Gallstone ileus resulting in strong intestinal obstruction

Mechanic intestinal obstruction, caused by the passage of biliary calculus from vesicle to intestine, through fistulization, although not frequent, deserve study due to the morbi-mortality rates. Incidence in elder people explains the association with chronic degenerative diseases, increasing complexity in terms of therapy decision. Literature discusses the need and opportunity for the one or two-phase surgical attack of the cholecyst-enteric fistule, in front of the resolution on the obstructive urgency and makes reference to Gallstone Ileus as an exception for strong intestinal obstruction. The more frequent intestinal obstruction observed is when it occurs a Gallstone Ileus impacting in terms of ileocecal valve. The authors submit a Gallstone Ileus manifestation as causing strong intestinal obstruction, discussing aspects regarding diagnostic and treatment.     

A fluid-filled condom causing intestinal obstruction: nonsurgical therapy of an ileus by ultrasound-guided transabdominal tapping

The coincidence of an urachal adenocarcinoma with another similar tumour in other location makes necessary to separate a true primary from a metastatic adenocarcinoma. We report the case of a 66-years-old-man with an urachal mucinous adenocarcinoma and two colonic adenocarcinoma excised in the same surgical act, showing both macro and microscopic studies together with immunohistochemical techniques, that were useful to differentiate the origin of both neoplasms. Among them, the antibody to keratin 7, a cytoplasmic epithelial protein, was positive in the urachal and negative in the colonic tumour.     

Meconium ileus and intestinal atresia in fetuses and neonates

A collaborative study was performed to determine the different types and mechanisms of intestinal abnormalities during gestation. Cases had to fulfill one or more of the following three criteria: (1) meconium ileus, (2) intestinal stenosis or atresia, and (3) meconium peritonitis. Esophageal atresia, anorectal atresia, and abdominal wall defects were excluded. One hundred two cases were reviewed from the autopsies of 42 induced abortions, 22 stillborns, and the surgical findings in 38 neonates. Meconium ileus was detected mainly during the second trimester (28/38), and was associated with cystic fibrosis (15), fetal blood deglutition (4), infection (6), or multiple-abnormalities (10), in which three chromosomal aberrations were found. Intestinal stenosis or atresia was more commonly detected during the third trimester of gestation (46/56). Sixteen of the 30 duodenal malformations were associated with trisomy 21, whereas in the 26 small intestinal atresias, signs of distress or ischemia were most frequently detected. Only 8 of 25 meconium peritonitis cases were isolated. A total of 20 cystic fibrosis cases could be proved. In this series, functional abnormalities were observed predominantly in the second trimester and associated mainly with cystic fibrosis or amniotic fluid abnormalities. Anatomic lesions were commonly detected later on and associated with ischemic conditions, chromosomal aberrations, and even cystic fibrosis.     

Internal intestinal splinting with a soluble tube for the prevention of recurrent adhesion ileus

An absorbable, non-toxic, easy gliding, cross-linked gelatine tube has been developed to prevent and to treat chronical adhesion ileus. The tube is patterned upon the interior intestinal splinting with long tubes. By doing a small enterotomy it was possible to splint the whole intestine in pigs or endangered parts within a few minutes. The flexible gelatine tube does not kink and is melting off from the surface. It prevents the intestine from kinking and does not cause any lesions even on previously damaged intestinal walls. Possible complications seen by insertion and extraction of conventional tubes were not observed.     

The benefits of endoscopic nasobiliary drainage without sphincterotomy for acute cholangitis

OBJECTIVE: Endoscopic nasobiliary drainage for acute cholangitis is performed with or without endoscopic sphincterotomy. However, sphincterotomy carries a small but important risk of complications. We evaluated the benefits of endoscopic nasobiliary drainage without sphincterotomy for acute cholangitis. METHODS: A total of 166 patients underwent endoscopic nasobiliary drainage with sphincterotomy (73 patients, sphincterotomy group) or without (93 patients, nonsphincterotomy group). The indications were acute cholangitis due to choledocholithiasis (120 patients) or benign (10 patients) or malignant (36 patients) biliary stricture. Patient backgrounds were similar in the two groups. The outcomes of nasobiliary drainage were compared between the groups. RESULTS: Nasobiliary drainage was successful in 69 patients (95%) in the sphincterotomy group and in 89 (96%) in the nonsphincterotomy group. Efficient drainage was achieved in 67 patients (92%) in the sphincterotomy group and in 87 (94%) in the nonsphincterotomy group. Procedure-related complications developed in eight sphincterotomy-group patients (hemorrhage in three, acute cholecystitis in three, acute pancreatitis in one, catheter withdrawal in one) and in two nonsphincterotomy patients (pancreatitis in one, catheter withdrawal in one) (11% vs 2%; p < 0.05). There were no deaths. CONCLUSIONS: Endoscopic nasobiliary drainage without endoscopic sphincterotomy is a simple, safe, and effective treatment for acute cholangitis. This procedure is especially useful for critically ill patients and those with coagulopathy.     

Percutaneous transhepatic gallbladder drainage for acute acalculous cholecystitis following cardiovascular surgery

Four (1.2%) out of 321 patients required percutaneous transhepatic gallbladder drainage (PTGBD) following cardiovascular surgery. Cholecystitis was initially suspected based upon the occurrence of postoperative fever and the results of abdominal X-ray films. The main physical finding was tenderness of the right upper quadrant abdomen in all patients. Spontaneous pain and Blumberg's sign were not apparent. Distension of the gallbladder and sludge in the gall-bladder were detected in all four patients by ultrasonography, but calculi were not observed. Thickening and edema of the gallbladder wall, generally suggestive of cholecystitis, were observed in only one patient. PTGBD was performed from 5 to 43 (mean 16) days after surgery. The drained fluid was concentrated bile and not purulent. High fever dropped and serum transaminase and C-reactive protein levels decreased within three days after PTGBD. Bacteriologic examinations of the bile and arterial blood were negative in all cases. No complications as a result of PTGBD introduction occurred. PTGBD is a safe and effective procedure, and therefore should be actively performed even in the early phase of acute cholecystitis.     

A method for assaying intestinal brush-border sucrase in an intact intestinal preparation

Small intestinal brush-border hydrolases usually are assayed in intestinal mucosal homogenates resuspended in solutions of unphysiological ionic composition. Thus, extrapolation of measured Vmax values (maximal reaction rates at high substrate concentrations) to in vivo conditions, hence comparison with physiological substrate loads, is uncertain. We therefore have developed a sucrase assay in an intact preparation of mouse small intestine, an everted intestinal sleeve incubated in a physiological Ringer's solution. As in homogenate studies, sucrase is assayed by glucose production measured colorimetrically, but uptake of liberated glucose into the intestinal sleeve is prevented by the transport inhibitor phlorizin. The coefficient of variation of Vmax is 16% for sleeves from the same mouse and 8% for mean values from different mice. Sleeve sucrase activity is abolished by the inhibitor castanospermine. Activity in sleeves and homogenates proves to be the same when measured under identical solution conditions, but variations in assay conditions cause large activity changes from values measured in physiological solutions.     

Biliary colonic ileus: an unusual cause of colonic obstruction]

PD 108635 (1) was identified as a potent dopamine D4 ligand and we wanted to replace the benzylic alcohol with a metabolically more stable moiety. Investigations led to the discovery of a series of isoindolinones having D4 affinity.     

Incidence of fistulas after drainage of acute anorectal abscesses

PURPOSE: The aim of this study was to assess the incidence of anal fistulas and factors related to this incidence after incision and drainage of acute cryptoglandular anorectal abscesses. METHODS: Of 170 patients without previous anal fistulas, 146 were followed up for an average of 99 (range, 22-187) months after abscess drainage or until a fistula appeared. RESULTS: Fifty-four (37 percent) patients developed a fistula, and 15 (10 percent) patients developed a recurrent abscess. The incidence of fistulas was higher in females than in males (50 vs. 31 percent; P = 0.0403), especially regarding anterior abscesses (88 vs. 33 percent). Abscesses growing Escherichia coli were more prone to fistula formation than those growing other bacteria (46 vs. 27 percent; P = 0.0368). CONCLUSION: Incision and drainage alone of acute anorectal abscesses is recommended, because an unnecessary primary fistulotomy can be avoided in more than half of the patients by this approach. For superficial anterior abscesses in females, however, primary fistulotomy may be considered.     

Gallbladder puncture and drainage as therapy of acute cholecystitis

PATIENTS AND METHODS: An ultrasound-guided, percutaneous puncture (n = 30) and cholecystostomy (n = 10) was performed on 40 high-risk patients aged between 38 and 99 (mean age 78 years old) suffering from acute lithogenic cholecystitis or acalculous stress cholecystitis on account of general inoperability. Two catheter dislocations and in 3 cases a slight bile leakage were observed as complications. RESULTS: The puncture and drainage led to a dramatic alleviation of pain for all patients, the involution of a paralytic subileus and improvement of the general condition. Eighteen patients underwent a laparoscopic or open interval cholecystectomy in a stabilised condition. There was no recurrence of inflammation in 22 patients over a follow-up period of up to 5 years, so that one can assume a cicatrised healing of the acute choleycstitis. CONCLUSIONS: Ultrasound-guided, percutaneous puncture and cholecystostomy are effective, low-risk, and only slightly invasive procedures which can be employed for risk patients with acute cholecystitis as a life-saving, and in some cases definitive treatment. On account of pathogenic considerations, they should be included in the diagnostic and therapeutic concept at an early stage, particularly for acute, acalculous stress cholecystitis.     

Postoperative ileus as an indication for a 2d operation during the early postoperative period

The phagocytic and bactericidal activities to Salmonella pullorum (strain 9-25) or Salmonella senftenberg (strain 99D) were examined in chicken splenic phagocytes from 0-day-old to 2-month-old chickens. The phagocytic activity against S pullorum increased in splenic phagocytes from chickens older than 7 days, but significant changes in activity against S senftenberg were not observed during the experimental period. The bactericidal activity of splenic phagocytes against S senftenberg was higher than that of phagocytes against S pullorum during the same period. Increase of the bactericidal activity against S pullorum was observed with increasing age, but the activity of the splenic phagocytes from 0-day-old chickens against S senftenberg was similar to that of the phagocytes from 2-month-old chickens. Although delayed hypersensitivity was confirmed by delayed wattle reaction in 2-month-old chickens sensitized with living S pullorum, the sensitization did not markedly affect phagocytic and bactericidal activities.     

Role of vasoactive intestinal polypeptide in the adaptation of intestinal smooth muscle cells to mechanical distension

Distension of the small intestine can play a role in the pathogenesis of various functional intestinal disorders. This study determined the role of vasoactive intestinal polypeptide (VIP) in the adaptative response of intestinal smooth muscle to acute and chronic distension of the ileum in vivo. Several in vitro experiments were performed to identify the mechanism of receptor regulation. Distension was applied by a balloon inflated with air in the ileum either during a single episode in anesthetized or repeatedly in conscious guinea pigs. Then, muscle cells were isolated by enzymatic digestion from the distended and nondistended adjacent ileal segments. In addition, in vitro experiments were performed on freshly dispersed cells for determination of mechanisms. Control cells maximally relaxed (Cmax) at 1 microM VIP (EC50 = 50 pM) and 100 microM isoproterenol (EC50 = 7 nM). Both acute and chronic distensions triggered a right-ward shift of the concentration-response curves for VIP (Cmax = 100 microM, EC50 = 10 nM). A desensitization of the relaxing effect of VIP receptors was also observed when cells were preincubated for 30 min in vitro with VIP. By contrast, the relaxing effect of isoproterenol was affected neither by in vivo distension nor by in vitro incubation with isoproterenol. Desensitization of VIP receptors was prevented by in vitro incubation of cells with VIP plus a VIP antagonist [(D-P-Cl-Phe6,Leu17)VIP] and by intraluminal perfusion of the VIP antagonist during acute distention in vivo. Moreover, desensitization of VIP receptors did not occur after 30 min preincubation with either forskolin or 8-Bromo-cyclic AMP. These results indicate that mechanical distension of the ileum induces a homologous desensitization of VIP receptors on circular smooth muscle cells, which requires the occupation of its receptors by VIP.     

钢包引流砂机械式投放技术的开发应用

针对莱芜钢铁集团有限公司银山型钢有限公司炼钢厂采用人工投放钢包引流砂,导致引流砂大量浪费,增加钢水夹杂,影响水口自开率,制约炼钢生产等问题,通过开发引流砂复合引流器投放工艺技术以及对钢包水口座砖内径进行调整优化等措施,实现了钢包引流砂机械式投放。使水口自开率由95.5%提高到99.2%,吨钢引流砂消耗降低了0.37 kg。     

Diagnosis of gallstone ileus

Gallstone ileus is a rare disorder, which, because it is often misdiagnosed preoperatively, may become life-threatening. The classic triad of Rigler (aerobilia, small bowel ileus and a calcified, dystopic stone) is visualized on abdominal plain films in only 14-35% of cases. Further work-up includes ultrasound, upper gastrointestinal series with water soluble contrast medium and computed tomography (CT). CT is especially reliable in demonstrating all three criteria.     

Methods for measuring the intestinal absorption of calcium in humans (author's transl)

For the determination of intestinal absorption of calcium, the fasting (12 hours) patient receives radioactive labeled calcium (45Ca, more frequently 47Ca) by mouth. After 10, 20, 30, 60, 90, 120, 180 and 240 min, samples of venous blood are taken. The stool is also collected for three days. The determination of radiocalcium in the plasma and in the stool samples is done with a Geiger counter. This oral test provides informative results on numerous aspects of the pathophysiology of intestinal assimilation of calcium. In humans, the duodenum seems to be of the greatest importance for calcium absorption.