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Small-Intestinal Gallstone Ileus and Use of Barium Sulfate per Os in Its Diagnosis

Small-Intestinal Gallstone Ileus and Use of Barium Sulfate per Os in Its Diagnosis Abstract An unequivocal preoperative diagnosis of small-intestinal ileus is very often difficult to make, and a positive determination of the etiology of such obstruction is usually impossible. Once a fairly certain diagnosis has been established, it becomes extremely important to discover the source of the trouble without unnecessary delay, for the correct management of the condition may depend upon the identification of the causative agent. Certain mechanical small-bowel obstructions can be treated conservatively, deliberately, and nonsurgically, with complete symptomatic relief, by decompression suction therapy. In most cases of small-intestinal ileus, however, dilatory procedures are contraindicated and procrastination is hazardous. The delay is particularly dangerous when such ileus is caused by an impacted gallstone, for the mortality rate in cholelithic obstruction has been reported as varying from 30% to 70%, owing, in great part, to the tardiness in diagnosis and treatment.5 Since it is an accepted fact that radiologic examination of References 1. Renografin is a mixture of sodium and methylglucamine salts of diatrizoate. 2. Cantor, M. O.; McCollum, B. E., and Hodges, J.: Intestinal Intubation for Barium Produced Bowel Obstruction , Am. J. Digest. Dis. 19:148, 1952.Crossref 3. Case, J. T.: Umbrathor as a Substitute for Barium in the Roentgen Study of Acute Intestinal Obstruction , Am. J. Roentgenol. 58:422, 1947. 4. Davis, L. A.; Huang, K-C., and Pirkey, E. L.: Water-Soluble, Nonabsorbable Radiopaque Mediums in Gastrointestinal Examination , J. A.M.A. 160:373, 1956.Crossref 5. Davis, L. A.: Use of Soluble Non-Absorbable Opaque Media in the Examination of the Gastrointestinal Tract in Children , South. M. J. 49:1011, 1956.Crossref 6. Drucker, V., and McElwee, C. H.: Recurrent Cholelithic Intestinal Obstruction , Gastroenterology 32:927, 1957. 7. Epstein, B. S.: Nonabsorbable, Water-Soluble Contrast Mediums: Their Use in Diagnosis of Intestinal Obstruction , J. A. M. A. 165:44, 1957.Crossref 8. Epstein, B. S.: The Use of a Water Soluble Contrast Medium (Hypaque) for Gastrointestinal Roentgenography , Am. J. Roentgenol. 78:694, 1957. 9. Frimann-Dahl, J.: Administration of Barium Orally in Acute Obstruction: Advantages and Risks , Acta radiol. 42:285, 1954.Crossref 10. Fulton, H.: The Gastrointestinal Radiologist, Editorial , Am. J. Roentgenol. 77:745, 1957. 11. Gipson, E. N.: Preliminary Report on the Use of Oral Renografin (Gastrografin) in Gastrointestinal Studies, Monographs on Therapy , Squibb Institute for Medical Research, New Brunswick, N. J., 1957, p. 242. 12. Hayden, R. S.: Perforation of Duodenal Ulcer During Fluoroscopy , Radiology 57:214, 1951.Crossref 13. Huston, J., Jr.; Wallach, D. P., and Cunningham, G. J.: Pulmonary Reaction to Barium Sulfate in Rats , A. M. A. Arch. Path. 54:430, 1952. 14. Kay, S.: Tissue Reaction to Barium Sulfate Contrast Medium—Histopathologic Study , A. M. A. Arch. Path. 57:279, 1954. 15. Kleinsasser, L. J., and Warshaw, H.: Perforation of the Sigmoid Colon During Barium Enema , Ann. Surg. 135:560, 1952.Crossref 16. Love, L.: Oral Use of Renografin, Monographs on Therapy , Squibb Institute for Medical Research, New Brunswick, N. J., 1957, p. 260. 17. Martin, J. F., and Friedell, H. L.: Partial Obstruction of the Small Intestine , Radiology 59:49, 1952.Crossref 18. Osgood, E. C.: The Role of the Radiologist in the Management of Patients with Intestinal Obstruction, with Special Reference to the Use of the Miller-Abbott Tube , Radiology 49:529, 1947.Crossref 19. Rigler, L. G.; Borman, C. N., and Noble, J. F.: Gallstone Obstruction: Pathogenesis and Roentgen Manifestations , J. A. M. A. 117:1753, 1941.Crossref 20. Roberts, J. C., Jr., and Carlson, K. E.: Hepatic Duct Carcinoma 17 Years After Injection of Thorium Dioxide , A. M. A. Arch. Path. 62:1, 1956. 21. Shehadi, W. H.: Use of Oral Renografin (Gastrografin) in the Examination of the Gastrointestinal Tract, Monographs on Therapy , Squibb Institute for Medical Research, New Brunswick, N. J., 1957, p. 233. 22. Stalker, L. K.: Barium as a Factor in Intestinal Obstruction , Am. J. Surg. 72:756, 1946.Crossref 23. Vögtlin, J., and Minder, W.: Damage Due to Thorotrast After Bronchography, Retrograde Pyelography, Salpingography and Arteriography , Radiol. Clin., Basel , 21:96, 1952. 24. Weber, H. M., and Kirklin, B. R.: The Roentgenologic Investigation of the Small Intestine , M. Clin. North America 22:1059, 1938. 25. Zatzkin, H. R.; Tugendhaft, R. I., and Curran, H. P.: Roentgen Diagnosis of Spontaneous Internal Biliary Fistulas and Gallstone Ileus , Surg. Gynec. & Obst. 102:234, 1956. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png A.M.A. Archives Surgery American Medical Association

Small-Intestinal Gallstone Ileus and Use of Barium Sulfate per Os in Its Diagnosis

A.M.A. Archives Surgery , Volume 79 (1) – Jul 1, 1959

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Publisher
American Medical Association
Copyright
Copyright © 1959 American Medical Association. All Rights Reserved.
ISSN
0096-6908
DOI
10.1001/archsurg.1959.04320070026004
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Abstract

Abstract An unequivocal preoperative diagnosis of small-intestinal ileus is very often difficult to make, and a positive determination of the etiology of such obstruction is usually impossible. Once a fairly certain diagnosis has been established, it becomes extremely important to discover the source of the trouble without unnecessary delay, for the correct management of the condition may depend upon the identification of the causative agent. Certain mechanical small-bowel obstructions can be treated conservatively, deliberately, and nonsurgically, with complete symptomatic relief, by decompression suction therapy. In most cases of small-intestinal ileus, however, dilatory procedures are contraindicated and procrastination is hazardous. The delay is particularly dangerous when such ileus is caused by an impacted gallstone, for the mortality rate in cholelithic obstruction has been reported as varying from 30% to 70%, owing, in great part, to the tardiness in diagnosis and treatment.5 Since it is an accepted fact that radiologic examination of References 1. Renografin is a mixture of sodium and methylglucamine salts of diatrizoate. 2. Cantor, M. O.; McCollum, B. E., and Hodges, J.: Intestinal Intubation for Barium Produced Bowel Obstruction , Am. J. Digest. Dis. 19:148, 1952.Crossref 3. Case, J. T.: Umbrathor as a Substitute for Barium in the Roentgen Study of Acute Intestinal Obstruction , Am. J. Roentgenol. 58:422, 1947. 4. Davis, L. A.; Huang, K-C., and Pirkey, E. L.: Water-Soluble, Nonabsorbable Radiopaque Mediums in Gastrointestinal Examination , J. A.M.A. 160:373, 1956.Crossref 5. Davis, L. A.: Use of Soluble Non-Absorbable Opaque Media in the Examination of the Gastrointestinal Tract in Children , South. M. J. 49:1011, 1956.Crossref 6. Drucker, V., and McElwee, C. H.: Recurrent Cholelithic Intestinal Obstruction , Gastroenterology 32:927, 1957. 7. Epstein, B. S.: Nonabsorbable, Water-Soluble Contrast Mediums: Their Use in Diagnosis of Intestinal Obstruction , J. A. M. A. 165:44, 1957.Crossref 8. Epstein, B. S.: The Use of a Water Soluble Contrast Medium (Hypaque) for Gastrointestinal Roentgenography , Am. J. Roentgenol. 78:694, 1957. 9. Frimann-Dahl, J.: Administration of Barium Orally in Acute Obstruction: Advantages and Risks , Acta radiol. 42:285, 1954.Crossref 10. Fulton, H.: The Gastrointestinal Radiologist, Editorial , Am. J. Roentgenol. 77:745, 1957. 11. Gipson, E. N.: Preliminary Report on the Use of Oral Renografin (Gastrografin) in Gastrointestinal Studies, Monographs on Therapy , Squibb Institute for Medical Research, New Brunswick, N. J., 1957, p. 242. 12. Hayden, R. S.: Perforation of Duodenal Ulcer During Fluoroscopy , Radiology 57:214, 1951.Crossref 13. Huston, J., Jr.; Wallach, D. P., and Cunningham, G. J.: Pulmonary Reaction to Barium Sulfate in Rats , A. M. A. Arch. Path. 54:430, 1952. 14. Kay, S.: Tissue Reaction to Barium Sulfate Contrast Medium—Histopathologic Study , A. M. A. Arch. Path. 57:279, 1954. 15. Kleinsasser, L. J., and Warshaw, H.: Perforation of the Sigmoid Colon During Barium Enema , Ann. Surg. 135:560, 1952.Crossref 16. Love, L.: Oral Use of Renografin, Monographs on Therapy , Squibb Institute for Medical Research, New Brunswick, N. J., 1957, p. 260. 17. Martin, J. F., and Friedell, H. L.: Partial Obstruction of the Small Intestine , Radiology 59:49, 1952.Crossref 18. Osgood, E. C.: The Role of the Radiologist in the Management of Patients with Intestinal Obstruction, with Special Reference to the Use of the Miller-Abbott Tube , Radiology 49:529, 1947.Crossref 19. Rigler, L. G.; Borman, C. N., and Noble, J. F.: Gallstone Obstruction: Pathogenesis and Roentgen Manifestations , J. A. M. A. 117:1753, 1941.Crossref 20. Roberts, J. C., Jr., and Carlson, K. E.: Hepatic Duct Carcinoma 17 Years After Injection of Thorium Dioxide , A. M. A. Arch. Path. 62:1, 1956. 21. Shehadi, W. H.: Use of Oral Renografin (Gastrografin) in the Examination of the Gastrointestinal Tract, Monographs on Therapy , Squibb Institute for Medical Research, New Brunswick, N. J., 1957, p. 233. 22. Stalker, L. K.: Barium as a Factor in Intestinal Obstruction , Am. J. Surg. 72:756, 1946.Crossref 23. Vögtlin, J., and Minder, W.: Damage Due to Thorotrast After Bronchography, Retrograde Pyelography, Salpingography and Arteriography , Radiol. Clin., Basel , 21:96, 1952. 24. Weber, H. M., and Kirklin, B. R.: The Roentgenologic Investigation of the Small Intestine , M. Clin. North America 22:1059, 1938. 25. Zatzkin, H. R.; Tugendhaft, R. I., and Curran, H. P.: Roentgen Diagnosis of Spontaneous Internal Biliary Fistulas and Gallstone Ileus , Surg. Gynec. & Obst. 102:234, 1956.

Journal

A.M.A. Archives SurgeryAmerican Medical Association

Published: Jul 1, 1959

References