University of Chicago Medical School and colleagues Tupesis JP diagnosis and treatment of one case of 22-year-old female who presented with abdominal pain 3 weeks of emergency admission. In the initial history taking, the patient denied history of foreign body ingestion, but in the abdominal and pelvic CT examination of patients admitted after the reach of a one-cent coin. Coins found in surgical exploration of incarcerated in the intestine near the ileocecal valve, and the local formation of 10 * 7 cm size of inflammatory mass was completely blocked intestine.
Dr. Tupesis speculated that because the coin surface oxidation in patients after exposure to zinc core, leading to the final form a series of inflammatory response of inflammatory mass.
This is mechanical intestinal obstruction: the more common. Caused due to organic lesions smaller lumen, intestinal contents through the occurrence of obstacles. The disease groups as insects, fecal material, stones and plastic pipe blockage, intestinal torsion, incarcerated in the hernia sac neck, adhesion with oppression and involved, as well as tumors and other intra-abdominal mass to lumen pressure; or tumor, set stack, inflammatory bowel disease induced.
Treatment: All patients with suspected intestinal obstruction should be hospitalized, the treatment and diagnosis of acute intestinal obstruction must be at the same time. Treatment should be based on the fact that: surgery on the specific diagnosis of strangulated obstruction is necessary.
Small bowel obstruction nasal catheter insertion, and to attract. In small bowel obstruction, the use of a long intestine, rather than surgery, for a simple suction tube can be tested in the treatment of early postoperative obstruction or adhesions caused by repeated obstruction without abdominal symptoms. Although 2 or 3 hours to be spent to improve the situation of dehydration in patients with poor access to some status and urine output, but most surgeons prefer early stage caesarean section.
Indwelling bladder catheter to monitor urine output. Intravenous fluids should be started (in lactate Ringer's solution is appropriate) and the electrolyte. If repeated vomiting, decreased serum sodium and potassium may be added, must continue to maintain fluid balance, measured at least once a day serum electrolytes. On dehydrated patients, the determination of central venous pressure can be helpful. If possible, try to remove the primary tumor. Should take measures to prevent recurrence, including hernia repair, removal of foreign bodies and full release adhesions.
Obstructive gallstone surgery can be removed through the stones, but also at the same time or after a cholecystectomy gastrolith is another reason for causing obstruction may be removed by endoscopy. More common approach is laparotomy be removed through bowel resection. Involving the small intestine with diffuse peritoneal tumor was small bowel obstruction in adults leading cause of death. Short-circuit the efforts of any obstruction seems to have only a short help.
Adult treatment, including removal of duodenal obstruction in the lesion can not be removed or used palliative gastrojejunostomy.
Treatment of large bowel obstruction and small bowel obstruction is basically similar. In emergency surgery the stomach is necessary before its nose to attract, intravenous fluids and electrolytes and urinary catheters.
Can usually be Ⅰ resection and anastomosis of the treatment of obstructive colon cancer. Other options include bypass of colostomy and anastomosis, and occasionally need to make colostomy, further extension of resection. When diverticulitis causing obstruction, may be associated with perforation. In case of perforation and diffuse peritonitis, although it is difficult to involvement in regional resection, but indications for surgery, that is, resection and colostomy surgery, anastomosis should be deferred. Fecal impaction are more common in the rectum, the stool can remove your fingers. However, with simple fecal or barium or a mixture of antacids can cause complete obstruction (often in the sigmoid colon), required laparotomy.
Cecal volvulus treatment, including involvement of bowel resection and anastomosis or colostomy will by cecal appendix fixed to the normal position. Reversed in the sigmoid colon, the abdominal X-ray shows that the expansion of the sigmoid colon bowel, endoscopy, or a long rectal tube can be used for regular bowel decompression, surgical resection and anastomosis may be delayed a few days, if not for resection, recurrence is almost inevitable.
Care: Water fasting, gastrointestinal decompression to relieve abdominal distention. Selected semi-supine position to reduce the pressure on the diaphragm. Closely observe the condition changes, if sicker. Strangulated intestinal obstruction should be alert to the occurrence and timely treatment.
Prevention: intestinal obstruction in remission should diet, not to eat hard food, soft food diet in order to dilute the main.
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