OBJECTIVE: To observe the effect of electroacupuncture (EA) on postoperative ileus after laparotomy for gastrointestinal cancer. METHODS: A total of 90 patients with postoperative ileus after laparotomy for gastrointestinal cancer were randomized into an EA group and a conventional treatment group, 45 cases in each one. In the conventional treatment group, the postoperative fast track surgical regimen was accepted. In the EA group, on the base of the treatment as the conventional treatment group, acupuncture was applied to Zusanli (ST 36), Shangjuxu (ST 37), Yinlingquan (SP 9) and Taichong (LR 3) and electric stimulation was attached on Zusanli (ST 36) and Yinlingquan (SP 9), with continuous wave, 2 Hz in frequency and 3-5 mA in intensity. Acupuncture was provided once daily till the onset of postoperative exhaust and defecation. The first postoperative exhaust time, the first postoperative defecation time, the postoperative hospital stay and the wound pain under standing on the next morning after entering group were compared in the patients between the two groups. The impact of the EA expectation was analyzed on the first postoperative exhaust time, the first postoperative defecation time and the postoperative hospital stay separately. RESULTS: The first postoperative exhaust time and the first postoperative defecation time in the EA group were earlier than the conventional treatment group (P<0.05), the postoperative hospital stay was shorter than the conventional treatment group (P<0.05), and the rate of wound pain in the postoperative standing was lower than the conventional treatment group (P<0.05). EA expectation had no obvious correlation with the clinical therapeutic effect (P>0.05). CONCLUSION EA can relieve postoperative ileus symptoms, alleviate pain and shorten hospital stay in the patients after laparotomy for gastrointestinal cancer.
Acupuncture Points ; Electroacupuncture ; Gastrointestinal Neoplasms ; Humans ; Ileus/therapy* ; Laparotomy/adverse effects*

For patients with short bowel syndrome who undergo ileostomy, nutritional management is essential to prevent complications associated with a high-output stoma (HOS). We report a practical example of ostomic, medical nutrition therapy provided by an intensive nutritional support team (NST). A 42-year-old male with a history of Crohn's disease visited Seoul National University Hospital for treatment of mechanical ileus. He underwent loop ileostomy after extensive small bowel resection. As his remaining small bowel was only 160 cm in length, the stomal output was about 3,000 mL/day and his body weight fell from 52.4 to 40.3 kg. Given his clinical condition, continuous tube feeding for 24 h was used to promote adaptation of the remnant bowel. Thereafter, an oral diet was initiated and multiple, nutritional educational sessions were offered by dietitians. Constant infusion therapy was prescribed and included in the discharge plan. Two months after discharge, his body weight had increased to 46.6 kg and his hydration status was appropriately maintained. This case suggests that the critical features of medical nutritional therapy for ostomy management are frequent assessments of fluid balance, weight history, and laboratory data and after nutritional interventions.
Adult ; Body Weight ; Crohn Disease ; Diet ; Diet Therapy ; Enteral Nutrition ; Humans ; Ileostomy ; Ileus ; Male ; Nutrition Therapy ; Nutritional Support ; Nutritionists ; Ostomy ; Seoul ; Short Bowel Syndrome ; Water-Electrolyte Balance

Acupuncture Points ; Acupuncture Therapy ; Adult ; Female ; Humans ; Ileus ; complications ; Intestinal Diseases ; etiology ; pathology ; therapy ; Tissue Adhesions ; pathology ; therapy

Plasmacytoma in patients with multiple myeloma usually develops in the advanced stage of the disease. We report herein an atypical case of extramedullary relapse of multiple myeloma that presented as mechanical obstruction of the small bowel in a patient who had achieved complete remission after chemotherapy. A 75-year-old man was diagnosed with multiple myeloma 25 months previously and treated with a bortezomib-containing chemotherapy regimen. He presented for evaluation of abdominal pain. A circumferential mass resulting in mechanical ileus was observed by abdominal computed tomography. Biopsy after surgical resection confirmed the diagnosis of plasmacytoma. The patient was subsequently treated with thalidomide-containing chemotherapy, but he died of disease progression after 6 months. We suggest careful observation of unusual relapses of multiple myeloma in patients who have achieved complete remission after antimyeloma therapy.
Abdominal Pain ; Aged ; Biopsy ; Diagnosis ; Disease Progression ; Drug Therapy ; Humans ; Ileus ; Intestinal Obstruction ; Multiple Myeloma* ; Plasmacytoma ; Recurrence*

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.
Administration, Oral ; Animals ; Benzamides/pharmacology ; Benzofurans/administration & dosage/*pharmacology ; Charcoal/pharmacokinetics ; Colon/drug effects ; Dose-Response Relationship, Drug ; Gastrointestinal Motility/*drug effects ; Guinea Pigs ; Ileus/*surgery ; Indoles/pharmacology ; Laparotomy ; Male ; Morpholines/pharmacology ; Postoperative Complications/drug therapy ; Serotonin/pharmacology ; Serotonin 5-HT4 Receptor Agonists/*pharmacology

Acupuncture Therapy ; Defecation ; Female ; Humans ; Ileus ; physiopathology ; therapy ; Middle Aged

OBJECTIVETo assess the clinical efficacy on adhesive ileus treated by electroacupuncture (EA) at Zhigou (TE 6) and Zusanli (ST 36), and to explore the different effects of acupoint and non-acupoint.

METHODSForty cases were randomized into an acupoint group and a non-acupoint group, 20 cases in each one. At the same time of the basic treatment, in the acupoint group, EA was applied at bilateral Zhigou (TE 6) and Zusanli (ST 36). In the non-acupoint group, EA was applied at the sites (that were neither on any meridian nor belonged to any acupoint) that were 0.5 to 1 cm lateral to Zhigou (TE 6) and Zusanli (ST 36) on both sides. Acupuncture was given twice a day, lasting for 4 days totally. The situation of abdominal pain, the time for the improvement in abdominal distention, the time of first voluntary defecation, the time of solid food intake and the others were observed.

RESULTSIn the acupoint group, the abdominal pain and distention were relieved rapidly as compared with those in the non-acupoint group. The results of the assessment face scale (AFS), the first anal exhaust time [(51.35 +/- 32.40) h vs (101.85 +/- 53.87) h], the first defecation time [(82.70 +/- 57.27) h vs (154.70 +/- 145.28) h] and the first solid food intake time [(119.65 +/- 56. 16) h vs (231.95 +/- 180.89) h] were all remarkably improved as compared with those in the non-acupoint group, presenting the statistical significance (P<0.05, P<0.01). Concerning the case number for the conversion to surgery, the death number and the number for the re-admission in 1 year follow-up visit, there was no significant difference in statistics between two groups (all P>0.05). But, the data suggested that the results were improved in tendency in the acupoint group.

CONCLUSIONEA at Zhigou (TE 6) and Zusanli (ST 36) achieves the good clinical efficacy on adhesive ileus. This therapy can remarkably improve abdominal pain and distention and promote the intestinal peristalsis for the patients and is superior to EA at non-acupoint.

Acupuncture Analgesia ; Acupuncture Points ; Adult ; Aged ; Electroacupuncture ; Female ; Humans ; Ileus ; therapy ; Male ; Middle Aged ; Pain Management ; Tissue Adhesions ; therapy

A 63-year-old woman was admitted to the hospital with abdominal pain and nausea. Her abdomen was distended with obstructive bowel sounds on exam. There was diffuse abdominal tenderness but no palpable masses. Abdominal computed tomography (CT) scan revealed a large gallstone in the ileum. Surgical intervention was deferred given patient's known significant liver cirrhosis (Child-Pugh class B). Instead colonoscopy was performed and a large gallstone was found to be impacted at the ileocecal valve. The gallstone was fragmented using electrohydraulic lithotripsy (EHL) and then retrieved with snare and forceps. The patient made a full recovery and was eventually discharged home. This is the first reported case of an impacted gallstone at the ileocecal valve with successful colonoscopic treatment using electrohydraulic lithotripsy in Korea. This case highlights the potential therapeutic benefits for colonscopic retrieval of a gallstone impacted at the ileocecal valve in well selected individuals.
Abdominal Pain/radiography ; Colonoscopy ; Female ; Gallstones/*diagnosis/therapy ; Humans ; Ileus/*diagnosis/therapy ; Intestinal Obstruction/diagnosis/therapy ; Lithotripsy/*methods ; Middle Aged ; Tomography, X-Ray Computed

A 46-year-old woman with chronic renal failure due to polyarteritis nodosa was referred to the hospital for evaluation of abdominal pain. She had been treated with cathartics (magnesium oxidate 2.0 g/day) for constipation for several days. One day before the admission, the patient had been taken magnesium enema twice at another hospital. On admission, she was comatose, suffering from lethargy and respiratory failure. Her serum magnesium and amylase concentrations were markedly elevated (8.2 mg/dL and 1,698 IU/L respectively), and plain abdominal image and abdominal computed tomography revealed acute pancreatitis and non-obstuctive ileus. Thereafter, aggressive cardiopulomonary support with mechanical ventilation and continuous renal replacement therapy using continuous veno-venous hemofiltration (CVVH) applied due to cardio-respiratory failure and hypermagnesemia. After 3 days of CVVH treatment, the concentration of serum magnesium was normalized to 3.2 mg/dL, and respiratory failure and abdominal ileus were markedly improved. Four days after aggressive treatment, her hemodynamic and gastroenteric symptoms stabilized. Therefore, we report the case of hypermagnesemia with acute pancreatitis, severe hypotension and respiratory failure after cathartic ingestion and enema containing magnesium oxidate treated with CVVH.
Abdominal Pain ; Amylases ; Cathartics ; Coma ; Constipation ; Dialysis ; Eating ; Enema ; Female ; Hemodynamics ; Hemofiltration ; Humans ; Hypotension ; Ileus ; Kidney Failure, Chronic ; Lethargy ; Magnesium ; Middle Aged ; Pancreatitis ; Polyarteritis Nodosa ; Renal Replacement Therapy ; Respiration, Artificial ; Respiratory Insufficiency ; Stress, Psychological

PURPOSE: We performed a retrospective non-randomized clinical study of locally advanced rectal cancer, to evaluate the anal sphincter preservation rates, down staging rates and survival rates of preoperative chemoradiotherapy. MATERIALS AND METHODS: From January 2002 to December 2005, patients with pathologically confirmed rectal cancer with clinical stage T2 or higher, or patients with lymph node metastasis were enrolled in this study. A preoperative staging work-up was conducted in 36 patients. All patients were treated with preoperative chemoradiotherapy, and curative resection was performed for 26 patients at Hallym University Sacred Heart Hospital. Radiotherapy treatment planning was conducted with the use of planning CT for all patients. A total dose of 45.0~52.2 Gy conventionally fractionated three-dimensional radiotherapy was delivered to the whole pelvis. Chemotherapy was given at the first and fifth week of radiation therapy with continuous infusion i.v. 5-FU (Fluorouracil) and LV (Leucovorine). Surgical resection was performed 2 to 4 weeks after the completion of the chemoradiotherapy regimen. RESULTS: The complete resection rate with negative resection margin was 100% (26/26). However, a pathologically complete response was not seen after curative resection. Surgery was done by LAR (low anterior resection) in 23 patients and APR (abdomino-perineal resection) in 3 patients. The sphincter preservation rate was 88.5% (23/26), down staging of the tumor occurred in 12 patients (46.2%) and down-sizing of the tumor occurred in 19 patients (73%). Local recurrence after surgical resection developed in 1 patient, and distant metastasis developed in 3 patients. The local recurrence free survival rate, distant metastasis free survival rate, and progression free survival rate were 96.7%, 87% and 83.1%, respectively. Treatment related toxicity was minimal except for one grade 3, one grade 4 anemia, one grade 3 leukopenia, and one grade 3 ileus. CONCLUSION: Preoperative concurrent chmoradiotherapy for locally advanced rectal cancer seems to have some potential benefits: high sphincter preservation and down staging. Treatment related toxicity was minimal and a high compliance with treatment was seen in this study. Further long-term follow-up with a larger group of patients is required.
Anal Canal ; Anemia ; Chemoradiotherapy* ; Compliance ; Disease-Free Survival ; Drug Therapy ; Fluorouracil ; Follow-Up Studies ; Heart ; Humans ; Ileus ; Leukopenia ; Lymph Nodes ; Neoplasm Metastasis ; Pelvis ; Radiotherapy ; Rectal Neoplasms* ; Recurrence ; Retrospective Studies ; Survival Rate