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Purpose: Post-operative paralytic ileus (POI) occurs after surgery because of gastrointestinal dysfunction caused by surgical invasion. We therefore investigated the frequency of POI after laparoscopic colorectal surgery in patients with colorectal cancer using a strictly defined POI diagnosis and identified associated risk factors. Methods: Patients who underwent initial laparoscopic surgery for colorectal cancer between January 2014 and December 2018 were included. The primary end point was the incidence of POI. A multivariate logistic regression analysis revealed the contributing risk factors for POI. Results: Of the 436 patients, 94 (21.6%) had POI. Compared with the non-POI group, the POI group had significantly higher frequencies of infectious complications (p < 0.001), pneumonia (p < 0.001), intra-abdominal abscess (p = 0.012), anastomotic leakage (p = 0.016), and post-operative bleeding (p = 0.001). In the multivariate analysis, the right colon (odds ratio [OR] 2.180, p = 0.005), pre-operative chemotherapy (OR 2.530, p = 0.047), pre-operative antithrombotic drug (OR 2.210, p = 0.032), and post-operative complications of CD grade ≥ 3 (OR 12.90, p < 0.001) were independent risk factors for POI. Conclusion: Post-operative management considering the risk of post-operative bowel palsy may be necessary for patients with right colon, pre-operative chemotherapy, pre-operative antithrombotic drug or severe post-operative complications. [ABSTRACT FROM AUTHOR]

Background and Aims: Feed intolerance (FI) is common in cirrhosis patients in intensive care units (ICU). Prokinetics are the first line treatment for FI but their efficacy and safety in critically ill patient with cirrhosis is unknown. We evaluated the role of prokinetics in reversal of FI and clinical outcomes. Methods: Consecutive patients admitted in ICU developing new-onset FI, were randomized to receive either intravenous metoclopramide (Gr.A, n = 28), erythromycin (Gr.B, n = 27) or placebo (Gr.C, n = 28). FI was defined with the presence of 3 of 5 variables- absence of bowel sounds, gastric residual volume ≥ 500 ml, vomiting, diarrhoea and bowel distension. Primary end-point was complete resolution of FI (≥ 3 variables resolved) within 24-h and secondary end-points included resolution within 72-h and survival at 7-days. Results: Of the 1030 ICU patients, 201 (19.5%) developed FI and 83 patients were randomized. Baseline parameters between the groups were comparable. Complete resolution at 24-h was higher in Gr.A (7.14%) and B (22.2%) than C (0%, p = 0.017). Overall, 58 (69.9%) patients achieved resolution within 72 h, more with metoclopramide (n = 24, 85.7%) and erythromycin (n = 25, 92.6%) than with placebo (n = 9, 32.1%, p < 0.001). The 7-day survival was better in patients who achieved resolution within 72-h (65.5 vs. 36%, p = 0.011) than non-responders. High lactate (OR-3.32, CI-1.45–7.70, p = 0.005), shock at baseline (OR-6.34, CI-1.67–24.1, p = 0.007) and resolution of FI within 72 h (OR-0.11, CI, 0.03–0.51, p = 0.04) predicted 7-day mortality. Conclusions: FI is common in critically-ill cirrhosis patients and non-resolution carries high mortality. Early recognition and treatment with prokinetics is recommended to improve short-term survival. [ABSTRACT FROM AUTHOR]

Background: Benzyl alcohol is used as stripping agent in paints and other applications, and benzyl alcohol poisoning is indicated by symptoms, such as impaired consciousness, respiratory depression, hypotension, metabolic acidosis, and renal dysfunction. Case presentation: A 27-year-old Asian man was transported to a hospital for severe disturbance of consciousness following exposure to a paint stripper containing benzyl alcohol, ethylene glycol, and hydrogen peroxide, which he was using to repaint a bridge. The patient was treated under sedation for benzyl alcohol poisoning. On day 3 of hospitalization, his abdominal computed tomography scan revealed a paralytic ileus, so he was transferred to our hospital. The combined toxicity from multiple substances, mainly benzyl alcohol, was thought to be a contributing factor for the paralytic ileus. Upon arrival, the patient also had chemical burns, hypernatremia, and elevated myogenic enzyme levels. His urinary hippuric acid level was high (14.9 g/L) upon admission to the previous hospital. We treated the patient with artificial respiration management, while avoiding high-density oxygen, and with gastrointestinal decompression by gastric tube implantation; laxatives were also administered. The paralytic ileus improved on the 4th day, the tube was removed on the 6th day, and the patient was discharged on the 11th day of hospitalization. No apparent complications were observed at discharge. Conclusions: To the best of our knowledge, this is the first case report of paralytic ileus caused by benzyl alcohol, although multiple factors may have influenced the symptoms. After exposure to benzyl alcohol by inhalation and dermal absorption, the patient developed impaired consciousness, metabolic acidosis, and paralytic ileus, and the presence of elevated urinary hippuric acid led to a definitive diagnosis. [ABSTRACT FROM AUTHOR]

Caecal bascule refers to a rare condition wherein the caecum folds upon the ascending colon causing intestinal obstruction. We describe a case report of caecal bascule following lung transplantation which required right hemicolectomy. It was initially thought to be due to post-operative paralytic ileus which is, not uncommonly, seen following lung transplantation. While most cases of paralytic ileus respond to conservative measures, it is important to maintain a close watch—keeping in mind a high degree of suspicion for possible surgically correctable causes, which can be a lifesaving intervention. The clinical dilemma in subjecting a heavily immunosuppressed patient, soon after lung transplantation (where painless abdominal distention is not uncommon), to a major abdominal surgery in the background of minimal clinical signs of acute abdomen is discussed. The thought process behind the surgical strategy, including the pros and cons of various surgical options and the management of nutrition and immunosuppression in this patient, is elaborated. [ABSTRACT FROM AUTHOR]

Paralytic ileus (PI) is the pseudo-obstruction of the intestine secondary to intestinal muscle paralysis. Causes of PI include electrolyte imbalances, gastroenteritis (inflammation or infection of the stomach or intestines), overuse of medications, abdominal surgery, etc. Predicting mortality in PI patients hospitalized to ICU is crucial for assessing the severity of illness and adjudicating the value of treatment strategy and resource planning. We have developed a Statistically Robust Machine Learning based Mortality Prediction framework namely SRML-MortalityPredictor that could potentially help intensivists, surgeons, and other medical professionals to carefully plan treatment strategies for critically ill PI patients. We used MIMIC III v1.4, a publicly available ICU database to extract patients data (with age > 18 years old) admitted to the ICU with paralytic ileus (PI) as their primary illness. At phase 1, the SRML-MortalityPredictor framework uses univariate statistical analysis to filter out those risk factors which are not associated with the label of the data. Subsequently, it uses the risk survival statistical methods such as cox-regression and Kaplan–Meier survival analyses. The cox-regression analysis provides the hazard ratio about the potential PI risk factors that later used in conjunction with the Kaplan–Meier analysis to generate a rank order list (highest to lowest risk factors). At phase 2, we used several machine learning classification approaches such as linear discriminant analysis (LDA), Gaussian naive bayes (GNB), decision tree (DT) model, k-nearest neighbor (KNN), and support vector machine (SVM) to find the one with highest predictive power using the rank order features extracted at phase 1. We have evaluated the SRML-MortalityPredictor framework and recorded the accuracy, sensitivity, specificity, receiver operating characteristic (ROC) curves, and area under the curve (AUC) scores for each model. The SRML-MortalityPredictor framework with support vector machine (using RBF kernel) showed better performance and yielded an accuracy score: 81.30% and AUC score: 81.38% while predicting mortality in PI patients. We demonstrated a feasible framework for the mortality risk prediction in PI patients admitted to the ICU. The proposed framework could potentially be helpful for intensivists in clinical decision making. Further research is necessary to incorporate more risk factors associated with PI patients to ensure the adaptability of SRML-MortalityPredictor at the bedside. [ABSTRACT FROM AUTHOR]

Present communication reports about the rare case of paralytic ileus in a calf and its successful management. A two-month-old buffalo calf was referred to the hospital, with history of not passing dung and intermittent colic signs. On clinical examination, severe dehydration, congested mucus membranes, elevated vital parameters, empty rectum and fluid splashing sounds on the right side of abdomen were observed. Ultrasonographic examination revealed the distended proximal intestinal loops along with thickened intestinal wall and empty colon. Case was treated with oral piperazine compound at 200 mg/kg body weight, liquid paraffin at 5 ml/kg body weight along with fluid therapy. On the second day of treatment, the calf was passed the huge number of the Toxocara vitulorum worms and uneventful recovery was noticed after eight days of therapy. [ABSTRACT FROM AUTHOR]

The diagnosis ileus is one of the most common indications for an emergency laparotomy. In 70% of the cases, the small intestine is affected, and in 30% it is the colorectum. While stuck hernias are a major cause in developing countries, the most common causes in western countries are postoperative adhesions that lead to an acute bowl obstruction. The timeframe for treatment of a complete mechanical obstruction is short as acute ischemia can lead to necrosis with bowl perforation within 6 h. The perioperative lethality for an emergency laparotomy due to an ileus ranges from 5-15%. In addition to the mechanical ileus, primary and secondary paralytic ileus is important in the differential diagnosis. As the genesis of postoperative ileus is multifactorial, a multimodal concept is required for successful treatment. [ABSTRACT FROM AUTHOR]

Background: Prolonged ileus is one of the most common postoperative complications after colorectal surgery. We sought to investigate the predictors of prolonged ileus following elective colon resections procedures.Methods: The national participant user files of NSQIP databases were utilized to examine the clinical outcomes of patients undergoing elective colon resection during 2012-2013. Multivariate regression analysis was performed to investigate predictors of prolonged ileus. Prolonged ileus was defined as no return of bowel function in 7 days.Results: We sampled a total of 27,560 patients who underwent colon resections; of these, 3497 (12.7%) patients had prolonged ileus. Patients with ileocolonic anastomosis (ICA) had a significantly higher rate of prolonged ileus compared to patients with colorectal anastomosis (CRA) (15 vs. 11.5%, AOR 1.25, P < 0.01). Prolonged ileus was significantly associated with intra-abdominal infections (13 vs. 2.8%, AOR 2.56, P < 0.01) and anastomotic leakage (12 vs. 2.4%, AOR 2.50, P < 0.01). Factors such as preoperative sepsis (AOR 1.63, P < 0.01), disseminated cancer (AOR 1.24, P = 0.01), and chronic obstructive pulmonary disease (AOR 1.27, P = 0.02) were associated with an increased risk of prolonged ileus, whereas oral antibiotic bowel preparation (AOR 0.77, P < 0.01) and laparoscopic surgery (AOR 0.51, P < 0.01) are associated with decreased prolonged ileus risk.Conclusions: Prolonged ileus is a common condition following colon resection, with an incidence of 12.7%. Among colon surgeries, colectomy with ICA resulted in the highest rate of postoperative prolonged ileus. Prolonged ileus is positively associated with anastomotic leak and intra-abdominal infections; thus, a high index of suspicion must be had in all patients with prolonged postoperative ileus. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effects of gum chewing on recovery of bowel function after cesarean section. Methods: Fifty pregnant women who underwent cesarean section at Chiang Mai University hospital from September 2010 to December 2010 were recruited. After cesarean section, patients were randomized into two groups. In group 1 (conventional), patients were fed according to conventional feeding protocol without gum chewing. For group 2 (gum chewing), patients were asked to chew two pieces of sugarless gum for 30 min in the morning, noon, evening and bedtime until the first flatus, along with conventional postoperative feeding protocol. Categorical variables were analyzed using the Chi-square or Fischer's exact test, as appropriate. For continuous variables with skewed distribution, the Mann-Whitney U test was employed. Results: There were 25 patients in each group. Median time to the first flatus was shorter in the gum chewing group (36.37 vs. 41.33 h, P = 0.02). Also, there was a trend toward less abdominal cramping on days 1 and 2 in the gum chewing group. However, no difference in other outcome measures of bowel function recovery and ileus-related complications between the groups could be demonstrated. Approximately three-fourth of the women in each group had good tolerance to their first meal. Hospital stay and participants' satisfaction to the assigned feeding schedules were comparable between the study groups. Conclusion: Gum chewing is associated with faster recovery of bowel function following cesarean section. It is safe, practical, inexpensive, and well tolerated. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to examine the effects of a postsurgical, inpatient exercise program on postoperative recovery in operable colon cancer patients Methods: We conducted the randomized controlled trial with two arms: postoperative exercise vs. usual care. Patients with stages I-III colon cancer who underwent colectomy between January and December 2011 from the Colorectal Cancer Clinic, were recruited for the study. Subjects in the intervention group participated in the postoperative inpatient exercise program consisted of twice daily exercise, including stretching, core, balance, and low-intensity resistance exercises. The usual care group was not prescribed a structured exercise program. The primary endpoint was the length of hospital stay. Secondary endpoints were time to flatus, time to first liquid diet, anthropometric measurements, and physical function measurements. Results: A total of 31 (86.1 %) patients completed the trial, with adherence to exercise interventions at 84.5 %. The mean length of hospital stay was 7.82 ± 1.07 days in the exercise group compared with 9.86 ± 2.66 days in usual care (mean difference, 2.03 days; 95 % confidence interval (CI), −3.47 to −0.60 days; p = 0.005) in per-protocol analysis. The mean time to flatus was 52.18 ± 21.55 h in the exercise group compared with 71.86 ± 29.2 h in the usual care group (mean difference, 19.69 h; 95 % CI, −38.33 to −1.04 h; p = 0.036). Conclusions: Low-to-moderate-intensity postsurgical exercise reduces length of hospital stay and improves bowel motility after colectomy procedure in patients with stages I-III colon cancer. [ABSTRACT FROM AUTHOR]

Copyright of Der Gastroenterologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Gastrointestinal dysmotility is commonly noted in the intensive care unit and postoperative settings. Characterized by delayed passage of stool and flatus, nausea, vomiting, and abdominal distention, the condition is associated with nutritional deficiencies, risk of aspiration, and considerable allocation of health care resources. Knowledge of gastrointestinal function in health and illness continues to expand. While the factors that precipitate ileus differ between postoperative and critically ill patients, the two clinical scenarios seem to have similar mechanisms and share many of the same pathophysiologic patterns. By reviewing and comparing the literature on the respective mechanisms and contributing factors generated in these separate clinical settings, a common more comprehensive management strategy may be derived with the potential for newer innovative therapeutic options. [ABSTRACT FROM AUTHOR]

We retrospectively analyzed the medical history of 19 elderly myeloma patients treated with the 'novel subcutaneous formulation of bortezomib.' In our experience, two patients (10 %) discontinued treatment for paralytic ileus. The exact pathogenetic mechanisms of toxic megacolon and paralytic ileus due to 'novel subcutaneous formulation of bortezomib' are unclear. Probably, it may be related to possible damage of the autonomic nerve fibers that control organ functions. Adequate prevention and management of the gastrointestinal (GI) toxicities with the use of fluid intake and prokinetic and laxative drugs (at least two types of agents in a suboptimal dose) especially in patients with risk factors for GI side effects (anti-myeloma novel agents, opioids or antiemetics, iron supplements, spinal and cord compression, immobility, history of constipation) can decrease the possibility of interruption of administration of drug and increase adherence to treatment. Clearly this complication must be borne in mind whenever a patient develops acute abdominal pain and distension. [ABSTRACT FROM AUTHOR]

Copyright of Der Internist is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

To report the occurrence of abdominal compartment syndrome (ACS) due to infection with Clostridium difficile. Case report. Trauma intensive care unit (TICU) of Hamad General Hospital, a teaching hospital in Doha, Qatar. A 36-year-old man involved in a motor vehicle accident had severe traumatic brain injury and received ceftriaxone. On day 7, he developed severe abdominal distension and diarrhoea followed by paralytic ileus with oliguria, hyperkalaemia, and intra-abdominal hypertension. The patient's stool sample was positive for C. difficile toxin A and B An ACS was diagnosed. The patient was successfully treated in the TICU by stopping the offending antibiotic and starting metronidazole plus neostigmine as a prokinetic agent. The fluid status was guided by pulse-induced continuous cardiac output, and frusemide was added to the treatment. With this aggressive management the abdominal pressure decreased and the renal function improved, with full recovery of renal function by day 21. Unfortunately the patient's Glasgow coma score (GCS) deteriorated, so percutaneous tracheostomy was performed. He was transferred to the neurosurgical ward on day 35. A week later he was shifted to the rehabilitation unit for further management. C. difficile colitis can cause intra-abdominal hypertension (IAH) and ACS. Rapid diagnosis, early aggressive supportive care, metronidazole and prokinetics are necessary to lower the morbidity and mortality of C. difficile colitis associated with IAH and ACS. [ABSTRACT FROM AUTHOR]

A comparison was made between the toxic effects of chronic chlorpromazine, haloperidol or atropine on the guinea pig intestinal tract. Chlorpromazine, administered at a dose of 30 mg/kg/day, IP for 7 days, produced marked pathologic changes in the guinea pig cecum, consisting of inflammation, edema and hemorrhage. None of these effects were noted when haloperidol, 2 or 10 mg/kg/day or atropine 30 mg/kg/day were similarly administered. Similar toxic effects may occur in humans on long-term chlorpromazine or other phenothiazine therapy, thereby accounting for the paralytic ileus observed with these drugs. [ABSTRACT FROM AUTHOR]

Copyright of Langenbeck's Archives of Surgery is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We report herein a rare case of a 26 year old woman with pheochromocytoma complicated by paralytic ileus. She presented with remarkable abdominal distension and respiratory difficulty but was effectively treated by surgical removal of the tumor with preoperative and operative management using α and β adrenergic blocking agents. An excessive and persistent catecholamine production from large tumors or massive metastases characterizes this rare complication, and a review of the English and Japanese literature is given following this report. [ABSTRACT FROM AUTHOR]

Three hundred sixty clinical cases which presented with or without mechanical intestinal obstruction were evaluated in order to discover reliable quantitative and qualitative criteria for pre-surgical x-ray diagnoses. It was discovered that small bowel distension of above 1.0 (ratio) together with obvious gas fluid level is usually indicative of small bowel obstruction, while large bowel distension of above 1.5 (ratio) together with obvious gas fluid level is usually indicative of large bowel obstruction. Subsequent surgery confirmed that there exists a correlation between the degree of small bowel distension seen on radiographs prior to surgery and the actual small bowel distension secondary to small bowel obstruction measured during surgery. The present results may be diagnostically useful in the radiological differentiation of mechanical intestinal obstructions from other abdominal conditions. [ABSTRACT FROM AUTHOR]

Copyright of Langenbecks Archiv fuer Chirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Nimodipine, now widely used for treatment and prevention of cerebrovascular spasm, is regarded as a safe drug. Despite a preferential action on cerebral vessels, there is clinical and experimental evidence of effects on systemic vascular and intestinal smooth muscle cells. Gastro-intestinal side-effects, however, have not been reported in clinical studies dealing with treatment of vasospasm following subarachnoid haemorrhage. We report on a patient with subarachnoid haemorrhage who developed an acute life-threatening pseudo-obstruction of the colon, a variant of adynamic ileus, while being treated with intravenous nimodipine. The relationship between this complication and calcium antagonist therapy is discussed and therapeutic strategies are presented. We conclude that neurosurgeons and neurologists should be aware of calcium antagonist-related ileus in patients treated with nimodipine. [ABSTRACT FROM AUTHOR]

Background: Pneumatosis cystoides intestinalis (PCI) is a rare disease characterized by multiple gas-filled cysts in the intestinal wall and is associated with various comorbidities. We report herein a case of intractable paralytic ileus caused by primary PCI.Case presentation: A 73-year-old man visited out hospital complaining of abdominal pain and vomiting. He had been hospitalized twice for intestinal obstruction in the past 2 months. Based on his history of appendectomy, mechanical bowel obstruction caused by adhesion was diagnosed, and the patient underwent surgery. However, laparotomy revealed small bowel dilatation despite the absence of obstruction or stenosis. Multiple nodules were found in the wall of the dilated bowel loops. The dilated jejunum was excised. Histological examination revealed that the nodules were small gas-filled cysts, suggesting PCI. We made a diagnosis of ileus with underlying PCI and managed the patient conservatively. A large amount of nasogastric tube drainage continued for a long period postoperatively. The patient underwent relaparotomy 35 days after the first operation. The upper jejunum was markedly dilated, although no mechanical stenosis was found. The atonic, dilated jejunum was excised and the ileal stump was anastomosed to the duodenum in a double tract fashion. The patient underwent hyperbaric oxygen therapy because the ileus persisted postoperatively. His condition gradually improved and he was discharged 53 days after the second operation.Conclusions: Non-operative treatment is recommended for primary PCI of unknown etiology. Surgeons should be mindful of the possibility of primary PCI when considering surgical intervention for patients with bowel obstruction. [ABSTRACT FROM AUTHOR]

Dysautonomia is commonly observed in Guillain–Barré syndrome (GBS). However, hypotension is rarely a presenting and persisting symptom. A man with orthostatic hypotension progressively suffered with distal sensory disturbance, weakness in limbs, and persisting paralytic ileus. Dr Liu et al. made the diagnosis of GBS and successfully treated him with intravenous immunoglobulin. Chronic alcoholism might underlie this atypical course. [ABSTRACT FROM AUTHOR]

Copyright of Langenbecks Archiv fuer Chirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)