2.Transient Intesinal Obstruction Due to Stool Impaction in the Elderly.
Young Hye BYUN ; Young Sook PARK ; Seok Jin MYUNG ; Woo Youn EOM ; Won Wook CHOI ; Tae Hun KIM ; Yun Ju JO ; Seong Hwan KIM ; Moon Hee SONG
The Korean Journal of Gastroenterology 2005;46(3):211-217
BACKGROUND/AIMS: Acute intestinal obstruction is an urgent disease to be diagnosed and treated promptly. In elderly, fecal impaction may be an important and preventable cause of colonic obstruction. We investigated the clinical features of patients presenting with denical features of intestinal obstruction transiently due to fecal impaction. METHODS: From February 2001 to March 2004, nineteen patients were diagnosed as transient intestinal obstruction due to fecal impaction. We evaluated clinical characteristics, radiologic findings, sigmoidoscopic or colonoscopic findings and managements. RESULTS: Male and female ratio was 1:1.1. Mean age was 79.3 years. All 19 patients had abdominal pain and distension. On digital rectal examination, the hard feces was palpable in only 8 patients (42%) while others showed empty rectum. The abnormal laboratory findings included leukocytosis in 5 patients (26%), anemia in 10 patients (53%) and electrolyte abnormalities in 7 patients (37%). Simple abdominal X-rays showed diffuse small and/or large bowel dilatations. In only 3 patients (16%) air-fluid levels were definite, but most patients showed abundant feces in the rectum and colon. During emergency sigmoidoscopy, abdominal pain and distension were relieved and there were Bristol type 1 hard stool in the recto-sigmoid junction in 7 patients (37%) and multiple rectal ulcers in 1 patient. On colonoscopy, there were no mass or pathologic obstruction in all patients. Patients were discharged after the adequate medication and toilet training. CONCLUSIONS: In elderly patients, fecal impaction is odd and preventable cause of intestinal obstruction. It is often significant to differentiate fecal impaction from other pathologic conditions in patients with chronic constipation.
Aged
;
Aged, 80 and over
;
Fecal Impaction/*complications/diagnosis/therapy
;
Female
;
Humans
;
Intestinal Obstruction/diagnosis/*etiology/therapy
;
Male
3.Successful management of colonic perforation with a covered metal stent.
Sang Woo KIM ; Wook Hyun LEE ; Jin Soo KIM ; Ha Nee LEE ; Soo Jung KIM ; Seok Jong LEE
The Korean Journal of Internal Medicine 2013;28(6):715-717
Self-expandable stents are widely available for the treatment of perforation of the gastrointestinal tract. Because of the risk of migration, there has been no report of the use of self-expandable stents for the treatment of perforation of the colon or rectum. This is a report of successful treatment of iatrogenic colonic perforation during balloon dilatation of anastomotic stricture with a fully covered stent. Fully covered, self-expandable metallic stents can be considered useful tools for management of this condition.
Aged, 80 and over
;
Colon/*injuries/pathology/radiography
;
Colonic Diseases/diagnosis/*therapy
;
Constriction, Pathologic
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Dilatation/*adverse effects
;
Humans
;
*Iatrogenic Disease
;
Intestinal Obstruction/diagnosis/*therapy
;
Intestinal Perforation/diagnosis/etiology/*therapy
;
Male
;
*Metals
;
Prosthesis Design
;
Sigmoidoscopy
;
*Stents
;
Treatment Outcome
;
Wound Healing
4.Eosinophilic gastroenteritis presenting with duodenal obstruction and ascites.
Kian Chai LIM ; Hsien Khai TAN ; Andrea RAJNAKOVA ; Sudhakar Kundapur VENKATESH
Annals of the Academy of Medicine, Singapore 2011;40(8):379-381
Adult
;
Ascites
;
diagnosis
;
etiology
;
Biopsy
;
Diagnosis, Differential
;
Duodenal Obstruction
;
diagnosis
;
etiology
;
Endoscopy, Gastrointestinal
;
Enteritis
;
complications
;
drug therapy
;
Eosinophilia
;
complications
;
drug therapy
;
Gastritis
;
complications
;
drug therapy
;
Humans
;
Intestinal Mucosa
;
pathology
;
Male
;
Tomography, X-Ray Computed
5.Bowel Obstruction Caused by an Intramural Duodenal Hematoma: A Case Report of Endoscopic Incision and Drainage.
Chang Il KWON ; Kwang Hyun KO ; Hyo Young KIM ; Sung Pyo HONG ; Seong Gyu HWANG ; Pil Won PARK ; Kyu Sung RIM
Journal of Korean Medical Science 2009;24(1):179-183
Complications associated with an intramural hematoma of the bowel, is a relatively unusual condition. Most intramural hematomas resolve spontaneously with conservative treatment and the patient prognosis is good. However, if the symptoms are not resolved or the condition persists, surgical intervention may be necessary. Here we describe internal incision and drainage by endoscopy for the treatment of an intramural hematoma of the duodenum. A 63-yr-old woman was admitted to the hospital with hematemesis. The esophagogastroduodenoscopy (EGD) showed active ulcer bleeding at the distal portion of duodenal bulb. A total of 10 mL of 0.2% epinephrine and 2 mL of fibrin glue were injected locally. The patient developed diffuse abdominal pain and projectile vomiting three days after the endoscopic treatment. An abdominal computed tomography revealed a very large hematoma at the lateral duodenal wall, approximately 10X5 cm in diameter. Follow-up EGD was performed showing complete luminal obstruction at the second portion of the duodenum caused by an intramural hematoma. The patient's condition was not improved with conservative treatment. Therefore, 21 days after admission, endoscopic treatment of the hematoma was attempted. Puncture and incision were performed with an electrical needle knife. Two days after the procedure, the patient was tolerating a soft diet without complaints of abdominal pain or vomiting. The hematoma resolved completely on the follow-up studies.
Drainage
;
Duodenal Diseases/*diagnosis/pathology/surgery
;
Endoscopy, Digestive System
;
Female
;
Gastrointestinal Hemorrhage/*etiology/therapy
;
Hematoma/*diagnosis/pathology/surgery
;
Humans
;
Intestinal Obstruction/*etiology/therapy
;
Middle Aged
;
Tomography, X-Ray Computed
6.A Case of Colonic Pseudoobstruction Related to Bacterial Overgrowth Due to a Sigmoidocecal Fistula.
Kyoung Myeun CHUNG ; Seong Uk LIM ; Hyoung Ju HONG ; Seon Young PARK ; Chang Hwan PARK ; Hyun Soo KIM ; Sung Kyu CHOI ; Jong Sun REW
The Korean Journal of Gastroenterology 2014;63(2):125-128
Colocolic fistulas are usually a complication of an inflammatory or neoplastic process. Development of these abnormal bowel communications may lead to bacterial overgrowth. We report on a 71-year-old man with a one-year history of recurrent abdominal distension and irregular bowel habits. Abdominal X-rays and computed tomography showed multiple air-fluid levels and loops of distended bowel without evidence of mechanical obstruction or diverticulitis. Colonoscopy showed a fistulous tract between the sigmoid colon and cecum. Results of a lactulose breath test showed high fasting breath CH4 levels, which were thought to be the result of intestinal bacterial overgrowth. The patient was diagnosed with a colonic pseudo-obstruction associated with bacterial overgrowth due to a sigmoidocecal fistula. We recommended surgical correction of the sigmoidocecal fistula; however, the patient requested medical treatment. After antibiotic therapy, the patient still had mild symptoms but no acute exacerbations.
Aged
;
Anti-Bacterial Agents/therapeutic use
;
Breath Tests
;
Colonic Pseudo-Obstruction/*diagnosis/etiology
;
Colonoscopy
;
Humans
;
Intestinal Fistula/*diagnosis/drug therapy/microbiology
;
Male
;
Methane/chemistry/metabolism
;
Tomography, X-Ray Computed
7.RE: Metastasis of Gallbladder Adenocarcinoma to Bauhin's Valve: An Extremely Rare Cause of Intestinal Obstruction.
Edoardo VIRGILIO ; Valentina GIACCAGLIA ; Genoveffa BALDUCCI
Korean Journal of Radiology 2014;15(5):655-656
No abstract available.
Adenocarcinoma/*complications/*diagnosis/pathology
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Aged, 80 and over
;
Colonoscopy
;
Ethanol/therapeutic use
;
Female
;
Gallbladder Neoplasms/*complications/*diagnosis/pathology
;
Humans
;
Intestinal Obstruction/*etiology
;
Liver Neoplasms/complications/drug therapy/secondary
;
Tomography, X-Ray Computed
8.Comparison of Clinical Outcomes between Endoscopic and Radiologic Placement of Self-expandable Metal Stent in Patients with Malignant Colorectal Obstruction.
Ji Won KIM ; Ji Bong JEONG ; Kook Lae LEE ; Byeong Gwan KIM ; Yong Jin JUNG ; Won KIM ; Hwi Young KIM ; Dong Won AHN ; Seong Joon KOH ; Jae Kyung LEE
The Korean Journal of Gastroenterology 2013;61(1):22-29
BACKGROUND/AIMS: This study compared the clinical outcomes between endoscopic and radiologic placement of self-expandable metal stent (SEMS) in patients with malignant colorectal obstruction. METHODS: In total, 111 patients were retrospectively enrolled in this study between January 2003 and June 2011 at Seoul National University Boramae Hospital. Technical and clinical success rates, complication rates, and stent patency were compared between using an endoscopic (n=73) or radiologic (n=38) method during the SEMS placement procedure. RESULTS: The technical success rate was higher in the endoscopic method than in the radiologic method (100% [73/73] vs. 92.1% [35/38], respectively; p=0.038). In addition, in 3 of the remaining 35 patients in the radiologic-method group, adjuvant endoscopic assistance was required. In the six patients (including the three aforementioned patients), the causes of technical failure were the inability to pass the guidewire into an obstructive lesion due to a tortuous, curved angulation of the sigmoid or descending colon (n=4), and a difficult approach to a lesion located at the descending or transverse colon (n=2). The clinical success rate, complication rate, and stent patency did not differ significantly between the two methods (p=0.424, 0.303, and 0.423, respectively). CONCLUSIONS: When the colorectal obstruction had a tortuous, curved angulation of the colon or was located at or proximal to the descending colon, the endoscopic method of SEMS placement appears to be more useful than the radiologic method. However, once SEMS placement was technically successful, the clinical success rate, complication rate, and stent patency did not differ with the method of insertion.
Adult
;
Aged
;
Aged, 80 and over
;
Colonoscopy
;
Colorectal Neoplasms/complications/*diagnosis
;
Female
;
Follow-Up Studies
;
Humans
;
Intestinal Obstruction/*diagnosis/etiology/therapy
;
Male
;
Metals/chemistry
;
Middle Aged
;
Palliative Care/*methods
;
Retrospective Studies
;
*Stents
;
Treatment Outcome
9.Analysis of the diagnosis, treatment and prognosis in acute obstruction of proximal and distal colorectal cancers.
Zhong-lin WANG ; Jie PAN ; Zhong-liang PAN ; Wei SUN
Chinese Journal of Oncology 2013;35(1):59-62
OBJECTIVEThe study aimed to review the treatment and prognosis of acute obstruction of colorectal cancers and to compare different treatment strategies of those cancers, and to evaluate the risk factors affecting perioperative complications.
METHODSClinical data of 184 patients with acute obstruction of colorectal cancer undergone operation were analyzed retrospectively.
RESULTSA total of 184 patients with acute obstruction of colorectal cancer was collected in this study, including 58 patients with proximal and 126 patients of distal colorectal cancers. Perioperative death occurred in 2/58 patients (3.4%) with distal colorectal cancer and 6/126 cases (4.8%) of distal colorectal cancer (P > 0.05). The overall perioperative complications in the two groups were not significantly different (P = 0.794). Among the 58 patients with proximal colorectal cancer, one patient underwent colostomy, but among the 126 patients with distal colorectal cancer, 41 patients underwent colostomy, showing a significant difference between the two groups (P = 0.002). ASA scores (grade 3 - 4), elderly age (≥ 70 years) and colon perforation peritonitis were independent prognostic factors associated with perioperative mortality and morbidity. Patients in the self-expandable metallic stent (SEMS) group had a significantly shorter hospital stay (25.4 ± 8.3) d than that in the emergency surgery group (32.8 ± 16.4) d, (P = 0.039).
CONCLUSIONSEndoscopic stent implantation provides an acceptable modality of palliation for acute proximal large bowel obstruction caused by malignancies. In acute colorectal cancer obstruction, SEMS can provide a minimally invasive management compared with surgical intervention.
Acute Disease ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Colorectal Neoplasms ; complications ; diagnosis ; surgery ; Colostomy ; Endoscopy ; Female ; Humans ; Intestinal Obstruction ; etiology ; therapy ; Intestinal Perforation ; etiology ; Intraoperative Complications ; Length of Stay ; Male ; Middle Aged ; Palliative Care ; methods ; Peritonitis ; etiology ; Prognosis ; Retrospective Studies ; Risk Factors ; Stents ; Young Adult
10.Intestinal Amyloidosis with Intractable Diarrhea and Intestinal Pseudo-obstruction.
Yeon Joo KIM ; Hyun Soo KIM ; Seon Young PARK ; Sang Woo PARK ; Yoo Duk CHOI ; Chang Hwan PARK ; Sung Kyu CHOI ; Jong Sun REW
The Korean Journal of Gastroenterology 2012;60(3):172-176
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.
Administration, Oral
;
Adult
;
Amyloidosis/complications/*diagnosis/drug therapy
;
Anti-Inflammatory Agents/therapeutic use
;
Colchicine/therapeutic use
;
Colonoscopy
;
Diarrhea/*etiology
;
Female
;
Humans
;
Intestinal Mucosa/pathology
;
Intestinal Pseudo-Obstruction/*diagnosis/etiology
;
Prednisolone/therapeutic use
;
Serum Amyloid A Protein/metabolism
;
Tomography, X-Ray Computed
;
Tubulin Modulators/therapeutic use