1
|
VON-Diemen V, Volkweis BS, Martins EF, Silva LLDM, Cavazzola LT. THE WATER-SOLUBLE CONTRAST FOR ADHESIVE SMALL BOWEL OBSTRUCTION: ARE THERE ADVANTAGES? ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2023; 36:e1777. [PMID: 38088723 PMCID: PMC10712923 DOI: 10.1590/0102-672020230059e1777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 09/21/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Adhesive small bowel obstruction is one of the most common causes of surgical emergencies, representing about 15% of hospital admissions. Defining the need and timing of surgical intervention still remains a challenge. AIMS To report the experience of using meglumine-based water-soluble contrast in a tertiary hospital in southern Brazil, comparing with the world literature. METHODS Patients suspected of having adhesive small bowel obstruction, according to their clinical conditions, underwent an established protocol, consisting of the administration of water-soluble contrast, followed by plain abdominal radiograph within 12 hours and by a new clinical evaluation. The protocol was initiated after starting conservative management, including fasting and placement of a nasogastric tube, as well as intravenous fluid reposition. RESULTS A total of 126 patients were submitted to the protocol. The water-soluble contrast test sensitivity and specificity after the first radiograph were 94.6 and 91.0%, respectively; after the second radiograph, these values were 92.3 and 100%. The general test values for sensitivity and specificity were 91.9 and 100%, respectively. CONCLUSIONS The measure parameters evaluated in this study were similar to those found in the literature, contributing to endorse the importance of this test in the evaluation of patients with adhesive small bowel obstruction. The particular relevance of this study was the similar results that were found using a different type of meglumine-based contrast, which is available in Brazil.
Collapse
Affiliation(s)
- Vinicius VON-Diemen
- Universidade Federal do Rio Grande do Sul, Porto Alegre University Hospital, General Surgery Service - Porto Alegre (RS), Brazil
| | - Bernardo Silveira Volkweis
- Universidade Federal do Rio Grande do Sul, Porto Alegre University Hospital, General Surgery Service - Porto Alegre (RS), Brazil
| | - Eduardo Ferreira Martins
- Universidade Federal do Rio Grande do Sul, Porto Alegre University Hospital, General Surgery Service - Porto Alegre (RS), Brazil
| | - Lara Luz de Miranda Silva
- Universidade Federal do Rio Grande do Sul, Porto Alegre University Hospital, General Surgery Service - Porto Alegre (RS), Brazil
| | - Leandro Totti Cavazzola
- Universidade Federal do Rio Grande do Sul, Porto Alegre University Hospital, General Surgery Service - Porto Alegre (RS), Brazil
| |
Collapse
|
2
|
Jung KS, Choi KJ, Yoon KW, Yoo K, Gil E, Park CM. Feasibility of the Gastrografin Challenge for Adhesive Small Bowel Obstruction. JOURNAL OF ACUTE CARE SURGERY 2021. [DOI: 10.17479/jacs.2021.11.2.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Purpose: This retrospective study investigated the feasibility, diagnostic, and therapeutic advantages of the gastrografin challenge on patients with adhesive small bowel obstruction (ASBO). Methods: There were 125 patients reviewed who were admitted to the Department of General Surgery at a single institution (September 2018 to August 2019) with a diagnosis related to ASBO. The study population included 100 patients (114 cases) who had received initial conservative management. Patient characteristics and operation rates were compared between the gastrografin challenge success group and failure group, and operation rates and length of hospital stay were compared between the gastrografin challenge group and “non-challenge” group. Results: During the study period, 21 patients with ASBO underwent the gastrografin challenge. The challenge was successful in 17 patients where the bowel obstruction was resolved without the need for surgery. Among patients who failed the challenge, 2 patients underwent adhesiolysis and 2 patients were able to progress their diet avoiding surgery. In patients who underwent surgery (<i>n</i> = 2), the length of hospital stay was significantly shorter in the gastrografin challenge group compared with the “non-challenge” group sub analysis (<i>n</i> = 13 cases; 10.5 vs. 20 days, <i>p</i> = 0.038), indicating that the gastrografin challenge assisted rapid decision-making for surgery. No adverse events were reported for the 21 gastrografin challenges. Conclusion: In patients with ASBO, the gastrografin challenge is an accurate, safe method to determine the need for surgery. In addition, the gastrografin challenge may reduce the length of stay in patients who required surgery for ASBO resolution.
Collapse
|
3
|
Mansoori B, Vasan V, Xi Y, Fielding JR. Variations in use of "water soluble contrast challenge" for small bowel obstruction among academic radiologists: results of a national survey. Abdom Radiol (NY) 2020; 45:1050-1056. [PMID: 32052131 DOI: 10.1007/s00261-020-02436-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To assess the frequency and indications for use of oral water-soluble contrast challenge as a diagnostic test for small bowel obstruction in four regions of the USA. MATERIALS AND METHODS We distributed a 9-question web-based survey to the abdominal section heads of academic radiology departments throughout the USA (N = 97). The questions pertained to use of water-soluble contrast for management of small bowel obstruction. Descriptive statistics and Fisher's exact tests were used for data analysis. RESULTS The overall response rate was 46%. Eighty percent of the responding hospitals had more than 500 beds in operation. Water-soluble contrast challenge was considered standard of care for management of non-operative small bowel obstruction in 60% of the responding radiology departments. The majority of the responding departments (41%) performed 2-8 contrast challenge studies per month on average. The most frequent indication for the study was distinguishing partial vs complete bowel obstruction. Eighty percent of the responding radiologists believed that the contrast challenge is useful for management of small bowel obstruction. Overall, there was no statistically significant difference in frequency and indication for use of water-soluble contrast challenge based on geographic location. CONCLUSION The water-soluble contrast challenge was considered standard of care for non-operative management of small bowel obstruction in majority of the academic radiology departments represented in this survey. Surgeons were referring clinicians in every case. The most common clinical indication for the study was distinguishing partial versus complete small bowel obstruction.
Collapse
Affiliation(s)
- Bahar Mansoori
- Abdominal Imaging Division, Department of Radiology, University of Washington Medical Center, Seattle, WA, USA.
| | - Vasantha Vasan
- Abdominal Imaging Division, Department of Radiology, University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | - Yin Xi
- Abdominal Imaging Division, Department of Radiology, University of Texas, Southwestern Medical Center, Dallas, TX, USA.,Department of Population and Data Sciences, University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | - Julia R Fielding
- Abdominal Imaging Division, Department of Radiology, University of Texas, Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
4
|
Koh A, Adiamah A, Chowdhury A, Mohiuddin MK, Bharathan B. Therapeutic Role of Water-Soluble Contrast Media in Adhesive Small Bowel Obstruction: a Systematic Review and Meta-Analysis. J Gastrointest Surg 2020; 24:473-483. [PMID: 31485900 DOI: 10.1007/s11605-019-04341-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/22/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Adhesive small bowel obstruction (ASBO) is a common post-operative cause of hospitalisation. Water-soluble contrast media (WSCM) has become a popular non-surgical approach to treatment. However, previous reviews have concluded with conflicting results. This meta-analysis of randomised controlled trials (RCTs) re-evaluated the therapeutic value of WSCM in the management of ASBO. METHODS A comprehensive search of PubMed, Embase, and Cochrane databases was undertaken to identify RCTs from January 2000 to November 2018. The primary outcomes of length of stay and secondary outcomes of time to resolution, need for surgery, and mortality were extracted from the included studies. Quantitative pooling of the data was based on the random effects model. RESULTS Eight hundred and seventy-nine patients from the nine studies were included in the analysis. The administration of oral WSCM reduced the length of hospital stay (weighted mean difference - 0.15 days, P < 0.0001). However, WSCM does not reduce the need for surgery (relative risk 0.84, P < 0.009) and makes no difference to mortality rate (RR 0.99, P < 1.000). The definition of time to resolution of ASBO differed between the studies, ranging from time to passing flatus, to cessation of abdominal pain, and time to initiating oral intake. The significant differences in definition precluded meaningful quantitative pooling of this outcome. CONCLUSIONS This meta-analysis evaluating the therapeutic value of WSCM has shown that it does not reduce the need for operative management in ASBO or impact mortality rates. It shortens hospital stay by 0.15 days (3.6 h) which is not clinically significant.
Collapse
Affiliation(s)
- Amanda Koh
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Biomedical Research Centre, Queens Medical Centre, Nottingham, NG7 2UH, UK
| | - Alfred Adiamah
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Biomedical Research Centre, Queens Medical Centre, Nottingham, NG7 2UH, UK.
| | - Abeed Chowdhury
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Biomedical Research Centre, Queens Medical Centre, Nottingham, NG7 2UH, UK
| | - Mohamed Khalid Mohiuddin
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Biomedical Research Centre, Queens Medical Centre, Nottingham, NG7 2UH, UK
| | - Balamurali Bharathan
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Biomedical Research Centre, Queens Medical Centre, Nottingham, NG7 2UH, UK
| |
Collapse
|
5
|
Linden AF, Raiji MT, Kohler JE, Carlisle EM, Pelayo JC, Feinstein K, Kandel JJ, Mak GZ. Evaluation of a water-soluble contrast protocol for nonoperative management of pediatric adhesive small bowel obstruction. J Pediatr Surg 2019; 54:184-188. [PMID: 30414689 DOI: 10.1016/j.jpedsurg.2018.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 10/01/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND/PURPOSE We examined outcomes before and after implementing an enteral water-soluble contrast protocol for management of pediatric adhesive small bowel obstruction (ASBO). METHODS Medical records were reviewed retrospectively for all children admitted with ASBO between November 2010 and June 2017. Those admitted between November 2010 and October 2013 received nasogastric decompression with decision for surgery determined by surgeon judgment (preprotocol). Patients admitted after October 2013 (postprotocol) received water-soluble contrast early after admission, were monitored with serial examinations and radiographs, and underwent surgery if contrast was not visualized in the cecum by 24 h. Group outcomes were compared. RESULTS Twenty-six patients experienced 29 admissions preprotocol, and 11 patients experienced 12 admissions postprotocol. Thirteen (45%) patients admitted preprotocol underwent surgery, versus 2 (17%) postprotocol patients (p = 0.04). Contrast study diagnostic sensitivity as a predictor for ASBO resolution was 100%, with 90% specificity. Median overall hospital LOS trended shorter in the postprotocol group, though was not statistically significant (6.2 days (preprotocol) vs 3.6 days (postprotocol) p = 0.12). Pre- vs. postprotocol net operating cost per admission yielded a savings of $8885.42. CONCLUSIONS Administration of water-soluble contrast after hospitalization for pediatric ASBO may play a dual diagnostic and therapeutic role in management with decreases in surgical intervention, LOS, and cost. TYPE OF STUDY Retrospective comparative study. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Allison F Linden
- University of Chicago Medicine Comer Children's Hospital, 5841 S. Maryland Ave, MC 4062, Chicago, IL, USA 60637.
| | - Manish T Raiji
- University of Chicago Medicine Comer Children's Hospital, 5841 S. Maryland Ave, MC 4062, Chicago, IL, USA 60637.
| | - Jonathan E Kohler
- University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, MC 7375, Madison, WI, USA 53792.
| | - Erica M Carlisle
- University of Iowa Children's Hospital, 200 Hawkins Drive, Iowa City, IA, USA 52242.
| | - J Carlos Pelayo
- Children's Hospital Los Angeles, Keck School of Medicine, 4650 Sunset Blvd, Mailstop 100, Los Angeles, CA, USA 90027.
| | - Kate Feinstein
- University of Chicago Medicine Comer Children's Hospital, 5841 S. Maryland Ave, MC 2026, Chicago, IL, USA 60637.
| | - Jessica J Kandel
- University of Chicago Medicine Comer Children's Hospital, 5841 S. Maryland Ave, MC 4062, Chicago, IL, USA 60637.
| | - Grace Z Mak
- University of Chicago Medicine Comer Children's Hospital, 5841 S. Maryland Ave, MC 4062, Chicago, IL, USA 60637.
| |
Collapse
|
6
|
Milne TGE, Vather R, O'Grady G, Miquel J, Biondo S, Bissett I. Gastrografin may reduce time to oral diet in prolonged post-operative ileus: a pooled analysis of two randomized trials. ANZ J Surg 2018; 88. [PMID: 29510463 DOI: 10.1111/ans.14443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 01/09/2018] [Accepted: 01/13/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Gastrografin has been suggested as a rescue therapy for prolonged post-operative ileus (PPOI) but trial data has been inconclusive. This study aimed to determine the benefit of gastrografin use in patients with PPOI by pooling the results of two recent randomized controlled trials assessing the efficacy of gastrografin compared to placebo given at time of PPOI diagnosis. METHODS Anonymized, individual patient data from patients undergoing elective bowel resection for any indication were included, stoma closure was excluded. The primary outcome was duration of PPOI. Secondary outcomes were time to tolerate oral diet, passage of flatus/stool, requirement and duration of nasogastric tube, length of post-operative stay and rate of post-operative complications. RESULTS Individual patient data were pooled for analysis (53 gastrografin, 55 placebo). Gastrografin trended towards a reduction in PPOI duration compared to placebo, respectively, median 96 h (interquartile range, IQR, 78 h) versus median 120 h (IQR, 84 h), however, this result was non-significant (P = 0.11). In addition, no significant difference was detected between the two groups for time to passage of flatus/stool (P = 0.36) and overall length of stay (P = 0.35). Gastrografin conferred a significantly faster time to tolerate an oral diet compared to placebo (median 84 h versus median 107 h, P = 0.04). There was no difference in post-operative complications between the two interventions (P > 0.05). CONCLUSION Gastrografin did not significantly reduce PPOI duration or length of stay after abdominal surgery, but did reduce time to tolerate a solid diet. Further studies are required to clarify the role of gastrografin in PPOI.
Collapse
Affiliation(s)
- Tony G E Milne
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Ryash Vather
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Gregory O'Grady
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Colorectal Unit, Department of Surgery, Auckland District Health Board, Auckland, New Zealand
| | - Jordi Miquel
- Colorectal Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona and IDIBELL, Barcelona, Spain
| | - Sebastiano Biondo
- Colorectal Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona and IDIBELL, Barcelona, Spain
| | - Ian Bissett
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Colorectal Unit, Department of Surgery, Auckland District Health Board, Auckland, New Zealand
| |
Collapse
|
7
|
Mori H, Kaneoka Y, Maeda A, Takayama Y, Takahashi T, Onoe S, Fukami Y. Determination of therapeutic strategy for adhesive small bowel obstruction using water-soluble contrast agents: An audit of 776 cases in a single center. Surgery 2017; 162:139-146. [PMID: 28347571 DOI: 10.1016/j.surg.2017.01.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 01/26/2017] [Accepted: 01/31/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Several studies have investigated the diagnostic and therapeutic role of water-soluble contrast agents in adhesive small bowel obstruction, but there is no clear diagnostic classification for the determination of therapeutic strategy. The aim of this study was to clarify the clinical value of classification using water-soluble contrast agents in patients with adhesive small bowel obstruction. METHODS Between January 2009 and December 2015, 776 consecutive patients with adhesive small bowel obstruction were managed initially with water-soluble contrast agents and were included in the study. Abdominal x-rays were taken 5 hours after administration of 100 mL water-soluble contrast agents and classified into 4 types. The medical records of the patients with adhesive small bowel obstruction were analyzed retrospectively and divided into 2 groups of patients with complete obstruction (ie, the absence of contrast agent in the colon) with (type I) or without (type II) a detectable point of obstruction and a group with an incomplete obstruction (ie, the presence of contrast agent in the colon) with (type IIIA) or without (type IIIB) dilated small intestine. RESULTS Types I, II, IIIA, and IIIB were identified in 27, 90, 358, and 301 patients, respectively. The overall operative rate was 16.6%. In the patients treated conservatively (types IIIA and IIIB), 647 patients (98.2%) were treated successfully without operative intervention. The operative rate was 3.4% (n = 12/358) in type IIIA vs 0% (n = 0/301) in the type IIIB group (P = .001). Compared with type IIIA, type IIIB was associated with earlier initiation of oral intake (2.1 vs 2.6 days, P < .001) and a lesser hospital stays (9 vs 11 days, P < .001). CONCLUSION This new classification using water-soluble contrast agents is a simple and useful diagnostic method for the determination of therapeutic strategy for adhesive small bowel obstruction.
Collapse
Affiliation(s)
- Haruki Mori
- Department of Surgery, Ogaki Municipal Hospital, Gifu, Japan
| | - Yuji Kaneoka
- Department of Surgery, Ogaki Municipal Hospital, Gifu, Japan
| | - Atsuyuki Maeda
- Department of Surgery, Ogaki Municipal Hospital, Gifu, Japan
| | - Yuichi Takayama
- Department of Surgery, Ogaki Municipal Hospital, Gifu, Japan
| | | | - Shunsuke Onoe
- Department of Surgery, Ogaki Municipal Hospital, Gifu, Japan
| | - Yasuyuki Fukami
- Department of Surgery, Ogaki Municipal Hospital, Gifu, Japan.
| |
Collapse
|
8
|
Water-soluble contrast agent in adhesive small bowel obstruction: a systematic review and meta-analysis of diagnostic and therapeutic value. Am J Surg 2016; 211:1114-25. [DOI: 10.1016/j.amjsurg.2015.06.012] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 06/21/2015] [Accepted: 06/29/2015] [Indexed: 11/22/2022]
|
9
|
Catena F, Di Saverio S, Coccolini F, Ansaloni L, De Simone B, Sartelli M, Van Goor H. Adhesive small bowel adhesions obstruction: Evolutions in diagnosis, management and prevention. World J Gastrointest Surg 2016; 8:222-231. [PMID: 27022449 PMCID: PMC4807323 DOI: 10.4240/wjgs.v8.i3.222] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 10/04/2015] [Accepted: 01/07/2016] [Indexed: 02/06/2023] Open
Abstract
Intra-abdominal adhesions following abdominal surgery represent a major unsolved problem. They are the first cause of small bowel obstruction. Diagnosis is based on clinical evaluation, water-soluble contrast follow-through and computed tomography scan. For patients presenting no signs of strangulation, peritonitis or severe intestinal impairment there is good evidence to support non-operative management. Open surgery is the preferred method for the surgical treatment of adhesive small bowel obstruction, in case of suspected strangulation or after failed conservative management, but laparoscopy is gaining widespread acceptance especially in selected group of patients. "Good" surgical technique and anti-adhesive barriers are the main current concepts of adhesion prevention. We discuss current knowledge in modern diagnosis and evolving strategies for management and prevention that are leading to stratified care for patients.
Collapse
|
10
|
Zhang X, Li H, Shen S, Cai M. Investigation of the flow-field in the upper respiratory system when wearing N95 filtering facepiece respirator. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2016; 13:372-82. [PMID: 26653154 DOI: 10.1080/15459624.2015.1116697] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This article presents a reverse modeling of the headform when wearing a filtering facepiece respirator (FFR) and a computational fluid dynamics (CFD) simulation based on the modeling. The whole model containing the upper respiratory airway, headform, and FFR was directly recorded by computed tomography (CT) scanning, and a medical contrast medium was used to make the FFR "visible." The FFR was normally worn by the subject during CT scanning so that the actual deformation of both the FFR and the face muscles during contact can be objectively conserved. The reverse modeling approach was introduced to rebuild the geometric model and convert it into a CFD solvable model. In this model, we conducted a transient numerical simulation of air flow containing carbon dioxide, thermal dynamics, and pressure and wall shear stress distribution in the respiratory system taking into consideration an individual wearing a FFR. The breathing cycle was described as a time-dependent profile of the air velocity through the respiratory airway. The result shows that wearing the N95 FFR results in CO2 accumulation, an increase in temperature and pressure elevation inside the FFR cavity. The volume fraction of CO2 reaches 1.2% after 7 breathing cycles and then is maintained at 3.04% on average. The wearers re-inhale excessive CO2 in every breathing cycle from the FFR cavity. The air temperature in the FFR cavity increases rapidly at first and then stays close to the exhaled temperature. Compared to not wearing an FFR, wearers have to increase approximately 90 Pa more pressure to keep the same breathing flow rate of 30.54 L/min after wearing an FFR. The nasal vestibule bears more wall shear stress than any other area in the airway.
Collapse
Affiliation(s)
- Xiaotie Zhang
- a School of Power and Mechanical Engineering, Wuhan University , Wuhan , China
| | - Hui Li
- a School of Power and Mechanical Engineering, Wuhan University , Wuhan , China
| | - Shengnan Shen
- a School of Power and Mechanical Engineering, Wuhan University , Wuhan , China
| | - Mang Cai
- a School of Power and Mechanical Engineering, Wuhan University , Wuhan , China
| |
Collapse
|
11
|
A protocol for the management of adhesive small bowel obstruction. J Trauma Acute Care Surg 2015; 78:13-9; discussion 19-21. [PMID: 25539198 DOI: 10.1097/ta.0000000000000491] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Differentiating between partial adhesive small bowel obstruction (aSBO) likely to resolve with medical management and complete obstruction requiring operative intervention remains elusive. We implemented a standardized protocol for the management of aSBO and reviewed our experience retrospectively. METHODS Patients with symptoms of aSBO were admitted for intravenous fluid resuscitation, bowel rest, nasogastric tube decompression, and abdominal examinations every 4 hours. Laboratory values and a computed tomography scan of the abdomen and pelvis with intravenous contrast were obtained. Patients with peritonitis or computed tomography scan findings suggesting bowel compromise were taken to the operating room for exploration following resuscitation. All other patients received 80 mL of Gastroview (GV) and 40 mL of sterile water via nasogastric tube. Abdominal plain films were obtained at 4, 8, 12, and 24 hours. If contrast did not reach the colon within 24 hours, then operative intervention was performed. RESULTS Over 1 year, 91 patients were admitted with aSBO. Sixty-three patients received GV, of whom 51% underwent surgery. Twenty-four patients went directly to the operating room because of clinical or imaging findings suggesting bowel ischemia. Average time to surgery was within 1 day for the no-GV group and 2 days for the GV group. Patients passing GV to the colon within 5 hours of administration had a 90% rate of resolution of obstruction. There was a direct relationship between the duration of time before passing GV to the colon and hospital length of stay (HLOS) (r = 0.459). Patients who received GV and did not require surgery had lower HLOS (3 days vs. 11 days, p < 0.0001). CONCLUSION The GV protocol facilitated early recognition of complete obstruction. Administration of GV had diagnostic and therapeutic value and did not increase HLOS, morbidity, or mortality. LEVEL OF EVIDENCE Therapeutic study, level V. Epidemiologic study, level V.
Collapse
|
12
|
Beutner U, Leowardi C, Bork U, Lüthi C, Tarantino I, Pahernik S, Wente MN, Büchler MW, Schmied BM, Müller SA. Survival after renal cell carcinoma metastasis to the thyroid: single center experience and systematic review of the literature. Thyroid 2015; 25:314-24. [PMID: 25491306 DOI: 10.1089/thy.2014.0498] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Renal cell carcinoma can metastasize to uncommon sites, for example, the thyroid gland where metastases are rarely found. To determine the patient survival and the time between cancer diagnosis and thyroid metastasis, we analyzed a large patient cohort from our hospital records and performed a systematic review. PATIENTS AND METHODS Patients diagnosed between 1978 and 2007 with thyroid metastases from renal cell carcinoma were retrospectively identified from the hospital database. A systematic literature search was performed for publications describing at least three cases of thyroid metastasis from renal cell carcinoma. Case data from the identified studies were collected and used to determine the survival data. RESULTS We identified 34 patients (19 females) from our hospital records with a mean age of 67 years (range, 33-79) when thyroid metastasis was diagnosed. Median time to primary metastasis after resection of renal cell carcinoma was 6.5 years (range, 0-25) with a single case of synchronous metastasis. Median survival after primary metastasis was 4.7 years (95% confidence interval [CI]: 1.8-7.6). The systematic review included 32 studies with 285 patients. Case data could be extracted for 202 patients. Median time to thyroid metastasis (without synchronous cases) was 8.8 years (95% CI: 7.5-10.1). Median actuarial survival after thyroid metastasis was 3.4 years (95% CI: 2.2-4.6). Total thyroidectomy was not associated with a better survival compared to partial thyroidectomies. CONCLUSIONS Time to thyroid metastasis of renal cell carcinoma can be very long, and survival after thyroidectomy is favorable compared to metastasis to other sites.
Collapse
Affiliation(s)
- Ulrich Beutner
- 1 Department of Surgery, Kantonsspital St. Gallen , St. Gallen, Switzerland
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Fukami Y, Kurumiya Y, Mizuno K, Sekoguchi E, Kobayashi S. Clinical effect of hyperbaric oxygen therapy in adhesive postoperative small bowel obstruction. Br J Surg 2014; 101:433-7. [PMID: 24496799 DOI: 10.1002/bjs.9389] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND Hyperbaric oxygen (HBO) therapy is a controversial treatment for adhesive postoperative small bowel obstruction, with only a few small studies reported. The aim of this study was to assess the clinical value of HBO therapy in the treatment of adhesive postoperative small bowel obstruction. METHODS Between April 2006 and March 2012, all patients with adhesive postoperative small bowel obstruction were treated using either decompression therapy or HBO. Patients undergoing HBO therapy were treated once a day at a pressure of 2·0 atmospheres absolute and received 100 per cent oxygen. Patients showing no clinical and radiological improvement with HBO therapy were converted to decompression therapy by means of a long tube. Medical records were reviewed and outcomes analysed. RESULTS A total of 305 patients were treated, of whom 142 underwent tube decompression therapy during the first 3 years and the remaining 163 had HBO therapy during the last 3 years. The median number of HBO treatments was 3 (range 1-7). A total of 143 patients (87·7 per cent) were treated successfully with HBO without long-tube decompression. HBO therapy was associated with earlier resumption of oral intake (mean 4·7 versus 6·5 days; P = 0·001) and a shorter hospital stay (mean 10·3 versus 14·1 days; P = 0·001). The rate of operation was 7·4 per cent in the HBO group and 14·8 per cent in group treated by decompression alone (P = 0·037). CONCLUSION In this study, HBO therapy was safe for the treatment of adhesive postoperative small bowel obstruction. It reduced the need for surgery and time to recovery as well as the hospital stay.
Collapse
Affiliation(s)
- Y Fukami
- Department of Surgery, Toyota Kosei Hospital, 500-1 Josui-cho, Toyota, Aichi 470-0396, Japan
| | | | | | | | | |
Collapse
|
14
|
Evaluation and management of small-bowel obstruction: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 2013; 73:S362-9. [PMID: 23114494 DOI: 10.1097/ta.0b013e31827019de] [Citation(s) in RCA: 163] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Small-bowel obstruction (SBO) represents as many as 16% of surgical admissions and more than 300,000 operations annually in the United States. The optimal strategies for the diagnosis and management of SBO continue to evolve secondary to advances in imaging techniques, critical care, and surgical techniques. This updated systematic literature review was developed by the Eastern Association for the Surgery of Trauma to provide up-to-date evidence-based recommendations for SBO. METHODS A search of the National Library of Medicine MEDLINE database was performed using PubMed interface for articles published from 2007 to 2011. RESULTS The search identified 53 new articles that were then combined with the 131 studies previously reviewed by the 2007 guidelines. The updated guidelines were then presented at the 2012 annual EAST meeting. CONCLUSION Level I evidence now exists to recommend the use of computed tomographic scan, especially multidetector computed tomography with multiplanar reconstructions, in the evaluation of patients with SBO because it can provide incremental clinically relevant information over plains films that may lead to changes in management. Patients with evidence of generalized peritonitis, other evidence of clinical deterioration, such as fever, leukocytosis, tachycardia, metabolic acidosis, and continuous pain, or patients with evidence of ischemia on imaging should undergo timely exploration. The remainder of patients can safely undergo initial nonoperative management for both partial and complete SBO. Water-soluble contrast studies should be considered in patients who do not clinically resolve after 48 to 72 hours for both diagnostic and potential therapeutic purposes. Laparoscopic treatment of SBO has been demonstrated to be a viable alternative to laparotomy in selected cases.
Collapse
|
15
|
Prospective evaluation of oral gastrografin(®) in the management of postoperative adhesive small bowel obstruction. Indian J Surg 2012; 75:195-9. [PMID: 24426426 DOI: 10.1007/s12262-012-0479-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Accepted: 03/29/2012] [Indexed: 10/28/2022] Open
Abstract
Oral Gastrografin®, a hyperosmolar water-soluble contrast medium, may have a therapeutic effect in adhesive small bowel obstruction. However, findings are still conflicting, as some authors did not find a therapeutic advantage. So, this prospective, randomized, and clinical trial study was designed to determine the value of Gastrografin in adhesive small bowel obstruction. The primary end points were the evaluation of the operative rate reduction and shortening the hospital stay after the use of Gastrografin. A total of 84 patients were randomized into two groups: the control group received conventional treatment, whereas the study group received in addition of 100 mL Gastrografin meal. Patients were followed up within 4 days after admission, and clinical and radiological (if needed) improvements were evaluated. Although the results showed that Gastrografin can decrease the need for surgical management by 14.5 %, no statistically significant differences were observed between the two groups (P = 0.07). Nevertheless, the length of hospital stay revealed a significant reduction from 4.67 ± 1.18 days to 2.69 ± 1.02 days (P = 0.00). The use of Gastrografin in adhesive small bowel obstruction is safe and reduces the length of hospital stay. As a result, the cost of hospital bed occupancy is reduced. Hence, if there was no indication of emergency surgery, administration of oral Gastrografin as a nonoperative treatment in adhesive small bowel obstruction is also recommended.
Collapse
|
16
|
Chung AY, Tran TB, Brumund KT, Weisman RA, Bouvet M. Metastases to the thyroid: a review of the literature from the last decade. Thyroid 2012; 22:258-68. [PMID: 22313412 DOI: 10.1089/thy.2010.0154] [Citation(s) in RCA: 171] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although clinically evident metastases of nonthyroid malignancies (NTMs) to the thyroid gland are uncommon, it is important to suspect them in patients who present with a new thyroid mass and a history, however far back, of prior malignancy. In fact, metastases from NTMs to the thyroid gland have been reported in 1.4%-3% of all patients who have surgery for suspected cancer in the thyroid gland. Here we review the literature over the last decade regarding this topic. SUMMARY Based on recent literature, the most common NTMs that metastasize to the thyroid gland are renal cell (48.1%), colorectal (10.4%), lung (8.3%), and breast carcinoma (7.8%), and sarcoma (4.0%). Metastases of NTMs to the thyroid are more common in women than men (female to male ratio=1.4 to 1) and in nodular thyroid glands (44.2%). The mean and median intervals between diagnosing NTMs and their metastases to thyroid gland are 69.9 and 53 months, respectively. In 20% of cases the diagnosis of the NTM and its metastases to the thyroid was synchronous. Recent reports indicate that there is a higher frequency of sarcoma metastasizing to the thyroid gland than reported in prior years. Fine-needle aspiration biopsy (FNAB) of thyroid masses is useful in diagnosis of thyroid metastases. However, this requires information about the NTM so that the proper antibodies can be used for immunohistochemical analysis; therefore it is of lesser utility if the NTM is occult. In patients with preexisting thyroid pathology the FNAB diagnosis can be more difficult due to more than one lesion being present. CONCLUSIONS It is important to keep in mind that the thyroid gland can be a site of metastases for a variety of tumors when evaluating a thyroid nodule, especially in a patient with a prior history of malignancy. In patients with thyroid lesions and a history of malignant disease, regardless of time elapsed since the initial diagnosis of the primary neoplasm, disease recurrence or progression of malignancy must be considered until proven otherwise.
Collapse
Affiliation(s)
- Alice Y Chung
- Department of Surgery, University of California San Diego, La Jolla, California 92093, USA
| | | | | | | | | |
Collapse
|
17
|
Zielinski MD, Eiken PW, Heller SF, Lohse CM, Huebner M, Sarr MG, Bannon MP. Prospective, Observational Validation of a Multivariate Small-Bowel Obstruction Model to Predict the Need for Operative Intervention. J Am Coll Surg 2011; 212:1068-76. [DOI: 10.1016/j.jamcollsurg.2011.02.023] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Revised: 02/14/2011] [Accepted: 02/15/2011] [Indexed: 12/27/2022]
|
18
|
Abstract
SBO is a common disease with multiple causes. The most significant advances over the past several years have involved, first, decision-making techniques to promptly and accurately identify patients who will require exploration, and, second, the increasing use of laparoscopic techniques. "Complete" bowel obstruction is becoming an outdated term, as treatment algorithms use predictive models and oral contrast challenges to select patients for operation without recourse to the notion of "complete obstruction." Laparoscopic techniques are gaining acceptance as a primary modality in the treatment of SBO. Appropriate patient selection is necessary for success, but successful laparoscopic SBO management can reduce postoperative pain, minimize hospital stay, and may lead to fewer adhesions, possibly preventing further adhesive SBO. Strangulation obstruction is the major cause of morbidity and mortality in SBO. Although unrecognized strangulation obstructions remain, their incidence is decreasing with the new protocols in development. Future efforts should focus on incorporating predictive models into management with the goal of eliminating unrecognized strangulation obstructions. Further refinement of the predictive models incorporating outcomes of oral contrast challenges and molecular biomarker data may allow surgeons to reach this goal. In addition, the benefit of the elimination of interpractitioner variability conferred by standardized protocols will in itself improve patient outcomes.
Collapse
|
19
|
Zielinski MD, Eiken PW, Bannon MP, Heller SF, Lohse CM, Huebner M, Sarr MG. Small bowel obstruction-who needs an operation? A multivariate prediction model. World J Surg 2010; 34:910-9. [PMID: 20217412 DOI: 10.1007/s00268-010-0479-3] [Citation(s) in RCA: 133] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Proper management of small bowel obstruction (SBO) requires a methodology to prevent nontherapeutic laparotomy while minimizing the chance of overlooking strangulation obstruction causing intestinal ischemia. Our aim was to identify preoperative risk factors associated with strangulating SBO and to develop a model to predict the need for operative intervention in the presence of an SBO. Our hypothesis was that free intraperitoneal fluid on computed tomography (CT) is associated with the presence of bowel ischemia and need for exploration. METHODS We reviewed 100 consecutive patients with SBO, all of whom had undergone CT that was reviewed by a radiologist blinded to outcome. The need for operative management was confirmed retrospectively by four surgeons based on operative findings and the patient's clinical course. RESULTS Patients were divided into two groups: group 1, who required operative management on retrospective review, and group 2 who did not. Four patients who were treated nonoperatively had ischemia or died of malignant SBO and were then included in group 1; two patients who had a nontherapeutic exploration were included in group 2. On univariate analysis, the need for exploration (n = 48) was associated (p < 0.05) with a history of malignancy (29% vs. 12%), vomiting (85% vs. 63%), and CT findings of either free intraperitoneal fluid (67% vs. 31%), mesenteric edema (67% vs. 37%), mesenteric vascular engorgement (85% vs. 67%), small bowel wall thickening (44% vs. 25%) or absence of the "small bowel feces sign" (so-called fecalization) (10% vs. 29%). Ischemia (n = 11) was associated (p < 0.05 each) with peritonitis (36% vs. 1%), free intraperitoneal fluid (82% vs. 44%), serum lactate concentration (2.7 +/- 1.6 vs. 1.3 +/- 0.6 mmol/l), mesenteric edema (91% vs. 46%), closed loop obstruction (27% vs. 2%), pneumatosis intestinalis (18% vs. 0%), and portal venous gas (18% vs. 0%). On multivariate analysis, free intraperitoneal fluid [odds ratio (OR) 3.80, 95% confidence interval (CI) 1.5-9.9], mesenteric edema (OR 3.59, 95% CI 1.3-9.6), lack of the "small bowel feces sign" (OR 0.19, 95% CI 0.05-0.68), and a history of vomiting (OR 4.67, 95% CI 1.5-14.4) were independent predictors of the need for operative exploration (p < 0.05 each). The combination of vomiting, no "small bowel feces sign," free intraperitoneal fluid, and mesenteric edema had a sensitivity of 96%, and a positive predictive value of 90% (OR 16.4, 95% CI 3.6-75.4) for requiring exploration. CONCLUSION Clinical, laboratory, and radiographic factors should all be considered when making a decision about treatment of SBO. The four clinical features-intraperitoneal free fluid, mesenteric edema, lack of the "small bowel feces sign," history of vomiting-are predictive of requiring operative intervention during the patient's hospital stay and should be factored strongly into the decision-making algorithm for operative versus nonoperative treatment.
Collapse
Affiliation(s)
- Martin D Zielinski
- Division of Trauma, Critical Care, and General Surgery, Mary Brigh 2-810, St. Mary's Hospital, Mayo Clinic, 1216 Second Street SW, Rochester, MN, 55902, USA.
| | | | | | | | | | | | | |
Collapse
|
20
|
Branco BC, Barmparas G, Schnüriger B, Inaba K, Chan LS, Demetriades D. Systematic review and meta-analysis of the diagnostic and therapeutic role of water-soluble contrast agent in adhesive small bowel obstruction. Br J Surg 2010; 97:470-8. [PMID: 20205228 DOI: 10.1002/bjs.7019] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND This meta-analysis assessed the diagnostic and therapeutic role of water-soluble contrast agent (WSCA) in adhesive small bowel obstruction (SBO). METHODS PubMed, Embase and Cochrane databases were searched systematically. The primary outcome in the diagnostic role of WSCA was its ability to predict the need for surgery. In the therapeutic role, the following were evaluated: resolution of SBO without surgery, time from admission to resolution, duration of hospital stay, complications and mortality. To assess the diagnostic role of WSCA, pooled estimates of sensitivity, specificity, positive and negative predictive values, and likelihood ratios were derived. For the therapeutic role of WSCA, weighted odds ratio (OR) and weighted mean difference (WMD) were obtained. RESULTS Fourteen prospective studies were included. The appearance of contrast in the colon within 4-24 h after administration had a sensitivity of 96 per cent and specificity of 98 per cent in predicting resolution of SBO. WSCA administration was effective in reducing the need for surgery (OR 0.62; P = 0.007) and shortening hospital stay (WMD -1.87 days; P < 0.001) compared with conventional treatment. CONCLUSION Water-soluble contrast was effective in predicting the need for surgery in patients with adhesive SBO. In addition, it reduced the need for operation and shortened hospital stay.
Collapse
Affiliation(s)
- B C Branco
- Division of Trauma, Emergency Surgery and Surgical Critical Care, University of Southern California, Los Angeles, California, USA
| | | | | | | | | | | |
Collapse
|
21
|
Trésallet C, Lebreton N, Royer B, Leyre P, Godiris-Petit G, Menegaux F. Improving the management of acute adhesive small bowel obstruction with CT-scan and water-soluble contrast medium: a prospective study. Dis Colon Rectum 2009; 52:1869-76. [PMID: 19966635 DOI: 10.1007/dcr.0b013e3181b35c06] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE Adhesive small bowel obstruction is usually managed nonoperatively, but there is still debate over the optimal duration of nonoperative management and the factors that predict failure of medical treatment. The aim of this study was to evaluate an algorithm using CT-scans and Gastrografin in the management of small bowel obstruction. METHODS In a prospective study, each patient admitted for small bowel obstruction underwent a physical examination, a plain film, and a CT-scan evaluation. Patients underwent emergency surgical exploration when bowel ischemia was suspected. Other patients received oral Gastrografin, and a second plain abdominal radiograph was done after 12 hours. In patients with clinical improvement, the nasogastric tube was removed and an immediate liquid diet was resumed. Other patients were referred for surgery. RESULTS In total, 118 patients with 123 episodes of small bowel obstruction were included. Thirty-six (29%) required immediate surgery because they presented clinical characteristics of bowel ischemia (36/36; 100%) or a defect in vascularization of the small bowel on CT-scan (5/36; 14%). The 87 remaining patients were managed nonoperatively, of which 28 deteriorated and were referred for surgery. The 59 other patients showed clinical improvement. CONCLUSION This study demonstrated the diagnostic role of Gastrografin(R) in discriminating between partial and complete small bowel obstruction. CT-scans were disappointing in their ability to predict the necessity of emergent laparotomies. We therefore recommend the use of Gastrografin(R) in adhesive small bowel obstruction patients who do not have clinical evidence of bowel ischemia. CT-scans should not be routinely performed in the decision-making process except when clinical history, physical examination, and plain film are not conclusive for small bowel obstruction diagnosis.
Collapse
Affiliation(s)
- Christophe Trésallet
- Department of General and Digestive Surgery, Hôpital de la Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie, 75013 Paris, France.
| | | | | | | | | | | |
Collapse
|
22
|
Di Saverio S, Catena F, Ansaloni L, Gavioli M, Valentino M, Pinna AD. Water-soluble contrast medium (gastrografin) value in adhesive small intestine obstruction (ASIO): a prospective, randomized, controlled, clinical trial. World J Surg 2009; 32:2293-304. [PMID: 18688562 DOI: 10.1007/s00268-008-9694-6] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Patients with adhesive small intestine obstruction (ASIO) are difficult to evaluate and to manage and their treatment is still controversial. The diagnostic and therapeutic role of water-soluble contrast medium (Gastrografin) in ASIO is still debated. This study was designed to determine the therapeutic role of Gastrografin in patients with ASIO. METHODS The study was a multicenter, prospective, randomized, controlled investigation. The primary end points were the evaluation of the operative rate reduction and shortening the hospital stay after the use of Gastrografin. A total of 76 patients were randomized into two groups: the control group received traditional treatment (TT), whereas the study group (GG) received in addition a Gastrografin meal and follow-through study immediately. Patients with Gastrografin in the colon within 36 hours were considered to be partially obstructed and submitted to nonoperative management. If after 36 hours, the Gastrografin had not entered the colon, the subjects were submitted to laparotomy. RESULTS No significant differences were found in age, sex, intravenous administration of prokinetics, incidence and characteristics of the previous procedures in surgical history of the patients, previous episodes of ASIO and surgery for adhesiolysis, or duration of symptoms before admission. In the GG group obstruction resolved subsequently in 31 of 38 cases (81.5%) after a mean time of 6.4 hours. The remaining seven patients were submitted to surgery, and one of them needed bowel resection for strangulation. In the control group, 21 patients were not submitted to surgery (55%), whereas 17 showed persistent untreatable obstruction and required laparotomy: 2 of them underwent bowel resection for strangulation. The difference in the operative rate between the two treatment groups reached statistical significance (p = 0.013). The time from the hospital admission for obstruction to resolution of symptoms was significantly lower in the GG group (6.4 vs. 43 hours; p < 0.01). The length of hospital stay revealed a significant reduction in the GG group (4.7 vs. 7.8 days; p < 0.05). This reduction was more evident in the subset of patients who did not require surgery (3 vs. 5.1 days; p < 0.01). No GG-related complications or significant differences in major complications and the relapse rate were found (relapse rate, 34.2% after a mean time to relapse of 6.3 months in the GG group vs. 42.1% after 7.6 months in the TT; p = not significant). CONCLUSIONS Data showed that the use of Gastrografin in ASIO is safe and reduces the operative rate and the time to resolution of obstruction, as well as the hospital stay.
Collapse
Affiliation(s)
- Salomone Di Saverio
- Emergency Surgery Unit, Department of Surgery, S. Orsola Malpighi University Hospital, University of Bologna, Via Massarenti 9, Bologna, Italy.
| | | | | | | | | | | |
Collapse
|
23
|
Yagci G, Kaymakcioglu N, Can MF, Peker Y, Cetiner S, Tufan T. Comparison of Urografin Versus Standard Therapy in Postoperative Small Bowel Obstruction. J INVEST SURG 2009; 18:315-20. [PMID: 16319052 DOI: 10.1080/08941930500328789] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Water-soluble contrast media (Urografin) cause redistribution of intravascular and extracellular fluid into intestinal lumen due to their hyperosmolarity. As a consequence, these media decrease intestinal wall edema and act as a direct stimulant to intestinal peristalsis. In this prospective study, we aimed to examine objectively the therapeutic role and ability of Urografin in patients with postoperative small bowel obstruction for whom failed to respond to conservative treatment. Three hundred and seventeen patients with postoperative small bowel obstruction due to intraperitoneal adhesions were included prospectively in this study. In the Urografin group, 40 mL Urografin diluted in 40 mL distilled water was administered through the nasogastric tube. No contrast media were administered in the control group, but the patients were decompressed via a nasogastric tube continuously. The number of obstruction episode in 317 patients was 338. In total, 199 patients were in the Urografin group, and 118 patients were in the control group. In the Urografin group, 178 (89.4%) patients responded successfully to the treatment, but 21 (11.6%) patients underwent surgical operation. Intensive intraabdominal adhesions and obstructing fibrous bands were observed and repaired in 15 (71.4%) patients at the operation, while 6 patients underwent segmental small intestine resection in control group, conventional management was successful in only 89 (75.4%) patients, and the remaining 29 (24.6%) patients underwent surgical intervention. In conclusion, it was suggested that in patients with intestinal obstruction due to postoperative intra-abdominal adhesion, water-soluble contrast media such as Urografin may be safely administered via a nasogastric tube or oral route and may decrease the need for surgical operation; furthermore, they may help the physician to operate the patients who needs surgery as early as possible.
Collapse
Affiliation(s)
- Gokhan Yagci
- Department of General Surgery, Gulhane Military Medical Academy, Ankara, Turkey.
| | | | | | | | | | | |
Collapse
|
24
|
Farid M, Fikry A, El Nakeeb A, Fouda E, Elmetwally T, Yousef M, Omar W. Clinical impacts of oral gastrografin follow-through in adhesive small bowel obstruction (SBO). J Surg Res 2009; 162:170-6. [PMID: 19524265 DOI: 10.1016/j.jss.2009.03.092] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2008] [Revised: 03/25/2009] [Accepted: 03/30/2009] [Indexed: 12/24/2022]
Abstract
BACKGROUND Many studies have shown that gastrografin can be used for diagnosis of adhesive small bowel obstruction (ASBO) and for assessing the need for surgical intervention. However, several studies have reported conflicting results. Therefore, the aim of this study is to assess the diagnostic and therapeutic effect of gastrografin in ASBO. PATIENTS AND METHODS Altogether, 110 patients with ASBO were randomized into control and gastrografin groups. In the gastrografin group, 100 mL of the dye was administered through a nasogastric tube. Obstruction was considered complete if the contrast failed to reach the colon on the 24-h film. Patients with gastrografin in the colon within 24 h after dye administration were considered as partially obstructed, and were submitted to nonoperative treatment. The patients were operated on if they developed signs of strangulation or failed to improve within 48 h. RESULTS The overall operative rate was 14.5% in gastrografin group versus 34.5% in control group, P=0.04. The time from admission to resolution of symptoms was significantly lower in gastrografin group (19.5 versus 42.6 h, P=0.001), and the length of hospital stay was shorter in gastrografin group (3.8 versus 6.9 d 0.002), and in nonoperative patients (3.1 versus 5.1 days). Sensitivity, specificity, positive predictive value, and negative predictive value for gastrografin follow-through as an indicator for operative treatment of ASBO were 87.5%, 100%, 100 % , and 97.9%, respectively. CONCLUSIONS Oral gastrografin helps in the management of ASBO. Oral gastrografin is safe and reduces the operative rate and time of resolution as well as hospital stay.
Collapse
Affiliation(s)
- Mohammed Farid
- Department of General Surgery, Colorectal Surgery Unit, Mansoura University, Mansoura, Egypt
| | | | | | | | | | | | | |
Collapse
|
25
|
|
26
|
Iesalnieks I, Winter H, Bareck E, Sotiropoulos GC, Goretzki PE, Klinkhammer-Schalke M, Bröckner S, Trupka A, Anthuber M, Rupprecht H, Raab M, Meyer W, Reichmann F, Kästel M, Mayr M, Braun W, Schlitt HJ, Agha A. Thyroid metastases of renal cell carcinoma: clinical course in 45 patients undergoing surgery. Assessment of factors affecting patients' survival. Thyroid 2008; 18:615-24. [PMID: 18578610 DOI: 10.1089/thy.2007.0343] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Metastases of renal cell carcinoma (RCC) to the thyroid gland are uncommon. There is no clear consensus regarding the role of surgery in metastatic disease to the thyroid since most clinical studies include small numbers of patients. Also, risk factors associated with disease progression following thyroidectomy are not yet defined. We examined the determinants of the outcome in patients undergoing surgery for thyroid metastases of RCC. METHODS The medical records of 45 patients undergoing resection of thyroid metastases of RCC at 15 institutions in Germany and Austria were reviewed retrospectively. The outcome parameters assessed were overall survival and tumor-related survival. Factors associated with disease progression following thyroid surgery have been calculated. RESULTS The overall 5-year survival rate following thyroid metastasectomy was 51%. Nineteen patients died during the study: 14 of disseminated disease and 5 of non-tumor-related causes. In the multivariate analysis, the prognosis was significantly worse in patients older than > or = 70 years and in patients who had undergone nephrectomy for metastases in the contralateral kidney during the course of the disease. Nine patients developed a thyroid recurrence following surgery. No local disease relapse occurred if resection margins were documented to be free of the tumor. Of the 45 patients with thyroid metastases, 14 (31%) developed pancreatic metastases during the course of disease. Ten of these patients also underwent pancreatic surgery with a 5-year survival rate of 43% in this subgroup. CONCLUSIONS The overall survival of patients undergoing thyroidectomy for metastases of RCC is affected rather by general health status than by tumor-related factors. There is a significant coincidence of thyroid and pancreatic metastases of RCC.
Collapse
Affiliation(s)
- Igors Iesalnieks
- Department of Surgery, University of Regensburg, Regensburg, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Eloy JA, Mortensen M, Gupta S, Lewis MS, Brett EM, Genden EM. Metastasis of uterine leiomyosarcoma to the thyroid gland: case report and review of the literature. Thyroid 2007; 17:1295-7. [PMID: 17988195 DOI: 10.1089/thy.2007.0082] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Metastasis of uterine leiomyosarcoma to the thyroid is extremely rare. Only three cases have been previously reported. We present a case of uterine leiomyosarcoma metastatic to the thyroid gland and review the current literature on this topic.
Collapse
Affiliation(s)
- Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai School of Medicine, New York, New York 10029, USA.
| | | | | | | | | | | |
Collapse
|
28
|
Abbas S, Bissett IP, Parry BR. Oral water soluble contrast for the management of adhesive small bowel obstruction. Cochrane Database Syst Rev 2007; 2007:CD004651. [PMID: 17636770 PMCID: PMC6465054 DOI: 10.1002/14651858.cd004651.pub3] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Adhesions are the leading cause of small bowel obstruction. Gastrografin transit time may allow for the selection of appropriate patients for non-operative management. Some studies have shown when the contrast does not reach the colon after a designated time it indicates complete intestinal obstruction that is unlikely to resolve with conservative treatment. When the contrast does reach the large bowel, it indicates partial obstruction and patients are likely to respond to conservative treatment. Other studies have suggested that the administration of water-soluble contrast is therapeutic in resolving the obstruction. OBJECTIVES To determine the reliability of water-soluble contrast media and serial abdominal radiographs in predicting the success of conservative treatment in patients admitted with adhesive small bowel obstruction.Furthermore, to determine the efficacy and safety of water-soluble contrast media in reducing the need for surgical intervention and reducing hospital stay in adhesive small bowel obstruction. SEARCH STRATEGY The search was conducted using MESH terms: ''Intestinal obstruction'', ''water-soluble contrast'', "Adhesions" and "Gastrografin". The later combined with the Cochrane Collaboration highly sensitive search strategy for identifying randomised controlled trials and controlled clinical trials. SELECTION CRITERIA 1. Prospective studies were included to evaluate the diagnostic potential of water-soluble contrast in adhesive small bowel obstruction.2. Randomised clinical trials were selected to evaluate the therapeutic role. DATA COLLECTION AND ANALYSIS 1. Studies that addressed the diagnostic role of water-soluble contrast were critically appraised and data presented as sensitivities, specificities and positive and negative likelihood ratios. Results were pooled and summary ROC curve was constructed.2. A meta-analysis of the data from therapeutic studies was performed using the Mantel -Henszel test using both the fixed effect and random effect models. MAIN RESULTS The appearance of water-soluble contrast in the colon on an abdominal X ray within 24 hours of its administration predicts resolution of an adhesive small bowel obstruction with a pooled sensitivity of 0.97, specificity of 0.96. The area under the curve of the summary ROC curve is 0.98. Six randomised studies dealing with the therapeutic role of gastrografin were included in the review, water-soluble contrast did not reduce the need for surgical intervention (OR 0.81, p = 0.3). Meta-analysis of four of the included studies showed that water-soluble contrast did reduce hospital stay compared with placebo (WMD= - 1.83) P<0.001. AUTHORS' CONCLUSIONS Published literature strongly supports the use of water-soluble contrast as a predictive test for non-operative resolution of adhesive small bowel obstruction. Although Gastrografin does not cause resolution of small bowel obstruction there is strong evidence that it reduces hospital stay in those not requiring surgery.
Collapse
Affiliation(s)
- S Abbas
- University of Auckland, Surgery, Parks Road, Auckland, New Zealand.
| | | | | |
Collapse
|
29
|
Abbas SM, Bissett IP, Parry BR. Meta-analysis of oral water-soluble contrast agent in the management of adhesive small bowel obstruction. Br J Surg 2007; 94:404-11. [PMID: 17380561 DOI: 10.1002/bjs.5775] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Adhesions are the leading cause of small bowel obstruction. Identification of patients who require surgery is difficult. This review analyses the role of Gastrografin as a diagnostic and therapeutic agent in the management of adhesive small bowel obstruction. METHODS A systematic search of Medline, Embase and Cochrane databases was performed to identify studies of the use of Gastrografin in adhesive small bowel obstruction. Studies that addressed the diagnostic role of water-soluble contrast agent were appraised, and data presented as sensitivity, specificity, and positive and negative likelihood ratios. Results were pooled and a summary receiver-operator characteristic (ROC) curve was constructed. A meta-analysis of the data from six therapeutic studies was performed using the Mantel-Haenszel test and both fixed- and random-effect models. RESULTS The appearance of water-soluble contrast agent in the colon on an abdominal radiograph within 24 h of its administration predicted resolution of obstruction with a pooled sensitivity of 97 per cent and specificity of 96 per cent. The area under the summary ROC curve was 0.98. Water-soluble contrast agent did not reduce the need for surgical intervention (odds ratio 0.81, P = 0.300), but it did reduce the length of hospital stay for patients who did not require surgery compared with placebo (weighted mean difference--1.84 days; P < 0.001). CONCLUSION Published data strongly support the use of water-soluble contrast medium as a predictive test for non-operative resolution of adhesive small bowel obstruction. Although Gastrografin does not reduce the need for operation, it appears to shorten the hospital stay for those who do not require surgery.
Collapse
Affiliation(s)
- S M Abbas
- Department of Surgery, Auckland University Hospital, Auckland 1023, New Zealand.
| | | | | |
Collapse
|
30
|
Papi G, Fadda G, Corsello SM, Corrado S, Rossi ED, Radighieri E, Miraglia A, Carani C, Pontecorvi A. Metastases to the thyroid gland: prevalence, clinicopathological aspects and prognosis: a 10-year experience. Clin Endocrinol (Oxf) 2007; 66:565-71. [PMID: 17371476 DOI: 10.1111/j.1365-2265.2007.02773.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Metastases to thyroid (TM) are rarely observed in the clinical practice. OBJECTIVE To assess the prevalence, clinicopathological aspects and prognosis of TM, and to evaluate the role of thyroidectomy in the management of TM. METHODS The pathology files (databases) of two Italian Pathology Units were searched for thyroid cytology (FNAC) and histology reports covering the time period January 1993 through December 2003. RESULTS Thirty-six cases of TM were found, accounting for 0.13% of thyroidectomies and 0.07% of FNAC. The main site of origin of TM was the lung, followed by oesophagus, breast and kidney. TM patients were divided into two groups, based on whether they were (Group 1) or were not (Group 2) submitted to surgery. Thirty-five subjects diagnosed with the same primary tumours as TM patients, but without TM, served as controls. The mean patient age, the mean time from diagnosis of primary tumour to TM detection, and the mean survival time did not significantly differ in Group 1 and Group 2 (63.2 +/- 1.6 vs. 66.6 +/- 2.9 years, 24.7 +/- 8.6 vs. 19.7 +/- 4.4 months and 24.3 +/- 4.9 vs. 39 +/- 9.9 months, respectively). In contrast, the mean time from detection of TM to death was longer in Group 1 than in Group 2 (14.3 +/- 2.5 vs. 4.5 +/- 0.5 months, respectively; P = 0.002). The overall survival of TM patients and control subjects was not significantly different (33.7 +/- 6.6 vs. 32.3 +/- 6 months). CONCLUSIONS TM is a rare event, is more frequent in patients older than 60 years, and has the same impact on prognosis as nonthyroidal metastases. Although thyroidectomy may be useful to avoid further dissemination of the primary tumour in case of solitary TM, it does not contribute to prolonging patient's life.
Collapse
Affiliation(s)
- Giampaolo Papi
- Department of Internal Medicine, Endocrinology Unit, University of Modena and Reggio Emilia, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Cumbo-Nacheli G, de Sanctis JT, Chung MH. Proximal esophageal adenocarcinoma presenting as a thyroid mass: case report and review of the literature. Thyroid 2007; 17:267-9. [PMID: 17381361 DOI: 10.1089/thy.2006.0293] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Metastatic disease to the thyroid is not an unusual finding at autopsies, but it is rare to be found in clinical situations. We present the first case of adenocarcinoma of the proximal esophagus presenting as a thyroid mass in a young healthy patient without any previous history of malignancy. This case highlights the importance of thorough work-up when addressing a thyroid mass. A high index of suspicion should be maintained in order to be able to detect unusual etiologies of thyroid conditions, especially when histopathology is not characteristic for primary thyroidal malignancies.
Collapse
Affiliation(s)
- G Cumbo-Nacheli
- General Surgery Department, Grand Rapids Medical Education and Research Center, Michigan State University, Grand Rapids, Michigan, USA.
| | | | | |
Collapse
|
32
|
Iesalnieks I, Trupka A, Raab M, Glockzin G, Woenckhaus M, Schlitt HJ, Agha A. Renal cell carcinoma metastases to the thyroid gland-8 cases reported. Thyroid 2007; 17:49-52. [PMID: 17274749 DOI: 10.1089/thy.2006.0176] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Clinically important, isolated metastases to the thyroid gland is a rare occurrence. Renal cell carcinoma (RCC) is the most common primary tumor site. We report on 8 cases of late onset metachronous thyroid metastases of RCC. DESIGN Eight patients presented with metachronous thyroid metastases at a median of 12 years (range 9-18 years) after nephrectomy for RCC. Two patients had simultaneous lung and lymph node metastases, respectively. Four patients had been previously operated for other metastases 1 to 5 years earlier, three of them due to pancreatic metastases. The leading symptom was neck enlargement in all but one case. MAIN OUTCOME Four total thyroidectomies, 3 subtotal resections, and 1 lobectomy were performed. Complete removal of metastases were achieved in all but one case. There was no postoperative morbidity. Six metastases were bilateral, two unilateral. The 4 year overall survival rate following metastasectomy was 53%, median survival from the date of nephrectomy was 21 years. CONCLUSION Long-term survival can be achieved after resection of isolated metachronous RCC metastases to the thyroid gland. Total thyroidectomy is not required, unless it is necessary for complete metastasectomy.
Collapse
|
33
|
Sarr MG. How useful is methylglucamine diatrizoate solution in patients with small-bowel obstruction? ACTA ACUST UNITED AC 2006; 3:432-3. [PMID: 16883346 DOI: 10.1038/ncpgasthep0555] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2006] [Accepted: 06/12/2006] [Indexed: 11/08/2022]
Affiliation(s)
- Michael G Sarr
- Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA.
| |
Collapse
|
34
|
Al Salamah SMA, Fahim F, Mirza SM. Value of Water-soluble Contrast (Meglumine Amidotrizoate) in the Diagnosis and Management of Small Bowel Obstruction. World J Surg 2006; 30:1290-4. [PMID: 16773262 DOI: 10.1007/s00268-005-0409-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The object of the present study was to determine the effectiveness of a water-soluble contrast follow-through study for differentiating complete from incomplete small bowel obstruction (SBO) and for predicting the need for surgery. METHODS This prospective study was conducted at Riyadh Medical Complex, Saudi Arabia and spanned 2 years. All adult patients admitted with SBO were included, except those with obstructed hernias, peritonitis, or postabdominal irradiation. The initial resuscitation meglumine amidotrizoate (Gastrografin) follow-though was performed and was considered positive for complete obstruction if the contrast failed to reach the colon as shown on the 24-hour film. Patients were operated on only if they developed signs of strangulation or failed to improve within 48 hours. RESULTS Our study group consisted of 73 patients, 48 (65.7%) of whom were male. The mean age was 35.70+/-12.65 years. In 60 (82.2%) patients, contrast reached the ascending colon within 24 hours, giving a definitive diagnosis of incomplete obstruction; among these 60 cases, 49 (81.7%) resolved on conservative management. The other 13 (17.8%) patients were diagnosed as having a complete obstruction; 4 (30.8%) of them were treated conservatively, and 9 (69.2%) underwent surgery. Therefore the sensitivity, specificity, positive predictive value, and negative predictive value for meglumine amidotrizoate follow-through as an indicator for operative treatment of SBO were 45.0, 92.5, 81.7, and 69.2, respectively. The P value using Fisher's exact test was 0.0006. CONCLUSIONS We can confidently diagnose complete and incomplete SBO and differentiate one from the other. This accurate diagnosis indicates a high chance of success with conservative management for incomplete obstruction but does not always correlate with the need for surgical intervention.
Collapse
Affiliation(s)
- Saleh Moh'd Al Al Salamah
- Department of Surgery, College of Medicine, King Saud University, University Unit, Riyadh Medical Complex, Riyadh, 11342, Kingdom of Saudi Arabia.
| | | | | |
Collapse
|
35
|
Kapoor S, Jain G, Sewkani A, Sharma S, Patel K, Varshney S. Prospective Evaluation of Oral Gastrografin in Postoperative Small Bowel Obstruction. J Surg Res 2006; 131:256-60. [PMID: 16457844 DOI: 10.1016/j.jss.2005.12.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2005] [Revised: 10/27/2005] [Accepted: 12/12/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Orally administered gastrografin has been used for early resolution of postoperative small bowel obstruction (POSBO) and to reduce the need for surgery in various studies. However the studies have reported conflicting results as patients with complete obstruction and equivocal diagnosis of bowel strangulation were also included. PATIENTS AND METHODS We carried out a prospective study to evaluate the efficacy of gastrografin in patients with partial adhesive small bowel obstruction. Patients with suspected strangulation, complete obstruction, obstructed hernia, bowel malignancy, and radiation enteritis were excluded. Sixty-two patients with partial adhesive small bowel obstruction were given an initial trial of conservative management of 48 h. Thirty-eight patients improved within 48 h and the other 24 were given 100 ml of undiluted gastrografin through the nasogastric tube. In 22 patients the contrast reached the colon within 24 h. In the remaining two patients the contrast failed to reach the colon and these underwent surgery. RESULTS The use of gastrografin avoided surgical intervention in 91.3% (22 of 24) patients who failed conservative management of POSBO. Gastrografin also decreased the overall requirement for surgical management of POSBO from the reported rate of 25 to 30% to 3.2% (2 of 62). CONCLUSION Use of gastrografin in patients with partial POSBO helps in resolution of symptoms and avoids the need for surgical management in the majority of patients.
Collapse
Affiliation(s)
- Sorabh Kapoor
- Department of Surgical Gastroenterology, Bhopal Memorial Hospital and Research Centre, Bhopal, India.
| | | | | | | | | | | |
Collapse
|
36
|
Chen SC, Lee CC, Yen ZS, Lin GS, Chen WJ, Lee PH, Lai HS, Lin FY, Chen WJ. Specific oral medications decrease the need for surgery in adhesive partial small-bowel obstruction. Surgery 2006; 139:312-6. [PMID: 16546494 DOI: 10.1016/j.surg.2005.08.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2005] [Revised: 08/24/2005] [Accepted: 08/29/2005] [Indexed: 11/17/2022]
Abstract
BACKGROUND Nothing by mouth (NPO) is the standard treatment for small-bowel obstruction. Whether oral medications should be prohibited during treatment of adhesive, partial small-bowel obstruction is unclear. The goal of this study was to determine whether a combination of specific oral medications in adhesive, partial small-bowel obstruction will decrease the need for operative intervention. METHODS Of 266 consecutive adult patients with partial small-bowel obstruction admitted at a tertiary medical center, 236 were randomized into 2 groups. Group I patients were treated with intravenous hydration, nasogastric tube decompression, and NPO. Group II patients were placed on intravenous hydration, nasogastric tube decompression, and oral fluids incorporating an oral laxative, a digestant, and a defoaming agent. We compared differences between the groups in (1) the number of patients having a successful nonoperative treatment, (2) complications, and (3) recurrence of symptoms. RESULTS A total of 116 and 120 patients comprised groups I and II, respectively. The number of patients treated successfully by a nonoperative approach was less in group I than in group II (77% vs 90%, P < .01). The complications and recurrence rate for groups I and II did not differ (4% vs 5% and 5% vs 4%, respectively). CONCLUSIONS The NPO status for patients with adhesive, partial small-bowel obstruction may not be necessary. This cocktail of oral medications can decrease the need for operative intervention in patients with presumed adhesive, partial small-bowel obstruction.
Collapse
Affiliation(s)
- Shyr-Chyr Chen
- Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7 Chung-Shan South Road, Taipei 100, Taiwan.
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Tunca F, Giles Y, Güllüoglu M, Ozlük Y, Terzioglu TK, Tezelman S. A rapidly enlarging thyroid mass as the initial presentation of metastatic hepatocellular carcinoma. Thyroid 2005; 15:1399-400. [PMID: 16405417 DOI: 10.1089/thy.2005.15.1399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Fatih Tunca
- Department of General Surgery, Istanbul University, Istanbul Medical Faculty, Topkapi, 34390 Istanbul, Turkey.
| | | | | | | | | | | |
Collapse
|
38
|
Chen SC, Yen ZS, Lee CC, Liu YP, Chen WJ, Lai HS, Lin FY, Chen WJ. Nonsurgical management of partial adhesive small-bowel obstruction with oral therapy: a randomized controlled trial. CMAJ 2005; 173:1165-9. [PMID: 16275967 PMCID: PMC1277043 DOI: 10.1503/cmaj.1041315] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Patients with partial adhesive small-bowel obstruction are usually managed conservatively, receiving intravenous hydration and nothing by mouth. Previous studies have suggested that this approach is associated with longer hospital stays and an increased risk of delayed surgery. We conducted a randomized controlled trial to see if combining standard conservative treatment with oral administration of a laxative, a digestant and a defoaming agent would reduce the frequency of subsequent surgical intervention and reduce the length of hospital stay. METHODS We identified 144 consecutive patients admitted between February 2000 and July 2001 with adhesive partial small-bowel obstruction and randomly assigned 128 who met the inclusion criteria to either the control group (intravenous hydration, nasogastric-tube decompression and nothing by mouth) or the intervention group (intravenous hydration, nasogastric-tube decompression and oral therapy with magnesium oxide, Lactobacillus acidophilus and simethicone). The primary outcome measures were the number of patients whose obstruction was successfully treated without surgery and the length of hospital stay. We also monitored rates of complications and recurring obstructions. RESULTS Of the 128 patients, 63 were in the control group and 65 in the intervention group; the mean ages were 54.4 (standard deviation [SD] 15.9) years and 53.9 (SD 16.3) years respectively. Most of the patients were male. More patients in the intervention group than in the control group had successful treatment without surgery (59 [91%] v. 48 [76%], p = 0.03; relative risk 1.19, 95% confidence interval 1.03-1.40). The mean hospital stay was significantly longer among patients in the control group than among those in the intervention group (4.2 [SD 2.7] v. 1.0 [SD 0.7] days, p < 0.001). The complication and recurrence rates did not differ significantly between the 2 groups. INTERPRETATION Oral therapy with magnesium oxide, L. acidophilus and simethicone was effective in hastening the resolution of conservatively treated partial adhesive small-bowel obstruction and shortening the hospital stay.
Collapse
Affiliation(s)
- Shyr-Chyr Chen
- Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Chen SC, Lee CC, Hsu CY, Yen ZS, Fang CC, Ma MHM, Chen WJ, Lai HS, Lee PH, Lin FY, Chen WJ. Progressive increase of bowel wall thickness is a reliable indicator for surgery in patients with adhesive small bowel obstruction. Dis Colon Rectum 2005; 48:1764-71. [PMID: 15991069 DOI: 10.1007/s10350-005-0112-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE The aim of this study was to determine whether progressive increase of bowel wall thickness during nonoperative treatment is a reliable indicator for surgery in patients with adhesive small bowel obstruction. METHODS The study consisted of a prospective case series of 121 patients with adhesive small bowel obstruction who underwent an abdominal ultrasonographic examination. The results of ultrasonographic examinations were classified into two groups according to the presence (Group I) or absence (Group II) of bowel wall thickening. Bowel wall thickening was recognized as a visible small bowel wall > or =3 mm in width as seen by ultrasonographic examination. The findings of subsequent ultrasonographic examinations taken 24 hours later were compared with those taken at admission. Surgery was determined based on the presence of any toxic signs or the failure of nonoperative treatment. The number of patients who had successful nonoperative treatment, the number of patients who underwent surgeries, and the number of complications in each group were calculated to correlate with the ultrasonographic findings. RESULTS There are 49 and 72 patients in Groups I and II, respectively. The number of patients who had successful nonoperative treatment and number of patients who underwent surgeries in Group I are 40 (81.6 percent) and 9 (18.4 percent) and in Group II the numbers are 68 (94.4 percent) and four (5.6 percent), respectively (P = 0.036). All 12 (100 percent) patients with progressive increase of bowel wall thickness underwent surgery. Progressive increase of bowel wall thickness as an indicator for surgery has a sensitivity of 92.3 percent (95 percent confidence interval, 62.1-99.6 percent) and a specificity of 100 percent (95 percent confidence interval, 95.7-100 percent). CONCLUSIONS Patients with initial bowel wall thickening have a higher incidence of surgery, and progressive increase of bowel wall thickness that appears 24 hours later is a reliable indicator for surgery in patients with adhesive small bowel obstruction.
Collapse
Affiliation(s)
- Shyr-Chyr Chen
- Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Aulin A, Sales JP, Bachar S, Hennequin J, Moumouh A, Tasu JP. Telebrix Gastro in the management of adhesive small bowel obstruction. ACTA ACUST UNITED AC 2005; 29:501-4. [PMID: 15980741 DOI: 10.1016/s0399-8320(05)82119-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study aimed to determine whether an abdominal radiograph 8 hours after ingesting oral Telebrix Gastro is a reliable marker for non-operative management in patients with adhesive small bowel obstruction. METHODS During a 5-year period (January 1, 1995, through December 31, 2000), 97 patients were admitted for small bowel occlusion due to adhesion with no indication for immediate surgery. All received 100 mL of Telebrix Gastro via gastric tube for small bowel obstruction due to adhesion. If the contrast reached the colon within 8 hours on plain abdominal radiograph, the test was considered to be negative. RESULTS 126 cases of small bowel occlusions were analyzed due to recurring episodes for 11 patients. The test was negative in 113 cases (89.7%), and in this group, only two patients underwent surgery, the remaining being managed non-operatively. The 13 cases (10.3%) with a positive test for occlusion underwent surgery. The sensitivity, specificity and accuracy of the finding of contrast media reaching the colon as an indicator for conservative treatment were 98%, 100%, and 98%, respectively. CONCLUSIONS A water-soluble contrast study can be of significant help in the clinical management of patients suspected of having small bowel obstruction.
Collapse
Affiliation(s)
- Agnès Aulin
- Service de Radiologie, Hôpital Bicêtre, Le Kremlin-Bicêtre
| | | | | | | | | | | |
Collapse
|
41
|
Chen JH, Hsieh CB, Chao PC, Liu HD, Chen CJ, Liu YC, Yu JC. Effect of water-soluble contrast in colorectal surgery: A prospective randomized trial. World J Gastroenterol 2005; 11:2802-5. [PMID: 15884127 PMCID: PMC4305921 DOI: 10.3748/wjg.v11.i18.2802] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: Postoperative gastrointestinal-tract motility is normally delayed. Early feeding after colorectal surgery has been reported recently, but late feeding is common. Gastrografin not only enhances bowel peristalsis, but also decreases bowel-wall edema. Whether contrast medium allows early oral feeding and reduces the duration of hospitalization requires clarification.
METHODS: Fifty patients underwent elective colorectal surgery in a regional medical center. Patients were prosp-ectively randomized into a Gastrografin group or control group (n = 25 each). Patients in the Gastrografin group began their feeding schedule with 100 mL of 5% dextrose water with 100 mL of Gastrografin on postoperative d 3 and were advanced to a full liquid diet when the contrast reached the colon in 4 h. Patients in the control group began their feeding schedule with 200 mL of 5% dextrose water on postoperative d 3 and were advanced to a full liquid diet after the passage of flatus and stool. Nasogastric tubes were inserted for persistent postoperative vomiting. Fullness, nausea, vomiting, complications, time of anesthesia, time of operation, time of mobilization, time of oral feeding, and duration of hospital stay were recorded and analyzed with Student’s t-test.
RESULTS: In the Gastrografin group, one patient had aspiration pneumonia and one patient had anastomotic leakage resulting in sepsis and eventual death. This mortality was excluded from the subsequent statistical analysis. In the control group, two patients had wound infections. There was no significant difference between the two groups at the time of anesthesia, time of operation, or time of mobilization. There were significant differences between the two groups in the time of oral feeding (3.3±0.3 d in the Gastrografin group vs 4.8±0.4 d in the control group; P = odds ratio--, 95%CI [-0.5 to +0.7 d]) and in the length of hospital stay (7.6±1.1 d in the Gastrografin group vs 10.2±1.3 d in the control group; P = odds ratio--, 95% CI [-1.2 to +1.4 d]).
CONCLUSION: Gastrografin not only allowed early oral feeding but also reduced the duration of hospitalization after elective colorectal surgery.
Collapse
Affiliation(s)
- Jia-Hui Chen
- Division of General Surgery, Tri-Service General Hospital, #325 Sec. 2 Chen-Kung Road, Neihu 114, Taipei, Taiwan, China
| | | | | | | | | | | | | |
Collapse
|
42
|
Abstract
BACKGROUND Metastasis to the thyroid is uncommon, but the number of cases seems to have increased in recent years. This increase may be related to more frequent use of fine-needle aspiration biopsy (FNAB) in any suspected case. DESIGN A retrospective review of patients with thyroid metastasis diagnosed by FNAB at the Asan Medical Centre. PATIENTS Twenty-two patients who were seen at the Asan Medical Centre between 1997 and 2003. Median age was 55 years with range between 34 and 74 years. RESULTS Fourteen patients presented with a palpable thyroid nodule. Eight patients had an impalpable thyroid nodule that was found incidentally during the various imaging studies. The breast (five patients) was the most common primary site followed by the kidney (three), colon (three) and lung (three). FNAB confirmed metastatic disease in 19 patients and raised suspicion in three patients. The suspicion of metastasis to the thyroid was confirmed by Tru-cut needle core biopsy in one patient and surgery in two patients. Thyroid metastases were found during the initial work-up for primary tumour in eight patients. In the remaining 14 patients, the interval from diagnosis of primary tumour to the detection of thyroid metastasis varied from 8 months to 15 years, with a median of 54 months. Fifteen patients had metastatic disease elsewhere at the time of presentation. Ten patients received chemotherapy. Radiotherapy was used in two patients. Seven patients are still alive, with one patient disease free for 16 months following resection of the thyroid metastasis. CONCLUSIONS Thyroid metastases are uncommon but can be detected more frequently with routine use of FNAB. Breast cancer is the most common tumour that metastasizes to the thyroid. They usually occur when there are metastases elsewhere, sometimes many years after the diagnosis of the original primary tumour and show poor prognosis in general.
Collapse
MESH Headings
- Adenocarcinoma/diagnosis
- Adenocarcinoma/secondary
- Adenocarcinoma/therapy
- Adult
- Aged
- Biopsy, Needle
- Breast Neoplasms/therapy
- Carcinoma/diagnosis
- Carcinoma/secondary
- Carcinoma/therapy
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Ductal, Breast/therapy
- Carcinoma, Squamous Cell/diagnosis
- Carcinoma, Squamous Cell/secondary
- Carcinoma, Squamous Cell/therapy
- Colonic Neoplasms/therapy
- Esophageal Neoplasms/therapy
- Female
- Humans
- Kidney Neoplasms/therapy
- Lung Neoplasms/therapy
- Male
- Middle Aged
- Retrospective Studies
- Sensitivity and Specificity
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/secondary
- Thyroid Neoplasms/therapy
Collapse
Affiliation(s)
- Tae Yong Kim
- Department of Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea
| | | | | | | | | |
Collapse
|
43
|
Abbas S, Bissett IP, Parry BR. Oral water soluble contrast for the management of adhesive small bowel obstruction. Cochrane Database Syst Rev 2005:CD004651. [PMID: 15674958 DOI: 10.1002/14651858.cd004651.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Adhesions are the leading cause of small bowel obstruction. Most adhesive small bowel obstructions resolve following conservative treatment but there is no consensus as to when conservative treatment should be considered unsuccessful and the patient should undergo surgery. Studies have shown that failure of an oral water-soluble contrast to reach the colon after a designated time indicates complete intestinal obstruction that is unlikely to resolve with conservative treatment. Other studies have suggested that the administration of water-soluble contrast is therapeutic in resolving the obstruction. OBJECTIVES The aims of this review are:1. To determine the reliability of water-soluble contrast media and serial abdominal radiographs in predicting the success of conservative treatment in patients admitted with adhesive small bowel obstruction.2. To determine the efficacy and safety of water-soluble contrast media in reducing the need for surgical intervention and reducing hospital stay in adhesive small bowel obstruction. SEARCH STRATEGY The search was conducted using MeSH terms: ''Intestinal obstruction'', ''water-soluble contrast'', "Adhesions" and "Gastrografin", and combined with the Cochrane Collaboration highly sensitive search strategy for identifying randomised controlled trials and controlled clinical trials. SELECTION CRITERIA 1. Prospective studies (to evaluate the diagnostic potential of water-soluble contrast in adhesive small bowel obstruction);2. Randomised clinical trials (to evaluate the therapeutic role). DATA COLLECTION AND ANALYSIS 1. Studies addressing the diagnostic role of water-soluble contrast were critically appraised and data presented as sensitivities, specificities and positive and negative likelihood ratios. Results were pooled and summary receiver operating characteristic (ROC) curve was constructed. 2. A meta-analysis of the data from therapeutic studies was performed using the Mantel -Haenszel test using both the fixed effect and random effects model. MAIN RESULTS The appearance of water-soluble contrast in the caecum on an abdominal radiograph within 24 hours of its administration predicts resolution of an adhesive small bowel obstruction with a pooled sensitivity of 0.96, specificity of 0.96. The area under the curve of the summary ROC was 0.98. Four randomised studies dealing with the therapeutic role of Gastrografin were included in the review, water-soluble contrast did not reduce the need for surgical intervention (odds ratio 1.29, P = 0.36). Meta-analysis of two studies showed that water-soluble contrast reduced hospital stay compared with placebo (weighted mean difference = - 2.58) P = 0.004. AUTHORS' CONCLUSIONS Published literature strongly supports the use of water-soluble contrast as a predictive test for non-operative resolution of adhesive small bowel obstruction. Although Gastrografin does not cause resolution of small bowel obstruction, it does appear to reduce hospital stay.
Collapse
Affiliation(s)
- S Abbas
- Surgery, University of Auckland, Parks Road, Auckland, New Zealand, 1.
| | | | | |
Collapse
|
44
|
Roadley G, Cranshaw I, Young M, Hill AG. Role of Gastrografin in assigning patients to a non‐operative course in adhesive small bowel obstruction. ANZ J Surg 2004; 74:830-2. [PMID: 15456423 DOI: 10.1111/j.1445-1433.2004.03183.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adhesive small bowel obstruction (SBO) is a common surgical emergency. Water soluble contrast agents have been used to identify patients who might be treated non-operatively rather than operatively. The present study was designed to audit the introduction of such use of Gastrografin contrast into clinical practice. METHOD Patients presenting acutely to hospital with clinically suspected and radiologically proven SBO were entered in the study. As soon as practicable, 100 mL of undiluted Gastrografin was given either orally or by the nasogastric tube (which was then spigotted). After 4 h, a plain supine abdominal X-ray (AXR) was taken. If the contrast was seen in the large bowel, and there had been no deterioration in the patient's condition, then non-operative treatment was continued. If the contrast remained in the small bowel, a clinical judgement was made as to whether to proceed with operative intervention. A group of historical controls were obtained by a retrospective review of the hospital medical records through data obtained from the Department of General Surgery Audit System. RESULTS Twenty-five patients were entered into the study. In 20 of these patients the contrast was seen to arrive in the large bowel at 4 h. All of these patients completed a non-operative course to full recovery. In another two patients a successful decision was made to pursue a non-operative management strategy. These 22 patients had a mean hospital stay of 3.9 days. Eighty historical controls had successfully completed a non-operative course for SBO. They had a mean hospital stay of 5.6 days. This was significantly longer than that of the Gastrografin group (P < 0.016, t-test). CONCLUSION This paper has demonstrated that undiluted Gastrografin may be safely used to assign patients to a non-operative management plan and this results in a decreased hospital stay.
Collapse
Affiliation(s)
- Graeme Roadley
- University Department of Surgery, South Auckland Clinical School, University of Auckland, Otahuhu, Auckland, New Zealand
| | | | | | | |
Collapse
|
45
|
Stojanovic D, Radovanović D, Caparević Z, Jakovljevic-Stojanović M, Lalosević D, Stevanović P. [Occurrence of carcinoma in solitary thyroid nodules]. ACTA ACUST UNITED AC 2004; 50:47-50. [PMID: 15179754 DOI: 10.2298/aci0303047s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Find of malignancies in solitary thyroid gland nodes represent an entity in itself in thyroid surgery and endocrinology because of frequency in occurrence and differential diagnosis of thyroid diseases. Similarities in clinical characteristics and differences in the histological structure and development of the disease, request quick and adequate application of all available diagnostic procedures in evaluation of disease. After all clinic methods of examination, surgery includes necessary range of extraction of tissue at benign changes while at malignant changes radical intervention on the gland is suggested and if it is necessary on the surrounding structures of the neck. "Biopsio ex tempore" still represents vital method in histological diagnosis and help in making decision about radically of operative procedure. Because of that, surgery represents at last diagnostic and therapy procedure. Data analysis shows the presence of carcinoma in solitary thyroid gland nodes in 15% of all cases.
Collapse
|
46
|
Potluri V, Zhukovsky DS. Recent advances in malignant bowel obstruction: an interface of old and new. Curr Pain Headache Rep 2003; 7:270-8. [PMID: 12828876 DOI: 10.1007/s11916-003-0047-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Malignant bowel obstruction continues to be a difficult problem for patients with abdominal and pelvic primary tumors and tumors originating in other sites. The main treatment options consist of surgery, stenting, and pharmacotherapy. Despite recent advances, the impact of available treatment modalities on symptom control, longevity, quality of life, and associated health care costs have not been evaluated rigorously. This article reviews the available data and suggests an approach to the management of this challenging patient population.
Collapse
Affiliation(s)
- Vinaya Potluri
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Box 8, Houston, TX 77030, USA
| | | |
Collapse
|
47
|
Brochwicz-Lewinski MJ, Paterson-Brown S, Murchison JT. Small bowel obstruction--the water-soluble follow-through revisited. Clin Radiol 2003; 58:393-7. [PMID: 12727169 DOI: 10.1016/s0009-9260(02)00538-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIMS The aim of the present study to examine the use of a modified water-soluble follow-through in the diagnosis and management of small bowel obstruction (SBO). MATERIALS AND METHODS Sixty-two patients were recruited to the study: 33 into the control group and 29 into the study group. A modified small bowel follow-through (SBFT) was performed in the study group patients. The control group was managed conventionally. Assessment was made by questionnaire documenting initial surgical diagnosis and likelihood of operative intervention, final diagnosis and surgical outcome (operative versus non-operative). RESULTS SBFT changed the diagnosis in 12/24 of the study group (p<0.01). In the study group 8/24 proceeded to surgery whereas 19/33 underwent laparotomy in the control group, representing a relative risk reduction of 52%, but this was not statistically significant (0.10>p>0.05, chi-squared test). CONCLUSION SBFT remains a valid and useful tool in surgical management of SBO. In particular it aids diagnostic confidence in planning surgical intervention, particularly in uncomplicated patients.
Collapse
|
48
|
Biondo S, Parés D, Mora L, Martí Ragué J, Kreisler E, Jaurrieta E. Randomized clinical study of Gastrografin administration in patients with adhesive small bowel obstruction. Br J Surg 2003; 90:542-6. [PMID: 12734858 DOI: 10.1002/bjs.4150] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Oral Gastrografin has been used to differentiate partial from complete small bowel obstruction (SBO). It may have a therapeutic effect and predict the need for early surgery in adhesive SBO. The aim of this study was to determine whether contrast examination in the management of SBO allows an early oral intake and reduces hospital stay. METHODS Eighty-three patients admitted between February 2000 and November 2001 with 90 episodes of symptoms and signs suggestive of postoperative adhesive SBO were randomized into two groups, a control group and Gastrografin group. Patients in the control group were treated conservatively. If symptoms of strangulation developed or the obstruction did not resolve spontaneously after 4-5 days, a laparotomy was performed. Patients in the Gastrografin group received 100 ml Gastrografin. Those in whom the contrast medium reached the colon in 24 h were considered to have partial SBO, and were fed orally. If Gastrografin failed to reach the colon and the patient did not improve in the following 24 h a laparotomy was performed. RESULTS Conservative treatment was successful in 77 episodes (85.6 per cent) and 13 (14.4 per cent) required operation. Among patients treated conservatively, hospital stay was shorter in the Gastrografin group (P < 0.001). All patients in whom contrast medium reached the colon tolerated an early oral diet. Gastrografin did not reduce the need for operation (P = 1.000). No patient died in either group. CONCLUSION Oral Gastrografin helps in the management of patients with adhesive SBO and allows a shorter hospital stay.
Collapse
Affiliation(s)
- S Biondo
- Department of Surgery, Hospital Universitario de Bellvitge, University of Barcelona, Barcelona, Spain.
| | | | | | | | | | | |
Collapse
|
49
|
Wolf G, Aigner RM, Humer-Fuchs U, Schwarz T, Krippl P, Wehrschuetz M. [Renal cell carcinoma metastasis in a microfollicular adenoma of the thyroid gland]. ACTA MEDICA AUSTRIACA 2002; 29:141-2. [PMID: 12424940 DOI: 10.1046/j.1563-2571.2002.02009.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 60-year-old woman had a nephrectomy of her left kidney because of a renal cell carcinoma. She came to us for an oncologic F-18-fluordeoxyglucose-positron emission tomography (F-18-FDG-PET). In the positron emission tomography there was a pathologic fluordeoxyglucose-uptake in the left thyroid gland lobe. Thyroid investigation and Tc-99 m pertechnetate scintigraphy of the thyroid gland was done. It showed a hyperfunctioning nodule in the left thyroid gland lobe. Surgery was suggested. Histology showed a metastasis of a clear cell renal carcinoma in a microfollicular adenoma of the thyroid gland--a very rare combination.
Collapse
Affiliation(s)
- G Wolf
- Klinische Abteilung für Nuklearmedizin, Universitätsklinik für Radiologie, Auenbruggerplatz 9, A-8036 Graz.
| | | | | | | | | | | |
Collapse
|
50
|
Choi HK, Chu KW, Law WL. Therapeutic value of gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment: a prospective randomized trial. Ann Surg 2002; 236:1-6. [PMID: 12131078 PMCID: PMC1422541 DOI: 10.1097/00000658-200207000-00002] [Citation(s) in RCA: 118] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess the therapeutic value of Gastrografin in the management of adhesive small bowel obstruction after unsuccessful conservative treatment. SUMMARY BACKGROUND DATA Gastrografin is a hyperosmolar water-soluble contrast medium. Besides its predictive value for the need for surgery, there is probably a therapeutic role of this contrast medium in adhesive small bowel obstruction. METHODS Patients with clinical evidence of adhesive small bowel obstruction were given trial conservative treatment unless there was suspicion of strangulation. Those who responded in the initial 48 hours had conservative treatment continued. Patients showing no clinical and radiologic improvement in the initial 48 hours were randomized to undergo either Gastrografin meal and follow-through study or surgery. Contrast that appeared in the large bowel within 24 hours was regarded as a partial obstruction, and conservative treatment was continued. Patients in whom contrast failed to reach the large bowel within 24 hours were considered to have complete obstruction, and laparotomy was performed. For patients who had conservative treatment for more than 48 hours with or without Gastrografin, surgery was performed when there was no continuing improvement. RESULTS One hundred twenty-four patients with a total of 139 episodes of adhesive obstruction were included. Three patients underwent surgery soon after admission for suspected bowel strangulation. Strangulating obstruction was confirmed in two patients. One hundred one obstructive episodes showed improvement in the initial 48 hours and conservative treatment was continued. Only one patient required surgical treatment subsequently after conservative treatment for 6 days. Thirty-five patients showed no improvement within 48 hours. Nineteen patients were randomized to undergo Gastrografin meal and follow-through study and 16 patients to surgery. Gastrografin study revealed partial obstruction in 14 patients. Obstruction resolved subsequently in all of them after a mean of 41 hours. The other five patients underwent laparotomy because the contrast study showed complete obstruction. The use of Gastrografin significantly reduced the need for surgery by 74%. There was no complication that could be attributed to the use of Gastrografin. No strangulation of bowel occurred in either group. CONCLUSIONS The use of Gastrografin in adhesive small bowel obstruction is safe and reduces the need for surgery when conservative treatment fails.
Collapse
Affiliation(s)
- Hok-Kwok Choi
- Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China
| | | | | |
Collapse
|