Íleo paralítico em três bovinos: Relato de caso / Paralytic ileus in three cattle: case report

O íleo paralítico é uma obstrução do tipo funcional, na qual o lúmen intestinal está patente, comprometendo a passagem da ingesta no intestino. Este relato objetiva descrever três casos em vacas com aptidão leiteira, atendidos na rotina hospitalar e diagnosticados com íleo paralítico. Em seus históricos, os proprietários queixavam-se que os animais apresentavam redução do apetite, timpania ruminal, diminuição da produção de leite e eliminação das fezes. Ao exame físico, alguns sinais clínicos apresentaram destaque, como apatia, desidratação, redução da motilidade ruminal e intestinal, fezes em pequena quantidade e com muco, distensão do abdômen e ao balotamento constatou-se a presença de líquido. Na análise do fluido ruminal todos os animais apresentaram o teor de cloreto elevado (>30 mEq/L), caracterizando, dessa forma, um processo obstrutivo. Diante dos achados, suspeitou-se inicialmente de um quadro de obstrução intestinal. Nos casos, a conduta adotada foi realizar uma laparotomia exploratória através do flanco direito, porém constatou-se, que não existia qualquer segmento com obstrução de natureza mecânica, que justificasse as alterações físicas e laboratoriais encontradas. Diante destes resultados, configurou-se um quadro clínico indicativo de íleo paralítico. As vacas foram submetidas a um protocolo terapêutico pós-cirúrgico composto por antibioticoterapia, anti-inflam

Paralytic ileus is an obstruction of the functional type, in which the intestinal lumen is patent, compromising the passage of the intake in the intestine. The objective of this study was to describe three cases in dairy cows treated in the hospital routine diagnosed with paralytic ileus. In their histories, the owners complained that the animals presented reduced appetite, ruminal tympany, decreased milk yield and elimination of faeces. At the physical examination, some clinical signs were prominent in both, such as apathy, dehydration, reduction of ruminal and intestinal motility, faeces were present in small quantity and with mucus present, abdominal enlargement and the succession produced sloshing sounds. In the analysis of the ruminal fluid, the chloride content in both was high (>30 mEq/L), characterizing an obstructive process. In the face of the findings, a diagnosis of intestinal obstruction was initially suspected. In animals, the adopted approach was to perform an exploratory laparotomy through the right flank, but it was verified that there was no segment with mechanical obstruction that justified the physical and laboratorial alterations found. In view of these results, a clinical diagnosis indicative of paralytic ileus was established. The three animals were submitted to a post-surgical therapeutic protocol consisting of antibiotic therapy, anti-inflammatory, calcium, pro-kinetic and supportive treatment. The animals showed a favourable response to therapeutic treatment, with restoration of gastrointestinal function and other physiological parameters, and was discharged after a clinical evolution ranging from ten to twelve days.

Sobrecrecimiento bacteriano intestinal y pseudoobstrucción intestinal crónica: una relación poco conocida / Small intestinal bacterial overgrowth and chronic intestinal pseudo-obstruction

Chronic intestinal pseudo-obstruction (CIP) is the most severe intestinal motility disorder. Small intestinal bacterial overgrowth (SIBO) is frequently associated to dysmotility. In spite of this association, there is scare data on the relation between CIP and SIBO. To establish occurrence of CIP in SIBO patients in inter-crisis periods. To compare clinical and manometric characteristics of SIBO and non-SIBO patients. Retrospective analysis of 40 CIP patients (average age: 41 years; range: 18-76 years; 75 percent women). The following elements were registered: symptoms (such as pain, distention, vomit, constipation, diarrhea and weight loss); findings of the intestinal manometry (neuropathic, miopatic and mix pattern; intestinal motility index); and SIBO using lactulose H2 breath test, defined as an increase > 20 ppm in 2 or more figures in the first 60 minutes. Statistical analysis: t-test y and comparison of two ratios. SIBO was observed in 60 percent of the patients with CIP. Three or more symptoms were observed in 70.8 percent of the patients with SIBO 50 percentwithout SIBO (p = NS). In patients with SIBO, the most frequent symptom was abdominal pain (70.8 percent p= 0.032). There were no differences between SIBO patients and the different motility patterns, however, the intestinal motility index was lower for the SIBO group (9.7 +/- 44 12.3 +/-7; p < 0.001). : There is a high prevalence of SIBO in CIP patients. This is associated to a major compromise of intestinal motility assessed by the intestinal motility index...

Introducción: La pseudoobstrucción intestinal crónica (POIC) es el trastorno más grave de la motilidad intestinal. El sobrecrecimiento bacteriano intestinal (SBI) se asocia frecuentemente a estados de dismotilidad. A pesar de esta asociación existen escasos datos sobre la relación entre POIC y SBI. Objetivo: Determinar SBI en pacientes con POIC en período inter-crisis. Comparar características clínicas y manométricas de pacientes con y sin SBI. Material y Método: Análisis retrospectivo de 40 pacientes con POIC (edad promedio: 41 años, rango: 18-76 años; 75 por ciento mujeres). Se registraron síntomas (dolor, distensión, vómitos, constipación, diarrea, baja de peso), hallazgos en manometría intestinal (patrón neuropático, miopático o mixto, índice de motilidad intestinal (IMI)) y SBI con test de H2 con lactulosa, definido como la elevación > 20 ppm en 2 o más cifras en los primeros 60 min. Análisis estadístico: t-test y comparación de 2 proporciones. Resultados: Se observó SBI en 60 por ciento de los pacientes con POIC. Tres o más síntomas se presentaron en 70,8 por ciento de los pacientes con SBI vs 50 por ciento en POIC sin SBI (p = NS). El síntoma dolor abdominal fue más frecuente en pacientes con SBI (70,8 por ciento vs 31,2 por ciento, p = 0,032). No hubo diferencias entre pacientes con SBI y los distintos patrones de motilidad, sin embargo, el IMI fue menor para el grupo con SBI (9,7 +/- 1,44 vs 12,3 +/- 1,7, p < 0,001). Conclusiones: Existe una alta prevalencia de SBI en pacientes con POIC. Esto se relaciona con mayor compromiso de la motilidad intestinal evaluado por el IMI.

Intestinal obstruction and pseudo-obstruction in patients with systemic sclerosis / Intestinal obstruction and pseudo-obstruction in patients with systemic sclerosis.

Chronic intestinal pseudo-obstruction is a known complication of patients with systemic sclerosis, manifested as nausea, vomiting, constipation, abdominal distension and pain. We report a series of cases with systemic sclerosis that presented with signs of intestinal obstruction. In all cases, the differentiation between a pseudo-obstruction and true mechanical obstruction remained a formidable challenge. Our goal was to present different scenarios of patients with systemic sclerosis and features of intestinal obstruction, with a review on its clinical approach.

Intestinal Amyloidosis with Intractable Diarrhea and Intestinal Pseudo-obstruction / 대한소화기학회지

We report herein a case of intestinal amyloidosis with grave prognosis that caused intractable diarrhea and intestinal pseudo-obstruction, alternately in spite of intensive conservative treatment. A 44-year-old woman was admitted for fever, diarrhea, and crampy abdominal pain which had been continuned during 6 months. Abdomen CT scan showed edematous wall thickening of the small bowel and right colon, and colonoscopic biopsy revealed amyloid deposition in the mucosa. Monoclonal light chains in serum and/or urine were not detected and highly elevated serum amyloid A was shown. In spite of intensive treatment including oral prednisolone and colchicine, diarrhea and intestinal pseudo-obstruction developed alternately, general status rapidly got worsened and died after two months.

Permanent intestinal failure.

CONTEXT: Intestinal failure (IF) requires the use of parenteral nutrition as long as it persists and may be in case of persistence an indication for intestinal transplantation. EVIDENCE ACQUISITION: Literature search was performed both electronically and manually. RESULTS AND CONCLUSIONS: Biological evaluation of IF is becoming possible with the use of plasma citrulline as a marker of intestinal mass. Short bowel syndrome (SBS) is the leading cause of intestinal failure in infants while few epidemiological data are available to date. Data on morbidity and mortality in pediatric patients with SBS are very limited while long-term outcome seems to be improving. Other causes of intestinal failure include neuro muscular intestinal disease and congenital disease of enterocyte development. The management of IF should include therapies adapted to each type and stage of IF based on a multidisciplinary approach, in centers involving pediatric surgery, pediatric gastroenterology, parenteral nutrition expertise, home parenteral nutrition program, and liver-intestinal transplantation experience. Timing for referral of patients in specialized centers remains a crucial issue. The main causes of IF are briefly reviewed emphasizing the medico-surgical strategy for prevention and care-provision, adapted to each type and stage of IF.

Antroduodenal manometry: experience from a tertiary care center.

BACKGROUND: Though antroduodenal manometry (ADM) is an important research tool, experience on its clinical utility is scanty. METHODS: All ADM performed as a clinical service, using an 8-channel water perfusion system were retrospectively analyzed. Impact on clinical management was classified as: (1) new diagnosis made, (2) change in management (new drug, decision regarding surgical treatment), (3) further special investigation done, (4) referral to another specialty. RESULTS: ADM was successful in 32/33 (97%) patients (age 30 years [range 8-71]); 6 patients were < 12 years old. Clinical impression before ADM was: chronic intestinal pseudo-obstruction (CIPO) in 16 (50%), suspected gastroparesis in 11 (34.3%), dyspepsia in 5 (15.6%). Consequent to ADM in patients with CIPO, a new diagnosis was made in two (intestinal neuronal dysplasia and celiac disease), new drugs were started in five, surgery was performed in three and specific referral was sought in three. ADM confirmed gastroparesis in 9 of 11 patients. A new diagnosis was made in three patients, new drugs were started in three, and three were referred. In five dyspeptic patients, ADM was normal and no therapy was suggested. Overall, eleven patients with CIPO and four with gastroparesis benefited after ADM. CONCLUSION: ADM was found useful in CIPO and gastroparesis, helped in decision making regarding surgery; however in nonspecific indications its utility was limited.

Motility disorders of the gastrointestinal tract.

Over the past decades our knowledge of normal and abnormal gastrointestinal motility has increased tremendously. The availability of manometry to study bowel contraction patterns, laparoscopy to perform full thickness bowel biopsies for histological examination, have added to the investigative armamentarium and helped better diagnose motility disorders. However, the development of newer therapies for bowel motility disorders has been disappointingly slow. Newer modalities such as gastric and bowel pacing provides some hope for the future. In this article we have provided an overview of some of the common motility disorders in children and discussed their management.

Intestinal pseudo-obstruction as initial presentation of thymoma.

A 45-year-old-man presented with severe vomiting, constipation, abdominal distention and bilateral ocular abductor palsy. Evaluation revealed diffuse autonomic dysfunction characterized by intestinal pseudo-obstruction, xerophthalmia, xerostomia, postural hypotension, erectile dysfunction and loss of sinus arrhythmia. Paraneoplastic work-up revealed thymoma. Most symptoms resolved after surgical removal of the thymoma. Six weeks later he developed worsening of external ophthalmoparesis with ptosis, responding to acetylcholinesterase inhibitor, confirming myasthenia gravis.

Síndrome de seudobstrucción intestinal crónica en la infancia / Chronic intestinal pseudos-obstruction in childhood

RESUMEN Introducción. El síndrome de seudobstrucción intestinal crónica se define por episodios recurrentes de oclusión intestinal sin obstrucción mecánica. Puede clasificarse como miopático o neuropático por biopsia intestinal. El objetivo del estudio fue analizarla clínica, evolución y tratamiento en un grupo de pacientes con diagnóstico clínico de seudobstrucción intestinal crónica.Población, material y método. Se estudiaron 12 niños(2 varones y 10 mujeres) cuyos criterios de inclusión fueron: pacientes con diagnóstico clínico de síndrome de seudobstrucción intestinal crónica primitivo seguidos en el Servicio entre 1988 y 2001.Es un trabajo retrospectivo sobre datos extraídos de historias clínicas. Resultados. La media de edad del grupo fue 88,6meses (rango: 0,6 menos 238 m). Cuatro habían fallecido al concluir el estudio (33,3 por ciento), tres de ellos por sepsisy uno por muerte súbita. El debut fue neonatal en el 50 por ciento y 92 por ciento presentaron síntomas durante el primer semestre. El 33,3 por ciento evidenció mega vejiga por ecografía antenatal. Al diagnóstico todos habían presentado uno o más síntomas como: vómitos, distensión,constipación, desnutrición, diarrea o infecciones urinarias. De las 8 biopsias trasmurales: 1 evidenció neuropatía, 3 miopatías y 4 indeterminadas.Como tratamiento se utilizaron proquinéticos, antibióticos orales, kinesiología y descompresión abdominal.Ocho de 12 pacientes recibieron nutrición parenteral total durante más de 6 meses (media: 51meses, rango: 6,3mas o menos 129,6 m) y 33,3 por ciento soporte enteral (media 11 meses). Se realizaron 30 cirugías (2,5cirugías/paciente). La evolución fue mala en el 67 por ciento de la serie.Conclusión. El síndrome de seudobstrucción intestinal crónica es infrecuente y condiciona dependencia de nutrición parenteral total o parcial en la mayoría de los pacientes. La mortalidad se asocia a las complicaciones. Los síntomas aparecen generalmente en lactantes y se observa un alto porcentaje de compromiso extra digestivo.

Neostigmine for the Treatment of Acute Hepatic Encephalopathy with Acute Intestinal Pseudo-obstruction in a Cirrhotic Patient

We treated a 49-yr-old man with neostigmine, who had liver cirrhosis, acute hepatic encephalopathy, and acute intestinal pseudoobstruction. He was admitted in a state of hepatic confusion. On physical examination, the abdomen was distended; and bowel sound was absent. Plain abdomen film revealed multiple airfluid levels and distention of bowel loops. Initially, we gave him lactulose enemas every 6 hr for one day without improvement in his mental state. Furthermore, he became to a state of coma. Therefore, we gave him 0.5 mg of neostigmine subcutaneously to improve his peristaltic movement, and 2 L of polyethylene glycol electrolyte solution through a nasogastric tube for 4 hr to reduce the production and absorption of gutderived toxins of nitrogenous compounds. After these treatments, the venous ammonia level decreased to the normal range within 12 hr, and the coma disappeared after 2 days. We suggest that neostigmine may be one of the most effective treatments to initiate peristaltic movement and bowel cleansing in cirrhotic patients with acute hepatic encephalopathy and acute intestinal pseudoobstruction.

Pseudo-obstrucción intestinal por miopatía visceral esporádica / Intestinal pseudo-obstruction due to sporadic visceral myopathy

We report an unusual case of a patient with sporadic visceral myopathy and involvement of the entire gastrointestinal and urinary tract. Visceral myopathy is a form of chronic idiophatic intestinal pseudo-obstruction characterized by vacuolar degeneration, atrophy and fibrosis of the intestinal propia muscle layer without inflammatory cells. It can be found in childhood and adolescence affecting the gastrointestinal and urinary visceral muscle. The familial occurrence can be found in about 30% of cases and the mode of transmission is autosomal recessive in most families. It is crucial to exclude secondary forms of chronic intestinal pseudo-obstruction and to obtain full thickness intestinal biopsy for the diagnosis. Surgical treatment is only beneficial in cases with isolated segmental involvement of the gastrointestinal tract.

Se presenta el caso infrecuente de un paciente con miopatía visceral esporádica y afectación de la totalidad del tracto gastrointestinal y de la vía urinaria. La miopatía visceral es una forma de pseudo-obstrucción intestinal crónica idiopática caracterizada por degeneración vacuolar, atrofia y fibrosis de la capa muscular propia de la pared intestinal, sin células inflamatorias. Se puede presentar en niños y adolescentesafectando la musculatura visceral digestiva y urinaria. La manifestación familiar se encuentra en aproximadamente el 30% de los casos y se transmite de forma autosómica recesiva en la mayoría de las familias. Esfundamental descartar causas secundarias de pseudo-obstrucción intestinal crónica y la realización de biopsia de todo el espesor de la pared gastrointestinal para poder arribar al diagnóstico. El tratamiento quirúrgico sólo es eficaz en los que tienen afectación de porciones aisladas del tubo digestivo.

Pseudo-obstrução intestinal: relato de dois casos / Pseudo-intestinal obstruction: report oof two cases

São apresentados dois casos de Pseudo-Obstrução Intestinal em pacdientes idosos, cujos principais sintomas foram dos abdominal difusa, parada de eliminação de gases e fezes e distençxão abdominal. Foram submetidas a laparotomia, com verificação da existência de grande dilataçào dos cólons e ausência de lesão orgânica. A primeira paciente foi submetida a cecostomia devido à eminência de ruptura cecal e a segunda recebeu terap6eutica com indometacina (inibidor da síntese de prostaglandina) com regressào completa de toda a sintomatolgia

Pseudo-obstrucción intestinal crónica idiopática del adulto / Chronic intestinal pseudo-obstruction

Antecedentes: La pseudo-obstrucción intestinal crónica (POIC) es una entidad de diagnóstico infrecuente que se caracteriza por síntomas crónicos o recurrentes de oclusión del intestino delgado y/o grueso, sin obstrucción mecánica demostrable. Objetivo: Comunicar nuestra experiencia con esta entidad y efectuar una revisión de su diagnóstico y tratamiento. Lugar de aplicación: Hospital Municipal y Sanatorio Municipal Dr. Julio Méndez. Diseño: Observacional retrospectivo. Población: Pacientes con diagnóstico de POIC asistidos entre 1997 y 2002. Método: Revisión de historias clínicas consignando antecedentes personales y familiares, características demográficas y clínicas, estudios diagnósticos y tratamientos efectuados. Investigación bibliográfica sobre el tema. Resultados: Se analizaron 5 pacientes, 4 mujeres y un hombre de 39 años de edad promedio (rango: 27-70 años). Todos fueron idiopáticos y uno de ellos familiar. Todos presentaron distensión y dolor abdominal, y 4 de los 5 tuvieron vómitos, constipación y pérdida de peso. El diagnóstico inicial fue abdomen agudo obstructivo en 4 casos y perforativo en uno. La demora promedio hasta el diagnóstico de POIC fue de 6,6 años (rango: 2 semanas - 15 años) y en todos los pacientes surgió tras laparotomías negativas para obstrucción mecánica. La radiografía simple de abdomen mostró en todos dilatación del intestino delgado y/o colon con niveles hidroaéreos, y en 2 pacientes neumoperitoneo asociado. Los estudios contrastados evidenciaron dilatación completa del intestino delgado en 2 pacientes y megacolon en otros 2, uno con megaduodeno asociado. La manometría antroduodenoyeyunal diagnosticó neuropatía visceral en 2 casos y en otros 2 el estudio histopatológico de la pieza de resección reveló una displacia neuronal intestinal y una miopatía visceral...

Seudo-obstrucción intestinal crónica primaria / Primary chronic intestinal pseudo-obstruction

Se presentan 7 pacientes de sexo femenino, con una larga historia de trastornos del hábito defecatorio, cuyo estudio radiológico demostraba grados variables de dolicomegacolon de etiología desconocida. Todas ellas fueron sometidas a colectomía total con ileoproctoanastomosis. El estudio anatomopatológico reveló miopía visceral difusa en 5 y displasia neuronal en 2. La evolución alejada ha sido ominosa en 3 pacientes, que han presentado repetidos episodios invalidantes de dolor y distensión abdominal, vómitos fecaloideos y desnutrición, simulando cuadros de obstrucción intestinal mecánica. La seudo-obstrucción intestinal crónica primaria es una entidad mórbida compleja que requiere un manejo multidisciplinario y en que las opciones quirúrgicas son sólo paliativas.

Primary hypertrophic colonopathy.

We report a 45-year-old man and a 60-year-old woman who presented with features of intermittent intestinal obstruction. Barium enema revealed narrowing at the pelvic-rectal junction in the man, and from the pelvic colon to the anal verge in the woman. Histology of the resected sections showed marked hypertrophy of the muscularis propria in both cases, with normal mucosa, submucosa and myenteric plexus. Both patients are asymptomatic at 4 years' and 2 years' follow up. This entity of primary hypertrophic colonopathy may be a variant of primary visceral myopathy.

Síndrome de Ogilvie associada ao hérpes zóster / Ogilvie's syndrome associated with hespes zoster

Sir Heneage Ogilvie descresveu, em 1948, a síndrome que leva o seu nome. Desde então muitos casos foram relatados na literatura e várias denominações utilizadas, sendo a pseudo-obstrução aguda do cólon a mais empregada em nosso meio. Apresenta baixa prevalência, resolução geralmente espontânea, mas pode ter complicações graves, como necrose e perfuração de ceco. O caso aqui apresentado mostra o aparecimento da pseudo-obstrução aguda do cólon simultaneamente ao herpes zóster em uma paciente previamente hígida, que não apresentava outro fator predisponente ao desenvolvimento de síndrome de Ogilvie. Além disso, a melhora da dilatação do cólon coincidiu com a resolução das lesões de pele. Estes fatos, reforçados por outros casos relatados na literatura, sugerem a participação do herpes zóster na etiologia da síndrome de Ogilvie

Un caso atípico de abdomen agudo / Atipical case of acute abdomen

Introducción: El potasio es el ión más importante en el funcionamiento de las células excitables, la hiperkalemia se relaciona con efectos peligrosos sobre miocardio, músculo liso y nervios periféricos. A pesar de la clara asociación fisiopatológica entre el aumento del potasio y el íleo paralítico, no se han hallado casos que mencionen al abdomen agudo como forma de presentación en la búsqueda bibliográfica por Medline de los últimos diez años. Se presenta por tanto un caso en el cual el motivo de consulta fue dolor abdominal. Presentación: Paciente de sexo femenino, 83 años, consulta por dolor abdominal muy intenso asociado a náuseas y oliguria de 24 hs de evolución. Antecedentes: tromboembolismo de pulmón a repetición a pesar de estar anticoagulada de forma suficiente, hipertensión pulmonar, fibrilación auricular, medicada con furosemida, espironolactoma, digoxina, acenocumarol. Examen físico: desasosegada, taquipneica, soplo de regurgitación tricúspidea, abdomen doloroso, sin ruidos hidroaéreos. Urea: 108 mg por ciento, creatinina: 1,91 mg/dl, K: 6,8 meq, Ph: 7,52, Po2: 142, PCo2 35, COH3 29,9. ECG: ritmo nodal. Colon por enema: dolicocolon. Ecografía abdominal y endoscopía esófago-gástrica normales. Se trata con soluciones polarizantes, cediendo el dolor abdominal y retornando el ritmo cardíaco a fibrilación auricular, recupera el ritmo diurético y normaliza urea y creatinina. Conclusiones: 1) Esta hiperkalemia sin fallo renal crónico previo fue multifactorial. a- Uso prolongado de espironolactona en paciente deshidratada con escaso aporte de Na. b- Seudohipoaldosteronismo. c- Alcalosis mixta. 2) Debido a la acción del potasio sobre las células excitables, la hiperkalemia puede provocar íleo paralítico y presentarse como abdomen agudo sobre todo en pacientes polimedicados