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Ontan MS, Isik AT. Ogilvie's syndrome: bidirectional effect of hypokalaemia. BMJ Support Palliat Care 2024; 13:e957-e959. [PMID: 36754591 DOI: 10.1136/spcare-2022-004138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/01/2023] [Indexed: 02/10/2023]
Affiliation(s)
- Mehmet Selman Ontan
- Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Ahmet Turan Isik
- Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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2
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Kubiszewski K, Chapman RW, Piazza Y, Patel D, Neychev V. Hypothyroidism Presenting as Adynamic Ileus Mimicking a Mechanical Small Bowel Obstruction: A Diagnostic and Management Dilemma. Cureus 2023; 15:e50799. [PMID: 38239558 PMCID: PMC10796157 DOI: 10.7759/cureus.50799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2023] [Indexed: 01/22/2024] Open
Abstract
Patients who present with nausea, vomiting, constipation, and abdominal pain typically undergo workups for small bowel obstruction (SBO). SBO is commonly caused by mechanical obstruction due to adhesions, inflammatory conditions, or malignancies. Hypothyroidism is primarily associated with decreased basal metabolic rate and rarely, in severe cases, gastrointestinal motility dysfunction. We report a case of a 44-year-old man who presented to the emergency department with abdominal pain, nausea, and vomiting. The workup, including computed tomography, showed a small bowel feces sign, highly suspicious for a mechanical SBO. His past medical history was significant for a poorly controlled hypothyroidism due to Hashimoto's thyroiditis with a markedly elevated thyroid stimulating hormone (TSH) level. He had no prior surgical history, and his family history was significant for a suspected inflammatory bowel disease (IBD) in his son. The patient failed initial resuscitative nonoperative management and underwent exploratory laparoscopy that revealed diffusely dilated small bowel loops with no obvious cause of mechanical obstruction. Inflammatory markers for IBD were found to be negative, and the patient's gastrointestinal motility gradually improved with daily intravenous levothyroxine.
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Affiliation(s)
- Kacper Kubiszewski
- Medical School, University of Central Florida College of Medicine, Orlando, USA
| | - Rachel W Chapman
- Medical School, University of Central Florida College of Medicine, Orlando, USA
| | - Yelena Piazza
- Pathology, University of Central Florida College of Medicine, Orlando, USA
- Pathology, UCF-Lake Nona Hospital, Orlando, USA
| | - Dhruv Patel
- Radiology, University of Central Florida College of Medicine, Orlando, USA
- Radiology, UCF-Lake Nona Hospital, Orlando, USA
| | - Vladimir Neychev
- Surgery, University of Central Florida College of Medicine, Orlando, USA
- Surgery, UCF-Lake Nona Hospital, Orlando, USA
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3
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Traeger L, Koullouros M, Bedrikovetski S, Kroon HM, Thomas ML, Moore JW, Sammour T. Cost of postoperative ileus following colorectal surgery: A cost analysis in the Australian public hospital setting. Colorectal Dis 2022; 24:1416-1426. [PMID: 35737846 PMCID: PMC9796387 DOI: 10.1111/codi.16235] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/30/2022] [Accepted: 06/11/2022] [Indexed: 01/01/2023]
Abstract
AIM Postoperative ileus (POI) following surgery results in significant morbidity, drastically increasing hospital costs. As there are no specific Australian data, this study aimed to measure the cost of POI after colorectal surgery in an Australian public hospital. METHODS A cost analysis was performed, for major elective colorectal surgical cases between 2018 and 2021 at the Royal Adelaide Hospital. POI was defined as not achieving GI-2, the validated composite measure, by postoperative day 4. Demographics, length of stay and 30-day complications were recorded retrospectively. Costings in Australian dollars were collected from comprehensive hospital billing data. Univariate and multivariate analyses were performed. RESULTS Of the 415 patients included, 34.9% (n = 145) developed POI. POI was more prevalent in males, smokers, previous intra-abdominal surgery, and converted laparoscopic surgery (p < 0.05). POI was associated with increased length of stay (8 vs. 5 days, p < 0.001) and with higher rates of complications such as pneumonia (15.2% vs. 8.1%, p = 0.027). Total cost of inpatient care was 26.4% higher after POI (AU$37,690 vs. AU$29,822, p < 0.001). POI was associated with increased staffing costs, as well as diagnostics, pharmacy, and hospital services. On multivariate analysis POI, elderly patients, stoma formation, large bowel surgery, prolonged theatre time, complications and length of stay were predictive of increased costs (p < 0.05). CONCLUSION In Australia, POI is significantly associated with increased complications and higher costs due to prolonged hospital stay and increased healthcare resource utilisation. Efforts to reduce POI rates could diminish its morbidity and associated expenses, decreasing the burden on the healthcare system.
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Affiliation(s)
- Luke Traeger
- Colorectal Unit, Department of SurgeryRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia,Adelaide Medical School, Faculty of Health and Medical SciencesUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Michalis Koullouros
- Colorectal Unit, Department of SurgeryRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Sergei Bedrikovetski
- Colorectal Unit, Department of SurgeryRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia,Adelaide Medical School, Faculty of Health and Medical SciencesUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Hidde M. Kroon
- Colorectal Unit, Department of SurgeryRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia,Adelaide Medical School, Faculty of Health and Medical SciencesUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Michelle L. Thomas
- Colorectal Unit, Department of SurgeryRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia,Adelaide Medical School, Faculty of Health and Medical SciencesUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - James W. Moore
- Colorectal Unit, Department of SurgeryRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia,Adelaide Medical School, Faculty of Health and Medical SciencesUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Tarik Sammour
- Colorectal Unit, Department of SurgeryRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia,Adelaide Medical School, Faculty of Health and Medical SciencesUniversity of AdelaideAdelaideSouth AustraliaAustralia
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4
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Gastrointestinal Dysmotility in Critically Ill Patients: Bridging the Gap Between Evidence and Common Misconceptions. J Clin Gastroenterol 2022; 57:440-450. [PMID: 36227004 DOI: 10.1097/mcg.0000000000001772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Disruption of normal gastrointestinal (GI) function in critical illness is linked to increased morbidity and mortality, and GI dysmotility is frequently observed in patients who are critically ill. Despite its high prevalence, the diagnosis and management of GI motility problems in the intensive care unit remain very challenging, given that critically ill patients often cannot verbalize symptoms and the general lack of understanding of underlying pathophysiology. Common clinical presentations of GI dysmotility issues among critically ill patients include: (1) high gastric residual volumes, acid reflux, and vomiting, (2) abdominal distention, and (3) diarrhea. In this review, we discuss the differential diagnosis for intensive care unit patients with symptoms and signs concerning GI motility issues. There are many myths and longstanding misconceptions about the diagnosis and management of GI dysmotility in critical illness. Here, we uncover these myths and discuss relevant evidence in each subject area, with the goal of re-conceptualizing GI motility disorders in critical care and providing evidence-based recommendations for clinical care.
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Zaborovskii NS, Ptashnikov DA, Mikhailov DA, Smekalenkov OA, Masevnin SV, Diusenov DO, Kazantsev ND. Complications in spinal tumor surgery (review of literature). GREKOV'S BULLETIN OF SURGERY 2022. [DOI: 10.24884/0042-4625-2022-181-2-92-99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Combined anterior and posterior approaches are required in spinal tumor surgery and considered highly invasive. Anatomical and physiological features of the surgical intervention area should be taken into consideration as well. Thus, these criteria reflect the severity of intraoperative complications during the surgical treatment of spinal tumors. The authors reviewed the scientific literature on the frequency and nature of complications in surgical interventions for spinal tumors.The most significant risk factors for intraoperative complications have been considered, the main of which are: the proximity of the location of the main vessels and viscera, the development of postoperative liquorrhea, as well as surgical site infection. Based on the studied information, we presented the methods of prevention and surgical tactics options in complications.
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Affiliation(s)
- N. S. Zaborovskii
- Russian Scientific Research Institute of Traumatology and Orthopedics named after R. R. Vreden; Saint Petersburg University
| | - D. A. Ptashnikov
- Russian Scientific Research Institute of Traumatology and Orthopedics named after R. R. Vreden; North-Western State Medical University named after I. I. Mechnikov
| | - D. A. Mikhailov
- Russian Scientific Research Institute of Traumatology and Orthopedics named after R. R. Vreden
| | - O. A. Smekalenkov
- Russian Scientific Research Institute of Traumatology and Orthopedics named after R. R. Vreden
| | - S. V. Masevnin
- Russian Scientific Research Institute of Traumatology and Orthopedics named after R. R. Vreden
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6
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Traeger L, Kroon HM, Bedrikovetski S, Moore JW, Sammour T. The impact of acetylcholinesterase inhibitors on ileus and gut motility following abdominal surgery: a clinical review. ANZ J Surg 2021; 92:69-76. [PMID: 34927331 DOI: 10.1111/ans.17418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 12/22/2022]
Abstract
Postoperative ileus is a common complication in the days following colorectal surgery occurring in up to 50% of patients. When prolonged, this complication results in significant morbidity and mortality, doubling the total costs of hospital stay. Postoperative ileus (POI) results from the prolonged inflammatory phase that is mediated in part by the cholinergic anti-inflammatory pathway. Acetylcholinesterase inhibitors, such as neostigmine and pyridostigmine, delay the degradation of acetylcholine at the synaptic cleft. This increase in acetylcholine has been shown to increase gut motility. They have been effective in the treatment of acute colonic pseudo-obstruction, but there is limited evidence for the use of these medications for reducing the incidence of POI. This review was conducted to summarise the evidence of acetylcholinesterase inhibitors' effect on gut motility and discuss their potential use as part of an enhanced recovery protocols to prevent or treat POI.
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Affiliation(s)
- Luke Traeger
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Surgery, Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Hidde M Kroon
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Surgery, Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Sergei Bedrikovetski
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Surgery, Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - James W Moore
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Surgery, Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Tarik Sammour
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Surgery, Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
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7
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Alavi K, Poylin V, Davids JS, Patel SV, Felder S, Valente MA, Paquette IM, Feingold DL. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Colonic Volvulus and Acute Colonic Pseudo-Obstruction. Dis Colon Rectum 2021; 64:1046-1057. [PMID: 34016826 DOI: 10.1097/dcr.0000000000002159] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Karim Alavi
- University of Massachusetts Medical School, Worcester, Massachusetts
| | | | - Jennifer S Davids
- University of Massachusetts Medical School, Worcester, Massachusetts
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8
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Mutalib M, Kammermeier J, Vora R, Borrelli O. Prucalopride in intestinal pseudo obstruction, paediatric experience and systematic review. Acta Gastroenterol Belg 2021; 84:429-434. [PMID: 34599567 DOI: 10.51821/84.3.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Intestinal pseudo obstruction both acute and chronic is an uncommon severe motility disorder that affect both children and adults, can lead to significant morbidity burden and have no standard management strategy. Prucalopride a highly selective serotonin receptor agonist is an effective laxative with reported extra colon action. We aim to report our experience in children with acute and chronic intestinal pseudo obstruction who responded to prucalopride and systemically review the use of prucalopride in intestinal pseudo obstruction. METHODS A report of clinical experience and systemic review of the relevant medical databases to identify the outcome of usage of prucalopride in patients with acute and chronic intestinal pseudo obstruction. Studies meeting the selection criteria were reviewed including abstract only and case reports. RESULTS All reported cases showed clinical response to prucalopride. There were three full text, two abstracts only and three case reports all reporting clinical improvement with prucalopride. CONCLUSION Prucalopride appears to show promising results in children and adults with acute and chronic intestinal pseudo obstruction.
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Affiliation(s)
- M Mutalib
- Department of Paediatric Gastroenterology, Evelina London Children's Hospital, London, UK
| | - J Kammermeier
- Department of Paediatric Gastroenterology, Evelina London Children's Hospital, London, UK
| | - R Vora
- Department of Paediatric Gastroenterology, Evelina London Children's Hospital, London, UK
| | - O Borrelli
- Department of Paediatric Gastroenterology, Great Ormond Street Hospital, London, UK
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9
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Bresadola V, Brollo PP, Graziano M, Biddau C, Occhiali T, Driul L. The rare Ogilvie's Syndrome in pregnancy. How to manage? A case report and literature review. J OBSTET GYNAECOL 2021; 42:1-9. [PMID: 33938346 DOI: 10.1080/01443615.2021.1887113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Acute colonic pseudo-obstruction, or Ogilvie's syndrome (OS), is a complication in gynaecology and obstetrics. Its occurrence during pregnancy is rare, redefining the therapeutic decision-making and treatment options. In this review we describe the case of a 37-year-old pregnant patient who developed OS at the 30th week of gestation. A laparotomy with colonic decompression was performed. Foetal condition, regularly monitored throughout the hospital stay, remained normal. The patient experienced an uncomplicated, natural delivery at 40 weeks. A comprehensive literature search, describing the occurrence of OS during pregnancy, was conducted. We identified six cases of OS arising during pregnancy. Demographic, clinical, diagnostic and therapeutic features were analysed. Non-surgical management is generally the first-line option, with intravenous drug administration, rectal and nasogastric tube positioning and colonoscopic decompression the treatments of choice. Surgical decompression in usually performed in cases of failure of the first-line treatments. Including our own experience, in all cases, neither maternal nor foetal mortality was reported. A conservative approach is mandatory as first-line treatment, but when prompt resolution is not achieved, a multidisciplinary team, involving the gynaecologist/obstetrician, the surgeon, the radiologist and the intensivist is mandatory to avoid diagnostic delays, thereby reducing morbidity and mortality rates.
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Affiliation(s)
- Vittorio Bresadola
- General Surgery Department and Simulation Center, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - Pier Paolo Brollo
- General Surgery Department and Simulation Center, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - Michele Graziano
- General Surgery Department and Simulation Center, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - Carlo Biddau
- General Surgery Department and Simulation Center, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - Tommaso Occhiali
- Obstetrics and Gynecology Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - Lorenza Driul
- Obstetrics and Gynecology Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
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10
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Sinagra E, Pellegatta G, Maida M, Rossi F, Conoscenti G, Pallio S, Alloro R, Raimondo D, Anderloni A. Could Chronic Idiopatic Intestinal Pseudo-Obstruction Be Related to Viral Infections? J Clin Med 2021; 10:jcm10020268. [PMID: 33450988 PMCID: PMC7828444 DOI: 10.3390/jcm10020268] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 12/12/2022] Open
Abstract
Chronic idiopathic intestinal pseudo-obstruction (CIIPO) is a disease characterized by symptoms and signs of small bowel obstruction in the absence of displayable mechanical obstruction. Due to the known neuropathic capacity of several viruses, and their localization in the intestine, it has been hypothesized that such viruses could be involved in the pathogenesis of CIIPO. The most frequently involved viruses are John Cunningham virus, Herpesviridae, Flaviviruses, Epstein–Barr virus and Citomegalovirus. Therefore, the present narrative review aims to sum up some new perspectives in the etiology and pathophysiology of CIIPO.
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Affiliation(s)
- Emanuele Sinagra
- Gastroenterology and Endoscopy Unit, Fondazione Istituto San Raffaele-Giuseppe Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, Italy; (F.R.); (G.C.); (D.R.)
- Euro-Mediterranean Institute of Science and Technology (IEMEST), 90139 Palermo, Italy
- Correspondence: ; Tel.: +39-921-920-712
| | - Gaia Pellegatta
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center (IRCCS), 20089 Rozzano, Italy; (G.P.); (A.A.)
| | - Marcello Maida
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, 93100 Caltanissetta, Italy;
| | - Francesca Rossi
- Gastroenterology and Endoscopy Unit, Fondazione Istituto San Raffaele-Giuseppe Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, Italy; (F.R.); (G.C.); (D.R.)
| | - Giuseppe Conoscenti
- Gastroenterology and Endoscopy Unit, Fondazione Istituto San Raffaele-Giuseppe Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, Italy; (F.R.); (G.C.); (D.R.)
| | - Socrate Pallio
- Endoscopy Unit, University Hospital Policlinic G. Martino, 98125 Messina, Italy;
| | - Rita Alloro
- Division of General and Oncologic Surgery, Department of Surgical, Oncological and Oral Sciences (DICHIRONS), University of Palermo, 90133 Palermo, Italy;
| | - Dario Raimondo
- Gastroenterology and Endoscopy Unit, Fondazione Istituto San Raffaele-Giuseppe Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, Italy; (F.R.); (G.C.); (D.R.)
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center (IRCCS), 20089 Rozzano, Italy; (G.P.); (A.A.)
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11
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Peng Y, Peng C. Acute colonic pseudo-obstruction with bowel rupture after caesarean section in HELLP syndrome: a case report. BMC Pregnancy Childbirth 2020; 20:727. [PMID: 33238905 PMCID: PMC7687834 DOI: 10.1186/s12884-020-03414-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/12/2020] [Indexed: 12/17/2022] Open
Abstract
Background Ogilvie syndrome, also known as acute colonic pseudo-obstruction (ACPO), can occur postpartum after caesarean section (C-section), often resulting in caecal dilatation. The incidence rate is approximately 100 cases in 100,000 patients per year (Ross et al., Am Surg 82:102-11, 2016). Without proper diagnosis and treatment, it may progress to intestinal perforation or other fatal complications. Case presentation A 39-year-old pregnant woman underwent emergency low-segment C-section due to complications of Haemolysis, Elevated Liver enzymes and Low Platelets syndrome (HELLP) syndrome. ACPO was suspected on the third day after C-section based on inability to pass flatus, evident abdominal distension, slight abdominal pain, and computed tomography (CT) scan revealing severe, diffuse colonic distention with caecal dilatation of approximately 9 cm. Based on these findings, conservative treatment was implemented. However, 6 days after C-section, her symptoms worsened, and CT showed possible intestinal perforation; thus, an emergency laparotomy was performed. Due to a 3-cm (diameter) laceration in the anterolateral wall of the ascending colon and a 5-cm tear in the ileocecal junction, in combination with mucosal eversion in the colon, resection of the ileocecum, distal closure of the ascending colon, and a terminal ileostomy were performed. The patient was discharged 2 weeks post-laparotomy and continued to undergo nursing care for the incision and stoma. Ileostomy was performed 4 months later. Conclusion Ogilvie syndrome after C-section is an extremely rare but severe condition, which warrants early recognition and treatment to prevent potentially fatal complications, especially in patients with poor health status.
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Affiliation(s)
- Ying Peng
- Department of Obstetrics and Gynaecology, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, 17, Lu Jiang Road, Hefei, 230001, Anhui, P. R. China.
| | - Cheng Peng
- Department of Obstetrics and Gynaecology, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, 17, Lu Jiang Road, Hefei, 230001, Anhui, P. R. China
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12
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Solanki S, Chakinala RC, Haq KF, Singh J, Khan MA, Solanki D, Vyas MJ, Kichloo A, Mansuri U, Shah H, Patel A, Haq KS, Iqbal U, Nabors C, Khan HMA, Aronow WS. Paralytic ileus in the United States: A cross-sectional study from the national inpatient sample. SAGE Open Med 2020; 8:2050312120962636. [PMID: 33088567 PMCID: PMC7545785 DOI: 10.1177/2050312120962636] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 09/07/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction: Paralytic ileus is a common clinical condition leading to significant morbidity and mortality. Most studies to date have focused on postoperative ileus, a common but not exclusive cause of the condition. There are limited epidemiological data regarding the incidence and impact of paralytic ileus and its relationship to other clinical conditions. In this cross-sectional study, we analyzed national inpatient hospitalization trends, demographic variation, cost of care, length of stay, and mortality for paralytic ileus hospitalizations as a whole. Methods: The National Inpatient Sample database was used to identify all hospitalizations with the diagnosis of paralytic ileus (International Classification of Diseases, 9th Revision code 560.1) as primary or secondary diagnosis during the period from 2001 to 2011. Statistical analysis was performed using Cochran–Armitage trend test, Wilcoxon rank sum test, and Poisson regression. Results: In 2001, there were 362,561 hospitalizations with the diagnosis of paralytic ileus as compared to 470,110 in 2011 (p < 0.0001). The age group 65–79 years was most commonly affected by paralytic ileus throughout the study period. In-hospital all-cause mortality decreased from 6.03% in 2001 to 5.10% in 2011 (p < 0.0001). However, the average cost of care per hospitalization increased from US$19,739 in 2001 to US$26,198 in 2011 (adjusted for inflation, p < 0.0001). Conclusion: There was a significant rise in the number of hospitalizations of paralytic ileus with increased cost of care and reduced all-cause mortality.
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Affiliation(s)
- Shantanu Solanki
- Department of Medicine, Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | | | - Khwaja Fahad Haq
- Division of Gastroenterology, Henry Ford Hospital, Detroit, MI, USA
| | - Jagmeet Singh
- Department of Medicine, Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Muhammad Ali Khan
- Division of Gastroenterology, The University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - Manasee J Vyas
- Mahatma Gandhi Mission Institute of Health Sciences, Navi Mumbai, India
| | - Asim Kichloo
- Department of Medicine, Central Michigan University, Saginaw, MI, USA
| | - Uvesh Mansuri
- Department of Medicine, MedStar Health, Baltimore, MD, USA
| | | | | | - Khwaja Saad Haq
- Department of Medicine, Kingsbrook Jewish Medical Center, Brooklyn, NY, USA
| | - Umair Iqbal
- Department of Medicine, Geisinger Health, Danville, PA, USA
| | | | | | - Wilbert S Aronow
- Division of Cardiology, Westchester Medical Center, Valhalla, NY, USA
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13
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Detz DJ, Podrat JL, Muniz Castro JC, Lee YK, Zheng F, Purnell S, Pei KY. Small bowel obstruction. Curr Probl Surg 2020; 58:100893. [PMID: 34130796 DOI: 10.1016/j.cpsurg.2020.100893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/04/2020] [Indexed: 02/06/2023]
Affiliation(s)
| | | | | | - Yoon K Lee
- Houston Methodist Hospital, Houston, Texas
| | - Feibi Zheng
- Weill Cornell Medicine, Houston Methodist Hospital, Houston, Texas
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Comparing Clinical, Imaging, and Physiological Correlates of Intestinal Pseudo-Obstruction: Systemic Sclerosis vs Amyloidosis and Paraneoplastic Syndrome. Clin Transl Gastroenterol 2020; 11:e00206. [PMID: 32931184 PMCID: PMC7410023 DOI: 10.14309/ctg.0000000000000206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Intestinal pseudo-obstruction is characterized by impaired transit and luminal dilation in the absence of mechanical obstruction. Our study aims to describe the clinical, radiographic, and physiological findings in pseudo-obstruction associated with systemic sclerosis (SSc), amyloidosis, and paraneoplastic syndrome. METHODS A retrospective cohort of patients evaluated at our institution between January 1, 2008, and August 1, 2018, was assembled. Clinical, imaging, and physiological characteristics were abstracted from electronic medical records. RESULTS We identified 100 cases of pseudo-obstruction (55 SSc, 27 amyloidosis, and 18 paraneoplastic). Female population predominance was seen in SSc (71%) vs male population in amyloidosis (74%). Most common symptom was abdominal bloating in all 3 groups. Vomiting was more common in SSc than amyloidosis (73% vs 46%, P = 0.02). Diarrhea was more common in amyloidosis and SSc compared with paraneoplastic (81% and 67% vs 28%, P < 0.01). Weight loss (>5%) was more common in SSc compared with amyloidosis and paraneoplastic (78% vs 31% and 17%, P < 0.0001). Only small bowel dilation was seen in 79%, 40%, and 44% and only large bowel dilation in 2%, 44%, and 44% of patients in SSc, amyloidosis, and paraneoplastic, respectively. Five of 8 SSc patients had myopathic and 3 of 5 paraneoplastic had neuropathic involvement on gastroduodenal manometry. DISCUSSION SSc-associated pseudo-obstruction demonstrates female population predominance and presents with vomiting, diarrhea, and weight loss. Amyloidosis-associated pseudo-obstruction shows male population predominance. Small bowel is more commonly involved than large bowel on both imaging and transit studies in SSc. Myopathic involvement was more common in SSc, contrary to neuropathic in paraneoplastic syndrome.
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Verheyden C, Orliac C, Millet I, Taourel P. Large-bowel obstruction: CT findings, pitfalls, tips and tricks. Eur J Radiol 2020; 130:109155. [PMID: 32711335 DOI: 10.1016/j.ejrad.2020.109155] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 10/23/2022]
Abstract
Large bowel obstruction (LBO) is associated with high morbidity and mortality due to delayed diagnosis and/or treatment. MDCT has become the standard of care to identify the site, severity, and etiology of obstruction. The goal of this review is fourfold. The first objective is to give clues to differentiate LBO from colonic pseudo-obstruction. The second objective is to describe CT features in the most common cause of LBO which is colonic cancer by illustrating classical and atypical features of colonic cancer responsible for LBO and by giving the features which must be reported when differentiating malignant from benign: presence of local lymph nodes, other colic localizations, length of involved segment, presence of diverticula, or other. The third objective is to illustrate the various causes of LBO which can mimic a colon cancer by leading to a thickening of the colonic wall: diverticulitis, ischemic colitis, endometriosis, inflammatory disease and to give tips which permit to evoke another diagnosis than a colon cancer in patient with a LBO and a thickening of the colic wall. The fourth objective is to describe the common signs of cecal and sigmoid volvulus and to give tips for a diagnosis sometimes difficult particularly for cecal volvulus: one of two transition points according to the type of volvulus and the presence of a whirl sign with a torsion of the mesenteric vessels.
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Affiliation(s)
- Cécile Verheyden
- CHU MONTPELLIER, 391 avenue du doyen Gaston Giraud, 34000, Montpellier, France.
| | - Céline Orliac
- CHU MONTPELLIER, 391 avenue du doyen Gaston Giraud, 34000, Montpellier, France.
| | - Ingrid Millet
- CHU MONTPELLIER, 391 avenue du doyen Gaston Giraud, 34000, Montpellier, France.
| | - Patrice Taourel
- CHU MONTPELLIER, 391 avenue du doyen Gaston Giraud, 34000, Montpellier, France.
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Berry N, Noor MT, Kochhar R. Acute Abdominal Distension. ICU PROTOCOLS 2020:401-406. [DOI: 10.1007/978-981-15-0898-1_40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Petersen PC, Balakrishnan B, Vitola B, Hong JC. Case report series of a novel application of neostigmine to successfully relieve refractory ileus status post-pediatric orthotopic liver transplantation. Pediatr Transplant 2019; 23:e13564. [PMID: 31407849 DOI: 10.1111/petr.13564] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 06/03/2019] [Accepted: 07/03/2019] [Indexed: 01/24/2023]
Abstract
Post-operative ileus is common after abdominal surgeries. Children undergoing liver transplant are at increased risk of ileus for various reasons including multiple abdominal procedures and use of narcotic medications. Ileus can lead to abdominal compartment syndrome and compromise the integrity of the liver graft. In some of these patients, ileus is resistant to standard therapies including stool softeners, bowel stimulants, enemas, and even methylnaltrexone. Neostigmine has been shown in pediatric case series to be efficacious in some children for refractory post-operative ileus. We report three children (9 months, 3 years, and 12 years old) who developed refractory ileus after liver transplant, with one of them developing abdominal compartment syndrome, who were treated successfully with continuous infusions of neostigmine. Clinical responses included passage of flatus and stool and improvement in abdominal distension. All patients tolerated the infusion without serious adverse effects such as bradycardia or bronchospasm. Neostigmine was used safely in our patients and may be safe and efficacious for the treatment of refractory ileus in pediatric patients after liver transplantation. Neostigmine should be considered early in the treatment of these patients.
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Affiliation(s)
- Pamela C Petersen
- Section of Pediatric Critical Care Medicine, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Binod Balakrishnan
- Section of Critical Care, Children's Hospital of Wisconsin, Milwaukee, Wisconsin.,Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Bernadette Vitola
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.,Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Johnny C Hong
- Division of Transplant Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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Hughes AE, Smart NJ, Daniels IR. Acute colonic pseudo‐obstruction after caesarean section: a review and recommended management algorithm. ACTA ACUST UNITED AC 2019. [DOI: 10.1111/tog.12602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Alice E Hughes
- Academic Clinical Fellow and ST2 trainee in Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology Rosie Hospital Cambridge CB2 0QQ UK
| | - Neil J Smart
- Consultant Colorectal Surgeon, Royal Devon and Exeter NHS Foundation Trust and Honorary Associate Professor, University of Exeter Medical School Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital Exeter EX2 5DW UK
| | - Ian R Daniels
- Consultant Colorectal Surgeon, Royal Devon and Exeter Hospital NHS Foundation Trust and Honorary Clinical Senior Lecturer, University of Exeter Medical School Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital Exeter EX2 5DW UK
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Abstract
Gastrointestinal failure (GIF) is frequent in patients managed in the intensive care units and manifests as gut paralysis or ileus. GIF is often associated with sepsis or multiorgan failure. In critically ill patients, the precipitating causes of GIF include inflammation, sepsis, electrolyte abnormalities, and acidosis. It is possible that GIF is associated with an increase in bacterial translocation, especially in those with cirrhosis and portal hypertension, and this may play a significant pathogenic or prognostic role in acute-on-chronic liver failure (ACLF). The critical care literature suggests that GIF is associated with a higher mortality risk. In this review, we summarize the evidence for a potential association between GIF and ACLF and propose treatment options for the management of GIF. Moreover, we suggest GIF to be considered as another organ failure when the severity of ACLF is assessed.
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Catena F, De Simone B, Coccolini F, Di Saverio S, Sartelli M, Ansaloni L. Bowel obstruction: a narrative review for all physicians. World J Emerg Surg 2019; 14:20. [PMID: 31168315 PMCID: PMC6489175 DOI: 10.1186/s13017-019-0240-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/10/2019] [Indexed: 12/13/2022] Open
Abstract
Small and large bowel obstructions are responsible for approximately 15% of hospital admissions for acute abdominal pain in the USA and ~ 20% of cases needing acute surgical care. Starting from the analysis of a common clinical problem, we want to guide primary care physicians in the initial management of a patient presenting with acute abdominal pain associated with intestinal obstruction.
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Affiliation(s)
- Fausto Catena
- 1Emergency and Trauma Surgery Department, Parma University Hospital, Via Gramsci 14, 43126 Parma, Italy
| | - Belinda De Simone
- 1Emergency and Trauma Surgery Department, Parma University Hospital, Via Gramsci 14, 43126 Parma, Italy
| | | | | | | | - Luca Ansaloni
- Emergency and Trauma Surgery Department, Cesena Hospital, Cesena, Italy
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Anaya-Prado R, Pérez-Navarro JV, Corona-Nakamura A, Anaya-Fernández MM, Anaya-Fernández R, Izaguirre-Pérez ME. Intestinal pseudo-obstruction caused by herpes zoster: Case report and pathophysiology. World J Clin Cases 2018; 6:132-138. [PMID: 29988868 PMCID: PMC6033747 DOI: 10.12998/wjcc.v6.i6.132] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/27/2018] [Accepted: 05/15/2018] [Indexed: 02/05/2023] Open
Abstract
Herpes zoster (HZ) infection occurs in approximately 10% to 30% of individuals. Visceral neuropathies secondary to HZ can cause cystitis and urinary retention. But colonic pseudo-obstruction can also occur. Peripheral neuropathy may reveal segmental motor paresis of either upper or lower limbs, the abdominal muscles or the diaphragm. We report the case of a 62-year-old male patient who presented with abdominal distention and cutaneous vesicular eruption on the left side of the abdominal wall. Plain X-rays and computed tomography scan showed distended small bowel. A diagnosis of intestinal pseudo-obstruction was made secondary to segmental paresis of the small intestine and visceral neuropathy. Conservative management was successful and the patient was discharged uneventfully. Intestinal pseudo-obstruction ought to be considered when dealing with non-obstructive (adynamic) conditions of the digestive tract associated with HZ infection; since early recognition may help to avoid unnecessary surgery.
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Affiliation(s)
- Roberto Anaya-Prado
- Department of Surgery at Western Medical Center, the Mexican Institute of Social Security, Guadalajara, JAL 44340, México
- Division of Research at Autonomous University of Guadalajara, Guadalajara, JAL 45200, México
| | - José V Pérez-Navarro
- Department of Surgery at Western Medical Center, the Mexican Institute of Social Security, Guadalajara, JAL 44340, México
| | - Ana Corona-Nakamura
- Department of Infectious Diseases at Western Medical Center, the Mexican Institute of Social Security, Guadalajara, JAL 44340, México
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A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction. Curr Gastroenterol Rep 2017; 19:28. [PMID: 28439845 DOI: 10.1007/s11894-017-0566-9] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW This study aimed to systematically review small bowel obstruction (SBO), focusing on recent changes in diagnosis/therapy. RECENT FINDINGS SBO incidence is about 350,000/annum in the USA. Etiologies include adhesions (65%), hernias (10%), neoplasms (5%), Crohn's disease (5%), and other (15%). Bowel dilatation occurs proximal to obstruction primarily from swallowed air and secondarily from intraluminal fluid accumulation. Dilatation increases mural tension, decreases mucosal perfusion, causes bacterial proliferation, and decreases mural tensile strength that increases bowel perforation risks. Classical clinical tetrad is abdominal pain, nausea and emesis, abdominal distention, and constipation-to-obstipation. Physical exam may reveal restlessness, acute illness, and signs of dehydration and sepsis, including tachycardia, pyrexia, dry mucous membranes, hypotension/orthostasis, abdominal distention, and hypoactive bowel sounds. Severe direct tenderness, involuntary guarding, abdominal rigidity, and rebound tenderness suggest advanced SBO, as do marked leukocytosis, neutrophilia, bandemia, and lactic acidosis. Differential diagnosis includes postoperative ileus, narcotic bowel, colonic pseudo-obstruction, mesenteric ischemia, and large bowel obstruction. Medical resuscitation includes intravenous hydration, correcting electrolyte abnormalities, intravenous antibiotics, nil per os, and nasoenteral suction. Abdominal CT with oral and intravenous gastrografin contrast is highly sensitive and specific in detecting/characterizing SBO. SBO usually resolves with medical therapy but requires surgery, preferentially by laparoscopy, for unremitting total obstruction, bowel perforation, severe ischemia, or clinical deterioration with medical therapy. Overall mortality is 10% but increases to 30% with bowel necrosis/perforation. Key point in SBO is early diagnosis, emphasizing abdominal CT; aggressive medical therapy including rehydration, antibiotics, and nil per os; and surgery for failed medical therapy.
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Abstract
Urinary diversion (UD) with an intestinal segment has significant risks of short- and long-term complications. With modern reporting criteria, understanding of the true prevalence and spectrum of these complications has improved. Methods to minimize early postoperative complications include enhanced recovery pathways, restricted intraoperative fluid protocols, and referral to high-volume centers. With long-term follow-up after UD, the risk of complications steadily rises. Late surgical complications include ureterointestinal anastomotic strictures, urolithiasis, and stomal issues. Patients with UDs require close surveillance to monitor for anatomic, infectious, and metabolic complications and surgeons who perform UD should be aware of the risk and timing of postoperative complications.
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Kim SH, Park KN, Kim J, Eun CK, Park YM, Oh MK, Choi KH, Kim HJ, Kim DW, Choo HJ, Cho JH, Oh JH, Park HY. Accuracy of Plain Abdominal Radiography in the Differentiation between Small Bowel Obstruction and Small Bowel Ileus in Acute Abdomen Presenting to Emergency Department. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791101800202] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Introduction Our purpose was to evaluate whether plain abdominal radiography (PAR) could accurately differentiate between small bowel obstruction (SBO) and small bowel ileus (SBI) in an emergency setting. We also evaluated the value of known classic signs on the PAR for differentiating between SBO and SBI. Methods This retrospective study included 216 emergency room patients who had small bowel distension (maximal small bowel diameter ≥2.5 cm) on the PAR and who underwent successive abdominal computed tomography. One radiologist and one emergency physician retrospectively reviewed PAR in consensus, unaware of the patients' clinical data; they divided the patients into an SBO group and an SBI group according to the radiographic findings. Presence or numeric values of 10 radiographic signs were also recorded. Final diagnoses of SBO and SBI were established by a combined analysis of medical charts, surgical records, radiographic findings on abdominal computed tomography, and small bowel studies. The differential diagnoses based on PAR and the final diagnoses were compared, and the sensitivity and specificity of PAR were calculated. We also evaluated the differences among 10 radiographic signs between the final SBO and SBI groups. Results Sensitivity and specificity of PAR for SBO were 82.0% and 92.4%, respectively. Among the 10 radiographic signs, all except maximal colon diameter were statistically significant predictors on the final diagnosis. Conclusions PAR is an accurate and effective initial imaging modality for differentiating between SBO and SBI in an emergency setting, and most of the classic radiographic signs have a diagnostic value.
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Affiliation(s)
- SH Kim
- Inje University Haeundae Paik Hospital, Department of Emergency Medicine, 1435 Jwa-dong, Haewondae-gu, Busan 612-030, Republic of Korea
| | - KN Park
- Inje University Haeundae Paik Hospital, Department of Emergency Medicine, 1435 Jwa-dong, Haewondae-gu, Busan 612-030, Republic of Korea
| | - J Kim
- Inje University Haeundae Paik Hospital, Department of Emergency Medicine, 1435 Jwa-dong, Haewondae-gu, Busan 612-030, Republic of Korea
| | - CK Eun
- Inje University Haeundae Paik Hospital, Department of Emergency Medicine, 1435 Jwa-dong, Haewondae-gu, Busan 612-030, Republic of Korea
| | - YM Park
- Inje University Haeundae Paik Hospital, Department of Emergency Medicine, 1435 Jwa-dong, Haewondae-gu, Busan 612-030, Republic of Korea
| | - MK Oh
- Inje University Haeundae Paik Hospital, Department of Emergency Medicine, 1435 Jwa-dong, Haewondae-gu, Busan 612-030, Republic of Korea
| | - KH Choi
- Inje University Haeundae Paik Hospital, Department of Emergency Medicine, 1435 Jwa-dong, Haewondae-gu, Busan 612-030, Republic of Korea
- Uijeongbu St. Mary's Hospital, Department of Emergency Medicine, The Catholic University of Korea, 65-1 Geumo-dong, Uijeongbu-si, Gyeonggi-do, 480-717, Republic of Korea
| | - HJ Kim
- Uijeongbu St. Mary's Hospital, Department of Emergency Medicine, The Catholic University of Korea, 65-1 Geumo-dong, Uijeongbu-si, Gyeonggi-do, 480-717, Republic of Korea
| | - DW Kim
- Inje University Haeundae Paik Hospital, Department of Emergency Medicine, 1435 Jwa-dong, Haewondae-gu, Busan 612-030, Republic of Korea
| | - HJ Choo
- Inje University Haeundae Paik Hospital, Department of Emergency Medicine, 1435 Jwa-dong, Haewondae-gu, Busan 612-030, Republic of Korea
| | - JH Cho
- Inje University Haeundae Paik Hospital, Department of Emergency Medicine, 1435 Jwa-dong, Haewondae-gu, Busan 612-030, Republic of Korea
| | - JH Oh
- Inje University Haeundae Paik Hospital, Department of Emergency Medicine, 1435 Jwa-dong, Haewondae-gu, Busan 612-030, Republic of Korea
| | - HY Park
- Inje University Haeundae Paik Hospital, Department of Emergency Medicine, 1435 Jwa-dong, Haewondae-gu, Busan 612-030, Republic of Korea
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Wells CI, O’Grady G, Bissett IP. Acute colonic pseudo-obstruction: A systematic review of aetiology and mechanisms. World J Gastroenterol 2017; 23:5634-5644. [PMID: 28852322 PMCID: PMC5558126 DOI: 10.3748/wjg.v23.i30.5634] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 06/29/2017] [Accepted: 07/22/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To critically review the literature addressing the definition, epidemiology, aetiology and pathophysiology of acute colonic pseudo-obstruction (ACPO). METHODS A systematic search was performed to identify articles investigating the aetiology and pathophysiology of ACPO. A narrative synthesis of the evidence was undertaken. RESULTS No consistent approach to the definition or reporting of ACPO has been developed, which has led to overlapping investigation with other conditions. A vast array of risk factors has been identified, supporting a multifactorial aetiology. The pathophysiological mechanisms remain unclear, but are likely related to altered autonomic regulation of colonic motility, in the setting of other predisposing factors. CONCLUSION Future research should aim to establish a clear and consistent definition of ACPO, and elucidate the pathophysiological mechanisms leading to altered colonic function. An improved understanding of the aetiology of ACPO may facilitate the development of targeted strategies for its prevention and treatment.
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Peker KD, Cikot M, Bozkurt MA, Ilhan B, Kankaya B, Binboga S, Seyit H, Alis H. Colonoscopic decompression should be used before neostigmine in the treatment of Ogilvie's syndrome. Eur J Trauma Emerg Surg 2016; 43:557-566. [PMID: 27432173 DOI: 10.1007/s00068-016-0709-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 07/11/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Performance of urgent colonoscopy for the purposes of diagnosis and treatment of Ogilvie's syndrome remains controversial. However, no trials have directly compared neostigmine with endoscopic therapy. This study aimed to compare the effect of neostigmine and colonoscopic decompression in the treatment of Ogilvie's syndrome. METHODS This study was designed as a retrospective, non-randomized clinical study of sequential patients. Patients who were diagnosed as having acute colonic pseudo-obstruction were separated into two groups after conservative treatment. Group 1 comprised patients who underwent colonoscopic decompression, because they had a poor first response to neostigmine treatment. Group 2 constituted patients who had a poor first response to colonoscopic decompression, and neostigmine was added to the treatment regimen. Groups 1 and 2 were compared for the success of disease management. RESULTS In groups 1 and 2, the average age of the patients was 63.19 years (±14.71 years) and 59.45 years (±15.31 years) (p = 0.312), respectively. No significant difference was determined between the groups in terms of distribution of sex, hospital stay, etiologies, and initial cecal sizes in imaging (p > 0.05). Response to first intervention was statistically significant (p < 0.01). Also, the total response was determined statistically significant for hospital stay if colonoscopic decompression was performed (p < 0.01). No recurrence was determined during the 1-month follow-up in both groups. Although there was no etiologic factor for neostigmine response according to univariate analysis results, colonoscopic success was decreased due to age, sex, and the presence of a cardiac disease. CONCLUSIONS Although the success rate of neostigmine treatment was significantly lower in our homogeneous groups, no significant decrease was determined in terms of hospital stay, intensive care unit stay, and requirement of colostomy compared with colonoscopic decompression. By comparison, colonoscopic decompression, which was performed by experienced endoscopists as a first-line treatment option, was more effective as an initial therapy and was more effective at avoiding a second treatment modality.
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Affiliation(s)
- K D Peker
- Department of General Surgery, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No. 11, Bakirkoy, 34147, Istanbul, Turkey.
| | - M Cikot
- Department of General Surgery, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No. 11, Bakirkoy, 34147, Istanbul, Turkey
| | - M A Bozkurt
- Department of General Surgery, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No. 11, Bakirkoy, 34147, Istanbul, Turkey
| | - B Ilhan
- Department of General Surgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - B Kankaya
- Department of General Surgery, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No. 11, Bakirkoy, 34147, Istanbul, Turkey
| | - S Binboga
- Department of General Surgery, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No. 11, Bakirkoy, 34147, Istanbul, Turkey
| | - H Seyit
- Department of General Surgery, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No. 11, Bakirkoy, 34147, Istanbul, Turkey
| | - H Alis
- Department of General Surgery, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No. 11, Bakirkoy, 34147, Istanbul, Turkey
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Abstract
Abdominal pain in the elderly can be a challenging and difficult condition to diagnose and treat. The geriatric population has significant comorbidities and often takes polypharmacy that can mask symptoms. The presentation of common conditions can be different than that in the younger population, often lacking the traditional indicators of disease, making it of pivotal importance for the clinician to consider a wide differential during their workup. It is also important to consider extra-abdominal abnormality that may manifest as abdominal pain.
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Affiliation(s)
- Amy Leuthauser
- Department of Emergency Medicine, Bay of Plenty District Health Board, Tauranga Hospital, Cameron Road, Private bag 12024, Tauranga 3142, New Zealand.
| | - Benjamin McVane
- Department of Emergency Medicine, Icahn School of Medicine, Mount Sinai Hospital, 1 gustav levy place, New York, NY 10028, USA
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Yoon SI, Kang JM. Aspiration Pneumonia in a Pediatric Patient under General Anesthesia despite Adequate Preoperative Fasting. Korean J Crit Care Med 2015. [DOI: 10.4266/kjccm.2015.30.4.313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Abstract
Ogilvie's syndrome due to herpes zoster infection is a rare manifestation of VZV reactivation. The onset of rash of herpes zoster and the symptoms of intestinal obstruction can occur at different time intervals posing a significant diagnostic challenge resulting in avoidable surgical interventions. Herein, we describe a case of 35-year-old male who presented with 6-day history of constipation and colicky abdominal pain along with an exquisitely tender and vesicular skin eruption involving the T8–T11 dermatome. Abdominal X-ray and ultrasound revealed generalized gaseous distention of the large intestine with air up to the rectum consistent with paralytic ileus. Colonoscopy did not show any obstructing lesion. A diagnosis of Ogilvie's syndrome associated with herpes zoster was made. He was conservatively managed with nasogastric decompression, IV fluids, and acyclovir. The patient had an uneventful recovery and was later discharged.
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Kyriacou A, McLaughlin J, Syed AA. Thyroid disorders and gastrointestinal and liver dysfunction: A state of the art review. Eur J Intern Med 2015; 26:563-71. [PMID: 26260744 DOI: 10.1016/j.ejim.2015.07.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 07/17/2015] [Accepted: 07/18/2015] [Indexed: 12/19/2022]
Abstract
Thyroid disorders commonly impact on the gastrointestinal system and may even present with gastrointestinal symptoms in isolation; for example, metastatic medullary thyroid carcinoma typically presents with diarrhoea. Delays in identifying and treating the underlying thyroid dysfunction may lead to unnecessary investigations and treatment, with ongoing morbidity, and can potentially be life-threatening. Similarly, gastrointestinal diseases can impact on thyroid function tests, and an awareness of the concept and management of non-thyroidal illness is necessary to avoid giving unnecessary thyroid therapies that could potentially exacerbate the underlying gastrointestinal disease. Dual thyroid and gastrointestinal pathologies are also common, with presentations occurring concurrently or sequentially, the latter after a variable time lag that can even extend over decades. Such an association aetiologically relates to the autoimmune background of many thyroid disorders (e.g. Graves' disease and Hashimoto's thyroiditis) and gastrointestinal disorders (e.g. coeliac disease and inflammatory bowel disease); such autoimmune conditions can sometimes occur in the context of autoimmune polyglandular syndrome. Emphasis should also be given to the gastrointestinal side effects of some of the medications used for thyroid disease (e.g. anti-thyroid drugs causing hepatotoxicity) and vice versa (e.g. interferon therapy causing autoimmune thyroid dysfunction). In this review, we discuss disorders of the thyroid-gut axis and identify the evidence base behind the management of such disorders.
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Affiliation(s)
- Angelos Kyriacou
- Endocrinology and Diabetes, Salford Royal NHS Foundation Trust and University Teaching Hospital, Salford, Greater Manchester, UK.
| | - John McLaughlin
- Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, the University of Manchester, Manchester, UK; Gastroenterology, Salford Royal NHS Foundation Trust and University Teaching Hospital, Salford, Greater Manchester, UK
| | - Akheel A Syed
- Endocrinology and Diabetes, Salford Royal NHS Foundation Trust and University Teaching Hospital, Salford, Greater Manchester, UK; Manchester Medical School, Faculty of Medical and Human Sciences, the University of Manchester, Manchester, UK
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Jaffe T, Thompson WM. Large-Bowel Obstruction in the Adult: Classic Radiographic and CT Findings, Etiology, and Mimics. Radiology 2015; 275:651-63. [PMID: 25997131 DOI: 10.1148/radiol.2015140916] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Large-bowel obstruction is an abdominal emergency with high morbidity and mortality rates if left untreated. Although abdominal radiography is usually the initial imaging study performed in patients suspected of having large-bowel obstruction, it may not be sufficient to distinguish obstruction from other causes of colonic dilatation. Computed tomography is the imaging method of choice as it can establish the diagnosis and cause of large-bowel obstruction. A contrast agent enema may be used to confirm or exclude large-bowel obstruction. In this review, the imaging findings in multiple causes of large-bowel obstruction are illustrated and compared with acute colonic pseudo-obstruction.
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Affiliation(s)
- Tracy Jaffe
- From the Department of Radiology, Duke University Medical School, Box 3808, Durham, NC 27710 (T.J.); Department of Radiology, Veterans Administration Hospital, Albuquerque, NM (W.M.T.); and Department of Radiology, University of New Mexico, Albuquerque, NM (W.M.T.)
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Kusmenkov T, Kasparek MS, Brumann M, Bogner V, Mutschler W. [Posttraumatic adhesive ileus following pelvic ring fracture]. Unfallchirurg 2014; 118:808-11. [PMID: 25432671 DOI: 10.1007/s00113-014-2681-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report on two cases of posttraumatic ileus after pelvic ring fracture in two patients aged 73 and 74 years, respectively. Although all conservative measures were exhausted, in both cases the ileus resulted in additional operative procedures and a significant extension of the hospital stay. Intraoperatively both patients presented with a mechanical ileus caused by adhesions which were unapparent for decades. Only the trauma-related motility disorder led to a clinical manifestation. Pathophysiological mechanisms and their implications on prophylaxis and therapy are discussed.
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Affiliation(s)
- T Kusmenkov
- Klinik für Allgemeine, Unfall-, Hand- und Plastische Chirurgie, Klinikum der Ludwig-Maximilians-Universität, Campus Innenstadt, Nußbaumstr. 20, 80336, München, Deutschland,
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Valle RGL, Godoy FL. Neostigmine for acute colonic pseudo-obstruction: A meta-analysis. Ann Med Surg (Lond) 2014; 3:60-4. [PMID: 25568788 PMCID: PMC4284455 DOI: 10.1016/j.amsu.2014.04.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 04/01/2014] [Accepted: 04/09/2014] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Acute colonic pseudo-obstruction (ACPO) is an uncommon condition that occasionally develops in hospitalized patients with serious underlying ailments. Its early recognition is essential to reduce life-threatening complications. Few low-powered randomized clinical trials (RCTs) have confirmed the effectiveness of neostigmine for treatment. AIM To analyse the effectiveness and main side effects of neostigmine in the treatment of ACPO. EXPERIMENTAL A literature search was performed for all published RCTs, reporting on neostigmine as treatment for ACPO. RESULTS Four studies fulfilled the inclusion criteria, evaluating 127 patients: treatment group = 65, control group = 62. Neostigmine effectiveness to resolve ACPO with only one dose was 89.2% versus 14.65% (P < 0.001, NNT = 1 [95% CI 1-2]). CONCLUSIONS Neostigmine is a safe and effective option for patients with ACPO who failed to respond to conservative management.
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Affiliation(s)
- Raul Guillermo Lopez Valle
- Corresponding author. Affinity Medical Associates, 11550 Louetta Suite 1200, Houston, TX 77070, USA. Tel.: +1 281 320 1196; fax: +1 281 320 1209.
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Abstract
Ogilvie's syndrome [acute colonic pseudo-obstruction (ACPO)] presents as massive colonic dilatation without a mechanical cause, usually in critically ill patients due to imbalanced sympathetic and parasympathetic activity. The initial therapy remains conservative with supportive measures (correction of metabolic, infectious or pharmacologic factors) followed by neostigmine and decompressive colonoscopy. Surgery is reserved for patients with clinical deterioration or with evidence of colonic ischemia or perforation. A 60-year-old lady presented with fever, altered sensorium, obstipation, bradycardia and abdominal distension. Investigation revealed hyponatremia and acute colonic pseudo-obstruction. Supportive measures and decompressive colonoscopy were not of great benefit. Thyroid profile was suggestive of primary hypothyroidism. Colonic motility was restored only on starting thyroxin. The case is illustrative of the need to consider hypothyroidism, a common endocrine disorder, in the differential diagnosis of Ogilvie's.
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Affiliation(s)
- Uday Yanamandra
- Department of Internal Medicine, Armed Forces Medical College, Pune, India
| | - Narendra Kotwal
- Department of Endocrinology, Command Hospital, Pune, Maharashtra, India
| | - Anil Menon
- Department of Internal Medicine, Armed Forces Medical College, Pune, India
| | - Velu Nair
- Department of Internal Medicine, Armed Forces Medical College, Pune, India
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Wright S, Ali M, Robinson A, Ramanathan K, Parker RB. Paralytic ileus associated with use of diltiazem. Am J Health Syst Pharm 2011; 68:1426-9. [PMID: 21785032 DOI: 10.2146/ajhp100582] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE A case of paralytic ileus in a patient receiving oral diltiazem therapy for atrial fibrillation is reported. SUMMARY A 64-year-old man with a history of multiple serious comorbidities, poly-pharmacy, and a recent hospital stay for acute cardiac problems was readmitted to the hospital for gastrointestinal (GI) bleeding. On day 2 of the readmission, he suffered a myocardial infarction complicated by atrial fibrillation with a rapid ventricular response. After initial treatment with oral metoprolol for ventricular rate control was discontinued (due to ineffective rate control and patient complaints of respiratory symptoms), oral diltiazem hydrochloride therapy (30 mg every six hours) was initiated on day 7; the dose was adjusted to a maximum of 120 mg every six hours on day 10. On day 12, the patient complained of nausea, abdominal pain and tenderness, and infrequent bowel movements; imaging studies on day 13 indicated paralytic ileus. Pursuant to a surgical consultation, a nasogastric tube was inserted and nothing was given by mouth except medications. After initial improvement of the GI symptoms, the feeding tube was removed; however, the symptoms worsened over the next two to three days, requiring reinsertion of the tube on day 16. On day 18, after other potential causes of ileus were ruled out, diltiazem therapy was withdrawn. The man experienced rapid symptomatic improvement, with no further GI symptoms, and was discharged four days later. CONCLUSION A 64-year-old man receiving high-dose diltiazem to treat atrial fibrillation developed paralytic ileus, which quickly resolved after the medication was discontinued.
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MESH Headings
- Angiogenesis Inhibitors/adverse effects
- Anti-Bacterial Agents/adverse effects
- Anti-Inflammatory Agents, Non-Steroidal/administration & dosage
- Anti-Inflammatory Agents, Non-Steroidal/adverse effects
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal, Humanized
- Antigens, CD/drug effects
- Antineoplastic Agents/adverse effects
- Bevacizumab
- CTLA-4 Antigen
- Caustics/adverse effects
- Colitis/chemically induced
- Colitis/diagnosis
- Colitis/pathology
- Colitis, Collagenous/chemically induced
- Colitis, Ischemic/chemically induced
- Colitis, Lymphocytic/chemically induced
- Colitis, Ulcerative/chemically induced
- Colitis, Ulcerative/pathology
- Colon/drug effects
- Cyclooxygenase 2 Inhibitors/adverse effects
- Diclofenac/adverse effects
- Enterocolitis, Necrotizing/chemically induced
- Enterocolitis, Necrotizing/diagnostic imaging
- Humans
- Plants, Medicinal/adverse effects
- Serotonin Receptor Agonists/adverse effects
- Tomography, X-Ray Computed
- Triazoles/adverse effects
- Tryptamines/adverse effects
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Abstract
Abdominal pain in older adults is a concerning symptom common to a variety of diagnoses with high morbidity and mortality. Organizing the differential into categories based on pathology (inflammatory, obstructive, vascular, or other causes) provides a framework for the history, physical, and diagnostic studies. An organized approach and treatment and considerations specific to the geriatric population are discussed.
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Affiliation(s)
- Luna Ragsdale
- Division of Emergency Medicine, Duke University Medical Center, Durham, NC 27710, USA.
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Abstract
Bowel obstruction and abdominal hernia are commonly observed in patients seeking emergency care for abdominal pain. This article discusses bowel obstruction, adynamic ileus, acute colonic pseudo-obstruction, and abdominal hernias, with particular emphasis on the management of patients in the emergency department (ED). Although the diagnostic approach to bowel obstruction often requires imaging, abdominal hernia may be identified in most circumstances by history and physical examination alone. Urgent surgical consultation is indicated when there is a concern for bowel ischemia, strangulation, or complete obstruction. This article reviews an ED-based approach to the patient presenting with symptoms of bowel obstruction or hernia.
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Affiliation(s)
- Geoffrey E Hayden
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
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Kopelman Y, Triadafilopoulos G. Endoscopy in the diagnosis and management of motility disorders. Dig Dis Sci 2011; 56:635-54. [PMID: 21286936 DOI: 10.1007/s10620-011-1584-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Accepted: 01/14/2011] [Indexed: 12/14/2022]
Abstract
BACKGROUND Gastrointestinal illness may result from either an underlying structural abnormality (e.g. neoplastic obstruction), or a functional disorder (e.g. motor diarrhea), or both (e.g. achalasia with squamous esophageal cancer). AIMS The purpose of this study was to highlight the potential value and role of endoscopy in the recognition and management of patients with functional and motility disorders. METHODS We performed a literature review in PubMed. RESULTS Diagnostic and therapeutic endoscopy may be under-used by motility-oriented gastroenterologists; in contrast, motility and other functional studies may be under-used by endoscopists. Yet, many areas of cross-exchange exist. CONCLUSIONS This review aims to guide the appropriate indications for the use of endoscopy in diagnosing and treating functional GI and motility disorders and serve as a bridge and a forum of exchange between endoscopists and motility specialists.
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Affiliation(s)
- Yael Kopelman
- Stanford University School of Medicine, Stanford, CA, USA
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Cho FN, Liu CB, Li JY, Chen SN, Yu KJ. Adynamic ileus and acute colonic pseudo-obstruction occurring after cesarean section in patients with massive peripartum hemorrhage. J Chin Med Assoc 2009; 72:657-62. [PMID: 20028649 DOI: 10.1016/s1726-4901(09)70451-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The clinical histories (including radiographs) of 4 patients who suffered from significant adynamic ileus or acute colonic pseudo-obstruction after cesarean section are presented. The main manifestations were vomiting, severe colicky pain, and abdominal distension. These can occur immediately after or within 2 days of the operation. Based on our experience, the risk factors for the development of adynamic ileus are significant peripartum hemorrhage leading to unstable hemodynamic status, severe constipation, use of meperidine for pain relief, and overt bowel manipulation. Mild enema and metoclopramide seem to be helpful in facilitating its resolution. Here, we examine how to differentiate mechanical bowel obstruction from adynamic ileus and look at how to prevent the occurrence of adynamic ileus while minimizing its severity and shortening its clinical course.
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Affiliation(s)
- Fu-Nan Cho
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C.
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Daher R, Yazbeck T, Jaoude JB, Abboud B. Consequences of dysthyroidism on the digestive tract and viscera. World J Gastroenterol 2009; 15:2834-8. [PMID: 19533804 PMCID: PMC2699000 DOI: 10.3748/wjg.15.2834] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Thyroid hormones define basal metabolism throughout the body, particularly in the intestine and viscera. Gastrointestinal manifestations of dysthyroidism are numerous and involve all portions of the tract. Thyroid hormone action on motility has been widely studied, but more complex pathophysiologic mechanisms have been indicated by some studies although these are not fully understood. Both thyroid hormone excess and deficiency can have similar digestive manifestations, such as diarrhea, although the mechanism is different in each situation. The liver is the most affected organ in both hypo- and hyperthyroidism. Specific digestive diseases may be associated with autoimmune thyroid processes, such as Hashimoto’s thyroiditis and Grave’s disease. Among them, celiac sprue and primary biliary cirrhosis are the most frequent although a clear common mechanism has never been proven. Overall, thyroid-related digestive manifestations were described decades ago but studies are still needed in order to confirm old concepts or elucidate undiscovered mechanisms. All practitioners must be aware of digestive symptoms due to dysthyroidism in order to avoid misdiagnosis of rare but potentially lethal situations.
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Edelman DA, Antaki F, Basson MD, Salwen WA, Gruber SA, Losanoff JE. Ogilvie syndrome and herpes zoster: case report and review of the literature. J Emerg Med 2009; 39:696-700. [PMID: 19327938 DOI: 10.1016/j.jemermed.2009.02.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Revised: 01/28/2009] [Accepted: 02/06/2009] [Indexed: 12/13/2022]
Abstract
BACKGROUND The very unusual association between herpes zoster and Ogilvie syndrome has received scant attention in the published literature. OBJECTIVES This review discusses the published experience since 1950 and attempts to increase clinical awareness about the co-existence of both conditions. CASE REPORT An 84-year-old male patient affected by herpes zoster presented with advanced acute colonic pseudo-obstruction and was successfully treated with colonic diversion. DISCUSSION Twenty published studies (1950-2008) of 28 patients in whom the two conditions co-existed are reviewed. The review included 22 male and 7 female patients (24%) aged 32-87 years (mean, 61 years). Significant co-morbidities were present in 45% of the patients. The majority of patients were observed and treated conservatively (83%). Two patients died (7%), both suffering from respiratory complications and malignancy. CONCLUSION Recognition of the combined syndrome may help to avoid unnecessary surgery. Laparotomy should be reserved as a last resort for when the obstruction cannot be successfully managed by endoscopy. A diverting colostomy can be used to monitor the blood supply and thus provide early warning for an impending abdominal catastrophe.
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Affiliation(s)
- David A Edelman
- Department of Surgery, Wayne State University, Detroit, Michigan, USA
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Abstract
AbstractBackgroundAcute colonic pseudo-obstruction is characterized by clinical and radiological evidence of acute large bowel obstruction in the absence of a mechanical cause. The condition usually affects elderly people with underlying co-morbidities, and early recognition and appropriate management are essential to reduce the occurrence of life-threatening complications.MethodsA part-systematic review was conducted. This was based on key publications focusing on advances in management.Results and conclusionsAlthough acute colonic dilatation has been suggested to result from a functional imbalance in autonomic nerve supply, there is little direct evidence for this. Other aetiologies derived from the evolving field of neurogastroenterology remain underexplored. The rationale of treatment is to achieve prompt and effective colonic decompression. Initial management includes supportive interventions that may be followed by pharmacological therapy. Controlled clinical trials have shown that the acetylcholinesterase inhibitor neostigmine is an effective treatment with initial response rates of 60–90 per cent; other drugs for use in this area are in evolution. Colonoscopic decompression is successful in approximately 80 per cent of patients, with other minimally invasive strategies continuing to be developed. Surgery has thus become largely limited to those in whom complications occur. A contemporary management algorithm is provided on this basis.
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Affiliation(s)
- R De Giorgio
- Department of Clinical Medicine and Centro Unificato di Ricerca BioMedica Applicata, University of Bologna, Bologna, Italy
| | - C H Knowles
- Centre for Academic Surgery, Royal London Hospital, London, UK
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