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Management of Conditions and Symptoms
Published in Amy J. Litterini, Christopher M. Wilson, Physical Activity and Rehabilitation in Life-threatening Illness, 2021
Amy J. Litterini, Christopher M. Wilson
Unresolved or untreated chronic constipation can lead to fecal impaction and bowel obstruction. For the appropriate patient, and with communication with the medical provider, light abdominal massage may be a beneficial modality to consider for individuals with chronic constipation. Instruction in abdominal massage, particularly for individuals with Parkinson’s disease, has shown to be beneficial.84 Rectal suppositories and oil retention enemas may be successful in mild cases, and in severe cases, manual digital disimpaction (under the order of a physician and within the scope of nursing practice) can potentially address fecal impaction while the source is being evaluated to prevent recurrence. In patients with a suspected bowel obstruction, urgent medical intervention should be recommended and/or provided. For patients still wishing for intensive medical intervention in the presence of a life-threatening illness, strategies such as corticosteroids to relieve the obstruction can often be effective prior to the consideration for surgical intervention.85
Introduction to the clinical stations
Published in Sukhpreet Singh Dubb, Core Surgical Training Interviews, 2020
I would begin by formally resuscitating the patient myself and assessing their level of health using the ALS protocol A, B, C. Once the patient is stable, I would then wish to clarify the junior doctor's history, and confirm the examination findings. The important symptoms and signs of bowel obstruction I would identify include colicky abdominal pain, distension, constipation and vomiting. I would first consider the risk factors important in this patient such as recent abdominal surgery, medical conditions such as pneumonia and pancreatitis. Increasing analgesic use to control pain would also be important. I would also identify more systemic problems such as sepsis. With regards to the history, I would clarify the patient’s degree of nausea and vomiting episodes, as these may be an indication for nasogastric tube insertion. I would characterise the patient's abdominal pain, cramping and discomfort as typical in mechanical obstruction whilst in ileus they are less obvious. Finally, I would document the passage of flatus and stool from the patient and whether there was any absolute constipation.
Adult Intussusception
Published in Stephen M. Cohn, Peter Rhee, 50 Landmark Papers, 2019
Raphael Parrado, David M. Notrica
Clinical presentation in adults can be nonspecific, with a wide array of symptoms, as opposed to the classic triad in children of pain, palpable mass, and bloody stools. It presents with symptoms of bowel obstruction, namely abdominal pain, nausea, vomiting, obstipation, gastrointestinal bleeding, constipation, or bloating (Nagorney et al., 1981). Physical exam can reveal a distended abdomen with focal or generalized tenderness, decreased or absent bowel sounds, or a palpable mass (less than 50% of the cases). As obstruction processes, peritonitis from bowel ischemia with hypotension or tachycardia may be present. Depending on the cause and course of disease, laboratory findings may include leukocytosis, thrombocytosis. and elevated C-reactive protein (Marsicovetere et al., 2017).
A rare case of giant 5 mm port-site preperitoneal small-bowel incarceration without fascial defect following laparoscopic hysterectomy
Published in Journal of Obstetrics and Gynaecology, 2023
Ingrid Marton, Marko Sever, Matija Prka, Alan Šerman, Tvrtko Tupek, Tino Klancir
The increased use of laparoscopy has resulted in certain complications specifically associated with the laparoscopic approach like port-site hernia (PSH). PSH following laparoscopic surgery is less common compared with incisional hernia occurring after open surgery. According to the literature, the incidence of PSH ranges from 0.2% to 3.1% (Swank et al.2012). It is believed that port diameter and access technique affect the rate of hernia formation. In most of the reported cases, PSH appears when larger diameter port is used, in elderly and patients with higher body mass index (BMI). Extensive tissue manipulation, increased operative time and the effect of a partial vacuum while withdrawal of the port increase the risk of PSH formation (Tonouchi et al.2004). Clinical signs include gross disruption of the wound and the drainage, presence of a bulge with exertion or Valsalva or painful bulge due to bowel or omentum incarceration. Patients usually present with clinical signs of bowel obstruction or infarction.
A rare complication of laparoscopic Roux-en-Y gastric bypass: case report of gastric remnant necrosis
Published in Acta Chirurgica Belgica, 2023
Astrid Rycx, Hendrik Maes, Yves Van Nieuwenhove
In the first place, small bowel obstruction is a relatively common complication after a LRYGB and can have several causes including hernias, adhesions and stenosis or narrowing at the jejunojejunostomy or the gastrojejunostomy [1,3,5]. Small bowel obstruction due to a stenosis or a kinking at the jejunojejunal anastomosis can result in an important dilatation of the gastric remnant, especially when the biliopancreatic limb is involved. This phenomenon can be compared to the afferent limb syndrome, which is known to be a severe complication after a Billroth II procedure but can in fact occur after every surgery in the stomach region with the construction of an afferent limb. Afferent limb syndrome presents with severe epigastric pain, nausea, vomiting and when left untreated, evolves towards symptoms of shock, peritonitis and necrosis or perforation. Acute dilatation of the gastric remnant due to small bowel obstruction can cause a compromised blood flow and result in necrosis [1–6]. This is certainly a valuable hypothesis for the presented case.
The Diagnostic Value of ischemia-modified albumin (IMA) and signal peptide-CUB-EGF domain-containing protein-1 (SCUBE-1) in an Experimental Model of Strangulated Mechanical Bowel Obstruction
Published in Journal of Investigative Surgery, 2022
Arif Burak Cekic, Ozgen Gonenc Cekic, Ali Aygun, Sinan Pasli, Serap Yaman Ozer, Suleyman Caner Karahan, Suleyman Turedi, Sami Acar, Ozgur Tatli, Esin Yulug
Bowel obstruction causes the accumulation of gas and fluid which increases the intraluminal pressure.2 If the obstruction in patients with MBO is not resolved, irrespective of the underlying cause, edema occurring in the bowel wall will progress and lead to the accumulation of gas and fluid which increases the intraluminal pressure, finally resulting in intestinal ischemia and bowel necrosis. In addition, mucosal cells lose their barrier function with impairment of intestinal circulation, leading to bacterial translocation, which may progress to death from multiple organ failure.3 The decision to operate must therefore be made before the development of strangulation which is responsible for increased morbidity and mortality.4 Although MBO is the most frequently encountered surgery related disorder of small intestine, approximately 80% of cases resolve without incident under conservative treatment.5 In addition, the identification of patients in whom bowel obstruction resolves spontaneously is also important in terms of preventing unnecessary surgical interventions and future potential adhesions.