Intestinal strictures

Recurrent intestinal strictures, intestinal obstructions, type II diabetes mellitus... 

History of Crohn s disease, diverticulitis, G1 perforation and/or adhesions, impaired intestinal circulation or ischemic colitis, intestinal obstruction, intestinal stricture, or toxic megacolon... 

Crohn s disease may be complicated by intestinal strictures, fistulae and intra-abdominal abscesses. Surgery is often necessary but strictures may be amenable to endoscopic balloon dilatation and abscesses can be drained under radiographic control. 

The primary problem with ureteral-intestinal strictures is due to scarring secondary to impaired blood flow to the site of the anastomosis. Endoscopic incision combined with balloon dilatation gives better results than dilatation alone. In contrast, a permanent stent is the preferred way to manage patients with metastatic cancer. It is important that the side holes of the pigtail should lie only in the renal pelvis and in the stoma collection bag as, if left in the conduit, they may become blocked by mucous. The stents should be changed every 4-6 months. 

Megaloblastic Anemias Associated with Intestinal Strictures, Blind... 

Formation of strictures, abscesses, fistulae, and obstructions in patients with CD is possible. Patients with CD may develop significant weight loss or nutritional deficiencies secondary to malabsorption of nutrients in the small intestine, or as a consequence of multiple small- or large-bowel resections. Common nutritional deficiencies encountered in IBD include vitamin B12, fat-soluble vitamins, zinc, folate, and iron. Malabsorption in children with CD may contribute to significant reductions in growth and development. 

Inflammation. Chronic inflammatory bowel disease affecting the small bowel can lead to disturbances of intestinal motility [146], Potential mechanisms are previous surgery, development of fibrosis and strictures, malabsorption, and cross-talk between inflammatory and enteric nerves [156, 157], Patients with Crohn s disease are often included in aggregate studies of bacterial overgrowth [23, 75, 158], reflecting this link. 

Complications of Crohn s disease may involve the intestinal tract or organs unrelated to it. Small-bowel stricture and subsequent obstruction is a complication that may require surgery. Fistula formation is common and occurs much more frequently than with ulcerative colitis. 

These drugs act to increase the volume of stool by absorbing water and as a result softening of faeces occurs. These are safe drugs (except in patient with strictures when intestinal obstruction may be precipitated). Adequate hydration of the patient is to be maintained. The onset of action occurs in 12-24 hours after oral intake. 

Complications Potential complications include the perforation of the intestinal wall (covered or open), stenosis and stricture as well as intussusception or haemorrhage. 

Piroxicam can cause diaphragm-like strictures of the intestinal tract (9). 

Abnormalities of Bile Acid Delivery to the Bowel. Decreased bile flow from intrahepatic cholestasis or extra-hepatic bUe duct obstruction caused by bUiary atresia, stricture, stone, or carcinoma will result in bile acid retention and regurgitation from the liver ceU into plasma and a decrease in delivery to the intestine. The ratio of plasma trUiydroxy to dihydroxy acids increases in cholestasis. 

Radiographic evaluation of the GI tract often starts with plain films of the abdomen, which are straightforward, uncontrasted radiographs. Specific abdominal structures that may be identified include the kidney, ureters, and bladder (KUB) esophagus stomach intestine stones and vessels. Plain films are often used to evaluate abdominal pain. Clinicians frequently employ plain radiographic fluoroscopy to guide and position other instruments that are used to evaluate and treat GI disorders an example is the manipulation of dilation devices to treat esophageal strictures. Bowel obstruction and perforation are especially well identified by this technique. 

D. If the victim survives, scarring from the initial corrosive injury may result in pyloric stricture or other intestinal obstructions. 

Bowel obstruction may be present at birth due to meconium ileus. Older children might present with distal intestinal obstruction syndrome (DIOS), colonic stricture(s) and, less commonly, intussusception, fecal impaction of the appendix, gastroesophageal reflux or recurrent rectal prolapse (Fig. 5.24). 

Causes of constipation in infants and children include functional constipation, neurogenic constipation [aganglionosis, hypoganglionosis, neuronal intestinal dysplasia (NID)], chronic intestinal pseudo-obstruction, disorders of the spinal cord, cerebral palsy, constipation secondary to anal fissures and strictures, neonatal hypothyroidism and drug induced constipation (Potter 1998). 

Sonography may be used in patients with intestinal tuberculosis to document its classic features, i.e., bowel wall thickening, hyperemia, stricture, and mesenteric lymphadenopathy. When tuberculous peritonitis coexists, sonography shows ascites, omental cake, and thickened mesentery with an adherent small bowel loop thus, ultrasonography maybe used as a primary investigative tool in patients with suspected or recurrent tuberculosis. 

Intestinal tuberculosis is a chronic inflammation of the bowel caused by Mycobacterium tuberculosis. The ileocecal area is the most common site. The classic radiographic appearance of ileocecal tuberculosis on barium enema has been described as a conical, shrunken, retracted cecum associated with a narrow ulcerated terminal ileum (Reeder and Palmer 1989). This cecal deformity is the result of spasm early in the disease and transmural infiltration with fibrosis in advanced phases. Narrowing of the terminal ileum may be caused by persistent irritability with rapid emptying of the narrowed segment, corresponding to the acute inflammatory phase, or it may be the result of stricture with thickening and ulceration. 

In the active stage of intestinal tuberculosis,bowel wall thickening is usually accompanied by luminal narrowing, which results from spasm and edema. Later, fibrosis and scarringlead to permanent stricture (Fig. 12.5) however, it is difficult to detect stricture during sonographic examinations (Kedar et al 1994). 

Postactinic radiogenic colitis is characterized by concentric edematous thickening of the intestinal wall with preservation of the layered structure and may be associated with additional edematous thickening and infiltration of the perirectal fat. Radiation-induced stricture of the ureter or insufficiency fracture of the... 

Cornud F, Lefebre J, Chretien Y et al. (1988) Percutaneous transrenal electro-incision of ureter-intestinal anastomotic strictures comparison of open surgical and endourologi-cal repair. J Urol 139 1195-1198... 

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