Intestinal Obstruction: Etiology and Pathophysiology, Clinical Presentation and Imaging, Diagnosis and Treatment

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "General Surgery".

Deadline for manuscript submissions: closed (30 September 2023) | Viewed by 3534

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4th Academic Department of Surgery, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Alexandrou Mihailidi 13, 54640 Thessaloniki, Greece
Interests: acute care surgery; surgical infections; negative pressure wound therapy; vascular access; nutrition; open abdomen; minimally invasive surgery; enhanced
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Dear Colleagues,

Intestinal obstruction is among the most common surgical emergencies worldwide and is considered one of the most serious problems in surgery, with relatively high morbidity and mortality. In 80% of cases, it concerns the small intestine, and in 20%, the large intestine, and it can be incomplete or complete, acute or chronic, high or low. The clinical presentation varies depending on the etiology and level of the obstruction. Imaging studies are of great importance to establish the diagnosis, determine the cause, and guide treatment. Treatment can be either medical or surgical. Today, with the advancement of minimally invasive techniques, surgical treatment in addition to open surgery can be carried out laparoscopically and robotically, and there is great interest in implementing enhanced recovery protocols in the surgical management of these patients. In this Special Issue of the Journal of Clinical Medicine, we will discuss the etiology and pathophysiology, clinical presentation and imaging, diagnosis, differential diagnosis, and treatment of intestinal obstruction. Basic research based on animal models of small and large bowel obstruction as well as epidemiological and clinical studies, observational, retrospective, and prospective as well as reviews are welcome for submission.

Dr. Orestis M. Ioannidis
Guest Editor

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Keywords

  • small bowel
  • large bowel
  • acute care surgery
  • intestine
  • laparoscopic surgery
  • robotic surgery
  • minimally invasive surgery
  • enhanced recovery
  • endoscopic treatment
  • fluorescence ICG (indocyanine green) imaging

Published Papers (3 papers)

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13 pages, 239 KiB  
Article
Malignant Bowel Obstruction: A Retrospective Multicenter Cohort Study
by Maria-Evanthia Sotirianakou, Maximos Frountzas, Athina Sotirianakou, Haridimos Markogiannakis, George E. Theodoropoulos, Sotirios Sotirianakos and Konstantinos G. Toutouzas
J. Clin. Med. 2024, 13(1), 263; https://doi.org/10.3390/jcm13010263 - 02 Jan 2024
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Abstract
Background: Malignant bowel obstruction (MBO) is a serious clinical entity that requires surgical intervention in almost 50% of cases. However, overall survival remains low even for operable cases. The aim of the present study was to investigate the correlation between patients’ characteristics, perioperative [...] Read more.
Background: Malignant bowel obstruction (MBO) is a serious clinical entity that requires surgical intervention in almost 50% of cases. However, overall survival remains low even for operable cases. The aim of the present study was to investigate the correlation between patients’ characteristics, perioperative details, histopathological results and postoperative outcomes of patients who were operated on due to MBO. Methods: A retrospective search of patients who were operated on due to MBO in a university and a rural hospital was conducted. Patients’ characteristics, perioperative details, histopathological results and postoperative outcomes were reported. Univariable and multivariable analysis was performed. Results: Seventy patients were included with a mean age of 76.1 ± 10.6 years. The 30-day mortality rate was 18.6%, the Intensive Care Unit (ICU) admission rate was 17.1% and the mean length of stay (LOS) was 12.4 ± 5.7 days. Postoperative 30-day mortality was associated with increased age, known malignant recurrence, microscopically visible metastatic foci and defunctioning stoma creation. Colorectal malignancy type, sigmoid obstruction and primary anastomosis were correlated with decreased 30-day mortality. In addition, operation at the university hospital led to increased LOS, while stoma creation led to decreased LOS. Finally, ICU admission rates were increased for operations at university hospitals, at least one comorbidity, known malignant recurrence and longer preoperative waiting interval, whereas they were decreased for colorectal primary malignancy type. Conclusions: Surgery due to MBO leads to increased morbidity and mortality. Therefore, prospective studies are needed to highlight inter-patient differences regarding the best individualized therapeutic strategy. Full article
15 pages, 4620 KiB  
Article
The EUPEMEN (EUropean PErioperative MEdical Networking) Protocol for Bowel Obstruction: Recommendations for Perioperative Care
by Orestis Ioannidis, Jose M. Ramirez, Javier Martínez Ubieto, Carlo V. Feo, Antonio Arroyo, Petr Kocián, Luis Sánchez-Guillén, Ana Pascual Bellosta, Adam Whitley, Alejandro Bona Enguita, Marta Teresa and Elissavet Anestiadou
J. Clin. Med. 2023, 12(13), 4185; https://doi.org/10.3390/jcm12134185 - 21 Jun 2023
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Abstract
Mechanical bowel obstruction is a common symptom for admission to emergency services, diagnosed annually in more than 300,000 patients in the States, from whom 51% will undergo emergency laparotomy. This condition is associated with serious morbidity and mortality, but it also causes a [...] Read more.
Mechanical bowel obstruction is a common symptom for admission to emergency services, diagnosed annually in more than 300,000 patients in the States, from whom 51% will undergo emergency laparotomy. This condition is associated with serious morbidity and mortality, but it also causes a high financial burden due to long hospital stay. The EUPEMEN project aims to incorporate the expertise and clinical experience of national clinical specialists into development of perioperative rehabilitation protocols. Providing special recommendations for all aspects of patient perioperative care and the participation of diverse specialists, the EUPEMEN protocol for bowel obstruction, as presented in the current paper, aims to provide faster postoperative recovery and reduce length of hospital stay, postoperative morbidity and mortality rate. Full article
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8 pages, 955 KiB  
Case Report
Intestinal Obstruction for Anisakiasis: Surgical and Physical Therapy Treatment
by Fernando Cózar-Bernal, Jorge Góngora-Rodríguez, Carmen Ayala-Martínez, Francisco Javier Martín-Vega, Maria Jesus Vinolo-Gil and Manuel Rodríguez-Huguet
J. Clin. Med. 2023, 12(13), 4470; https://doi.org/10.3390/jcm12134470 - 04 Jul 2023
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Abstract
Anisakiasis, a zoonotic disease that can lead to small intestine obstruction, has seen a significant rise in Spain. The country has become the first in Europe with an annual incidence of 8000 cases, primarily due to the popularity of consuming exotic dishes of [...] Read more.
Anisakiasis, a zoonotic disease that can lead to small intestine obstruction, has seen a significant rise in Spain. The country has become the first in Europe with an annual incidence of 8000 cases, primarily due to the popularity of consuming exotic dishes of undercooked or raw fish and the impact of climate change. The clinical presentation of anisakiasis can mimic symptoms of acute appendicitis or intestinal obstruction, leading to potential misdiagnosis. This case report describes a 37-year-old patient with no significant medical history who presented abdominal distension and intense pain in the right lower quadrant. The patient underwent surgery and received physiotherapy treatment, including therapeutic exercises and pulsed-pressure myofascial vacuum therapy, to facilitate functional recovery. The increasing incidence of anisakiasis in Spain underscores the need to consider it in the differential diagnosis of digestive diseases, given the high consumption of poorly prepared or raw fish in the region. Full article
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