Ethacrynic acid decreases expression of proinflammatory intestinal wall cytokines and ameliorates gastrointestinal stasis in murine postoperative ileus

OBJECTIVES: Several compounds characterized by an olefin linkage conjugated to a carbonyl group have anti-inflammatory properties. The diuretic ethacrynic acid (EA) is a compound of this type. Herein, we tested the hypothesis that ethacrynic acid can modulate the development of ileus after bowel manipulation. METHODS: Groups (n=9) of male C57Bl/6 mice underwent surgical manipulation of the small intestine using a pair of cotton-tipped applicators (MAN). Control animals (CONT) did not undergo any surgical intervention or receive treatment. MAN mice were pre- and post-treated with four intraperitoneal doses of phosphate buffered saline (PBS), EA1 (1mg/kg per dose), or EA10 (10mg/kg per dose). Gastrointestinal transit of non-absorbable FITC-labeled dextran was assessed by gavaging the mice with the tracer 24h after operation and assessing FD70 concentration 120 min later in the bowel contents from the stomach, 10 equally long segments of small intestine, cecum, and two equally long segments of colon. The geometric center for the tracer was calculated for each animal. Expression of interleukin-6 (IL-6) and inducible nitric oxide synthase (iNOS) transcripts in the ileal muscularis propria was assessed using semiquantitative reverse transcriptase-polymerase chain reaction. RESULTS: In control animals, the mean (±SE) geometric center for the transit marker was 9.89±0.47, whereas it was 4.59±0.59 for PBS-treated animals (p<0.05 vs CONT). The geometric center for pre- post treatment with low (1mg/kg) and high (10mg/kg) doses of ethacrynic acid were 7.23±0.97 and 5.15±0.57, respectively. Compared to PBS, treatment with ethacrynic acid (1mg/kg) significantly decreased manipulation-induced IL-6 and iNOS mRNA expression in the wall of the small bowel. CONCLUSIONS: Pre- and post-treatment with ethacrynic acid ameliorates ileus and modulates inflammation in the gut wall induced by bowel manipulation.

Patologías quirúrgicas en el embarazo / Surgical pathologies in pregnancy

Introducción: una de cada 50 mujeres presentará durante su embarazo dolor abdominal potencialmente quirúrgico y una de cada 600 mujeres embarazadas requerirá de cirugía abdominal no obstétrica durante el embarazo. Objetivos: determinar la frecuencia y características demográficas y clínicas de patologías quirúrgicas durante el embarazo en pacientes internadas en el Hospital Nacional del año 2010 al 2014. Metodología: diseñoobservacional, descriptivo, retrospectivo de corte trasversal. Población estudiada: gestantes y/o puérperas atendidas en el Hospital Nacional con diagnóstico de patologías quirúrgicas durante los años 2010-2014. Muestreo no probabilístico según criterio. Resultados: se hallaron 76 mujeres (0,5%) con patologías quirúrgicas, la edad media fue 27 ± 6,2 años. La litiasis vesicular y la apendicitis aguda fueron las más frecuentes. La media de edad gestacional fue 28 ± 9,4 semanas. Las complicaciones fueron abdomen agudo y pancreatitis aguda, requiriendo cirugía 39 (51,3%) pacientes. Conclusiones: la frecuencia de patologías quirúrgicas fue menor al 1%, las patologías biliares y apendiculares fueron las más frecuentes.

Introduction: One in 50 women during pregnancy will potentially present surgical abdominal pain and one of every 600 pregnant women will require nonobstetric abdominal surgery during pregnancy. To determine the frequency and types of surgical pathologies during pregnancy in patients hospitalized in the HNI from 2010 to 2014. Methodology: observational, descriptive, retrospective study population crosscut: population studied pregnant and / or postpartum women treated at the National Hospital with a diagnosis of surgical pathologies during the years 2010-2014, no probabilistic sampling according to criteria. Results: 76 (0.5%) with surgical pathologies, median age were found: 27 ± 6.2 years, Cholelithiasis and acute appendicitis were the most frequent. Median gestational age was 28 ± 9.4 weeks. The complication were acute abdominal patology and acute pancreatitis, requiring surgery 39 (51.3%) patients. Conclusions: The frequency of surgical pathologies were less than 1%, biliary and appendicular pathology were the most frequent.

Abdome agudo por obstrução por ileobiliar / Acute intestinal obstruction due to gallstone ileus

OBJETIVO: descrever a experiência na abordagem dos doentes com abdome agudo por obstrução por IB, desde o diagnóstico até o tratamento definitivo. MÉTODOS: estudo retrospectivo incluindo todos os casos de IB tratados em um período de 23 anos. De acordo com a abordagem cirúrgica realizada, os pacientes foram divididos em dois grupos (1) enterolitotomia com colecistectomia no segundo momento; e (2) enterolitotomia, colecistectomia e abordagem da fístula. RESULTADOS: Doze pacientes foram incluídos, sendo 11 mulheres (91,6%), com média de idade de 72,2 anos. Todos os pacientes apresentavam doenças associadas, principalmente hipertensão arterial sistêmica (75%). Dois pacientes não apresentavam sintomas significativos de obstrução intestinal. O diagnóstico de IB foi realizado em seis pacientes (50%) antes da laparotomia. O grupo 1 foi constituído de oito pacientes e o grupo 2 de quatro, e a morbidade foi, respectivamente, 33,3% e 8,3%. A mortalidade foi 16,6% (um paciente de cada grupo). CONCLUSÃO: O manejo do IB deve ser individualizado. O tratamento da obstrução mediante remoção do cálculo biliar por enterotomia proximal é a escolha inicial para o tratamento do IB. A colecistectomia e a correção da fístula bilioentérica podem ser realizadas juntamente com a remoção do cálculo, no entanto, em pacientes com comorbidades significativas, esses procedimentos devem ser realizados posteriormente.

OBJECTIVE: To perform a systematic review of the history, available image exams and clinical approach to the diagnosis and treatment of gallstone ileus. METHOD: Retrospective study in a university hospital including all cases of SBO treated over a period of 23 years. According to the surgical treatment the patients were divided into two groups: (1) enterolithotomy with cholecystectomy performed later (two-stage surgery); and (2) enterolithotomy, cholecystectomy and fistula closure (one-stage surgery). RESULTS: Twelve patients were included in the study, including 11 females (91,6%), with a mean age of 72.2 years. All patients presented associated diseases, mainly arterial hypertension (75%). All except one patient had multiple SBO symptoms. Gallstone ileus diagnosis was achieved in six patients (50%) before laparotomy. There were 8 patients in group 1 and 4 in group 2, and the morbidity was, respectively, 33.3% and 8.3%. Overall mortality was 16.6% (one patient in each group). CONCLUSIONS: Gallstone ileus should be suspected in the elderly with SBO symptoms. Early diagnosis can reduce post-operative complications. Treatment is urgent laparotomy, and surgical treatment must be individualized for each case. The majority of patients in this study were treated with enterolithotomy, with cholecystectomy being performed later in two symptomatic patients.

The Effects of Prucalopride on Postoperative Ileus in Guinea Pigs

PURPOSE: Postoperative ileus (POI) is an impairment of coordinated gastrointestinal (GI) motility that develops as a consequence of abdominal surgery and is a major factor contributing to patient morbidity and prolonged hospitalization. The aim of this study was to investigate the effects of different 5-hydroxytryptamine 4 (5-HT4) receptor agonists, which stimulate excitatory pathways, on a POI model. MATERIALS AND METHODS: The experimental model of POI in guinea pigs was created by laparotomy, gentle manipulation of the cecum for 60 seconds, and closure by suture, all under anesthesia. Different degrees of restoration of GI transit were measured by the migration of charcoal. Colonic transit was indirectly assessed via measurement of fecal pellet output every hour for 5 hours after administration of various doses of mosapride, tegaserod, prucalopride, and 5-HT. RESULTS: Charcoal transit assay showed that various 5-HT4 receptor agonists can accelerate delayed upper GI transit in a dose-dependent manner. However, fecal pellet output assay suggested that only prucalopride had a significant effect in accelerating colonic motility in POI. CONCLUSION: Although mosapride, tegaserod, and prucalopride produce beneficial effects to hasten upper GI transit in the POI model, prucalopride administered orally restores lower GI transit as well as upper GI transit after operation in a conscious guinea pig. This drug may serve as a useful candidate for examination in a clinical trial for POI.

Íleo biliar en paciente colecistectomizado: caso clínico / Biliary ileus: report of one case

El íleo biliar es una complicación rara de la litiasis biliar que ocurre en apenas el 0,1 por ciento de estos pacientes y supone el 1-6% del total de las oclusiones intestinales mecánicas del adulto. Se presenta un caso clínico de íleo biliar de localización colónica en un paciente de 45 años de edad, colecistectomizado hace 4 años, que ingresa a nuestra institución con el diagnóstico de oclusión intestinal intermitente. Tras un tratamiento inicial conservador con buena evolución durante las primeras 48 h, presenta posteriormente un agravamiento de su cuadro clínico. Se decide laparotomía exploradora con resección de colon sigmoides y anastomosis término-terminal con colostomía transversa de derivación. En el examen de la pieza se objetiva cálculo biliar de 3 cm de diámetro impactado en el colon sigmoides. Debido a lo excepcional de esta patología y los pocos reportes internacionales existentes en pacientes colecistectomizados, nuestro objetivo es poner en consideración este caso clínico y su correspondiente revisión de la literatura.

Biliary ileus is an uncommon complication of biliary stones and accounts for 1 to 6% of all mechanical intestinal obstructions in the adult. We report a 45 years oíd male, subjected to a cholecystectomy four years earlier, admitted with the diagnosis of intermittent intestinal obstruction. Due to a bad evolution with medical treatment, he was subjected to an exploratory laparotomy and sigmoid colon was excised. A latero-terminal anastomosis and a transverse colostomy were done. The examination of the surgical piece showed the presence of a 3 cm diameter biliary stone impacted in the sigmoid colon.

Gall stone ileus; a serious complication of cholelithiasis in an elderly

Gallstone ileus [GSI] is an uncommon cause of intestinal obstruction. The formation of a fistula between the gall bladder and the bowel wall may allow a gallstone to enter the intestinal tract. Plain abdominal films, abdominal ultrasound and abdominal computed tomography aid in the diagnosis. Surgery is the treatment of choice in cases of gallstone ileus rate. We describe the case of a 68-year-old man who presented with symptoms and signs of intestinal obstruction. Diagnostic evaluation revealed a large gallstone impacted in the ileum. The patient was scheduled for exploratory laparotomy. At the time of surgery stone was found in the sigmoid colon. It was milked down and brought out through the rectum