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"tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "54" "paginaFinal" => "55" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Treatment options of distal intestinal obstruction syndrome: And if the enemas fail?" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1030 "Ancho" => 975 "Tamanyo" => 76875 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Imagen de SOID incipiente, donde se objetiva imágenes de miga de pan en ciego, y fosa ilíaca derecha, así como rectosigma. 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"tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "54" "paginaFinal" => "55" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Fernández-Ibieta, L. Ayuso-González, M.S. Fernández-Córdoba, Y. Argumosa-Salazar, J. Gonzálvez-Piñera" "autores" => array:5 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Fernández-Ibieta" "email" => array:1 [ 0 => "mfndezibieta@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "L." "apellidos" => "Ayuso-González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "M.S." "apellidos" => "Fernández-Córdoba" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Y." "apellidos" => "Argumosa-Salazar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "J." "apellidos" => "Gonzálvez-Piñera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Cirugía Pediátrica, Hospital Virgen del Camino, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Cirugía Pediátrica, Hospital General Universitario de Albacete, Albacete, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Cirugía Pediátrica, Hospital General de Alicante, Alicante, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Opciones de tratamiento del síndrome de obstrucción intestinal distal: ¿y si los enemas fallan?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1030 "Ancho" => 975 "Tamanyo" => 76875 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Image of incipient DIOS, with a bubbly appearance of the caecum, right iliac fossa and sigmoid colon. Air-fluid level at the right iliac fossa and absence of distal gas.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Distal intestinal obstruction syndrome (DIOS) refers to a phenomenon of bowel obstruction in children with cystic fibrosis (CF) with manifestations that are very similar to those of meconium ileus in infants.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> It is characterised by an accumulation of viscid faecal material combined with thick mucosal secretions that adheres to the crypts of the terminal ileum and the caecum and is difficult to remove.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> It may develop in 8.3–16% of patients with CF, presenting as acute intestinal obstruction or subacutely (pseudo-obstructive episodes), and it recurs in 50–76% of cases.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1–3</span></a> The patient may present with a mass in the right iliac fossa (detection of faecal matter by radiography) along with obstruction of varying degrees (vomiting of bilious or faecal material, abdominal pain and distension). It is essential to differentiate DIOS from constipation, appendicitis, intussusception, adhesion-related disorders, Crohn's disease and fibrosing colonopathy.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1–4</span></a> The insufficient secretion of chloride and water, a slow intestinal transit, impaired ileal secretion and fat malabsorption are predisposing factors. There is no evidence of a link between DIOS and excessive pancreatic enzyme supplementation.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> Some of the risk factors for DIOS are: severe genotypes (DF508, W1282X), pancreatic insufficiency, dehydration, history of meconium ileus, lung transplant and a previous episode of DIOS.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1–3</span></a> The management of DIOS is usually conservative by means of antegrade or retrograde lavage with laxative or surfactant enemas (phosphate, N-acetylcysteine, polyethylene glycol [PEG], or meglumine diatrizoate [MD, Gastrografin<span class="elsevierStyleSup">®</span>, Schering, Berlin]).<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1–3</span></a> In this article, we present the cases of three patients with CF that suffered several episodes of DIOS.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case 1</span><p id="par0010" class="elsevierStylePara elsevierViewall">Male patient aged 11 years with CF DF508, afebrile, presenting with abdominal pain and distension, constipation and bilious vomiting of 48 hours’ duration. Abdominal radiography showed abundant faecal material in the right iliac fossa, while the ultrasound findings were normal. Treatment with N-acetylcysteine via enema was initiated due to suspected DIOS, leading to partial relief of symptoms and the production of a small volume of soft stools. At 24<span class="elsevierStyleHsp" style=""></span>h, a barium enema with Gastrografin<span class="elsevierStyleSup">®</span> was performed under radiographic control, and the episode resolved.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Case 2</span><p id="par0015" class="elsevierStylePara elsevierViewall">Female patient aged 6 years with CF DF508 presenting with constipation, bilious vomiting and abdominal pain of two days’ duration. Treatment with phosphate enemas was initiated for suspected DIOS, followed by an N-acetylcysteine enema that was repeated at 24<span class="elsevierStyleHsp" style=""></span>h, resulting in the production of soft stools and the resolution of symptoms.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Case 3</span><p id="par0020" class="elsevierStylePara elsevierViewall">Female patient aged 5 years with CF DF508, presenting with DIOS of 4 days’ duration with a sudden worsening of symptoms after conservative treatment. A laparotomy was performed, revealing plastic peritonitis and faecal impaction in the distal ileum and colon. Manual disimpaction was performed, followed by caecostomy (Chait procedure) with placement of a Kher tube used in subsequent days to start treatment with antegrade lavage with N-acetylcysteine and PEG. The Kher tube was replaced by a Chait trapdoor (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) for continued delivery of enemas, which was removed at seven months. In the four years that followed, the patient had two new episodes of DIOS (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) that were treated early with rectal Gastrografin<span class="elsevierStyleSup">®</span> gravity enemas (in the ward), with resolution of symptoms in both.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The conservative management of DIOS by means of laxatives or surfactants, administered either orally (in cases of low-grade obstruction) or via enema, is effective in 89–96% of cases,<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1–3</span></a> especially if it is initiated early. The administration of PEG at doses of 2<span class="elsevierStyleHsp" style=""></span>g/kg/day (or 20–40<span class="elsevierStyleHsp" style=""></span>mL/kg/h of solution, administered orally or with a nasogastric tube over 6–8<span class="elsevierStyleHsp" style=""></span>h) is recommended, or alternatively a solution of 50<span class="elsevierStyleHsp" style=""></span>mL of Gastrografin<span class="elsevierStyleSup">®</span> in 200<span class="elsevierStyleHsp" style=""></span>mL of water in children up to 6 years of age and of double this amount for older patients.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> The treatment can be repeated on subsequent days with the administration of half doses. The use of rectal lavage with water and/or Gastrografin<span class="elsevierStyleSup">®</span> delivered directly to the caecum by colonoscopy has also been reported.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">5,6</span></a> In case of treatment failure or poor response to treatment, the surgical approach should be based on disimpaction with washout of the ileocaecal area, and enterostomy or caecostomy are preferred over intestinal resection.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,5,6</span></a> We chose to perform a caecostomy with placement of a temporary button in our patient because a complete disimpaction was not possible and due to the presence of peritonitis. This option allowed the patient to continue undergoing antegrade lavage efficiently during the convalescence period. Another, more permanent alternative reported in adult CF patients with recurrent DIOS refractory to conservative treatment and with poor adherence to treatment (as a last step in management, after failed enemas and having decided against placement of a Chait caecostomy catheter), is the performance of an antegrade continence enema (ACE),<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> bringing the appendix out onto the abdominal wall to create a permanent stoma through which the bowel can be washed out periodically.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case 1" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Case 2" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Case 3" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Fernández-Ibieta M, Ayuso-González L, Fernández-Córdoba MS, Argumosa-Salazar Y, Gonzálvez-Piñera J. Opciones de tratamiento del síndrome de obstrucción intestinal distal: ¿y si los enemas fallan? An Pediatr (Barc). 2016;84:54–55.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1575 "Ancho" => 1502 "Tamanyo" => 102882 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Caecostomy with a Chait tube.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1030 "Ancho" => 975 "Tamanyo" => 76875 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Image of incipient DIOS, with a bubbly appearance of the caecum, right iliac fossa and sigmoid colon. Air-fluid level at the right iliac fossa and absence of distal gas.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidelines for the diagnosis and management of distal intestinal obstruction syndrome in cystic fibrosis patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Colombo" 1 => "H. Ellemunter" 2 => "R. Houwen" 3 => "A. Munck" 4 => "C. Taylor" 5 => "M. 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Year/Month | Html | Total | |
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2024 November | 10 | 11 | 21 |
2024 October | 73 | 47 | 120 |
2024 September | 120 | 48 | 168 |
2024 August | 134 | 61 | 195 |
2024 July | 144 | 51 | 195 |
2024 June | 113 | 34 | 147 |
2024 May | 116 | 45 | 161 |
2024 April | 136 | 28 | 164 |
2024 March | 111 | 36 | 147 |
2024 February | 126 | 34 | 160 |
2024 January | 134 | 27 | 161 |
2023 December | 161 | 18 | 179 |
2023 November | 161 | 25 | 186 |
2023 October | 180 | 34 | 214 |
2023 September | 182 | 25 | 207 |
2023 August | 137 | 29 | 166 |
2023 July | 162 | 27 | 189 |
2023 June | 159 | 38 | 197 |
2023 May | 161 | 20 | 181 |
2023 April | 151 | 29 | 180 |
2023 March | 135 | 20 | 155 |
2023 February | 163 | 15 | 178 |
2023 January | 220 | 37 | 257 |
2022 December | 273 | 32 | 305 |
2022 November | 235 | 45 | 280 |
2022 October | 282 | 39 | 321 |
2022 September | 206 | 24 | 230 |
2022 August | 212 | 49 | 261 |
2022 July | 188 | 40 | 228 |
2022 June | 131 | 41 | 172 |
2022 May | 180 | 50 | 230 |
2022 April | 137 | 38 | 175 |
2022 March | 170 | 52 | 222 |
2022 February | 147 | 22 | 169 |
2022 January | 141 | 26 | 167 |
2021 December | 123 | 50 | 173 |
2021 November | 130 | 44 | 174 |
2021 October | 139 | 65 | 204 |
2021 September | 158 | 50 | 208 |
2021 August | 144 | 47 | 191 |
2021 July | 145 | 43 | 188 |
2021 June | 132 | 51 | 183 |
2021 May | 114 | 55 | 169 |
2021 April | 292 | 70 | 362 |
2021 March | 185 | 40 | 225 |
2021 February | 166 | 39 | 205 |
2021 January | 161 | 33 | 194 |
2020 December | 138 | 42 | 180 |
2020 November | 130 | 23 | 153 |
2020 October | 119 | 30 | 149 |
2020 September | 112 | 22 | 134 |
2020 August | 85 | 17 | 102 |
2020 July | 101 | 22 | 123 |
2020 June | 122 | 9 | 131 |
2020 May | 136 | 24 | 160 |
2020 April | 69 | 21 | 90 |
2020 March | 85 | 19 | 104 |
2020 February | 115 | 15 | 130 |
2020 January | 122 | 24 | 146 |
2019 December | 122 | 29 | 151 |
2019 November | 115 | 15 | 130 |
2019 October | 120 | 15 | 135 |
2019 September | 122 | 20 | 142 |
2019 August | 143 | 32 | 175 |
2019 July | 125 | 25 | 150 |
2019 June | 123 | 20 | 143 |
2019 May | 233 | 19 | 252 |
2019 April | 204 | 47 | 251 |
2019 March | 138 | 14 | 152 |
2019 February | 98 | 21 | 119 |
2019 January | 143 | 22 | 165 |
2018 December | 140 | 34 | 174 |
2018 November | 146 | 32 | 178 |
2018 October | 155 | 35 | 190 |
2018 September | 79 | 19 | 98 |
2018 August | 2 | 0 | 2 |
2018 July | 6 | 0 | 6 |
2018 June | 7 | 0 | 7 |
2018 May | 23 | 0 | 23 |
2018 April | 48 | 0 | 48 |
2018 March | 54 | 0 | 54 |
2018 February | 40 | 0 | 40 |
2018 January | 115 | 0 | 115 |
2017 December | 115 | 0 | 115 |
2017 November | 48 | 0 | 48 |
2017 October | 38 | 0 | 38 |
2017 September | 42 | 0 | 42 |
2017 August | 56 | 0 | 56 |
2017 July | 35 | 1 | 36 |
2017 June | 49 | 8 | 57 |
2017 May | 34 | 12 | 46 |
2017 April | 37 | 2 | 39 |
2017 March | 42 | 4 | 46 |
2017 February | 111 | 7 | 118 |
2017 January | 17 | 4 | 21 |
2016 December | 65 | 10 | 75 |
2016 November | 72 | 10 | 82 |
2016 October | 101 | 6 | 107 |
2016 September | 104 | 13 | 117 |
2016 August | 72 | 10 | 82 |
2016 July | 51 | 4 | 55 |