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Bostancı SA, Öztorun Cİ, Erten EE, Akkaya F, Akbaş İ, Çayhan VS, Abay AN, Demir S, Ertürk A, Azılı MN, Şenel E. Clinical management of intestinal malrotation in different age groups. Pediatr Surg Int 2024; 40:204. [PMID: 39033256 PMCID: PMC11271324 DOI: 10.1007/s00383-024-05796-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2024] [Indexed: 07/23/2024]
Abstract
PURPOSE Intestinal malrotation, characterized by abnormal intestinal positioning, can lead to severe complications like volvulus and internal hernias, especially in neonates and children. Our aim was to evaluate the diagnostic methods, treatment results and postoperative follow-up of pediatric patients treated for intestinal malrotation. METHODS This retrospective study reviewed medical records of pediatric patients who underwent surgery for intestinal malrotation between January 2013 and January 2022. Data on demographics, symptoms, diagnostic approaches, surgical interventions, and postoperative outcomes were analyzed. RESULTS The study included 45 patients, with a male predominance (68.8%). Ages ranged from 1 day to 15 years, averaging 1.54 years. Presenting symptoms were acute abdomen (n = 21) and chronic abdominal pain with vomiting (n = 24). Diagnoses were established via physical exams and imaging, including upper gastrointestinal contrast studies and abdominal ultrasonography. All patients received the Ladd procedure, with some requiring necrotic bowel resection due to volvulus. CONCLUSION The diagnosis and management of pediatric intestinal malrotation present significant challenges due to its variable symptoms and potential for life-threatening complications. Early and accurate diagnosis, followed by appropriate surgical management, is crucial. This study emphasizes the importance of diligent postoperative follow-up to identify and mitigate complications, particularly in younger and severely affected patients.
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Affiliation(s)
- Süleyman Arif Bostancı
- Faculty of Medicine, Department of Pediatric Surgery, Ankara Yildirim Beyazit University, Ankara, Turkey.
| | - Can İhsan Öztorun
- Faculty of Medicine, Department of Pediatric Surgery, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Elif Emel Erten
- Department of Pediatric Surgery, Ankara Bilkent City Hospital, Childrens' Hospital, Universiteler Boulvard, 1604. Street, Çankaya, 06800, Ankara, Turkey
| | - Fahri Akkaya
- Department of Pediatric Surgery, Ankara Bilkent City Hospital, Childrens' Hospital, Universiteler Boulvard, 1604. Street, Çankaya, 06800, Ankara, Turkey
| | - İrem Akbaş
- Department of Pediatric Surgery, Ankara Bilkent City Hospital, Childrens' Hospital, Universiteler Boulvard, 1604. Street, Çankaya, 06800, Ankara, Turkey
| | - Vildan Selin Çayhan
- Department of Pediatric Surgery, Ankara Bilkent City Hospital, Childrens' Hospital, Universiteler Boulvard, 1604. Street, Çankaya, 06800, Ankara, Turkey
| | - Aslı Nur Abay
- Department of Pediatric Surgery, Ankara Bilkent City Hospital, Childrens' Hospital, Universiteler Boulvard, 1604. Street, Çankaya, 06800, Ankara, Turkey
| | - Sabri Demir
- Department of Pediatric Surgery, Health Science University, Ankara Bilkent City Hospital, Childrens' Hospital, Ankara, Turkey
| | - Ahmet Ertürk
- Faculty of Medicine, Department of Pediatric Surgery, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Müjdem Nur Azılı
- Faculty of Medicine, Department of Pediatric Surgery, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Emrah Şenel
- Faculty of Medicine, Department of Pediatric Surgery, Ankara Yildirim Beyazit University, Ankara, Turkey
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Charo DC, Mohammad FM, Ghmera MI, Saker BA, Ghosnah AA. Sigmoid and cecum colon volvulus: a case report. J Med Case Rep 2024; 18:297. [PMID: 38943209 PMCID: PMC11214250 DOI: 10.1186/s13256-024-04622-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/03/2024] [Indexed: 07/01/2024] Open
Abstract
INTRODUCTION Colon volvulus is the twisting of a segment of colon on its mesenteric axis, which can lead to the obstruction of the lumen and the blood supply. Colon volvulus is common in "volvulus belt" countries and can involve the sigmoid (60-70%) and cecum (25-40%). CASE PRESENTATION We report a case of a 47-year-old male, Alawites, who presented with bowel obstruction and dilated abdomen without any specific abdominal pain. Abdominal laparotomy showed both sigmoid and cecum volvulus with no signs of perforation or ischemia. DISCUSSION AND CONCLUSION One of the possible risk factors of sigmoid colon volvulus is the length of the rectum and sigmoid, while mobile cecum is considered as a possible reason for cecum volvulus. The management remains controversial and is specific for every case, depending mainly on the vitality of the colonic walls and the general condition of the patient.
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Affiliation(s)
- Dilawer Chofan Charo
- General Surgery Department, Ministry of Health, Latakia, Syria.
- Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA.
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Chu KM, Bust L, Forgan T. Colorectal Surgery Practice, Training, and Research in Low-Resource Settings. Clin Colon Rectal Surg 2022; 35:410-416. [PMID: 36111082 PMCID: PMC9470283 DOI: 10.1055/s-0042-1746190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Colorectal surgery (CRS) practice, training, and research differ between low- and middle-income countries (LMICs) and high-income countries due to disparity in resources. LMIC CRS is primarily done by general surgeons due to the paucity of fully trained colorectal surgeons. The majority of colon and rectal resections are done using open techniques, and laparoscopy and robotic platforms are only available in select private or academic centers. Multi-disciplinary teams are not available in most hospitals, so surgeons must have a broad knowledge base, and learn to adapt their practice. Formal CRS training opportunities through accredited post-residency fellowships and professional colorectal surgical associations are limited in LMICs. CRS is less established as an academic field, and less data are generated in LMICs. There are fewer staff and less dedicated funding for CRS research. However, LMIC colorectal surgeons and researchers can contribute valuable clinical findings especially on conditions of higher prevalence in their settings such as anal squamous cell carcinoma and obstetric fistulas. Effective surgical care for colorectal conditions requires significant investment in infrastructure, training, and governance in LMICs. This is critical to improve access to safe surgical care for all.
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Affiliation(s)
- Kathryn M. Chu
- Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Francie van Zijl Drive Stellenbosch University, Tygerberg, South Africa
- Department of Surgery, University of Botswana, Gaborone, Botswana
| | - Lynn Bust
- Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Francie van Zijl Drive Stellenbosch University, Tygerberg, South Africa
| | - Tim Forgan
- Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Francie van Zijl Drive Stellenbosch University, Tygerberg, South Africa
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Bayeh AB, Abegaz BA. Seasonality of Primary Small Bowel Volvulus and Its Variations Based on Sex and Place of Residence, North Western Ethiopia. Cureus 2022; 14:e27478. [PMID: 36060371 PMCID: PMC9422250 DOI: 10.7759/cureus.27478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2022] [Indexed: 11/12/2022] Open
Abstract
Background Primary small bowel volvulus is a common surgical emergency in some parts of the globe. Its seasonal nature has not been widely researched. The main objective of this study was to assess its underlying patterns among different gender and geographical location. Materials and methods A hospital-based retrospective cross-sectional study was conducted from November 2020 to February 2021 at two comprehensive specialized hospitals in North West Ethiopia. The monthly count of primary small bowel volvulus was analyzed for patterns using Minitab 18. Graphical techniques such as run sequence plots, multiple box plots, and correlogram were used. Additive decomposition was also done. The degree of seasonal variation was measured in terms of seasonal indices generated for each month. A chi-square goodness-of-fit test at p < 0.05 was applied to determine statistical significance. Results A total of 235 patients were found to have surgically confirmed diagnosis of primary small bowel volvulus over six years. Most were males (77.4%) and from rural residence (73.2%). The mean age in years was 40.5 (±16.7). Overall, 179 (76.2%) of the total cases, 148 (81.3%) of males, and 138 (80.2%) of rural cases were admitted during June through November. Conclusion Seasonal variation was found to be a feature of primary small bowel volvulus. Knowing its seasonal nature helps raise the threshold of suspicion among health care providers to pass timely clinical decisions particularly in resource-limited setups.
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Bayeh A, Abegaz B. The Role of Anatomic Dimensions in the Development of Primary Small Bowel Volvulus, NorthWestern Ethiopia: A Case-control Study. OPEN ACCESS SURGERY 2022. [DOI: 10.2147/oas.s355822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Sylvester KR, Ooko PB, Mwachiro MM, Parker RK. Cecal volvulus in rural Kenya: delayed presentation contributes to high mortality. BMC Surg 2021; 21:430. [PMID: 34923984 PMCID: PMC8684650 DOI: 10.1186/s12893-021-01416-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 12/01/2021] [Indexed: 11/30/2022] Open
Abstract
Background Cecal volvulus, which is a torsion involving the cecum, terminal ileum, and ascending colon around its own mesentery, results in a closed-loop obstruction. It is a rare reported cause of adult intestinal obstruction. This study aimed to review the clinical presentation, management, and outcomes at a rural, resource-limited referral center. Methods We performed a retrospective review of all patients with a diagnosis of cecal volvulus between January 1st, 2009 and December 31st, 2019 at Tenwek Hospital in Bomet, Kenya. The outcome of survival was compared by the time to presentation. Mortality was also compared with prior reports of intestinal obstruction at our institution. Results Thirteen patients were identified with a mean age of 52 years and a mean symptom duration of 5 days. All patients presented with abdominal pain and distension. Seven patients (54%) presented with perforation, gangrene, or gross peritoneal contamination. Identified risk factors were Ladds bands with malrotation, adhesions, and a sigmoid tumor. Procedures included primary resection and anastomosis (7), damage control (3) with anastomosis on second-look in 2 of these, simple surgical detorsion (1), and surgical detorsion and cecopexy (2). There were four mortalities (31%), of which all had delayed presentation with perforation and fecal contamination. Delays to presentation were associated with mortality (p = 0.03). Cecal volvulus resulted in increased perioperative mortality compared to all intestinal obstructions presenting to the institution (p < 0.0001). Conclusions Cecal volvulus carries a high risk of mortality. A high index of suspicion and early consideration in the differential diagnosis of intestinal obstruction should be considered to reduce the mortality associated with the delay in preoperative diagnosis.
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Affiliation(s)
| | - Philip B Ooko
- Department of Surgery, AIC Litein Hospital, Litein, Kenya
| | | | - Robert K Parker
- Department of Surgery, Tenwek Hospital, PO Box 39, Bomet, 20400, Kenya. .,Department of Surgery, Alpert Medical School of Brown University, Providence, RI, USA.
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Atamanalp SS. Comments on "Acute Colonic Volvulus in a Mexican Population: A Case Series". Ann Coloproctol 2021; 37:131-132. [PMID: 33887817 PMCID: PMC8273709 DOI: 10.3393/ac.2020.05.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/12/2020] [Indexed: 11/04/2022] Open
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Emna T, Atef M, Sarra S. Management of acute sigmoid volvulus: A tunisian experience. Asian J Surg 2021; 45:148-153. [PMID: 33895046 DOI: 10.1016/j.asjsur.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/23/2021] [Accepted: 04/05/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND/OBJECTIVE Sigmoid volvulus is the most common type of volvulus. Its epidemiological features, as well as its management, differ between developed and developing countries. This work aims to analyze the epidemiological features thus allowing to compare them to the rest of the "volvulus belt'' and assess the surgical management of sigmoid volvulus in Tunisia. METHOD This is a retrospective review of 64 patients with sigmoid volvulus treated in the General Surgery department of Jendouba Hospital. January 2005-December 2019. RESULTS 64 patients were treated for acute sigmoid volvulus. The sex ratio male to female ratio was 5.4/1 with male predominance. 5.4:1 (54 males to 10 females). The mean age was 62 years. The classic triad of intestinal occlusion was reported in 56 patients. The mean duration of symptoms was 4.2 days. An accurate preoperative diagnosis was made in 58 cases. Forty patients had a viable bowel obstruction, and all of them had a resection and primary anastomosis. Sixteen patients had a gangrenous bowel obstruction, of which 6 patients had resection-primary anastomosis, and 10 had Hartmann's procedure. Out of the total five deaths reported, there were only two among patients who had resection-primary anastomosis for gangrenous bowel obstruction. The most common postoperative complication was wound infections in 5 cases. The median length of hospital stay following surgery was 8 days. No recurrences of volvulus after a median follow-up of 11 months. CONCLUSIONS Although Tunisia belongs to the volvulus belt, the epidemiologic features of sigmoid volvulus tend rather be similar to those of developed countries. The use of primary surgery, if no endoscopy is performed, is a good alternative. For patients who have contraindications for endoscopic treatment, surgical treatment is the only option.
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Affiliation(s)
- Trigui Emna
- Department of General Surgery, Jendouba Hospital, Tunisia; Tunis El Manar University, Tunisia.
| | - Mejri Atef
- Department of General Surgery, Jendouba Hospital, Tunisia; Tunis El Manar University, Tunisia
| | - Saad Sarra
- Department of General Surgery, Jendouba Hospital, Tunisia; Tunis El Manar University, Tunisia
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Letter to the Editor: Characteristics of Intestinal Volvulus and Risk of Mortality in Malawi. World J Surg 2020; 44:2448-2449. [PMID: 32236728 DOI: 10.1007/s00268-020-05498-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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