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Comprehensively evaluate the short outcome of small bowel obstruction:A novel medical-economic score system

World Journal of Gastroenterology 2023年第9期29卷 1509-1522页

作者： Wei-Xuan Xu Qi-Hong Zhong Yong Cai Can-Hong Zhan Shuai Chen Hui Wang Peng-Sheng Tu Wen-Xuan Chen Xian-Qiang Chen Jun-Rong Zhang Shengli Clinical Medical College Fujian Medical UniversityFuzhou 350122Fujian ProvinceChina Department of General Surgery(Emergency Surgery) Fujian Medical University Union HospitalFuzhou 350001Fujian ProvinceChina

BACKGROUND small bowel obstruction(SBO)still imposes a substantial burden on the health care *** evaluation systems for SBO outcomes only focus on a single *** comprehensive evaluation of outcomes for patients with SBO remains poorly *** intensive clinical care would effectively improve the short-term outcomes for SBO,however,the full spectrum of the potential risk status regarding the high complication-cost burden is *** We aim to construct a novel system for the evaluation of SBO outcomes and the identification of potential risk *** Patients who were diagnosed with SBO were enrolled and stratified into the simple SBO(SiBO)group and the strangulated SBO(StBO)group.A principal component(PC)analysis was applied for data simplification and the extraction of patient characteristics,followed by separation of the high PC score group and the low PC score *** identified independent risk status on admission via a binary logistic regression and then constructed predictive models for worsened management *** operating characteristic curves were drawn,and the areas under the curve(AUCs)were calculated to assess the effectiveness of the predictive *** Of the 281 patients,45 patients(16.0%)were found to have StBO,whereas 236 patients(84.0%)had *** standardized length of stay(LOS),total hospital cost and the presence of severe adverse events(SAEs),a novel principal component was extracted(PC score=0.429×LOS+0.444×total hospital cost+0.291×SAE).In the multivariate analysis,risk statuses related to poor results for SiBO patients,including a low lymphocyte to monocyte ratio(OR=0.656),radiological features of a lack of small bowel feces signs(OR=0.316)and mural thickening(OR=1.338),were identified as risk *** the StBO group,higher BUN levels(OR=1.478)and lower lymphocytes levels(OR=0.071)were *** AUCs of the predictive models for poor outcomes were 0.715(95%CI:0.635-0.795

关键词： Principal component analysis small bowel obstruction Outcome evaluation system Risk factors Intensive clinical care Radiomics

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Predictors for success of non-operative management of adhesive small bowel obstruction

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World Journal of Gastrointestinal Surgery 2023年第6期15卷 1116-1124页

作者： Zi Qin Ng Vivien Hsu William Wei Han Tee Jih Huei Tan Ruwan Wijesuriya Department of General Surgery St John of God Midland HospitalMidland 6056Western AustraliaAustralia Department of Radiology St John of God Midland HospitalMidland 6056Western AustraliaAustralia Department of General Surgery Hospital Sultanah AminahJohor Bahru 80000JohorMalaysia

BACKGROUND Majority of adhesive small bowel obstruction(SBO)cases can be managed ***,a proportion of patients failed non-operative *** To evaluate the predictors of successful non-operative management in adhesive *** A retrospective study was performed for all consecutive cases of adhesive SBO from November 2015 to May *** collated included basic demographics,clinical presentation,biochemistry and imaging results and management *** imaging studies were independently analyzed by a radiologist who was blinded to the clinical *** patients were divided into group A operative(including those that failed initial non-operative management)and group B non-operative for *** Of 252 patients were included in the final analysis;group A(n=90)(35.7%)and group B(n=162)(64.3%).There were no differences in the clinical features between both *** tests of inflammatory markers and lactate levels were similar in both *** the imaging findings,the presence of a definitive transition point[odds ratio(OR)=2.67,95%confidence interval(CI):0.98-7.32,P=0.048],presence of free fluid(OR=2.11,95%CI:1.15-3.89,P=0.015)and absence of small bowel faecal signs(OR=1.70,95%CI:1.01-2.88,P=0.047)were predictive of the need of surgical *** patients that received water soluble contrast medium,the evidence of contrast in colon was 3.83 times predictive of successful non-operative management(95%CI:1.79-8.21,P=0.001).CONCLUSION The computed tomography findings can assist clinicians in deciding early surgical intervention in adhesive SBO cases that are unlikely to be successful with non-operative management to prevent associated morbidity and mortality.

关键词： small bowel obstruction Adhesive Conservative Non-operative

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small bowel obstruction caused by secondary jejunal tumor from renal cell carcinoma: A case report

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World Journal of Clinical Cases 2021年第19期9卷 5339-5344页

作者： Gao-Chen Bai Yue Mi Yi Song Jin-Rui Hao Zhi-Song He Jie Jin Department of Urology Peking University First HospitalBeijing 100034China

BACKGROUND Secondary jejunal tumor from renal cell carcinoma(RCC)is extremely rare in clinical practice and is easily missed and misdiagnosed because of the low incidence and atypical *** SUMMARY A 38-year-old male patient was diagnosed pathologically with left RCC after radical nephrectomy in *** patient then suffered multiple lung metastases 2 years later and was treated with oral sorafenib without progression for 6 *** 2020,an emergency intestinal segmental resection due to intestinal obstruction was required,and postoperative pathology confirmed a jejunal secondary tumor from *** patient had a smooth recovery following *** months after surgery,the patient was diagnosed with left adrenal metastasis,and subsequent sintilimab therapy has stabilized his *** This report is written to remind urologists and pathologists of the potential for small intestinal secondary tumors when a patient with a history of RCC seeks treatment for digestive *** and abdominal contrast-enhanced computed tomography are essential means of examination,but severe cases require immediate surgical intervention despite the lack of a preoperative examination to distinguish tumor attributes.

关键词： small bowel obstruction Secondary jejunal tumor Renal cell carcinoma Surgery Tumor metastasis Case report

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small bowel obstruction caused by a bezoar following an adult simultaneous liver-kidney transplantation:A case report

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World Journal of Clinical Cases 2020年第18期8卷 4109-4113页

作者： Gilbert Pan Robin D Kim Jeffrey Campsen George Rofaiel Department of Surgery Division of Transplantation and Advanced Hepatobiliary SurgeryUniversity of Utah School of MedicineSalt LakeUT 84132United States

BACKGROUND small bowel obstructions(SBOs)are common following a large intra-abdominal operation;however,SBOs caused by bezoars are unreported in patients following liver-kidney transplantation procedures,particularly in *** SUMMARY A 65-year-old Caucasian female presented with nausea and nonbilious emesis during her postoperative course following a simultaneous liver-kidney *** developed worsening nausea and vomiting with significant abdominal distension and *** tomography imaging showed a marked abnormal dilation of multiple small bowel loops with a distinct transition point that was suggestive of a small bowel *** exploratory laparotomy revealed a foreign body in the intestinal track approximately 30 cm from the ileocecal *** foreign body was extracted and identified as a bezoar with hair follicles and old digestive *** the operation,the patient demonstrated rapid clinical improvement with resolution of nausea,emesis,and progress in bowel *** SBOs caused by bezoars can occur immediately following a liver-kidney transplantation and should not be discounted as a diagnosis.

关键词： Case report Liver transplantation Liver-kidney transplantation small bowel obstruction Post-transplant complications Transplantation

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A prospective randomized trial of transnasal ileus tube vs nasogastric tube for adhesive small bowel obstruction

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World Journal of Gastroenterology 2012年第16期18卷 1968-1974页

作者： Xiao-Li Chen Feng Ji Qi Lin Yi-Peng Chen Jian-Jiang Lin Feng Ye Ji-Ren Yu Yi-Jun Wu Department of Gastroenterology The First Affiliated Hospital College of Medicine Zhejiang University Hangzhou 310003 Zhejiang Province China Department of Gastroenterology Ningbo Branch Hospital of the First Affiliated Hospital College of Medicine Zhejiang University Ningbo 315100 Zhejiang Province China Department of Colon and Rectal Surgery The First Affiliated Hospital College of Medicine Zhejiang University Hangzhou 310003 Zhejiang Province China

AIM:To study the therapeutic efficacy of a new transnasal ileus tube advanced endoscopically for adhesive small bowel ***:A total of 186 patients with adhesive small bowel obstruction treated from September 2007 to February 2011 were enrolled into this prospective randomized controlled *** endoscopically advanced new ileus tube was used for gastrointestinal decompression in 96 patients and ordinary nasogastric tube(NGT) was used in 90 *** therapeutic efficacy was compared between the two ***:Compared with the NGT group,the ileus tube group experienced significantly shorter time for relief of clinical symptoms and improvement in the findings of abdominal radiograph(4.1 ± 2.3 d vs 8.5 ± 5.0 d) and laboratory tests(P bowel obstruction,ileus tube was also significantly more effective than NGT(95.8% vs 31.6%).In the ileus tube group,the drainage output on the first day and the length of hospital stay were significantly different depending on the treatment success or failure(P small bowel *** placement of the ileus tube is convenient and worthy to be promoted despite the potential risks.

关键词： Adhesive small bowel obstruction Ileus tube Nasogastric intubation Gastrointestinal decompression

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Eosinophilic gastroenteritis presenting as small bowel obstruction: A case report and review of the literature

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World Journal of Gastroenterology 2007年第11期13卷 1758-1760页

作者： Min Young Yun Young Up Cho In Suh Park Sun Keun Choi Sei Joong Kim Seok Hwan Shin Kyung Rae Kim Department of Surgery College of Medicine Inha University Incheon Korea Department of Pathology College of Medicine Inha University Incheon Korea

Eosinophilic gastroenteritis is a rare disease of unknown etiology. It is characterized by eosinophilic infiltration of the bowel wall to a variable depth and symptoms associated with gastrointestinal tract. Recently, the authors experienced a case of eosinophilic gastroenteritis presenting as small bowel obstruction. A 51-year old woman was admitted to our hospital complaining of abdominal pain and vomiting. Physical examination revealed a distended abdomen with diffuse tenderness. Complete blood count showed mild leukocytosis without eosinophilia. Computed tomography confirmed a dilatation of the small intestine with ascites. An emergency laparotomy was performed for a diagnosis of peritonitis due to intestinal obstruction. Segmental resection of the ileum and end to end anastomosis were performed. Histologically, there was a dense infiltration of eosinophils throughout the entire thickness of ileal wall and eosinophilic enteritis was diagnosed. The patient recovered well, and was free from gastrointestinal symptoms at the time when we reported her disease.

关键词： Eosinophilic gastroenteritis small bowel obstruction Eosinophilic infiltration

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A Far-Out Case of Ascariasis Causing small bowel obstruction in Mauritius

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Open Journal of Internal Medicine 2023年第1期13卷 16-22页

作者： Samiihah Hafiz Boolaky Jaweed Mohammad Mowlabucus Dr. A. G. Jeetoo Hospital Port-Louis Mauritius Department of General Surgery Dr. A. G. Jeetoo Hospital Port-Louis Mauritius

Ascaris lumbricoides (A. lumbricoides), the soil-transmitted helminth is the most prevalent parasitic infection of the gastrointestinal tract in developing countries. Heavy worm loads mainly due to untreated worm infestations are often associated with increased risk of severe sequelae. We report the first complicated case of A. lumbricoides causing small bowel obstruction in a 9-year-old boy that necessitated surgical intervention on a tropical island in the Indian Ocean, where cases of Ascariasis are rarely encountered.

关键词： Ascaris lumbricoides Worm Infestation small bowel obstruction

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Persistent omphalomesenteric duct causing small bowel obstruction in an adult

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World Journal of Gastroenterology 2007年第15期13卷 2258-2260页

作者： Haridimos Markogiannakis Dimitrios Theodorou Konstantinos G Toutouzas Panagiotis Drimousis Sotirios Georgios Panoussopoulos Stilianos Katsaragakis Department of Propaedeutic Surgery Hippokration Hospital Athens Medical SchoolUniversity of AthensVasilissis Sofias 114 Avenue11527AthensGreece

An extremely rare case of persistent omphalomesenteric duct causing small bowel obstruction is presented. A 20-year-old female patient without medical history presented with colicky abdominal pain, vomiting, absence of passage of gas and feces, and abdominal distension of 24 h duration. Physical examination and blood tests were normal. Abdominal X-ray showed small bowel obstruction. Computed tomography of the abdomen demonstrated dilated small bowel and a band originating from the umbilicus and continuing between the small bowel loops; an omphalomesenteric duct remnant was suspected. In exploratory laparotomy, persistent omphalomesenteric duct causing small bowel obstruction was identified and resected. The patient had an uneventful recovery and was discharged on the 5^th postoperative day. Although persistent omphalomesenteric duct is an extremely infrequent cause of small bowel obstruction in adult patients, it should be taken into consideration in patients without any previous surgical history.

关键词： Persistent omphalomesenteric duct small bowel obstruction Adult patient

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Retroperitoneal fibrosis: A rare cause of both ureteral and small bowel obstruction

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World Journal of Gastroenterology 2006年第43期12卷 7061-7063页

作者： Faisal Aziz Srinivasulu Conjeevaram Than Phan Department of Surgery New York Medical College Valhallah NY 10595 United States Department of Surgery. North Oakland Medical Centers MI 48341 United States Attending Physician Department of Surgery North Oakland Medical Centers MI 48341 United States

Retroperitoneal fibrosis (RPF) is a rare condition of unclear etiology. It can cause ureteral obstruction. We present the unique case of a 54 years old female, who initially presented with spontaneous perforation of the cecum. Upon exploring the abdomen, the classical glistening white, unyielding retroperitoneal fibrosis was encountered. A right hemicolectomy was performed. Subsequently, the patient presented with bilateral ureteral obstruction, and later on with small bowel obstruction. Ureteral obstruction was treated with stents, and small bowel obstruction was treated with bypass. To our knowledge no case of idiopathic RPF presenting with features of both bilateral ureteral and small bowel obstruction has been reported in the literature.

关键词： Retroperitoneal fibrosis Ureteral obstruction small bowel obstruction Surgery for retroperitonealfibrosis

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Accuracy of abdominal ultrasound for the diagnosis of small bowel obstruction in the emergency department

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World Journal of Emergency Medicine 2018年第4期9卷 267-271页

作者： Sarah E. Frasure Amy F. Hildrcth Raghu Seethala Heidi H. Kimberly George Washington University Hospital Washington DC 20037 USA NavalMedical Center San Diego San Diego CA 92134 USA Department of Emergency Medicine Brigham and Women 's Hospital Boston MA 02115 USA

BACKGROUND： Emergency physicians frequently encounter patients with acute small bowel obstructions （SBO）. Although computed tomography （CT） imaging is the current gold standard in the assessment of patients with suspected SBO in the emergency department, a few studies have examined the use of ultrasound as an alternative imaging technique. METHODS： We evaluated the accuracy of ultrasound performed in the ED by a variety of providers （physicians with various levels of training, physician assistants） compared to CT imaging in 47 patients with suspected SBOs. RESULTS： Our data demonstrated a sensitivity of 93.8% and a specificity of 93.3% when compared to abdominal CT, and a sensitivity of 94.3% and specificity of 95.2% using a composite endpoint of abdominal CT and discharge diagnosis. CONCLUSION： Ultrasound can play an important role in the identification of small bowe obstructions in ED patients.

关键词： Abdominal ultrasound small bowel obstruction Emergency department

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