INDEX
• Adhesions : What, When, Symptoms, Diagnosing.
• Removal of: Laparoscopic surgery for abdominal adhesions.
• Specialty : Adhesions/Adhesiolysis.
• Procedure : The lysis of adhesions procedure.
• Technique : Adhesion Removal Surgery - Drs. Miklos & Moore.
• Epidemiology: Intestinal Obstruction and Ileus.
• Surgery : Intestinal Obstruction Repair.

• -Media-: Removing abdominal adhesions.
• -Media-: E-coli Fecal Impaction found by Medical Examiner.

• AFTERWORD: Appearances, Beliefs, and, Expectations can be deceiving.

Adhesions: What, When, Symptoms, Diagnosing.
http://www.laparoscopyindia.com/adhesions/

Occasionally adhesions are present from birth.
More commonly, however, they form following abdominal operations.
Everyone is different in the way his or her body responds to an operation.
Some people form extensive adhesions after an abdominal operation, while others undergoing a similar surgery may develop very few adhesions. Unfortunately, there is no way of predicting the severity of adhesions a patient is likely to develop after surgery.

Adhesions are also known to develop after an attack of infection such as appendicitis or inflammation of gallbladder (cholecystitis). Adhesions make loops of intestine stick to one another or cause a loop of intestine to stick to the inner surface of the abdominal wall.

What are the symptoms?
Often patients with adhesions do not experience any symptoms.
When adhesions do produce symptoms, they are likely to be of one of the following two types:

Symptoms of intestinal obstruction.
Sometimes adhesions entrap a portion of intestine and the normal flow of contents through the intestine gets blocked leading to intestinal obstruction. The symptoms of this condition are:

    Cramping abdominal pain
    Distention of the abdomen
    Intermittent or repeated vomiting, and
    Difficulty with passing gas or having a bowel movement

1. The patient may experience a sudden (acute) attack or the symptoms may be of recurrent nature.
   Sometimes the blockage in the intestine may get relieved on its own and the symptoms settle down within a few hours or days. More often than not the patient needs to be hospitalized for treatment that may involve an operation to correct the problem.

2. Chronic pain in the abdomen Sometimes adhesions are responsible for vague, intermittent pain in the abdomen that may go on for years. This occurs as a result of traction on the loops of intestines and is felt as a pulling sensation in the abdomen.

How are adhesions diagnosed?
The doctor can often suspect the possibility of a patient having adhesions from his symptoms.
If taken during an attack of acute pain, an abdominal x-ray may show gas-filled, dilated loops of intestine suggesting the possibility of adhesions.

Sometime a test called barium meal follow-through has to be performed.
In this test, the patient is made to drink a milky white liquid (containing barium sulphate) and a series of x-rays are taken to outline various parts of intestine. The x-rays may show up a hold-up or a blockage in the intestine. However, more often than not none of these tests are able to diagnose adhesions with certainty. In such cases the best way to diagnose the problem is by performing laparoscopy. In fact, the main advantage of using laparoscopy in this situation is that the adhesions can be diagnosed as well as treated at the same time.

Removal of: Laparoscopic surgery for abdominal adhesions. INDEX
Dr Deepraj Bhandarkar -- http://www.laparoscopyindia.com/adhesions/
Hinduja Hospital -- Hinduja Healthcare Surgical -- Breach Candy Hospital
Minimal Access Surgery Clinic -- Dalvi Hospital (all are located in Mumbai)
Single Incision Laparoscopic Surgery (SILS)
info@laparoscopyindia.com

Laparoscopic surgery is an operation in which inside of the abdomen is examined by means of a telescope called a laparoscope. The operation is performed by making two or three small punctures (about 0.5 to 1 cm in size) on the abdomen - i.e., without making a big incision. In fact, no other test or investigation can diagnose adhesions with certainty - looking for them through a laparoscope is the only way confirming their presence. If the surgeon encounters adhesions, they can be easily divided using long laparoscopic instruments. The procedure is called adhesiolysis. A patient recovers quickly after laparoscopic surgery for adhesions as he / she has very little pain.

What happens after the operation?
How soon you are allowed to drink liquids and eat food after your adhesiolysis operation depends on the extent of adhesiolysis. Generally, you will be allowed to drink fluids within 6 - 8 hours after the operation. You may be given a saline drip for that period. In the first 12 - 16 hours after recovery you may experience some nausea, but this soon passes away.

What about the pain after surgery?
After any laparoscopic operation there is some pain at the site of the cuts for a few days.
With the laparoscopic operation this is much less as compared to an open operation.
You will be prescribed medicines to control the pain. Also, you will be encouraged to get out of the bed soon after the operation despite the slight discomfort. Over a period of time the pain will gradually reduce and become almost negligible.

How soon can I resume work?
This depends very much on the nature of the job you do and the type of operation you have had.
Most patients are able to return to light desk job within 8 - 10 days after surgery and almost all activities will be permitted after about 15 days after surgery.

What are the risks of laparoscopic adhesiolysis?

• Any operation may be associated with complications.
  The primary complications of any operation are bleeding and infection, which are uncommon with laparoscopic adhesiolysis.

• There is a small risk of injury to the intestines which may be stuck to the scar of previous surgery.
  In the hands of surgeons experienced in laparoscopic surgery, however, this risk is negligible.
  In cases when this happens, the surgeon may take a decision to convert the operation to an open one.

Can adhesions regrow?
It is impossible to predict whether a person will have recurrent problems with adhesions after an operation.
If he / she has had adhesions after previous surgery it is likely that they may occur again.
In fact, adhesions are also known to form after surgery undertaken to tackle existing adhesions.
It must be remembered that adhesions are far more likely to form after an open operation than after a laparoscopic one. It is for this reason that laparoscopic adhesiolysis is the best form of treatment for patients suspected of having adhesions.

What are the advantages of laparoscopic adhesiolysis?

1. Less pain from the incisions after surgery
2. Shorter hospital stay
3. Shorter recovery time
4. Faster return to normal diet
5. Faster return to work or normal activity
6. Better cosmetic healing
7. Lower chance of re-formation of the adhesions

Specialty: Adhesions/Adhesiolysis. INDEX
Center for Special Minimally Invasive & Robotic Surgery
Camran Nezhat, M.D., FACOG, FACS.
PH: (650) 327- 8778 --- EM: DrNezhat@gmail.com

An adhesion is a band of scar tissue that initially develops as part of the body's natural repair mechanism in response to any tissue disturbance, such as from:

- surgery
- infections
- trauma
- radiation
- or pathologies like endometriosis.

Adhesiolysis is the term for the surgery that is performed to remove or divide adhesions so that normal anatomy and organ function can be restored and painful symptoms can be relieved.

In some rare cases, adhesions form without visible or known tissue trauma.
While some adhesion formation is part of the normal healing process, in some cases excessive scar tissue can develop, disproportionate to the original injury. ... adhesions can bind your organs or tissue together in a way that begins to cause pain, organ dysfunction, or other symptoms. In some rare cases, adhesions can even cause life-threatening injuries, such as bowel obstruction.

Adhesions may appear as thin, avascular sheets of tissue similar to plastic wrap or as thick, vascular fibrous bands of adhesions, which are considered the more severe and more difficult to remove.

Abdominal adhesions may involve any organ within the abdomen, such as the uterus (including inside of the uterus, as occurs in Asherman's Syndrome), ovaries, fallopian tubes, bowel, bladder, appendix, ureters, liver, kidneys, and spleen.

Although one of the leading causes of adhesions is surgery, infections can also cause them to develop.
For example, pelvic inflammatory disease (PID) results from an infection that frequently leads to adhesions within the Fallopian tubes. A woman's eggs pass through her fallopian tubes into her uterus for reproduction. Therefore, fallopian tube adhesions can lead to infertility and increased incidence of ectopic pregnancy in which a fetus develops outside the uterus.

Abdominal adhesions are a common complication of major open surgery, occurring in up to 93% of people who undergo traditional open abdominal surgery. However, surgeries performed in a minimally invasive way have been shown to significantly reduce the number of adhesions, particularly the severe form. For example, in one study, almost all of the patients who had open abdominal surgery later developed a dense network of thick, vascular adhesions, which, again, are the more serious type. In contrast, only 48% of patients in the minimally invasive group developed adhesions. And in those cases, they were the thin, avascular form, considered less severe because they cause fewer symptoms.

Abdominal adhesions also occur in 10.4% of people who have never had surgery.
Depending on the severity of the adhesion and the location, the indication of pain can differ.
However, adhesions cause 60%-70% of small bowel obstructions in adults and are believed to contribute to the development of chronic pelvic pain.

Adhesions typically begin to form within the first few days after surgery, but they may not produce symptoms for months or even years. As scar tissue begins to restrict motion of the small intestines, passing food through the digestive system becomes progressively more difficult; the bowel may become blocked. In extreme cases, adhesions may form fibrous bands around a segment of an intestine. This constricts blood flow and leads to tissue death (necrosis).

Symptoms:
Typically, patients with adhesions actually experience few or no symptoms at all.
However, in more severe cases, adhesions can cause pain by pulling nerves, either within an organ tied down by an adhesion or within the adhesion itself. Other signs and symptoms include:

- Adhesions above the liver may cause pain with deep breathing
- Intestinal adhesions may cause pain due to obstruction during exercise or when stretching
- Adhesions involving the vagina or uterus may cause pain during intercourse
- General pelvic pain
- Partial or complete loss of organ function or tissue death in more severe cases
- Ovulatory disruptions when the ovaries are involved
- Diminished fertility
- bowel obstruction

Diagnosis:
Depending on the clinical symptoms, x-rays may reveal the small obstructions caused by adhesions.
If pain is the only symptom and there is no evidence of obstruction, many other tests may be done to confirm the diagnosis. For example, visually examining inside of the body with various scopes (endoscope, colonoscope, hysteroscope, sigmoidoscope, proctoscope) can identify strictures which may have formed as a result of adhesions. MRI evaluation may be useful in some cases. In cases in which the diagnosis is questionable, videolaparoscopic surgical exploration and visualization may be the best option for determining a definitive diagnosis.

Treatment:
Adhesions within the abdomen can be effectively treated videolaparoscopically.
Lysis of adhesions (adhesiolysis or enterolysis if it's inside or near to the intestines (aka, bowel, rectum, colon, etc) can be performed as a part of other procedures (such as removal of ovarian cysts or fibroids), or as a procedure by itself. A common misconception is that adhesions are a contraindication to performing videolaparoscopy. However, this is definitely not true. In fact, videolaparoscopy offers several advantages over laparotomy in the treatment of adhesions.

The laparoscope allows excellent visualization and magnification of the adhesions and the affected abdominal/pelvic organs. In addition, the CO2 gas which is used to inflate the abdomen provides a natural separation of the abdominal structures, allowing the adhesions to be clearly defined and effectively treated. The microsurgical principles which are employed with a laparoscopic approach are also much more effective in preventing the development of adhesions from the surgery itself.

Recovery from adhesiolysis is fast, with patients usually discharged from the hospital within 24 hours.
A return to normal activities can be expected within 1-2 weeks.

Procedure: The lysis of adhesions procedure. INDEX
http://www.newyorksurgicalpartners.com/services/gastrointestinal-surgical-center/
gastrointestinal-procedures/lysis-of-adhesions-removal-of-scar-tissue-from-intestines/
http://www.newyorksurgicalpartners.com/contact
NYSP -- New York Surgical Partners
2200 Northern Blvd, Roslyn, New York 11576
Tel: (516) 627-5262

An adhesion is scar tissue that has developed within the body, most commonly in the area of the abdomen or pelvis. Lysis is the process of cutting away the adhesion. When there is an adhesion, two organs may form an abnormal attachment which can affect the functioning of one or both organs involved and may also cause pain. Surgery to repair adhesions was rarely done but with the development of minimally invasive laparoscopic techniques, the lysis of adhesions has become more common.

Causes of Adhesions
Adhesions may develop for a variety of reasons.
Most frequently, they are the result of surgery or inflammation. Specific causes may include the following:

    Endometriosis
    Diverticulitis
    Appendicitis
    Radiation treatment for cancer
    Gynecological infections

Symptoms of Adhesions
The most common symptom of adhesions is chronic pain at the site.
Symptoms may vary depending on the location of the adhesion, for example, vaginal adhesions may cause pain during sexual intercourse and pericardial adhesions may result in chest pain. Intestinal adhesions may cause one or more of the following symptoms:

Bloating
    Constipation
    Severe abdominal pain
    Loud bowel sounds
    Inability to pass gas
    Vomiting

Diagnosis of Adhesions
Most adhesions are discovered during exploratory surgery since diagnostic imaging tests, such as X-rays or ultrasound, are unable to detect them. If, however, an adhesion has resulted in an intestinal blockage, the blockage may be visualized in abdominal X-rays, lower GI studies, also called barium contrast studies, and computerized tomography.

Procedure
The lysis of adhesions procedure involves separating the connected organs.
This surgery is done laparoscopically through small incisions, using small instruments.
This minimally invasive procedure is performed to reduce the patient's symptoms and to free the involved organs so that they can return to their normal function. Any further surgery increases the chance of an adhesion recurring. Depending on the location in the body where the lysis procedure is taking place, it may be possible for the surgeon to place a barrier at the site to reduce the chance of recurrence.

Complications
While complications from this procedure are rare, there are always risks involved with any surgical procedure. As noted, the primary risk of surgery is the recurrence of an adhesion. Risks of any surgical procedure may include:

    Excessive bleeding
    Blood clots
    Adverse reactions to anesthesia or medications
    Post-surgical infection
    Damage to adjacent organs
    Breathing problems
    Hernia at the incision site

Recovery
Recovery from the lysis of adhesions is usually uneventful, particularly if the procedure has been done laparoscopically. The laparoscopic surgery is generally performed as an outpatient procedure and the patient should be mostly recovered after a few days. Pain medicine will be prescribed by the physician in the immediate aftermath of the surgery, and the incision should be kept clean and dry. Patients are usually advised to refrain from drinking carbonated beverages for a few days and to avoid heavy lifting for several weeks.

Technique: Adhesion Removal Surgery - Drs. Miklos & Moore. INDEX
http://www.miklosandmoore.com/adhesiolysis/
http://www.miklosandmoore.com/practice-info/our-sites.php
3400 Old Milton Pkwy, Building C, Suite 330 Alpharetta, GA 30005
9201 W Sunset Blvd Suite 406 Los Angeles, CA 90069
Atlanta: 770-475-4499 --- Beverly Hills: 310-776-7588

Adhesion Treatment - The medical term for adhesion removal surgery is adhesiolysis.
Laparoscopic surgery for abdominal adhesions is the most successful and least invasive approach to scar adhesion treatment. Drs. Miklos & Moore are experts in adhesion removal surgery and perform only laparoscopic surgery for abdominal adhesions. Several studies have proven that cutting adhesions (lysis or adhesiolysis) often provides pain relief.

Dr Miklos & Moore always attempt to minimize trauma and bleeding to the patient at the time adhesion removal by doing the following:

1. Use laparoscopic surgery for abdominal adhesions and pelvic adhesions
   - many surgeons will still perform a large incision on the belly for adhesion removal.
   This is not the preferred approach as the larger the incision the greater chance of adhesion formation.
   Doctors Miklos & Moore have not used a large belly incision in more than 8 years to treat a patient for any of their procedures.

2. Minimize electric energy -
   many surgeons will burn every adhesion prior to cutting them.
   The reason for burning the adhesion prior to cutting the adhesion is to prevent bleeding.
   The problem with burning adhesions is the heat creates thermal damage and the tissue begins to slough off over the next few days. This creates sticky tissue which creates even more adhesions. Drs. Miklos & Moore use electric energy ie cautery only when it is needed. So they actually cut the adhesions first and only if the bleeding persists will they use energy to cauterize or stop the bleeding. Drs. Miklos & Moore estimate they use electrocautery on less than 5% of their adhesions.

3. Gentle tissue handling
   - minimizing trauma to the area by handling tissue with the utmost care is crucial to minimizing adhesion formation

4. Minimize blood loss
   - blood loss comes from traumatized tissue, if one minimizes trauma to the tissue then there will be less blood loss. Less blood loss means less adhesion formation.

5. No Powdered gloves -
   some surgical gloves actually have a talc type powder on them.
   Dr Miklos & Moore make sure their gloves are foreign body free. Foreign bodies mean more adhesions.

6. Anti adhesive agents -- though no agent has ever been proven to definitively work against preventing adhesions, Dr Miklos & Moore are not against using products such as: Interceed, Spray Gel, Adept etc. Dr Miklos & Moore allow the patient to make the decision as to whether an anti adhesive agent should be used.

Drs. Miklos and Moore perform laparoscopic adhesiolysis using scissors with minimal electric energy.
Minimizing energy, utilizing precise surgical technique with minimal bleeding during the adhesiolysis will prevent further damage and potentially the reformation of more adhesions.

Photo NOTES:
Abdominal Fascia -- the abdomen fascia is grasped with two clamps and incised.
The fascia is the tissue which holds the abdominal wall together and along with the abdomen muscles gives the abdomen strength

Suture Tags of Fascia - sutures are placed on the edges of the fascia so the surgeon can better identify the fascia at the end of the case. Meticulous closure of the fascia helps to prevent hernia formation.

Hasson trocar placement -- this trocar is utilized for placement of the laparoscope ie. Camera scope.

Accessory port placement -- 2-3 other trocars are placed to complete the adhesion treatment surgery.

Epidemiology: Intestinal Obstruction and Ileus. , 6 pg PDF -- INDEX
http://www.patient.co.uk/doctor/intestinal-obstruction-and-ileus
Original Author: Dr Laurence Knott --- This Version: Dr Colin Tidy
E M I S is a trading name of Egton Medical Information Systems Limited.

The term ileus is now most often used to imply non-mechanical intestinal obstruction.
The term paralytic ileus is sometimes used when the problem is inactivity of the bowel.

NB: obstruction to free passage of contents can occur at any level of the gut but only obstruction beyond the duodenum will be considered here. For conditions causing obstruction at a higher level, see the separate articles on Oesophageal Strictures, Webs and Rings, Oesophageal Carcinoma, Gastric Carcinoma and Hypertrophic Pyloric Stenosis.

Epidemiology
Of all patients admitted to hospital with intestinal obstruction, most have small intestinal obstruction. Significant numbers of colorectal malignancies present with obstruction.

Volvulus, impaction of the intestine, constipation and megacolon are all more common in patients with presenile dementia and Alzheimer's disease, Parkinson's disease, multiple sclerosis and quadriplegia. Schizophrenia has an increased risk for megacolon and constipation whilst major depression is associated only with constipation but with none of the other colonic diseases.

Risk factors

Small intestinal obstruction:
May be due to adhesions, strangulated hernia, malignancy or volvulus.
The majority (75%) of small bowel obstructions are attributed to intra-abdominal adhesions from prior operations. Malignancy usually means a tumour of the caecum, as small bowel malignancies are very rare.

Large intestinal obstruction:
Is most often the result of colorectal malignancies. Patients are often aged over 70.
The risk of obstruction increases the further down the bowel the lesion is sited, as the contents become more solid. Tumours are often advanced and there may be distant metastases. Perforation can occur at the site of the tumour or in a dilated caecum.

Sigmoid and caecal volvulus:
Describes rotation of the gut on its mesenteric axis.
The sigmoid colon is the most common site of volvulus and accounts for 5% of large bowel obstruction.
It is usually seen in the elderly or those with psychiatric illness.
It is the most common cause of intestinal obstruction in Africa and Asia, where the incidence is 10 times higher than in Europe or North America.

Paralytic ileus describes the condition in which the bowel ceases to function and there is no peristalsis.
Intestinal pseudo-obstruction is also called Ogilvie's syndrome. It results from massive dilatation of the colon but possibly small intestine too. It may occur in association with a number of medical conditions including:

Chest infection
Acute myocardial infarction
Stroke
Acute kidney injury
Puerperium
Trauma
Severe hypothyroidism
Electrolyte disturbance
Diabetic ketoacidosis

Postoperative ileus is a significant problem. Reduced handling of the bowel at operation is recommended.

Congenital gastrointestinal malformations can cause neonatal intestinal obstruction.
Another cause of meconium ileus is cystic fibrosis. Volvulus and midgut malrotations affect children and are uncommon.

Hirschsprung's disease can cause blockage of the bowel.
It may present early or late in childhood.
Intussusception in children blocks the bowel.
Intussusception in adults is much less common and does not tend to obstruct.

Miscellaneous causes in adults include gallstone ileus (which occurs when a large gallstone is passed into the gut and blocks it), severe constipation causing faecal impaction and Crohn's disease. Malignancy may cause obstruction from outside the gut - eg, gynaecological tumours.

Bezoars - eg, medication bezoars (tablets or semi-liquid masses of medications, most often formed following overdose of sustained-release medications) and trichobezoars (a bezoar formed from hair).

Body packers can develop intestinal obstruction when packets of illicit drugs packed in condoms are swallowed and trapped in the bowel. The packages may be visible on X-ray. If they leak, intoxication will occur.

Presentation
The typical clinical symptoms associated with obstruction include nausea, vomiting, dysphagia, abdominal pain and failure to pass bowel movements. Clinical signs include abdominal distention, tympany due to an air-filled stomach and high-pitched bowel sounds.

History
There is considerable overlap with the presentation of the various conditions although some features may be more prominent or occur earlier in one cause than another. Differentiation on clinical grounds alone is often not possible.

• Diffuse, central abdominal pain of a colicky nature.
  Pain is less or absent in paralytic ileus but there may be a history to suggest causes.

• Vomiting tends to be early in high-level obstruction. Faeculent vomiting is extremely unpleasant and is limited to low obstruction. Retrograde peristalsis results in faecal material being brought back. The progress of the condition tends to be faster in small bowel obstruction and slower with lower levels of lesions.

• Abdominal distension: the lower the level of obstruction, the more marked this will be.

• Absolute constipation is early in low obstruction and late in high-level obstruction.
  In low-level obstruction there may be a history of progressive constipation or change in bowel habit.
  In paralytic ileus there is no bowel movement and no flatus.

• In sigmoid volvulus the picture is rather like large bowel obstruction with pain, constipation, late vomiting and a very marked degree of abdominal distension. Half of such patients will have had a previous episode.

• Colonic pseudo-obstruction:

  Occurs when there is an autonomic imbalance resulting in sympathetic over-activity affecting some part of the colon. The patient is often elderly with numerous comorbidities.

  Pseudo-obstruction presents like a large bowel obstruction but the other medical history may indicate the true nature.

• Severe pain and tenderness suggest ischaemia or perforation.

Examination

• Look for signs of dehydration such as poor peripheral perfusion, tachycardia and hypotension.
  Dehydration is caused by water remaining unabsorbed in the bowel and losses from vomiting without the ability to replace orally. Pyrexia may suggest perforation or infarction of the bowel.

• Examination of the abdomen starts with observation. Abdominal distension will be apparent.
  It may be worth measuring abdominal girth to monitor progress. Massive peristalsis may even by visible.

• Distended bowel is very resonant on percussion.
  Abdominal masses may possibly be felt but even a large mass may be missed in a grossly distended abdomen.

• If strangulation or perforation occurs there will be features of an acute abdomen with peritonism.

• Check hernial orifices. Femoral hernia is at high risk of obstruction.
  Inguinal hernia is a lower risk factor but it is much more common.

• Place a stethoscope on the abdomen to listen for bowel sounds.
  In obstruction they are very active and tinkling bowel sounds are characteristic.
  In ileus the bowel is silent or nearly so. Bowel sounds are very irregular and so auscultation must not be rushed if a true picture is to be achieved.

• The patient may be generally toxic and unwell because ischaemia of the bowel allows bacteria and toxins to enter the circulation.

Investigations

• Fluid charts are required to monitor intake and output, especially as an intravenous infusion is almost certainly required, a nasogastric tube may be passed and oliguria is an important sign of early dehydration.

• Plain abdominal X-ray is an important investigation although proximal small bowel obstruction may be overlooked if there is no gas in the small bowel:
  
  • Sensitivity is 50-66%. Films are taken supine and erect. A systematic approach is required.
  • Obstruction of the small bowel shows ladder-like series of small bowel loops but this also occurs with an obstruction of the proximal colon. Fluid levels in the bowel can be seen in upright views.
  • Distended loops may be absent if obstruction is at the upper jejunum.
  • The colon is in the more peripheral part of the film and distension may be very marked.
  • Fluid levels will also be seen in paralytic ileus and the small bowel is distended throughout its length. In an erect film a fluid level in the stomach is normal as may be a level in the caecum.
  • Multiple fluid levels and distension of the bowel are abnormal.
    Gas under the diaphragm suggests perforation.

• Blood should be taken for FBC, U&Es and creatinine and group and cross-match, as major surgery may be required. Glucose may be slightly elevated by stress but very high levels are a cause for concern.

• If there is doubt about a low-level obstruction, a water-soluble contrast enema X-ray may be helpful.
  Water-soluble contrast may also be helpful in small bowel obstruction due to adhesions.

• CT scanning:
  • Has been used to good effect to predict the need for surgery in small bowel obstruction.
  • Non-contrast CT is recommended if the index of suspicion is high or if suspicion persists despite normal X-rays.
  • Patients with peritoneal fluid evident on CT scan are three times more likely to require surgical intervention than those who do not have this sign.
  • Partial obstruction may not be detected on CT and suspicion should remain high if the clinical picture suggests obstruction despite a normal scan.
  
  

• Both MRI and ultrasound have been found useful in the diagnosis of small bowel obstruction.
  MRI is more expensive and less available but ultrasound can reliably exclude the condition in 89% of patients.

Differential diagnosis

• Abdominal pain and vomiting can occur with gastroenteritis but, if the abdomen is bloated and there is little or no bowel movement, obstruction must be considered. Diarrhoea and vomiting will also cause very active bowel sounds that may be confused with the tinkling of obstruction

• Ischaemia of the gut can cause pain and distension but there is usually bloody diarrhoea.

• The pain of acute pancreatitis tends to radiate to the back.
  There may be an associated paralytic ileus.
  Amylase is often raised in obstruction but levels are very high in pancreatitis.

• Perforation of the gut can produce an acute abdomen with pyrexia and vomiting.
  Peptic ulcer disease, perforated diverticular disease and a perforated carcinoma are all possible causes.

• Intussusception should be considered in children.

• Tuberculosis can present as gastrointestinal disease.

• Non-gastrointestinal conditions to bear in mind include myocardial infarction (small bowel) and ovarian cancer (large bowel).

Prognosis

• In patients with small bowel obstruction, the mortality is 25% if surgery is delayed beyond 36 hours; under 36 hours this drops to 8%.

• The prognosis of advanced carcinoma of the colon remains poor. A high proportion of patients who present with obstruction have distant metastases.

• 50% of sigmoid volvulus will recur in the following two years.

• Older patients, patients with hypoalbuminaemia and those in whom the primary tumour is not gastrointestinal in origin are less able to withstand the rigours of major surgery.

Surgery: Intestinal Obstruction Repair. INDEX
http://www.surgeryencyclopedia.com/Fi-La/Intestinal-Obstruction-Repair.html
(There are many unanswered Comments/Requests on the page from 2006 to 2014)
Stephanie Dionne Sherk

The small intestine is composed of three major sections: the duodenum just below the stomach; the jejunum, or middle portion; and the ileum, which empties into the large intestine. The large intestine is composed of the colon, where stool is formed; and the rectum, which empties to the outside of the body through the anal canal. A blockage that occurs in the small intestine is called a small bowel obstruction, and one that occurs in the colon is a colonic obstruction.

There are numerous conditions that may lead to an intestinal obstruction.
The three most common causes of small bowel obstruction are adhesions, which are bands of scar tissue that form in the abdomen following injury or surgery; hernias, which develop when a portion of the intestine protrudes through a weak spot in the abdominal wall; and cancerous tumors. Adhesions account for approximately 50% of all small bowel obstructions, hernias for 15%, and tumors for 15%.

Other causes include volvulus, or formation of kinks or knots in the bowel; the presence of foreign bodies in the digestive tract; intussusception, which occurs when a portion of the intestine telescopes or pulls over another portion; infection; and congenital defects. While most small bowel blockages can be treated with the administration of intravenous (IV) fluids and decompression of the bowel by the insertion of a nasogastric (NG) tube, surgical intervention is necessary in approximately 25% of patients with a partial obstruction, and 50%-65% of patients with a complete obstruction.

An obstruction of the large intestine is less common than blockages of the small intestine.
Blockages of the large bowel are usually caused by colon cancer; volvulus; diverticulitis (inflammation of sac-like structures called diverticula that form in the intestines); ischemic colitis (inflammation of the colon resulting from insufficient blood flow); Crohn's disease (a disease that causes chronic inflammation of the intestines); inflammation due to radiation therapy; and the presence of foreign bodies. As in the case of small bowel obstruction, most patients with a blockage of the large intestine can be treated with IV fluids and bowel decompression.

Description of Surgery.

After the patient has been prepared for surgery and given general anesthesia, the surgeon usually enters the abdominal cavity by way of a laparotomy, which is a large incision made through the patient's abdominal wall. This type of surgery is sometimes referred to as open surgery. An alternative to laparotomy is laparoscopy, a surgical procedure in which a laparoscope (a thin tube with a built-in light source) and other instruments are inserted into the abdomen through small incisions. The internal operating field is then visualized on a video monitor that is connected to the scope. In some patients, the technique may be used for abdominal exploration in place of a laparotomy. Laparoscopy is associated with faster recovery times, shorter hospital stays, and smaller surgical scars, but requires advanced training on the part of the surgeon as well as costly equipment. Moreover, it offers a more limited view of the operating field.

Treating an intestinal obstruction depends on the condition causing the blockage.
Some of the more common surgical procedures used to treat bowel obstructions include:

Lysis of adhesions.
The process of removing these bands of scar tissue is called lysis.
After the abdominal cavity has been opened, the surgeon locates the obstructed area and delicately dissects the adhesions from the intestine using surgical scissors and forceps.

Hernia repair.
This procedure involves an incision placed near the location of the hernia through which the hernia sac is opened. The herniated intestine is placed back in the abdominal cavity and the muscle wall is repaired.

Resection with end-to-end anastomosis.
"Resection" means to remove part or all of a tissue or structure.
Resection of the small or large intestine, therefore, involves the removal of the obstructed or diseased section.
Anastomosis is the connection of two cut ends of a tubular structure to form a continuous channel; the anastomosis of the intestine is most often accomplished with sutures or surgical staples.

Resection with ileostomy or colostomy.
In some patients, an anastomosis is not possible because of the extent of the diseased tissue. After the obstruction and diseased tissue is removed, an ileostomy or colostomy is created. Ileostomy is a surgical procedure in which the small intestine is attached to the abdominal wall; waste then exits the body through an artificial opening called a stoma and collects in a bag attached to the skin with adhesive. Colostomy is a similar procedure with the exception that the colon is the part of the digestive tract that is attached to the abdominal wall.

Diagnosis/Preparation

To diagnose an intestinal obstruction, the physician first gives a physical examination to determine the severity of the patient's condition. The abdomen is examined for evidence of scars, hernias, distension, or pain. The patient's medical history is also taken, as certain factors increase a person's risk of developing a bowel obstruction (including previous surgery, older age, and a history of constipation). A series of x rays may be taken of the abdomen, as a definitive diagnosis of obstruction can be made by x ray in 50-60% of patients. Computed tomography (CT; an imaging technique that uses x rays to produce two-dimensional cross-sections on a viewing screen) or ultrasonography (an imaging technique that uses high-frequency sounds waves to visualize structures inside the body) may also be used to diagnosis intestinal obstruction.

Unless a patient presents with symptoms that indicate immediate surgery may be necessary (high fever, severe pain, a rapid heart beat, etc.), a course of IV fluids, NG decompression, and antibiotic therapy is usually prescribed in an effort to avoid surgery.

Risks
Complications associated with intestinal obstruction repair include excessive bleeding; infection; formation of abscesses (pockets of pus); leakage of stool from an anastomosis; adhesion formation; paralytic ileus (temporary paralysis of the intestines); and reoccurrence of the obstruction.

Medical videos: Removing abdominal adhesions. INDEX
http://www.medicalvideos.org/

• LINK:
  https://www.youtube.com/watch?v=IDRres-QvgI

• LINK: 7 minutes
  https://www.youtube.com/watch?v=iNcuJKgZkDU

• LINK: Miklos and Moore, Surgical Removal of Adhesions.
  http://www.miklosandmoore.com/adhesiolysis/

• LINK: Laparoscopy adhesion surgery in India
  http://www.laparoscopyindia.com/adhesions/

• LINK: Nezhat, Adhesions Overview.
  http://www.nezhat.org/specialties/adhesions.php

• LINK: New York Surgical Partners, Removal of Intestinal Adhesions.
  http://www.newyorksurgicalpartners.com/services/gastrointestinal-surgical-center/gastrointestinal-procedures/lysis-of-adhesions-removal-of-scar-tissue-from-intestines/

• LINK: Dissection of Abdominal Pelvic Adhesions.
  http://www.layyous.com/en/laparoscopy-&-hysteroscopy/laparoscopy-operations-videos/
  video-laparoscopic-adhesiolysis-where-abdominal-pelvic-adhesions-are-dissected-clip-no-7/3-5133

• LINK: Websurgery,
  http://award.websurg.com/votes/rank.php?doi=vd01enWSAW7570149

• LINK: Surgery Encyclopedia, Intestinal Obstruction Repair.
  http://www.surgeryencyclopedia.com/Fi-La/Intestinal-Obstruction-Repair.html

• LINK: Cleveland Clinic, Best Ways to Control.
  http://health.clevelandclinic.org/2014/12/4-best-ways-to-take-control-of-abdominal-adhesions/

-Media-: E-coli Fecal Impaction found by Medical Examiner, mp4, 7:47 min INDEX
Videos/E-coli Fecal Impaction.mp4 -- Discovery Health -- 30 megabytes
Chief Medical Examiner: Dr. Jan Garavaglia.
District 9, Orange County, Florida, USA
Victim: Donald (Trench),
See also: GMO health Considerations.

Autopsy: Internal Exam - Impacted Waste
http://www.youtube.com/watch?v=bj3d7p2Fu6M

This video covers the Medical Examiner's diagnostic investigation of the death of a 32-yr-old male.

When his abdomen is surgically opened, a STRONG pungent odor is detected.

No cancers, tunors, or twisting/kinking of the bowel is detected, although ...
a large section of the collon is enlarged to the size of a football ... resulting in the intestinal wall being stretched thin.

Blood tests are run to determine if HIV or some other form of infection is a factor. (1 week results)

A MAJOR incision to open the complete abdomen reveals the huge bulge in the intestine.

On opening the intestine, it is found to have been impacted with a huge amount of fecal matter, divided into one ball, the size of a football, and, 16 to 19 smaller ones, some as large as a baseball.

Fecal impactions are usually only found in elderly or chronically ill persons who have been bedridden.

No obvious reason for the impaction is found by observation.

The results of the blood tests reveals a high presence of E-coli in the blood.

E-Coli is a normal intestinal bacteria.
An increase in fecal matter in the intestines will stretch the walls and can result in some e-coli passing through the wall into the bloodstream. If the e-coli pass through the intestinal wall and into the blood, it will result in an intensifying infection. This can lead to physical weakness and stupor, lethargy, sedentariness, and bedridden state resulting in bed sores.

This dynamic can lead to stool "drying out" in the bowel, hardening, and blocking the passage of other stool, excepting a small amount of liquid which may be passed as rectal incontinence. As the stool accumulates in the bowel, the walls will be stretched, nutritional benefit will wane, weakness will increase, and infection will intensify.

Eventually, the person will die.
The Medical Examiner was confused by the apparent lack of pain felt by the victim, and/or, his not reporting this, or, the lack of his doctor or the health care system to have responded to such complaints. No reason can be found for the original impaction.

AFTERWORD: INDEX
Appearances, Beliefs, and, Expectations can be deceiving. NONE of these prepare us for mutations, novelties.
Education, training, imprinting, authority, and, sanction can convert the professional into a technician.

The influence of eating GMO Foods may also be a significant, or contributing factor in autotoxicity deaths.
Some GMO foods are capable of changing the lifeform of stomach and intestinal cells and tissues and has led to deaths in cattle which occurred in as little as 24 hours after being introduced to the products. One or more of the following indicators and changes are common to this form of mutation.

• Unsatisfied eating leading to excessive intake.
• Anaesthetization
  --- The warning symptoms of headache, and, local, referred, and joint and muscle pain and discomfort often attending abdomenal distention, constipation, stool toxification of the blood ... are ABSENT.

• Abdomenal distention
  --- NOT to be confused with bloating as this usually does NOT involve gas buildup.

• Peristaltic paralysis
  --- An absence of any urge to defecate and no feeling of over-fullness.

• Laziness
  -- With the buildup of stagnant stool, toxins will eventually enter the blood stream and bring physical weakness.
  This is a form of PHYSICAL Depression in which the organ functions, including the brain, gradually reduce in activity, as if you were gradually and subtly falling asleep. Consciousness becomes less and less clear leading to constantly reducing awareness, motivation to resolve inabilities to concentrate-think-move.

• Intestinal blockages
  --- This is found in the later stages, IF, the person is performing daily colonics.
  --- These often consist of obvious fungal plugs consistently building at specific locations in the intestines.
  --- With the lack of motility of the feces and a portion of the intestines remaining empty, this is normal.

• Probiotics, enzymes, and other digestive aids will often result in the production of stomach and intestinal gas ... rather than the opposite. They are leading to food over-digestion rather than assisting under-digestion.

• Excrement stench
  --- A STRONG pungent bile-like odor accompanies the stool, usually found in autopsy, and, may be attributed to the activity of the GMO bacteria organism.

• GMO's are Human Engineered Genetically Mutated Combination Incomplete Lifeforms.
  Their health impact on humans will continue to be misunderstood, denied, excused, rationalized, misinterpreted, and generally allowed to build into a killing epidemic due to the following:
  1. Bureaucracies have forced professionals to become technicians.
  2. GMOs are LIFEFORMS .. not toxins, parasites, nor infections.
  3. Their influence is NOT dramatic. Subtle and quiet receive no notice.
  4. The deaths resulting will often continue to be "undefined" as "unremarkable."

Intestinal WORM parasites can be a further source of the symptoms may be that of creating a blocking bolus (mass or ball of parasites). This may be a more often occurrence with persons who have a diet high in poorly cooked, raw, or contaminated meats or fish (especially sushi), and/or, have close and frequent contact with animals (pets or cattle) who are so encumbered.