CURRENT CONCEPTS IN COLONIC DISORDERS Edited by Godfrey Lule Current Concepts in Colonic Disorders Edited by Godfrey Lule Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2011 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. 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DepositPhotos First published December, 2011 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Current Concepts in Colonic Disorders, Edited by Godfrey Lule p. cm. ISBN 978-953-307-957-8 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface IX Part 1 Intussusception 1 Chapter 1 Adult Intussusception 3 Saulius Paskauskas and Dainius Pavalkis Chapter 2 Predictors and Ultrasonographic Diagnosis of Intussusception in Children 23 Luca Lideo and Milan Roberto Chapter 3 Appendiceal Intussusception 47 Nikolaos Varsamis, Konstantinos Pouggouras, Nikolaos Salveridis, Aekaterini Theodosiou, Eftychios Lostoridis, Georgios Karageorgiou, Athanasios Mekakas and Konstantinos Christodoulidis Part 2 Diarrhoea 65 Chapter 4 Management of Secretory Diarrhea 67 Claudia Velázquez, Fernando Calzada, Mirandeli Bautista and Juan A. Gayosso Chapter 5 Clostridia Difficile Diarrhea 85 Enoch Lule Chapter 6 Introduction and Classification of Childhood Diarrhoea 91 Angela Ine Frank-Briggs Chapter 7 Traveller’s Diarrhoea and Intestinal Protozoal Diarrhoeal Disease 105 Constantine M. Vassalos and Evdokia Vassalou VI Contents Part 3 Appendicitis 141 Chapter 8 Alvarado Score Between 4 and 6, the Place of the CT Scan 143 S. Loudjedi, M. Bensenane, N. Meziane, F. Ghirane and M. Kherbouche Chapter 9 Perforated Appendicitis 151 Ali Akbar Salari Part 4 The Colon Pathologies 167 Chapter 10 Colonic Pseudo-Obstruction 169 Abdulmalik Altaf and Nisar Haider Zaidi Chapter 11 Treatment of Colorectal Stricture After Circular Stapling Anastomoses 187 S. Shimada, M. Kuramoto, A. Matsuo, S. Ikeshima, H. Kuhara, K. Eto and H. Baba Chapter 12 Postoperative Ileus: Pathophysiology and Treatment 203 N.S. Tropskaya and T.S. Popova Part 5 Inflammatory Bowel Syndrome 221 Chapter 13 Prospective Uses of Genetically Engineered Lactic Acid Bacteria for the Prevention of Inflammatory Bowel Diseases 223 Jean Guy LeBlanc, Silvina del Carmen, Fernanda Alvarenga Lima, Meritxell Zurita Turk, Anderson Miyoshi, Vasco Azevedo and Alejandra de Moreno de LeBlanc Chapter 14 Prognostic Relevance of Subjective Theories of Illness on the Clinical and Psychological Parameters in Irritable Bowel Syndrome Patients – A Longitudinal Study 239 A. Riedl, J. Maass, A. Ahnis, A. Stengel, H. Mönnikes, B.F. Klapp and H. Fliege Chapter 15 Modulation of Visceral Pain by Stress: Implications in Irritable Bowel Syndrome 251 Agata Mulak, Muriel Larauche and Yvette Taché Chapter 16 Dysbiosis of the Intestinal Microbiota in IBS 261 Anna Lyra and Sampo Lahtinen Preface The primary objective of the first edition of this book of colonic disorders is to try to fill the gap in the fields of gastroenterology that have not been properly covered in the past. Gastrointestinal diseases are the leading causes of morbidity and mortality in clinical practice with diarrhea and abdominal pain accounting for over 50% of the symptoms that patients present to their doctors. It is therefore not surprising that many of the chapters in this book are on diarrhea and acute or chronic abdominal pain. The chapters have been written by world renown experts in their respective fields, all of which are related to gastroenterology. Dr. Saulius Paskauskas has covered the area of adult intussusceptions, Prof. Azevedo et al write about prospective uses of genetic engineering, while dysbiosis of intestinal microbiota in irritable bowel syndrome has been very well covered by Dr. Anna Lyra and Dr. Sampo Lahtinen. Other interesting titles like perforated appendicitis, travelers’ diarrhea and management of various gastrointestinal conditions are some of the topics presented in simple and accessible language with well labeled illustrations where appropriate. Advances in the pathophysiology and treatment of postoperative ileus has been covered by Dr. Tropskaya and Dr. Popova, with evidence based on experiments carried out in animal models, while Prof. Yvette Tache et al ably handle modulation of visceral pain by stress implication and modulation. The later is a must read for all professionals as it utilizes simple theories to explain some of the recurrent symptomatologies that patients present with. This book will form useful reading for the inquisitive undergraduate medical student who wants to read more about the pathophysiology of various gastrointestinal diseases such as intussusceptions but also offers detail to the specialists out to explain causes and management of various conditions such as acute and chronic diarrhea. Most of the chapters have an introduction and objective, epidemiology, clinical presentation and investigation sections, with outlines on management and X Preface conclusions at the end. They have been presented in this way to make them easy to understand and for quick reference by the reader while in the clinic or classroom in these days of pressure for answers and maximum time constraint. To the reader, we hope that this book will offer you the right knowledge that would favorably modify your approach to problems of the gastrointestinal tract in the future. Godfrey Lule FRCP (E) Consultant Physician & Gastroenterologist/ Infectious Disease Specialist Professor of Medicine, Department of Medicine, University of Nairobi, Kenya [...]... Introduction INTUSSUSCEPTION IS THE invagination of a portion of the intestine, called intussusceptum, into the lumen of an adjacent segment of intestine, called intussuscipiens, in the direction of the normal peristalsis or occasionally in a retrograde direction The intussusceptum is composed of an inner or entering wall and an outer or returning wall The first description of intussusception appears in 1793... These individuals will also frequently describe a sensation of obstruction and pressure toward the sacrum, which may increase with straining Fecal incontinence is also a common symptom associated with rectoanal intussusception (Weiss & McLemore, 2008) 5.1 Physical and laboratorial findings of intussusception Adult intussusception has no specific physical findings Common physical findings include abdominal... Part 1 Intussusception 1 Adult Intussusception Saulius Paskauskas and Dainius Pavalkis Lithuanian University of Health Sciences Kaunas Lithuania 1 Introduction Intussusception is defined as the invagination of one segment of the gastrointestinal tract and its mesentery (intussusceptum) into the lumen of an adjacent distal segment of the gastrointestinal tract (intussuscipiens) Sliding within the bowel... occurs more commonly in boys than girls After 2 years of age, the incidence of intussusception declines Only 30% of all cases of intussusception occur in children older than 2 years Formation of the intussusceptum occurs differently in the pediatric and adult population Factors involved in causation include anatomic features of the developing gastrointestinal tract and infectious in uences The presentation... such as in coeliac disease In these cases the loss of normal tone in the small bowel owing to the toxic effect of gluten causes flaccid, dilated bowel loops that are more prone to non obstructing intussusception 6 Current Concepts in Colonic Disorders Individuals with pelvic floor abnormalities such as nonrelaxing puborectalis and rectocele may develop rectoanal intussusception in the setting of chronic... patches, increased bowel motility during diarrhoea resulting in an intussusceptum (Cera, 2008) In children, intussusception is idiopathic in 90% of cases and results in the common scenario of ileocolic intussusception (Demirkan et al., 2009) In contrast to children, adult intussusception is a rare disorder and is usually not idiopathic In less than 10% of pediatric cases, a lead point or underlying cause... only in 10% of 8 Current Concepts in Colonic Disorders cases In adults, intussusception typically manifests as an acute or chronic obstruction and the presentation of adult intussusception is similar to that of small and large bowel obstruction Unlike intussusception in children, an acute abdomen is very occasionally present in adults The most common symptom in the acute presentation is abdominal pain... 24 Current Concepts in Colonic Disorders B-mode ultrasonography has been used successfully in the diagnosis of intestinal intussusception in children The most common sonographic pattern observed in transverse sections of the bowel is a target-like mass consisting of multiple hyperechoic and hypoechoic concentric rings around a hyperechoic center that represents the entrapped mesentery In longitudinal... accessibility and a static and initially only single-plane exploration, apart from involving a dose of radiation and generally requiring the administration of oral and intravenous contrast material, which delays the study and may entail adverse effects Adult Intussusception 13 Abdominal CT scanning is the preferred noninvasive radiologic modality for diagnosing intussusception from colonic lipomas (Taylor... gastrointestinal tract by a food bolus produces an area of constriction above the bolus and relaxation below Any intraluminal lesion in the gastrointestinal tract or irritant within the lumen, which alters the normal peristaltic pattern, is able to initiate intussusception The duodenum, stomach, and esophagus are rarely involved in intussusception because they are less redundant and less mobile within . CURRENT CONCEPTS IN COLONIC DISORDERS Edited by Godfrey Lule Current Concepts in Colonic Disorders Edited by Godfrey Lule Published by InTech Janeza Trdine. Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Current Concepts in Colonic Disorders, . is found in less than 1 in 1300 abdominal operations and 1 in 100 patients operated for intestinal obstruction. Intussusception in adults occurs less frequently in the colon than in the small