pressure Hydrocephalus. Cureus 2020; 12:e8295. [PMID: 32601569 PMCID: PMC7317140 DOI: 10.7759/cureus.8295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Ogilvie’s syndrome is a rare postoperative condition commonly referred to as a “colonic pseudo-obstruction” due to the absence of mechanical obstruction. It should be a differential for patients over the age of 60 years who present with nausea, vomiting, and colonic dilatations on imaging. Ogilvie’s syndrome following a ventriculoperitoneal (VP) shunt placement is an extremely rare entity with only one other adult patient reported in the English literature. In this case report, we explore the diagnosis and management of a 76-year-old patient who presented with abdominal pain and multiple bouts of bilious, non-bloody vomitus two days after a ventriculoperitoneal shunt. The ultimate diagnosis of Ogilvie's syndrome along with imaging and subsequent management is detailed, and diagnosis guidelines and treatment options for Ogilvie's syndrome are analyzed and explained. This case highlights the importance of keeping Ogilvie's syndrome on the list of differentials in a postoperative patient in all abdominal surgeries, even if they are minimally invasive.
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Affiliation(s)
- Cherry Liu
- Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Daniel Smerin
- Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Isin Comba
- Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Lakhinder Bhatia
- Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
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52
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Scott M, Konstantatos AH, Bui T, Carne P, O'Donohoe R, Dearaugo S, Donovan S. Acute colonic pseudo‐obstruction leading to perforation: a case‐control study investigating associations to tapentadol. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2020. [DOI: 10.1002/jppr.1618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Matthew Scott
- Pharmacy Department, Alfred Health Faculty of Pharmacy and Pharmaceutical Sciences Monash University Melbourne Australia
| | - Alex H. Konstantatos
- Faculty of Medicine, Nursing and Health Sciences Monash University Melbourne Australia
- Faculty of Medicine Zhejiang University Hangzhou China
- Department of Anaesthesia and Perioperative Medicine Alfred Hospital Melbourne Australia
| | - Thuy Bui
- Pharmacy Department, Alfred Health Faculty of Pharmacy and Pharmaceutical Sciences Monash University Melbourne Australia
| | - Peter Carne
- Cabrini Hospital Department of Surgery Monash University Melbourne Australia
| | - Rory O'Donohoe
- Department of Anaesthesia and Perioperative Medicine Alfred Hospital Melbourne Australia
| | - Stephanie Dearaugo
- Department of Anaesthesia and Perioperative Medicine Alfred Hospital Melbourne Australia
| | - Sarah Donovan
- Department of Anaesthesia and Perioperative Medicine Alfred Hospital Melbourne Australia
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53
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Dako F, Hota P, Kahn M, Kumaran M, Agosto O. Post-lung transplantation abdominopelvic complications: the role of multimodal imaging. Abdom Radiol (NY) 2020; 45:1202-1213. [PMID: 31552464 DOI: 10.1007/s00261-019-02229-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Lung transplantation (LT) is an established method for treating end-stage lung disease. Although most of the post-lung transplant imaging surveillance is focused on chronic lung allograft rejection, abdominopelvic complications have been reported in 7-62% of patients. The reported wide range of post-LT abdominopelvic complications is thought to be secondary to lack of current standardized definitions. These complications encompass a heterogeneous group of disorders including upper and lower gastrointestinal (GI) disorders, inflammatory conditions of solid organs, lymphoproliferative disorders, and neoplasms; each with varying pathophysiology, timing, severity, and treatment. Clinical manifestations of these complications may overlap or be masked by immunosuppression; therefore, imaging plays a paramount role in the early management and treatment.
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Affiliation(s)
- Farouk Dako
- Department of Radiology, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA, 19123, USA.
| | - Partha Hota
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Mansoor Kahn
- Department of Radiology, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA, 19123, USA
| | - Maruti Kumaran
- Department of Radiology, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA, 19123, USA
| | - Omar Agosto
- Department of Radiology, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA, 19123, USA
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Abstract
PURPOSE OF REVIEW To provide a comprehensive update of diagnosis and treatment of gastrointestinal dysmotility in the critically ill, with a focus on work published in the last 5 years. RECENT FINDINGS Symptoms and clinical features consistent with upper and/or lower gastrointestinal dysmotility occur frequently. Although features of gastrointestinal dysmotility are strongly associated with adverse outcomes, these associations may be because of unmeasured confounders. The use of ultrasonography to identify upper gastrointestinal dysmotility appears promising. Both nonpharmacological and pharmacological approaches to treat gastrointestinal dysmotility have recently been evaluated. These approaches include modification of macronutrient content and administration of promotility drugs, stool softeners or laxatives. Although these approaches may reduce features of gastrointestinal dysmotility, none have translated to patient-centred benefit. SUMMARY 'Off-label' metoclopramide and/or erythromycin administration are effective for upper gastrointestinal dysmotility but have adverse effects. Trials of alternative or novel promotility drugs have not demonstrated superiority over current pharmacotherapies. Prophylactic laxative regimens to prevent non-defecation have been infrequently studied and there is no recent evidence to further inform treatment of established pseudo-obstruction. Further trials of nonpharmacological and pharmacological therapies to treat upper and lower gastrointestinal dysmotility are required and challenges in designing such trials are explored.
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55
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Liu Y, Lu H, Xu H, Fu Z, Zhang D, Jiang B. Heparin-induced thrombocytopenia and acute colonic pseudo-obstruction after therapeutic anticoagulation in a very elderly patient with hip fracture: a case report. BMC Musculoskelet Disord 2020; 21:85. [PMID: 32033561 PMCID: PMC7007645 DOI: 10.1186/s12891-020-3117-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 02/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hip fractures have become a severe public health problem, especially in very elderly patients. Most of them are treated with low molecular weight heparin as prophylaxis or treatment of venous thromboembolism. Heparin-induced thrombocytopenia is one of the complications induced by low molecular weight heparin, which may cause poor prognosis. However, there is not enough awareness for heparin-induced thrombocytopenia in very elderly trauma patients. CASE PRESENTATION We report a case of hip fracture with heparin-induced thrombocytopenia in a very elderly patient. The patient developed heparin-induced thrombocytopenia, digestive hemorrhage and acute colonic pseudo-obstruction after the use of low molecular weight heparin, which eventually led to death. CONCLUSIONS This is the first case report of digestive hemorrhage and acute colonic pseudo-obstruction in heparin-induced thrombocytopenia patients with major trauma. This case highlights the severity of HIT in very elderly patients with hip fractures using low molecular weight heparin, and the need for platelet monitoring in these patients. We indicate that there may be a correlation of pathogenesis between digestive hemorrhage and acute colonic pseudo-obstruction in heparin-induced thrombocytopenia patients.
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Affiliation(s)
- Yijun Liu
- Department of Orthopaedics and Trauma, Peking University People's Hospital, Beijing, 100044, China
| | - Hao Lu
- Department of Orthopaedics and Trauma, Peking University People's Hospital, Beijing, 100044, China
| | - Hailin Xu
- Department of Orthopaedics and Trauma, Peking University People's Hospital, Beijing, 100044, China.
| | - Zhongguo Fu
- Department of Orthopaedics and Trauma, Peking University People's Hospital, Beijing, 100044, China
| | - Dianying Zhang
- Department of Orthopaedics and Trauma, Peking University People's Hospital, Beijing, 100044, China.
| | - Baoguo Jiang
- Department of Orthopaedics and Trauma, Peking University People's Hospital, Beijing, 100044, China.
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56
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Wells CI, Paskaranandavadivel N, Lin AY, Du P, Penfold JA, Dinning P, Cheng LK, Bissett IP, Arkwright JW, O'Grady G. Development and feasibility of an ambulatory acquisition system for fiber-optic high-resolution colonic manometry. Neurogastroenterol Motil 2019; 31:e13704. [PMID: 31407459 DOI: 10.1111/nmo.13704] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 07/27/2019] [Accepted: 08/01/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND High-resolution colonic manometry is an emerging technique that has provided new insights into the pathophysiology of functional colorectal diseases. Prior studies have been limited by bulky, non-ambulatory acquisition systems, which have prevented mobilization during prolonged recordings. METHODS A novel ambulatory acquisition system for fiber-optic high-resolution colonic manometry was developed. Benchtop validation against a standard non-ambulatory system was performed using standardized calibration metrics. Clinical feasibility studies were conducted in three patients undergoing right hemicolectomy. RESULTS Pressure profiles obtained from benchtop testing were near-identical using the ambulatory and the non-ambulatory systems. Clinical studies successfully demonstrated ambulatory data capture with patients freely mobilizing postoperatively during continuous recordings of >60 hours. The occurrence (P = .56), amplitude (P = .65), velocity (P = .10), and extent (P = .12) of colonic motor patterns were similar to those obtained in non-ambulatory studies. CONCLUSIONS A novel ambulatory system for high-resolution colonic manometry has been developed and validated. This technique will facilitate prolonged ambulatory recordings of colonic motor activity, assisting with investigations into the role of colonic motility in disease states.
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Affiliation(s)
- Cameron I Wells
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | | | - Anthony Y Lin
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Peng Du
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - James A Penfold
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Phil Dinning
- Discipline of Human Physiology, Flinders University, Adelaide, South Australia, Australia
| | - Leo K Cheng
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Ian P Bissett
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - John W Arkwright
- Department of Computer Science, Engineering and Mathematics, Flinders University, Adelaide, South Australia, Australia
| | - Greg O'Grady
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.,Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
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57
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Wang Q, Zang J, Huang X, Lu H, Xu W, Chen J. Colonic Dysmotility in Murine Partial Colonic Obstruction Due to Functional Changes in Interstitial Cells. J Neurogastroenterol Motil 2019; 25:589-601. [PMID: 31587550 PMCID: PMC6786438 DOI: 10.5056/jnm19136] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 08/07/2019] [Accepted: 08/27/2019] [Indexed: 12/11/2022] Open
Abstract
Background/Aims Interstitial cells play important roles in gastrointestinal (GI) neuro-smooth muscle transmission. The underlying mechanisms of colonic dysmotility have not been well illustrated. We established a partial colon obstruction (PCO) mouse model to investigate the changes of interstitial cells and the correlation with colonic motility. Methods Western blot technique was employed to observe the protein expressions of Kit, platelet-derived growth factor receptor-α (Pdgfra), Ca2+-activated Cl− (Ano1) channels, and small conductance Ca2+- activated K+ (SK) channels. Colonic migrating motor complexes (CMMCs) and isometric force measurements were employed in control mice and PCO mice. Results PCO mice showed distended abdomen and feces excretion was significantly reduced. Anatomically, the colon above the obstructive silicone ring was obviously dilated. Kit and Ano1 proteins in the colonic smooth muscle layer of the PCO colons were significantly decreased, while the expression of Pdgfra and SK3 proteins were significantly increased. The effects of a nitric oxide synthase inhibitor (L-NAME) and an Ano1 channel inhibitor (NPPB) on CMMC and colonic spontaneous contractions were decreased in the proximal and distal colons of PCO mice. The SK agonist, CyPPA and antagonist, apamin in PCO mice showed more effect to the CMMCs and colonic smooth muscle contractions. Conclusions Colonic transit disorder may be due to the downregulation of the Kit and Ano1 channels and the upregulation of SK3 channels in platelet-derived growth factor receptor-α positive (PDGFRα+) cells. The imbalance between interstitial cells of Cajal-Ano1 and PDGFRα-SK3 distribution might be a potential reason for the colonic dysmotility.
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Affiliation(s)
- Qianqian Wang
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.,Department of Pediatric Surgery, Jiaxing Maternity and Child Health Care Hospital, Jiaxing, China
| | - Jingyu Zang
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.,Department of Pediatric Surgery, Jiaxing Maternity and Child Health Care Hospital, Jiaxing, China
| | - Xu Huang
- Department of Anatomy and Physiology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hongli Lu
- Department of Anatomy and Physiology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wenxie Xu
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.,Department of Anatomy and Physiology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jie Chen
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.,Department of Pediatric Surgery, Jiaxing Maternity and Child Health Care Hospital, Jiaxing, China
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58
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Harnsberger CR. Acute colonic pseudo-obstruction (Ogilvie's syndrome). SEMINARS IN COLON AND RECTAL SURGERY 2019. [DOI: 10.1016/j.scrs.2019.100690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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59
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Cheong JY, Byrne C, Austin K. Novel technique of insertion of decompression tube for Ogilvie's syndrome/colonic pseudo-obstruction. ANZ J Surg 2019; 90:150-151. [PMID: 31450262 DOI: 10.1111/ans.15371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 05/27/2019] [Accepted: 06/22/2019] [Indexed: 12/23/2022]
Abstract
Novel technique of management of colonic pseudo-obstructing using colonoscopy guided insertion of decompression tube.
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Affiliation(s)
- Ju Yong Cheong
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Christopher Byrne
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Kirk Austin
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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60
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Hughes AE, Smart NJ, Daniels IR. Acute colonic pseudo‐obstruction after caesarean section: a review and recommended management algorithm. ACTA ACUST UNITED AC 2019. [DOI: 10.1111/tog.12602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Alice E Hughes
- Academic Clinical Fellow and ST2 trainee in Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology Rosie Hospital Cambridge CB2 0QQ UK
| | - Neil J Smart
- Consultant Colorectal Surgeon, Royal Devon and Exeter NHS Foundation Trust and Honorary Associate Professor, University of Exeter Medical School Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital Exeter EX2 5DW UK
| | - Ian R Daniels
- Consultant Colorectal Surgeon, Royal Devon and Exeter Hospital NHS Foundation Trust and Honorary Clinical Senior Lecturer, University of Exeter Medical School Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital Exeter EX2 5DW UK
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61
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Pérez-Lara JL, Santana Y, Hernández-Torres J, Díaz-Fuentes G. Acute Colonic Pseudo-Obstruction Caused by Dexmedetomidine: A Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:278-284. [PMID: 30826812 PMCID: PMC6410604 DOI: 10.12659/ajcr.913645] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Patient: Male, 50 Final Diagnosis: Acute colonic pseudo-obstruction Symptoms: Abdominal pain • cough • fever Medication: — Clinical Procedure: Colonoscopy decompression and colectomy Specialty: Critical Care Medicine
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Affiliation(s)
- Jose L Pérez-Lara
- Department of Internal Medicine, BronxCare Health System, Bronx, NY, USA.,Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Yaneidy Santana
- Department of Internal Medicine, BronxCare Health System, Bronx, NY, USA.,Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Janette Hernández-Torres
- Department of Internal Medicine, BronxCare Health System, Bronx, NY, USA.,Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Gilda Díaz-Fuentes
- Department of Internal Medicine, BronxCare Health System, Bronx, NY, USA.,Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
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62
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Wells CI, O'Grady G, Bissett IP. Colonic Electromechanical Abnormalities Underlying Post-operative Ileus: A Systematic and Critical Review. J Neurogastroenterol Motil 2019; 25:36-47. [PMID: 30504526 PMCID: PMC6326204 DOI: 10.5056/jnm18030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 06/20/2018] [Accepted: 07/21/2018] [Indexed: 12/25/2022] Open
Abstract
Post-operative ileus (POI) is an inevitable consequence of major abdominal surgery, and may be prolonged in up to 30% of patients. Ileus is commonly presumed to result from paralysis of the GI tract, though there is little direct evidence to support this view. The aim of this review is to systematically search and critically review the literature investigating post-operative colonic electrical and mechanical activity. MEDLINE and Embase databases were systematically searched for articles investigating post-operative colonic motor or electrical activity in human patients. Nineteen original articles investigating post-operative colonic motor or electrical activity were identified. Most studies have used low-resolution techniques, with intermittent recordings of colonic motility. Numerous studies have shown that colonic electrical and motor activity does not cease routinely following surgery, but is of abnormal character for 3–6 days following laparotomy. One recent high-resolution manometry study identified hyperactive cyclic motor patterns occurring in the distal colon on the first post-operative day. Low-resolution studies have shown colonic slow waves are not inhibited by surgery, and are present even in the immediate post-operative period. Recovery of normal motility appears to occur in a proximal to distal direction and is temporally correlated with the clinical return of bowel function. No studies have investigated motility specifically in prolonged POI. Future studies should use high-resolution techniques to accurately characterise abnormalities in electrical and mechanical function underlying POI, and correlate these changes with clinical recovery of bowel function.
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Affiliation(s)
- Cameron I Wells
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand
| | - Gregory O'Grady
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand.,Department of Surgery, Auckland District Health Board, Auckland, New Zealand.,Auckland Bioengineering Institute, The University of Auckland, New Zealand
| | - Ian P Bissett
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand.,Department of Surgery, Auckland District Health Board, Auckland, New Zealand
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63
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Deane AM, Chapman MJ, Reintam Blaser A, McClave SA, Emmanuel A. Pathophysiology and Treatment of Gastrointestinal Motility Disorders in the Acutely Ill. Nutr Clin Pract 2018; 34:23-36. [PMID: 30294835 DOI: 10.1002/ncp.10199] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Gastrointestinal dysmotility causes delayed gastric emptying, enteral feed intolerance, and functional obstruction of the small and large intestine, the latter functional obstructions being frequently termed ileus and Ogilvie syndrome, respectively. In addition to meticulous supportive care, drug therapy may be appropriate in certain situations. There is, however, considerable variation among individuals regarding what gastric residual volume identifies gastric dysmotility and would encourage use of a promotility drug. While the administration of either metoclopramide or erythromycin is supported by evidence it appears that, dual-drug therapy (erythromycin and metoclopramide) reduces the rate of treatment failure. There is a lack of evidence to guide drug therapy of ileus, but neither erythromycin nor metoclopramide appear to have a role. Several drugs, including ghrelin agonists, highly selective 5-hydroxytryptamine receptor agonists, and opiate antagonists are being studied in clinical trials. Neostigmine, when infused at a relatively slow rate in patients receiving continuous hemodynamic monitoring, may alleviate the need for endoscopic decompression in some patients.
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Affiliation(s)
- Adam M Deane
- Intensive Care Unit, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Marianne J Chapman
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia.,Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, Australia
| | - Annika Reintam Blaser
- Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia.,Center of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Stephen A McClave
- Department of Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Anton Emmanuel
- Department of Neuro-Gastroenterology, University College London, London, UK
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64
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Opportunities and Challenges for Single-Unit Recordings from Enteric Neurons in Awake Animals. MICROMACHINES 2018; 9:mi9090428. [PMID: 30424361 PMCID: PMC6187697 DOI: 10.3390/mi9090428] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 08/17/2018] [Accepted: 08/23/2018] [Indexed: 12/18/2022]
Abstract
Advanced electrode designs have made single-unit neural recordings commonplace in modern neuroscience research. However, single-unit resolution remains out of reach for the intrinsic neurons of the gastrointestinal system. Single-unit recordings of the enteric (gut) nervous system have been conducted in anesthetized animal models and excised tissue, but there is a large physiological gap between awake and anesthetized animals, particularly for the enteric nervous system. Here, we describe the opportunity for advancing enteric neuroscience offered by single-unit recording capabilities in awake animals. We highlight the primary challenges to microelectrodes in the gastrointestinal system including structural, physiological, and signal quality challenges, and we provide design criteria recommendations for enteric microelectrodes.
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65
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Stoica RT, Cordoş I, Macri A. Post-Pneumonectomy ARDS and Ogilvie Syndrome - A Case Report. JOURNAL OF CRITICAL CARE MEDICINE (UNIVERSITATEA DE MEDICINA SI FARMACIE DIN TARGU-MURES) 2018; 4:34-37. [PMID: 29967899 DOI: 10.1515/jccm-2018-0007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 01/30/2018] [Indexed: 11/15/2022]
Abstract
Introduction The Acute Respiratory Distress Syndrome (ARDS) is a severe hypoxemic acute lung injury that may complicate lung resections. Reported mortality is very high, up to 50%. This report covers an ARDS case occurring post left pneumonectomy, with a favorable outcome, despite association with an acute colonic pseudo-obstruction syndrome (Ogilvie syndrome) that required abdominal surgery for decompression. Case Report A 60-year old Caucasian male, diagnosed with a stage IIIA left lung tumor underwent a left pneumonectomy. On the second postoperative day, the patient developed ARDS, requiring ventilatory support. Two days later, as the multiple organ dysfunction worsened, a bowel obstruction occurred. With an acute colonic pseudo-obstruction diagnosis, the decision was to perform laparotomy and a temporary cecostomy. A subsequent improvement in the respiratory parameters and vital functions resulted in weaning from ventilator 8 days after the onset of the ARDS and transfer to the surgery ward 14 days after pneumonectomy.
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Affiliation(s)
- Radu T Stoica
- "Marius Nasta" Pneumophtisiology Institute, Bucharest, Romania.,Faculty of Medicine, "Titu Maiorescu" University, Bucharest, Romania
| | - Ioan Cordoş
- "Marius Nasta" Pneumophtisiology Institute, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Anca Macri
- "Marius Nasta" Pneumophtisiology Institute, Bucharest, Romania
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66
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Lin YM, Fu Y, Hegde S, Tang Y, Radhakrishnan R, Shi XZ. Microsomal Prostaglandin E Synthase-1 Plays a Critical Role in Long-term Motility Dysfunction after Bowel Obstruction. Sci Rep 2018; 8:8831. [PMID: 29891860 PMCID: PMC5995953 DOI: 10.1038/s41598-018-27230-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 05/24/2018] [Indexed: 12/20/2022] Open
Abstract
Motility dysfunction is present not only during bowel obstruction (BO), but after obstruction is resolved. Previous studies found that lumen distension associated mechano-transcription of COX-2 and production of PGE2 in gut smooth muscle cells (SMC) account for motility dysfunction during obstruction. We hypothesized that PGE2 may exert autocrine effect in SMC to induce microsomal prostaglandin E synthase-1 (mPGES-1), which contributes to motility dysfunction after obstruction is resolved. Partial colon obstruction was induced in rats with an obstruction band, which was released 7 days later. Rats were further studied in the post-BO state. Circular muscle contractility of the mid colon (previously distended during obstruction) remained suppressed, and colon transit was impaired in the post-BO state. The COX-2, mPGES-1, and PGE2 levels were all increased in the distended bowel during obstruction. However, after obstruction was resolved, COX-2 expression returned to normal, whereas mPGES-1 and PGE2 levels remained increased. Expression of mPGES-1 in colon SMC was inducible by stretch or PGE2. Administration of mPGES-1 inhibitor Cay 10526 either before or after the release of obstruction normalized PGE2 levels and improved motility in the post-BO rats. In conclusion, mPGES-1 plays a critical role in the continuous suppression of motor function in the post-BO state.
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Affiliation(s)
- You-Min Lin
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Yu Fu
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Shrilakshmi Hegde
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Yanbo Tang
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA.,Department of Gastroenterology, The first Affiliated Hospital, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Ravi Radhakrishnan
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Xuan-Zheng Shi
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA.
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Shi XZ, Lin YM, Hegde S. Novel Insights Into the Mechanisms of Abdominal Pain in Obstructive Bowel Disorders. Front Integr Neurosci 2018; 12:23. [PMID: 29937720 PMCID: PMC6002527 DOI: 10.3389/fnint.2018.00023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 05/22/2018] [Indexed: 12/27/2022] Open
Abstract
Obstructive bowel disorders (OBD) are characterized by lumen distention due to mechanical or functional obstruction in the gut. Abdominal pain is one of the main symptoms in OBD. In this article, we aim to critically review the potential mechanisms for acute and chronic pain in bowel obstruction (BO). While clustered contractions and associated increase of intraluminal pressure may account for colicky pain in simple obstruction, ischemia may be involved in acute pain in severe conditions such as closed loop obstruction. Recent preclinical studies discovered that visceral sensitivity is increased in BO, and visceral hypersensitivity may underlie the mechanisms of chronic abdominal pain in BO. Mounting evidence suggests that lumen distension, as a circumferential mechanical stretch, alters gene expression (mechano-transcription) in the distended bowel, and mechano-transcription of nociceptive and inflammatory mediators plays a critical role in the development of visceral hypersensitivity in BO. Mechano-transcription of nerve growth factor (NGF) in gut smooth muscle cells is found to increase voltage-gated Na+ channel (Nav) activity of the primary sensory neurons by up-regulating expression of TTX-resistant Nav1.8, whereas mechanical stretch-induced brain-derived neurotrophic factor (BDNF) reduces Kv currents especially A-type (IA) currents by down-regulating expression of specific IA subtypes such as Kv1.4. The NGF and BDNF mediated changes in gene expression and channel functions in the primary sensory neurons may constitute the main mechanisms of visceral hypersensitivity in OBD. In addition, mechanical stretch-induced COX-2 and other inflammatory mediators in the gut may also contribute to abdominal pain by activating and sensitizing nociceptors.
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Affiliation(s)
- Xuan-Zheng Shi
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States
| | - You-Min Lin
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States
| | - Shrilakshmi Hegde
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States
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Hervik K, Vognild I, Bjerke LM, Almdahl SM. Gastropericardial fistula presenting with cardiac arrest: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2018; 2:yty057. [PMID: 31020136 PMCID: PMC6177083 DOI: 10.1093/ehjcr/yty057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/18/2018] [Indexed: 12/19/2022]
Abstract
Introduction Gastropericardial fistulas are rare conditions, with less than 100 reported cases. The diagnosis is associated with significant morbidity, prolonged hospitalization and often has a fatal outcome. Case presentation We describe a unique case of cardiac arrest caused by pneumopericardium and cardiac tamponade as the acute presentation of a gastropericardial fistula, in a patient admitted with an infection of unknown origin. Rapid return of spontaneous circulation occurred, and a computed tomography scan revealed the diagnosis. A benign penetrating ulcer was found on gastroscopy, and surgical management with laparotomy and gastrorrhaphy was performed. The patient had no risk factors for gastric ulceration. However, he had significant comorbidity, which makes survival through a complicated postoperative course to full recovery remarkable. Discussion This case shows that pneumopericardium due to a penetrating benign gastric ulcer can cause cardiac tamponade, and illustrates the value of a multidisciplinary approach to management.
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Affiliation(s)
- Kjersti Hervik
- Department of Cardiothoracic and Vascular Surgery, University Hospital of North-Norway Tromsø, Tromsø, Norway
| | - Ingrid Vognild
- Department of Radiology, University Hospital of North-Norway Tromsø, Tromsø, Norway
| | - Lars Martin Bjerke
- Department of Gastrointestinal Surgery, University Hospital of North-Norway Harstad, Harstad, Norway
| | - Sven Martin Almdahl
- Department of Cardiothoracic and Vascular Surgery, University Hospital of North-Norway Tromsø, Tromsø, Norway
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Ladopoulos T, Giannaki M, Alexopoulou C, Proklou A, Pediaditis E, Kondili E. Gastrointestinal dysmotility in critically ill patients. Ann Gastroenterol 2018; 31:273-281. [PMID: 29720852 PMCID: PMC5924849 DOI: 10.20524/aog.2018.0250] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 01/30/2018] [Indexed: 12/17/2022] Open
Abstract
Gastrointestinal (GI) motility disorders are commonly present in critical illness. Up to 60% of critically ill patients have been reported to experience GI dysmotility of some form necessitating therapeutic intervention. It has been attributed to various factors, related to both the underlying disease and the therapeutic interventions undertaken. The assessment of motility disturbances can be challenging in critically ill patients, as the available tests used to detect abnormal motility have major limitations in the setting of an Intensive Care Unit. Critically ill patients with GI dysmotility require a multifaceted treatment approach that addresses multiple causes and utilizes multiple pharmacological pathways. In this review, we discuss the pathophysiology, assessment and management of GI dysmotility in critically ill patients.
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Affiliation(s)
- Theodoros Ladopoulos
- Department of Intensive Care Medicine, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Maria Giannaki
- Department of Intensive Care Medicine, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Christina Alexopoulou
- Department of Intensive Care Medicine, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Athanasia Proklou
- Department of Intensive Care Medicine, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Emmanuel Pediaditis
- Department of Intensive Care Medicine, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Eumorfia Kondili
- Department of Intensive Care Medicine, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Crete, Greece
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Mira FS, Mendes J, Temido H, Gaspar E. Respiratory symptoms of an abdominal origin. BMJ Case Rep 2018; 2018:bcr-2017-224098. [DOI: 10.1136/bcr-2017-224098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
Abstract
Introduction: The Acute Respiratory Distress Syndrome (ARDS) is a severe hypoxemic acute lung injury that may complicate lung resections. Reported mortality is very high, up to 50%. This report covers an ARDS case occurring post left pneumonectomy, with a favorable outcome, despite association with an acute colonic pseudo-obstruction syndrome (Ogilvie syndrome) that required abdominal surgery for decompression.
Case report: A 60-year old Caucasian male, diagnosed with a stage IIIA left lung tumor underwent a left pneumonectomy. On the second postoperative day, the patient developed ARDS, requiring ventilatory support. Two days later, as the multiple organ dysfunction worsened, a bowel obstruction occurred. With an acute colonic pseudo-obstruction diagnosis, the decision was to perform laparotomy and a temporary cecostomy. A subsequent improvement in the respiratory parameters and vital functions resulted in weaning from ventilator 8 days after the onset of the ARDS and transfer to the surgery ward 14 days after pneumonectomy.
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