복회음절제술후의 장폐색증에 관한 고찰

노재형,박재갑,최국진,김진복 대한대장항문학회 1992 Annals of Coloproctolgy Vol.8 No.2

장폐쇄에서 나타나는 장점막 손상의 진단에서 내독소의 유용성

이정은(Jeong-Eun Lee),염차경(Cha-Kyong Yom),박재정(Jae-Jung Park),한기환(Ki-Hwan Han),허정원(Jung-Won Huh),성순희(Sun-Hee Sung),정구용(Ku-Yong Chung) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.74 No.2

Purpose: The treatment outcome of an intestinal obstruction depends on the early recognition and emergent operation of a strangulated intestinal obstruction. Endotoxin is a lipopolysaccharide component of the cell wall of gram negative bacteria that normally exist in the intestinal lumen. When a strangulated obstruction occurs, the endotoxin passes transluminally into the peritoneal cavity and blood stream. A disruption of the mucosal barrier is an important putative cause in this pathogenesis. This study investigated the relationship between the endotoxin level and progress of an intestinal obstruction to a strangulated obstruction. Methods: 25 adult male Sprague-Dawley rats (200∼250 g) were divided into 3 groups, the control group, simple obstruction group, and closed loop obstruction group. An intestinal obstruction was induced using a silk tie. Blood samples and obstructed bowel wall specimens were obtained at 24, 48 and 72 hours after surgery. The endotoxin and IL-6 levels were examined, and all specimens were reviewed by a pathologist for mucosal damage after H-E staining. Results: In the obstruction groups, dilated bowel loops at the proximal end of the obstruction site was identified but there were no ischemic changes. The endotoxin and IL-6 levels were similar regardless of the obstruction types and times. There were no differences between the three groups in the degree of mucosal damage. However, according to the endotoxin level, the groups with an endotoxin level <0.2 EU/㎖ showed mild mucosal damage. The severity of mucosal damage increased with increasing endotoxin level. Conclusion: There is a positive relationship (r2=0.673, P-value=0.002) between the endotoxin level and mucosal damage. This suggests the possibility of using endotoxin as a predictive factor for the detection of mucosal injury in an intestinal obstruction. However, a larger scale will be needed to confirm the statistical significance.

Intestinal obstruction: predictor of poor prognosis in colorectal carcinoma?

Mohd Azri Mohd Suan,Wei Leong Tan,Shahrul Aiman Soelar,Ibtisam Ismail,Muhammad Radzi Abu Hassan 한국역학회 2015 Epidemiology and Health Vol.37 No.-

OBJECTIVES: The goal of this study was to assess the relationship between intestinal obstruction and the prognosis of colorectal carcinoma. METHODS: Data pertaining to 4,501 colorectal carcinoma patients were extracted from the national colorec-tal registry and analysed. Survival analysis was performed using the Kaplan-Meier method. The log-rank test was used to compare the survival rate between patients with intestinal obstruction and those without intesti-nal obstruction. The p-values< 0.05 were considered to indicate statistical significance. Simple Cox proportion-al hazards regression analysis was used to estimate the crude hazard ratio of mortality from colorectal cancer. RESULTS: Intestinal obstruction was reported in more than 13% of patients. The 3-year survival rate after treat-ment was 48.3% (95% confidence interval [CI], 43.9 to 52.8) for patients with intestinal obstruction (n= 593) and 54.9% (95% CI, 53.1 to 56.6) for patients without intestinal obstruction (n= 3,908). The 5-year survival rate for patients with intestinal obstruction was 37.3% (95% CI, 31.9 to 42.8), which was lower than that of patients without intestinal obstruction (45.6%; 95% CI, 43.5 to 47.7). After adjusting the hazard ratio for oth-er prognostic variables, intestinal obstruction had a statistically significant negative correlation with the surviv-al rate of colorectal cancer patients, with an adjusted hazard ratio of 1.22 (p= 0.008). CONCLUSIONS: The presence of intestinal obstruction is associated with a lower survival rate among colorectal cancer patients.

전신성 홍반성 루푸스에서의 위장관 가성폐색증

안중경 ( Joong Kyung Ahn ),고재현 ( Jae Hyun Koh ),전찬홍 ( Chan Hong Jeon ),차훈석 ( Hoon Suk Cha ),김영호 ( Young Ho Kim ),고은미 ( Eun Mi Koh ) 대한류마티스학회 2002 대한류마티스학회지 Vol.9 No.4

Intestinal pseudo-obstruction is an uncommon and poorly understood complication of systemic lupus erythematosus. It is characterized by acute or chronic symptoms suggestive of the obstruction of small or large intestine without any radiologic, surgical or endoscopic evidence of mechanical obstruction. Although the exact pathogenesis of intestinal pseudo-obstruction in SLE remains unknown, it can be caused by derangement of the visceral smooth muscle, enteric nerves or visceral autonomic nervous system. Concomitant involvement with dilatation of gastrointestinal and genitourinary tract highly suggests of intestinal pseudo-obstruction in systemic lupus erythematosus. There is an apparent association between lupus-related intestinal pseudo-obstruction and ureterohydronephrosis. The management of intestinal pseudo-obstruction consists of high dose corticosteroid, adequate nutrition, hydration and prokinetics. Early recognition of intestinal pseudo-obstruction in systemic lupus erythematosus and the use of adequate dose of corticosteroid are important. We report a case of systemic lupus erythematosus presenting as intestinal pseudo-obstruction.

소아기 천공성 충수염 수술 후 장폐색

문기명,김대연,김성철,김인구,Moon, Ki-Myung,Kim, Dae-Yeon,Kim, Seong-Chul,Kim, In-Koo 대한소아외과학회 2004 소아외과 Vol.10 No.2

Intestinal obstruction secondary to intraabdominal adhesion is a well-known postoperative complication occurring after appendectomy. The aim of this study was to measure the incidence and clinical manifestations of mechanical intestinal obstruction after appendectomy for perforated appendicitis. We reviewed all of the children (age <16 years) who had been treated for appendicitis at Asan Medical Center between January 1996 and December 2001. Inclusion criterion included either gross or microscopic evidence of appendiceal perforation. Exclusion criteria were interval appendectomy, and patients immune compromised by chemotherapy. Associations of intestinal obstruction with age, sex, operation time, and use of peritoneal drains were analyzed. Four hundred and sixty two open appendectomies for appendicitis were performed at our department. One hundred and seventeen children were treated for perforated appendicitis (78 boys, 39 girls). The mean age was 8.9 years (range 1.5 to 14.8 years). There were no deaths. Eight patients were readmitted due to intestinal obstruction, but there was no readmission due to intestinal obstruction in patients with non-perforated appendicitis. The interval between appendectomy and intestinal obstruction varied from 12 days to 2 year 7 months. Four patients needed laparotomies. In three of four, only adhesiolysis was performed. One child needed small bowel resection combined with adhesiolysis. There was no significant association between age or sex and the development of intestinal obstruction. This was no association with operative time or use of peritoneal drain. Patients who required appendectomy for perforated appendicitis have a higher incidence of postoperative intestinal obstruction than those with nonperforated appendicitis. For the patients with perforated appendicitis, careful operative procedures as well as pre and postoperative managements are required to reduce adhesions and subsequent bowel obstruction.

수술후 장폐쇄 환자에서 감압목적의 Miller-Abbott 관을 통한 소장관장법의 유용성

이명환 대한영상의학회 1996 대한영상의학회지 Vol.34 No.2

Purpose : The purpose of this study is to assess the efficacy of enteroclysis through the previously insertedMiller-Abbott (M-A) tube for decompression in the postoperative intestinal obstruction. Materials & Methods : Thisstudy includes twenty patients who had intestinal obstruction symptoms after operation for benign(12) ormalignant(8) abdominal lesions. Small amount of barium was introduced to M-A tube for enteroclysis. We evaluatedthe presence, level, degree, and causes of obstruction on enteroclysis, compared with surgical(11) and clinical(9)findings. Results : Obstruction was seen in 18 cases including the two cases in which the level of obstruction wasnot clear. There was no obstruction in two cases. Obstruction on enteroclysis was demonstrated in all 11 operatedcases(100% accuracy, 11\11). The level of obstruction on enteroclysis were jejunum in three cases, ileum in seven,and colon in one case. The levels of obstruction on enteroclysis were matched with those in operation field in 10cases. There were two cases of nonobstruction, nine cases of low-grade partial obstruction, and nine cases ofhigh-grade partial obstruction. We analyzed the findings on enteroclysis regarding causes of obstruction in 16patients with the findings of adhesive bands of extrinsic cause(9), cancer recurrence of intrinsic cause(6), andbezoar of intraluminal cause(1). Misinterpreted cases were two cases(87.7% accuracy, 14/16). The cause, fornonvisualization of obstruction site on enteroclysis in four patients included technical failure such asinadequate location of tube(1) and bowel overlapping(1), minimal obstruction(1), and nonexistent obstruction(1),in spite of diffuse edematous mucosa. Conclusion : Enteroclysis through the M-A tube for decompression in patientswith postoperative intestinal obstruction is an useful method for evaluation of intestinal obstruction.

Laparoscopic Treatment of Intestinal Obstruction

Jae Hun Hur,Byeonghun Oh,Eunyoung Kim,Eun Jung Ahn,Sei Hyeog Park,Jong-Min Park 대한외상중환자외과학회 2016 Journal of Acute Care Surgery Vol.6 No.1

Purpose: Open adhesiolysis has been the favored approach regarding surgical management of intestinal obstruction. Following the development of laparoscopic devices and necessary surgical techniques, laparoscopic treatment of intestinal obstruction and adhesion has been tried in highly selected cases. Our study was designed to investigate laparoscopic adhesiolysis to treat intestinal obstruction.Methods: The clinicopathologic data and surgical outcomes of 14 patients who underwent emergency laparoscopy between January 2007 and April 2015 were retrospectively reviewed.Results: Five patients had a history of abdominal surgery, and twelve patients had adhesive intestinal obstruction. The causes of adhesive intestinal obstruction included tuberculous peritonitis, periappendiceal abscess, serosal fibrosis and chronic inflammation of intestine, gastric volvulus by fibrotic band. Two patients had non-adhesive intestinal obstruction, caused by intussusception and small bowel ulcer with stricture. The mean surgical time was 98.5 minutes, with mean blood loss of 35 ml. One case was converted to open surgery (7.1%). The mean postoperative hospital stay was 6.5 days. The mean time to oral intake was 3.4 days. There were no postoperative complications or deaths.Conclusion: When the patients are selected carefully in accordance with the guidelines, in our experience laparoscopic adhesiolysis is safe and feasible. (J Acute Care Surg 2016;6:23-28)

Chronic Intestinal Pseudo-obstruction: Clinical and Manometric Characteristics in the Chilean Population

( Edith Perez De Arce ),( Glauben Landskron ),( Sandra Hirsch ),( Carlos Defilippi ),( Ana Maria Madrid ) 대한소화기기능성질환·운동학회 2017 Journal of Neurogastroenterology and Motility (JNM Vol.23 No.2

Background/Aims Chronic intestinal pseudo-obstruction (CIPO) is a rare syndrome characterized by a failure of the propulsion of intraluminal contents and recurrent symptoms of partial bowel obstruction in the absence of mechanical obstruction. Regional variations of the intestinal compromise have been described. Intestinal manometry can indicate the pathophysiology and prognosis. Our objective is to establish the demographic and clinical characteristics of group Chilean patients and analyze the motility of the small intestine and its prognostic value. Methods Patients with symptoms of intestinal pseudo-obstruction with dilated bowel loops were included, in all of whom a manometry of the small intestine was performed using perfused catheters. Results Of the 64 patients included, 51 women (average age 41.5 ± 17.6 years), 54 primary and 10 secondary CIPO were included. Dilatation of the small intestine was the only finding in 38 patients; in the remaining, the compromise was associated with other segments, primarily the colon. Forty-nine patients underwent 65 surgeries, mainly exploratory laparotomies and colectomies. Intestinal manometry was performed on all patients; 4 “patterns” were observed: neuropathic (n = 26), myopathic (n = 3), mixed (n = 24), and a group without motor activity (n = 11). The most relevant findings were the complex migrating motor disorders and decreased frequency and propagation of contractions. The 9 patients who died had a severe myopathic compromise. Conclusions In our series, isolated small bowel compromise was the most common disorder. Neuropathic motor compromise was observed in most of the patients. Mortality was associated with severe myopathic compromise. (J Neurogastroenterol Motil 2017;23:273-280)

Serial Frozen Fecal Microbiota Transplantation in the Treatment of Chronic Intestinal Pseudo-obstruction: A Preliminary Study

( Lili Gu ),( Chao Ding ),( Hongliang Tian ),( Bo Yang ),( Xuelei Zhang ),( Yue Hua ),( Yifan Zhu ),( Jianfeng Gong ),( Weiming Zhu ),( Jieshou Li ),( Ning Li ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2017 Journal of Neurogastroenterology and Motility (JNM Vol.23 No.2

Background/Aims Chronic intestinal pseudo-obstruction (CIPO) is a serious, life-threatening motility disorder that is often related to bacterial overgrowth. Fecal microbiota transplantation (FMT) results in restoration of the normal intestinal microbial community structure. We investigated the efficacy of FMT in the treatment of CIPO patients. Methods Nine patients (age 18-53 years) with CIPO were enrolled in this prospective, open-label study. Patients received FMT for 6 consecutive days through nasojejunal (NJ) tubes and were followed up for 8 weeks after treatment. We evaluated the rate of clinical improvement and remission, feeding tolerance of enteral nutrition, and CT imaging scores of intestinal obstructions. Lactulose hydrogen breath tests were performed before FMT and 8 weeks after FMT to evaluate for the presence small intestinal bacterial overgrowth (SIBO). Results FMT significantly alleviated bloating symptoms, and symptoms of pain were relieved 2 weeks after FMT. Enteral nutrition administered through a NJ tube after FMT was well-tolerated by 66.7% (6/9) of patients. CT scores of intestinal obstructions were significantly reduced after FMT (P = 0.014). SIBO was eliminated in 71.0% (5/7) of patients. Conclusions This pilot study demonstrated the safety of using FMT. FMT may relieve symptoms in selected patients with CIPO. FMT may also improve patient tolerance of enteral nutrition delivered via a NJ tube. (J Neurogastroenterol Motil 2017;23:289-297)

일과 장폐색을 유발한 노인 분변 매복

변영혜 ( Young Hye Byun ),박영숙 ( Young Sook Park ),명석진 ( Seok Jin Myung ),엄우연 ( Woo Youn Eom ),최원욱 ( Won Wook Choi ),김태헌 ( Tae Hun Kim ),조윤주 ( Yun Ju Jo ),김성환 ( Seong Hwan Kim ),송문희 ( Moon Hee Song ) 대한소화기학회 2005 대한소화기학회지 Vol.46 No.3

목적: 급성 장폐색은 즉각적인 감별과 치료 방향을 결정해야 하는 응급 질환으로 비종양 원인 가운데 특히 노인 환자에서는 단순 분변에 의한 폐색도 중요한 원인이다. 급성 장폐색이 의심되었던 환자 가운데 다른 원인이 배제되고 단순 분변 매복에 의한 장폐색으로 진단된 환자를 대상으로 임상 특징을 살펴보고자 하였다. 대상 및 방법: 2001년 2월부터 2004년 3월까지 을지의대 노원을지병원에서 급성 장폐색이 의심되어 소화기내과로 입원한 78예 환자 가운데 단순 분변에 의한 장폐색으로 진단된 19예를 대상으로 임상 특징, 검사 소견 및 치료 경과 등을 조사하였다. 결과: 남녀 비는 1:1.1로 성별에는 큰 차이가 없었으며 환자들의 평균 연령은 79.3세로 대부분이 70세 이상의 고령이었다. 전예에서 복통과 복부 팽만감을 호소하였고 오심, 구토, 변비, 설사 등의 다양한 증상을 호소하였다. 장음은 7예(37%)에서 항진되었고 3예(16%)에서 감소되었으며 9예(47%)에서는 정상이었다. 직장수지검사 결과 8예(42%)에서 단단한 고형변을 촉지할 수 있었으나 4예(21%)에서는 특이 소견이 없었으며, 7예(36%)에서 치핵이 의심되었다. 말초혈액검사 결과 백혈구 증가는 5예(26%), 빈혈은 10예(53%)에서 관찰되었으며 전해질 검사에서는 저나트륨혈증이 4예, 저칼륨혈증이 3예, 고칼슘혈증이 1예에서 관찰되었다. 복부 단순 촬영에서 많은 양의 분변이 확장된 장내에 관찰되었고, 13예(68%)에서 소장과 대장의 확장, 4예에서 대장의 확장, 2예에서는 소장의 확장을 보였으며 공기액체층 음영은 3예(16%), 직장에서 분변의 음영은 11예(58%)에서 확인할 수 있었다. 응급 S자결장내시경 결과 Bristol I형의 단단하고 둥근 형태의 고형변을 관찰한 환자는 7예(37%)였고 전처치 후 시행한 대장내시경 결과 10예(53%)에서 굴곡이 심하고 무기력한 대장이 관찰되었으나 전 예에서 기계 폐색을 의심할 만한 병변은 없었다. 식이요법과 배변 훈련 및 약물치료를 하면서 추적 관찰 중이다. 결론: 고령 환자에서는 단순 분변 매복에 의해 대장 폐색이 유발될 수 있으며, 기질 질환과는 달리 단순히 분변 배출을 유도함으로써 신속한 증상 호전을 보이므로 만성변비의 과거력이 있는 환자에서 먼저 감별이 필요한 질환이다. 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. (Korean J Gastroenterol 2005;46:211-217)