泛影葡胺在诊治粘连性小肠梗阻中的临床应用

目的分析泛影葡胺在粘连性小肠梗阻的诊断和治疗中的作用。方法对本院484例粘连性小肠梗阻患者经口服或胃管注入76%泛影葡胺行胃肠道造影,对小肠梗阻进一步诊治的临床经过进行回顾性分析,并加以总结。结果484例患者中362例经应用泛影葡胺非手术治愈,122例经泛影葡胺造影明确诊断后根据具体情况实施手术治疗。结论泛影葡胺可用于诊断小肠梗阻并明确梗阻部位;可作为粘连性小肠梗阻非手术治疗常规措施并可重复使用;可为手术提供客观依据,对手术时机和切口选择有很好的指导作用。     

肠腔内异物所致机械性小肠梗阻的CT诊断

【摘要】 目的 探讨CT对肠腔内异物所致机械性小肠梗阻诊断的价值。 资料与方法 回顾性分析8例经手术证实的肠腔内异物所致机械性小肠梗阻的CT表现。 结果 8例患者均有程度不等的肠梗阻，术前均能正确诊断肠梗阻。其中，小肠食入性异物小肠梗阻3例，粪石性小肠梗阻 3例，胆石性小肠梗阻 2例，均无肠缺血坏死、穿孔等并发症。 结论 通过典型的征象分析，CT能术前诊断肠腔内异物所致机械性小肠梗阻。     

儿童小肠镜临床应用管理专家共识

小肠疾病是消化系统疾病诊治难点之一,检查技术有限,严重制约了儿童消化道疾病的诊疗水平。随着小肠镜在儿科临床应用的推广与小肠镜设备和附件的优化,小肠镜技术为儿科消化道诊疗提供了新的手段,但临床操作规范化和镜下治疗面临诸多问题和挑战。为规范儿童小肠镜诊疗技术及提高小肠疾病的诊疗水平,中华医学会儿科学分会消化学组牵头,组织专家充分讨论,并参考儿童小肠镜临床应用的最新进展,制定了儿童小肠镜临床应用管理专家共识。     

粪石性小肠梗阻56例诊治体会

粪石性小肠梗阻较少见,约占肠梗阻的0.5%.我科从2000年1月至2010年3月共收治粪石性小肠梗阻56例,现将诊治经验报告如下.     

CT在粘连性小肠梗阻诊断中的应用

粘连性小肠梗阻（ASBO）诊治中，对肠绞窄、肠扭转等并发症很难做出早期、及时、准确的诊断，依靠临床症状、体征、腹平片或其他检查做出诊断，往往为时已晚，因此许多作者主张早期手术，以降低病死率。近年，随着CT诊断技术不断提高，对小肠梗阻的部位、原因能做出诊断并能发现早期肠绞窄和肠粘连所致肠扭转。本文通过对我院粘连性小肠梗阻病例的分析，探讨CT在粘连性小肠梗阻诊断中的作用。     

水溶性对比剂可判断粘连性小肠硬阻是否需早期手术

术后粘连是成年小肠梗阻最常见原因，对其处理有很大争议。有报道粘连性小肠梗阻手术延误超过48小时，会发生严重并发症。为预防肠绞窄坏死，有必要早期判断小肠梗阻能否自然缓解。本前瞻性研究口服Urografin24小时腹部放射学检查能否作为粘连性小肠梗阻患手术的可靠指征。     

碘化油小肠造影在粘连性肠梗阻诊断及治疗决策中的价值

目的观察碘化油小肠造影在粘连性肠梗阻诊疗中的作用。方法220例患者行碘化油小肠造影,通过腹部X线摄片动态观察造影剂在胃肠道中的位置及通过情况,以确定梗阻部位以及梗阻是否完全,从而确定治疗方法。结果118例不全性肠梗阻（造影剂在24 h内到达结肠）给予保守治疗,116例症状消失,2例症状加重经手术治疗后痊愈;另102例完全性肠梗阻（24 h后造影剂不能到达结肠）,98例行手术治疗痊愈,4例拒绝手术,保守治疗成功。结论碘化油小肠造影在对粘连性、非绞窄性肠梗阻明确梗阻部位及治疗方法的选择方面有很好的作用。     

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肠梗阻的分类方法较多 ,有机械性、动力性和血运性 ;单纯性和绞窄性 ;完全性和不完全性 ;急性和慢性等。按梗阻部位分高位小肠梗阻、低位小肠梗阻和结直肠梗阻。高位肠梗阻通常是指十二指肠和空肠近端梗阻 ,低位是指回肠末端和结直肠梗阻。由于回肠梗阻在诊治方面同属于小肠梗阻。因此 ,本文综合国内外报道主要对结直肠梗阻的诊治情况进行论述。1　临床特点1 1　病因大肠梗阻占肠梗阻的 2 0 % [1] ,以机械性肠梗阻多见。麻痹性者可见于一些假性结肠梗阻 ,病变多限于盲肠、升结肠和横结肠 ,发生原因较多 ,约 5 0 %的病人发生在外科手术后和…     

柿结石致小肠急性梗阻诊治体会

柿结石致小肠急性梗阻较少见。我院于2000年1月--2007年12月共收治小肠梗阻838例，其中，柿结石致小肠急性梗阻7例，现报告如下。     

腹腔镜在小肠不全梗阻手术中的应用

目的探讨腹腔镜治疗小肠不全梗阻的可行性及临床效果。方法回顾性分析2011年1月~2016年1月85例肠梗阻资料。5例因腹腔束带粘连导致梗阻,腹腔镜下切断束带解除梗阻;75例因小肠与小肠、腹壁、盆腔粘连、成角导致梗阻,腹腔镜下分离粘连、成角解除梗阻;3例探查发现阑尾炎导致梗阻,行阑尾切除术;2例因肠腔异物导致梗阻,腹腔镜下取出异物。腹胀明显者术前留置肠梗阻导管减轻腹胀。结果除2例局部粘连广泛、致密做小切口辅助手术切除部分肠管行端端吻合外,均在腹腔镜下完成,无并发症发生。术后随访3~60个月,平均35个月,未见梗阻症状复发。结论腹腔镜治疗小肠梗阻是可行的,具有切口小、创伤轻、恢复快、术后住院时间短等微创特点,避免开腹手术造成的创伤。     

经鼻肠减压管选择性小肠造影诊断肠梗阻

目的 探讨经鼻肠减压管选择性小肠造影对小肠梗阻诊断的临床意义.方法 对35例临床诊断为小肠梗阻并排除急诊手术指征患者,在X线监视下经鼻置入300 cm长的减压管至空肠上段抽吸减压治疗,随着小肠减压的不断深入,减压管前端可以最大限度地接近病变部位进行选择性小肠造影.在透视下经减压管吸引口注入76%泛影葡胺20～100ml,再注入空气50～200ml,使造影剂和空气直接涌入梗阻病灶周围形成双对比造影.对局部进行动态多体位观察,摄取点片.必要时同抽减压管至空肠上段行全小肠双对比造影.结果 本组35例置管全部成功,小肠减压治疗后肠梗阻缓解20例,减轻15例,手术治疗10例.35例选择性小肠造影局部小肠显影清晰,不重叠,重点突出.未见明显异常X线征象6例,粘连性肠梗阻15例,小肠肿瘤4例(转移瘤3例,小肠癌1例),小肠克罗恩病3例,小肠放射性肠炎3例(其中1例造影误诊为小肠转移瘤),小肠套叠2例,小肠息肉1例,升结肠癌1例. 结论鼻肠减压管具有小肠减压治疗与选择性小肠造影检查的双重作用.选择性小肠造影可以明确梗阻部位、梗阻程度和梗阻病因,做出影像学定位与定性诊断,为确定手术时机和手术方案提供可靠依据.     

术后早期炎性肠梗阻综合治疗疗效分析

目的探讨综合治疗在术后早期炎性肠梗阻疗效。方法回顾分析43例术后早期炎性肠梗阻患者的临床资料。结果 39例早期炎性肠梗阻经胃肠减压、生长抑素、糖皮质激素和肠外营养等综合措施治愈,平均治愈时间12.1±8.4d;4例经手术治疗治愈。结论非手术综合治疗是术后早期炎性肠梗阻的有效治疗方法。     

Small bowel intussusception caused by metastasis from anaplastic thyroid carcinoma: case report and literature review

Symptomatic involvement of the small bowel by metastasis from an extra-abdominal primary malignancy is rare, most commonly resulting from malignant melanoma and lung cancer; very rarely is small bowel involvement as first metastatic site. The Authors report a case of anaplastic thyroid carcinoma with lung metastasis, brain metastasis and an isolated metastasis to the small bowel leading intestinal obstruction due to small bowel intussusception. The Authors review the international literature about frequency, etiopathogenesis, clinical and diagnostic features and therapy of small bowel metastasis by extra-abdominal malignancies, especially by primary anaplastic thyroid carcinoma. Small bowel metastasis from extra-abdominal malignancies are very unusual, especially from anaplastic thyroid carcinoma, and the etiopathogenesis is still unknown. Clinical findings are typical for abdominal urgency, especially by small bowel obstruction from anaplastic thyroid carcinoma. Computed Tomography has an important role in detecting the type of intestinal obstruction despite it is often unable to diagnose an isolated metastasis. Best therapy is surgical resection, that allows the assessment of metastasis and the definitive staging. The prognosis is poor, despite long-term survival has been occasionally reported for isolated small bowel metastasis     

Acute Small Bowel Obstruction Secondary to Ileal Endometriosis: Report of a Case

We report a case of acute small bowel obstruction occurring secondary to endometriosis of the terminal ileum. Ileal endometriosis is a rare condition that can cause acute small bowel obstruction. As this case and others in the literature highlight, establishing a preoperative diagnosis is very difficult due to the vagueness of symptoms and similarity in presentation to other causes of obstruction, and is based on a high index of suspicion. However, this disorder should be considered in the differential diagnosis of women of child-bearing age who present with symptoms of obstruction. The definitive treatment includes resection of the involved segment with primary anastomosis, and adjuvant hormonal therapy may prevent recurrence.     

Bacterial microflora, endogenous endotoxin, and prostaglandins in small bowel obstruction

The objective of this experimental study of small bowel obstruction was to investigate luminal bacterial colonization and assess the most likely mediator substances responsible for the pathophysiologic alterations, those being endogenous endotoxin and prostaglandins. Eighteen pigs with small bowel obstruction and 11 sham-operated control animals given constant infusion therapy were investigated over 7 days. Bacteria determinations were performed at operation and at sacrifice. Endotoxin levels were determined three times and prostaglandin levels, twice daily in portal and central venous blood. In the pigs with small bowel obstruction, greatly increased microflora with a predominance of E. coli bacteria was observed in the obstructed bowel. Endotoxin measurements proved general release into the circulation, with potentially toxic levels in the systemic circulation arising relatively late on the fourth postobstruction day. Beginning on the first postobstruction day, stimulation of the prostaglandin system occurred which was initially limited to the gastrointestinal tract but spread systemically when the obstruction persisted for more than 5 days. Vasoactive eicosanoids were predominantly involved. The control animals showed none of the alterations seen in the animals with small bowel obstruction.     

Idiopathic small bowel diaphragm disease identified by laparoscopic-assisted double-balloon enteroscopy in a child: an integrated successful definitive therapeutic method

In adults, small bowel diaphragm disease is a rare complication of small bowel enteropathy secondary to the use of nonsteroidal antiinflammatory drugs. The main clinical manifestations are gastrointestinal bleeding and subacute obstruction, and management can be challenging. We present a case of a 5-year-old girl with small bowel diaphragm disease. To our knowledge, this is the first idiopathic case (no history of nonsteroidal antiinflammatory drug use) in the pediatric age group. This report describes an integrated successful definitive therapeutic method of double-balloon enteroscopy and minimal invasive bowel surgery for small bowel pathology.     

Submucosal hematoma presenting as small bowel obturator obstruction in a patient on low-molecular-weight heparin

Recent studies have shown the efficacy of low-molecular-weight heparin (LMWH) in the treatment of venous thromboembolic disease in children. Compared to unfractionated heparin and coumadin, LMWH has more predictable pharmacokinetics and a reported lower incidence of osteoporosis and heparin-induced thrombocytopenia in children. The overall incidence of severe hemorrhage on LMWH in children is low. To date, there is a single report of a small bowel obstruction in a child secondary to a hematoma while on LMWH. We report the second case of a child, on enoxaparin (Lovenox) therapy, who underwent bowel resection secondary to a completely obstructing small bowel wall hematoma.     

Small bowel obstruction due to intramural hematoma during anticoagulant therapy. With regard to two cases treated conservatively

Hemorrhage following prolonged oral anticoagulant administrations is a well recognized hazard of therapy, and hemorrhagic complications are said to occur in 10-30% of patients. Following the presentation of the cases, the authors examine the current literature concerning the problems with anticoagulants, and recommend models of diagnosis and treatment of complications by bowel obstruction. Authors report on two cases of small bowel obstruction due to intramural hematoma during anticoagulant therapy. It is extremely important to recognize this syndrome in order to avoid unnecessary operative intervention. Therefore, laparotomy is not indicated.     

A laparoscopic approach to small bowel obstruction secondary to endometriosis

The complications of endometriosis are well recognized and extend beyond the pelvis. Gastrointestinal manifestations of this disease have been well described; however, reports of small bowel obstruction are rare. We describe the case of a 44 year-old-woman who presented with high-grade small bowel obstruction secondary to an endometrioma. We review the epidemiology and pathology associated with this condition and describe a laparoscopic approach to its management.