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García Calonge M, Barreiro Alonso E. Comments on "Sigmoid volvulus management, only endoscopic devolvulation?". REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024; 116:337. [PMID: 37539528 DOI: 10.17235/reed.2023.9880/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
We are grateful our case has aroused such interest from our Turkish colleagues, and we thank them for their kind reply. Sigmoid volvulus (SV) is the third leading cause of colonic obstruction in the world. Is it widely known there is a progressive aging of the population. Prevention with lifestyle habits and early treatment of cardiovascular risk factors has led to an increase of pluripatologic chronic conditions. A higher incidence of neurodegenerative diseases is also a proven fact. Their intestinalinvolvementcan be ina direct form, withneuronal destruction in myenteric plexus leading to chronic constipation, and alsodue to secondary drug effects (laxatives causing fecal overloading, increased intracolonic pressure, dolichocolon…), all favouringweakness in colonic wall, and therefore the appearance of sigmoid volvulus. We don´t have specific data about SV incidence and recurrence in our centre.However, literature reviews show recurrence is the norm in the majority of cases after colonic decompression. Data reported from our colleagues in Turkey represents a single centre cohort and a broad spectrum over time (from 1960s until now), so recurrence rate should not be generalized to global population. The continuous improvement in endoscopic procedures since their beginning might have despair results of colonic decompression and need of surgery among years. Nowadays we have more sophisticated and high-resolution endoscopes, as well as better trained endoscopists with more advanced therapeutic techniques. This might overlap with surgical development of less invasive techniques, lower rates of complication and shorter postoperative recovery. We suggest the authors to examin in their database the different outcomes through decades in their cohort since we believe medical/endoscopic/surgical approach has changed from 1960s until now. Finally, we agree elective surgery must be the final treatment in SV cases with American Society of Anesthesiologists (ASA) scores 1-3. Endoscopic or laparoscopic colopexychoice for ASA > 3 patients should be made based on each centre´s experience. We believe endoscopic approach with endoscopic colostomy or sigmoidopexy might be the first approach for fragile patients since it is an easily performed technique, with low rate of complications and acceptable long-term results preventing a recurrence of SV. Further studies are needed to compare minimally invasive surgery to endoscopic approach.
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El Nogoomi I, Jumah R, Zaidan KO, Agha A. Primary Midgut Volvulus: An Unusual Case of a Young Adult Necessitating Extensive Bowel Resection. Cureus 2024; 16:e54472. [PMID: 38510899 PMCID: PMC10954040 DOI: 10.7759/cureus.54472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 03/22/2024] Open
Abstract
Primary small bowel volvulus (SBV), commonly known as midgut volvulus, is an uncommon condition in which the small intestine rotates around its own mesenteric axis. This case report details the diagnostic and management challenges encountered in a rare presentation of primary SBV in a previously healthy 19-year-old male. Our patient presented with acute abdominal pain, vomiting, and signs of shock, prompting urgent medical attention. He was sent for exploratory laparotomy and underwent extensive resection of the gangrenous bowel. Diagnosis involved an abdominal computed tomography scan revealing the characteristic "whirl sign." According to the World Society of Emergency Medicine, surgical intervention should be done to address the SBV through resection of the gangrenous bowel segments. Despite efforts, the patient's prognosis remained guarded, necessitating ongoing supportive measures. This case highlights the complex challenges associated with primary SBV, emphasizing the need for continued research to enhance diagnostic precision and refine management strategies.
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Affiliation(s)
| | - Rania Jumah
- General Practice, Al Kuwait Hospital, Sharjah, ARE
| | | | - Ammar Agha
- General Practice, Al Kuwait Hospital, Sharjah, ARE
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Gislinge JIP, Scheuer CJ, Toustrup CH, Roenneberg ET. Caecal volvulus following a complicated caesarean section. BMJ Case Rep 2023; 16:e252757. [PMID: 37607760 PMCID: PMC10445342 DOI: 10.1136/bcr-2022-252757] [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] [Indexed: 08/24/2023] Open
Abstract
A caecal volvulus is a rare, but severe complication to a caesarean section, with serious risks of perforation, necrosis and peritonitis. We describe a case of a Middle Eastern woman admitted for an elective caesarean section due to a history of three cesareans in her home country. The operation was complicated by massive adhesions and a postpartum bleed of 1750 mL. She developed severe abdominal pain refractory to strong pain medication postoperatively. She was diagnosed with a caecal volvulus without perforation on CT, which was confirmed by laparotomy. The patient was treated with a hemicolectomy and made a full recovery.
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Affiliation(s)
| | | | | | - Elisabeth Thal Roenneberg
- Gynecology, Obstetrics and Fertility, Copenhagen University Hospital, Herlev Hospital, Herlev, Denmark
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4
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Liu G, Bao L, Chen C, Xu J, Cui X. The implication of mesenteric functions and the biological effects of nanomaterials on the mesentery. NANOSCALE 2023; 15:12868-12879. [PMID: 37492026 DOI: 10.1039/d3nr02494f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
A growing number of nanomaterials are being broadly used in food-related fields as well as therapeutics. Oral exposure to these widespread nanomaterials is inevitable, with the intestine being a major target organ. Upon encountering the intestine, these nanoparticles can cross the intestinal barrier, either bypassing cells or via endocytosis pathways to enter the adjacent mesentery. The intricate structure of the mesentery and its entanglement with the abdominal digestive organs determine the final fate of nanomaterials in the human body. Importantly, mesentery-governed dynamic processes determine the distribution and subsequent biological effects of nanomaterials that cross the intestine, thus there is a need to understand how nanomaterials interact with the mesentery. This review presents the recent progress in understanding the mesenteric structure and function and highlights the importance of the mesentery in health and disease, with a focus on providing new insights and research directions around the biological effects of nanomaterials on the mesentery. A thorough comprehension of the interactions between nanomaterials and the mesentery will facilitate the design of safer nanomaterial-containing products and the development of more effective nanomedicines to combat intestinal disorders.
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Affiliation(s)
- Guanyu Liu
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety & CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, Beijing 100190, China.
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Lin Bao
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety & CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, Beijing 100190, China.
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Chunying Chen
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety & CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, Beijing 100190, China.
- University of Chinese Academy of Sciences, Beijing 100049, China
- The GBA National Institute for Nanotechnology Innovation, Guangzhou 510700, Guangdong, China
| | - Jianfu Xu
- State Key Laboratory of NBC Protection for Civilian, Beijing 102205, China.
| | - Xuejing Cui
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety & CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, Beijing 100190, China.
- University of Chinese Academy of Sciences, Beijing 100049, China
- The GBA National Institute for Nanotechnology Innovation, Guangzhou 510700, Guangdong, China
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Schudrowitz N, Shahan CP, Moss T, Scarborough JE. Bowel Preparation Before Nonelective Sigmoidectomy for Sigmoid Volvulus: Highly Beneficial but Vastly Underused. J Am Coll Surg 2023; 236:649-655. [PMID: 36695556 DOI: 10.1097/xcs.0000000000000593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Although strong evidence exists for combined mechanical and oral antibiotic bowel preparation before elective colorectal resection, the utility of preoperative bowel preparation for patients undergoing sigmoid resection after endoscopic decompression of sigmoid volvulus has not been previously examined. The goal of this study was to evaluate the association between bowel preparation and postoperative outcomes for patients undergoing semielective, same-admission sigmoid resection for acute volvulus. STUDY DESIGN Patients from the 2012 to 2019 Colectomy-Targeted American College of Surgeons NSQIP dataset who underwent sigmoid resection with primary anastomosis after admission for sigmoid volvulus were included. Multivariable logistic regression was used to compare the risk-adjusted 30-day postoperative outcomes of patients who received combined preoperative bowel preparation with those of patients who received either partial (mechanical or oral antibiotic alone) or incomplete bowel preparation. Effort was made to exclude patients whose urgency of clinical condition at hospital admission precluded an attempt at preoperative decompression and subsequent bowel preparation. RESULTS Included were 2,429 patients, 322 (13.3%) of whom underwent complete bowel preparation and 2,107 (86.7%) of whom underwent partial or incomplete bowel preparation. Complete bowel preparation was protective against several postoperative complications (including anastomotic leak), mortality, and prolonged postoperative hospitalization. CONCLUSIONS This study demonstrates a significant benefit for complete bowel preparation before semielective, same-admission sigmoid resection in patients with acute sigmoid volvulus. However, only a small percentage of patients in this national sample underwent complete preoperative bowel preparation. Broader adoption of bowel preparation may reduce overall rates of complication in patients who require sigmoid colectomy due to volvulus.
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Affiliation(s)
- Natalie Schudrowitz
- From the Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
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6
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Fo Y, Kang X, Tang Y, Zhao L. Analysis of clinical diagnosis and treatment of intestinal volvulus. BMC Gastroenterol 2023; 23:93. [PMID: 36977994 PMCID: PMC10053424 DOI: 10.1186/s12876-023-02699-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 02/25/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND The aim of this study is to investigate the clinical characteristics and treatment experience of intestinal volvulus, and to analyze the incidence of adverse events and related risk factors of intestinal volvulus. METHODS Thirty patients with intestinal volvulus admitted to the Digestive Emergency Department of Xijing Hospital from January 2015 to December 2020 were selected. The clinical manifestations, laboratory tests, treatment and prognosis were retrospectively analyzed. RESULTS A total of 30 patients with volvulus were enrolled in this study, including 23 males (76.7%), with a median age of 52 years (33-66 years). The main clinical manifestations were abdominal pain in 30 cases (100%), nausea and vomiting in 20 cases (67.7%), cessation of exhaust and defecation in 24 cases (80%), and fever in 11 cases (36.7%). The positions of intestinal volvulus were jejunum in 11 cases (36.7%), ileum and ileocecal in 10 cases (33.3%), sigmoid colon in 9 cases (30%). All 30 patients received surgical treatment. Among the 30 patients underwent surgery, 11 patients developed intestinal necrosis. We found that the longer the disease duration (> 24 h), the higher the incidence of intestinal necrosis, and the higher the incidence of ascites, white blood cell count and neutrophil ratio in the intestinal necrosis group were significantly higher than those in the non-intestinal necrosis group (p < 0.05). After treatment, 1 patient died of septic shock after operation, and 2 patients with recurrent volvulus were followed up within 1 year. The overall cure rate was 90%, the mortality rate was 3.3%, and the recurrence rate was 6.6%. CONCLUSION Laboratory examination, abdominal CT and dual-source CT are very important for the diagnosis of volvulus in patients with abdominal pain as the main symptom. Increased white blood cell count, neutrophil ratio, ascites and long course of disease are important for predicting intestinal volvulus accompanied by intestinal necrosis. Early diagnosis and timely intervention can save lives and prevent serious complications.
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Affiliation(s)
- Yuhong Fo
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
| | - Xiaoyu Kang
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
| | - Yongqiang Tang
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Lifang Zhao
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
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Molyneux K, Beck-Esmay J, Koyfman A, Long B. High risk and low prevalence diseases: Mesenteric ischemia. Am J Emerg Med 2023; 65:154-161. [PMID: 36638612 DOI: 10.1016/j.ajem.2023.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 12/19/2022] [Accepted: 01/02/2023] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Mesenteric ischemia is a rare, frequently misdiagnosed, serious condition that carries with it a high rate of morbidity and mortality. OBJECTIVE This review highlights the pearls and pitfalls of mesenteric ischemia, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION Mesenteric ischemia is an abdominal vascular emergency that includes superior mesenteric arterial embolism, arterial thrombosis, venous mesenteric ischemia, and non-occlusive mesenteric ischemia. It is associated with a variety of risk factors including older age, cardiovascular disease, hypercoagulable state, and end-stage renal disease. The presentation depends on the underlying pathophysiology. While arterial embolic disease may present with sudden, severe pain, the early stages of the disease and other forms can present with vague symptoms, including generalized abdominal pain, weight loss, vomiting, and diarrhea. Laboratory testing can suggest the disease with leukocytosis and elevated lactate, but normal values should not be used to exclude the diagnosis. The imaging modality of choice is triple phase computed tomography with non-contrast, arterial, and delayed phases. The initial ED management includes fluid resuscitation, symptomatic therapy, broad-spectrum antibiotics, and anticoagulation. Emergent consultation with a multidisciplinary team including diagnostic and interventional radiologists and cardiovascular and general surgeons is necessary for definitive treatment. CONCLUSIONS An understanding of mesenteric ischemia can assist emergency clinicians in diagnosing and managing this disease.
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Affiliation(s)
- Kevin Molyneux
- Department of Emergency Medicine, Columbia University Irving Medical Center, 622 W 168th St, New York, NY 10032, USA
| | - Jennifer Beck-Esmay
- Department of Emergency Medicine, Mount Sinai Morningside - Mount Sinai West, 1111 Amsterdam Ave, New York, NY 10025, USA.
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Brit Long
- SAUSHEC, Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
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Huycke EM, Tom SS, Wezza A, Barr GC. Volvulus Irritating the Myocardium: A Case Report. Cureus 2023; 15:e35256. [PMID: 36968880 PMCID: PMC10038688 DOI: 10.7759/cureus.35256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
Gastric volvulus is a rare condition that may present with various symptoms and may occur as an acute or chronic condition. Signs and symptoms may include nausea, vomiting, abdominal pain, and chest pain. It is imperative to recognize acute gastric volvulus in a timely fashion, since a delay in diagnosis may result in foregut obstruction and increased risk of strangulation, if not recognized and treated promptly. Additionally, secondary complications that are equally life-threatening, such as cardiac arrhythmias, can occur. For this very reason, it is important to highlight gastric volvulus as a possibility when developing a differential diagnosis in patients complaining of abdominal pain. This case report describes a 73-year-old female with no past cardiac risk factors, who presented to the emergency department (ED) with symptoms of supraventricular tachycardia (SVT), intermittent diarrhea, and nausea per emergency medical services (EMS). Upon EMS arrival at the patient's home, her heart rate was 210 beats per minute (bpm). Despite her condition appearing to result from a cardiac condition, imaging studies found a large hiatal hernia through which the stomach had displaced. The patient's stomach had distended, forming a volvulus and placing pressure on thoracic organs. This case highlights a rare but potentially life-threatening cardiac arrhythmia associated with gastric volvulus.
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Khalifa A, Tawadros A, Broder A. Chronic Intrathoracic Gastric Volvulus Management: Could Less Be More? J Investig Med High Impact Case Rep 2023; 11:23247096231173400. [PMID: 37177804 PMCID: PMC10184223 DOI: 10.1177/23247096231173400] [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: 05/15/2023] Open
Abstract
Gastric volvulus is a rare medical condition that necessitates a high suspicion index to diagnose. Acute gastric volvulus will often present with nonspecific but severe symptoms of abdominal pain, nausea, vomiting, and in some instances, evidence of organ ischemia. In this case report, we present an 88-year-old woman who was admitted after a mechanical fall. On the third day of hospitalization, she complained of new-onset epigastric pain, nausea, and vomiting. Imaging demonstrated nonobstructed intrathoracic organo-axial gastric volvulus. Given the patient's significant comorbidities, surgical and endoscopic interventions were deemed high-risk (high risk of anesthesia and gastric perforation, respectively). This report evaluates the role of noninterventional conservative management in high-risk surgical patients with symptomatic acute and acute-on-chronic intrathoracic gastric volvulus. The present case and the current literature review suggest that supportive management may be appropriate to control disease symptoms, although it does not alter the disease's natural history, progression, and recurrence.
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Affiliation(s)
- Ali Khalifa
- Saint Peter's University Hospital/Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Augustine Tawadros
- Saint Peter's University Hospital/Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Arkady Broder
- Saint Peter's University Hospital/Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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10
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Ceballos-Esparragón J, Velaz-Pardo L, Martin-Camarillo R, Cano Burbano F, Petrone P. Obstrucción intestinal por vólvulo de ciego en paciente con malrotación intestinal asociado a situs ambiguous. REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.1283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introducción. La oclusión intestinal, completa o incompleta, es uno de los cuadros de abdomen agudo más frecuentes. Constituye entre 20 % y 35 % de los ingresos urgentes en las áreas quirúrgicas hospitalarias.
Caso clínico. Se presenta el caso de un paciente con antecedente de carcinoma de próstata, que consultó con un cuadro de obstrucción intestinal y abdomen agudo. Se le diagnosticó vólvulo de ciego, malrotación intestinal y situs ambiguous. El tratamiento quirúrgico del paciente fue exitoso.
Conclusión. El conocimiento de estas condiciones patológicas es imprescindible para poder brindarle un correcto tratamiento quirúrgico y disminuir la mortalidad que pueden acarrear.
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Bouassida M, Beji H, Chtourou MF, Ben Othmane N, Hamzaoui L, Touinsi H. Primary small bowel volvulus: A case report and literature review. Ann Med Surg (Lond) 2022; 80:104250. [PMID: 36045801 PMCID: PMC9422278 DOI: 10.1016/j.amsu.2022.104250] [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] [Received: 06/16/2022] [Revised: 07/16/2022] [Accepted: 07/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Small bowel volvulus (SBV) is an aberrant rotation of the small bowel segment along the axis of its mesentery. Secondary SBV is the most frequent situation. Postoperative adhesions represent the main cause. On the other hand, primary SBV is an extremely rare situation. There are no predisposing anatomical abnormalities. Herein, we present a case of a 73-year-old-patient, with no surgical history, presenting primary SBV. Case presentation A 73-year-old-patient presented to the emergency department with a one-day history of acute abdominal pain and vomiting. He had no medical comorbidities and no previous abdominal surgery. On examination, he was agitated and afebrile. Urgent computed tomography (CT) scan showed dilated small bowel loops with a “whirl sign”. A laparotomy was performed. It revealed a 320° SBV of the distal jejunum and the proximal ileum. The small bowel was ischemic. There were no congenital malformations, no adhesions, and no internal hernia. We performed a detorsion of the small bowel. It regained good vitality. To avoid recurrence, we performed enteropexy of the terminal ileum, and the caecum to widen the mesenteric base. We noted no recurrence of the pathology after three months of follow-up. Conclusion Primary SBV is an extremely rare situation. Physiopathology is still misunderstood. The clinical presentation is not specific. Diagnosis can be evoked by CT scan but can only be confirmed intraoperatively. The surgical treatment should be performed timely. Different techniques have been described to avoid recurrence. None of those techniques is consensual. Primary small bowel obstruction is an extremely rare situation. The physiopathology is still unclear. The diagnosis is difficult due to the non-specificity of the symptoms. The surgical treatment should be performed timely. Enteropexy is an option to avoid recurrence but it's not consensual.
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12
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Márquez-Ustáriz A, Echeverri C, Ariza-Gutiérrez A. Vólvulo cecal y del colon sigmoide como manifestación gastrointestinal de la esclerosis sistémica: reporte de un caso. REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. La esclerosis sistémica es una enfermedad del colágeno de etiología autoinmune, con manifestaciones gastrointestinales hasta en un 90 % de los pacientes. Aunque es infrecuente, se han descrito algunos casos de vólvulos colónicos, pero es extremadamente rara la presentación de vólvulo cecal y del colon sigmoide en un mismo paciente.
Caso clínico. Paciente femenina de 65 años, con antecedente de esclerosis sistémica, quien consultó a urgencias por dolor y distensión abdominal, asociados a emesis, con ausencia de flatos y deposiciones. Por imágenes sugestivas de obstrucción intestinal con zona de transición en el colon sigmoide se indicó laparotomía exploratoria, con hallazgo de vólvulo del sigmoide. Posteriormente reingresó por sintomatología similar, con imágenes sugestivas de vólvulo cecal. Se realizó hemicolectomía derecha con ileostomía y posterior cierre de ileostomía en misma hospitalización.
Discusión. El vólvulo del colon sigmoide y ciego en un mismo paciente es una condición muy infrecuente. Existen pocos casos reportados en la literatura.
Conclusión. La resección del segmento colónico afectado es el estándar de manejo quirúrgico.
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Tan HH, Sivasuthan G, Wong MS. A curious adult case of small bowel volvulus with congenital malrotation. J Surg Case Rep 2022; 2022:rjac285. [PMID: 35721260 PMCID: PMC9200430 DOI: 10.1093/jscr/rjac285] [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] [Received: 05/03/2022] [Accepted: 05/03/2022] [Indexed: 11/23/2022] Open
Abstract
Intestinal volvulus is defined as a twisting of the bowel on its mesentery. It itself is a rare occurrence, with documented incidence of 1% as the cause of all small bowel obstruction, with further 0.82% of them being associated with intestinal malrotation. The classical radiographic feature described in literatures is the whirlpool sign. We herein report a rare presentation of congenital malrotation causing a small bowel obstruction in a 43-year-old man. The patient presented with acute abdominal pain and underwent an emergency laparotomy and resection of small and large bowel (total of 3 m with primary anastomosis), with an estimated 2.6 m of viable small bowel left. The patient had a prolonged recovery complicated by another relook operation, superior mesenteric vein thrombus and a high-output stoma with subsequent electrolyte derangements and acute kidney injury. He was discharged on Day 26 and had been seen in the outpatient department with good functionality.
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Affiliation(s)
- Hao Han Tan
- Department of General Surgery, Ipswich Hospital , QLD , Australia
| | | | - Man-Shun Wong
- Department of General Surgery, Ipswich Hospital , QLD , Australia
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14
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Caecal Volvulus: A District General Hospital Experience and Review of the Literature. SURGERIES 2022. [DOI: 10.3390/surgeries3020010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Caecal volvulus (CV) is an uncommon cause of large bowel obstruction with potential for complications such as ischaemia and perforation. Prompt diagnosis and treatment only will ensure better outcomes. We aim to describe our experience in the largest series of CV reported in the United Kingdom. Methods: This was a retrospective study of 16 consecutive patients diagnosed with CV between March 2017 and March 2020. Results: Out of 16 patients, 11 were female, with a median age of 64 (range 33–80) years. All patients presented with abdominal pain and vomiting. An initial diagnosis of bowel obstruction was made only in 8 patients (50%). Computed tomography (CT) scan of the abdomen and pelvis correctly diagnosed CV in fourteen (87.5%). Fifteen patients (94%) underwent surgical intervention. All but one (n = 14, 93.4%) underwent laparotomy, and one patient (6.6%) underwent successful laparoscopic intervention. Right hemicolectomy was performed in all operated patients, and fourteen patients (93.4%) had primary anastomosis. Twelve patients (80%) had one or another form of morbidity. Seven patients (47%) and three patients (20%) had grade II and III (Clavien–Dindo Classification) complications, respectively, with a median hospital stay of 10 (range 1–49) days. One patient (6.7%) managed conservatively was deemed to be futile. There was no postoperative mortality. Conclusions: CV can present with non-specific symptoms, and a definite preoperative diagnosis is only possible with the aid of CT. Open resectional procedures with primary anastomosis are the most favoured approach in management, though laparoscopic access is also feasible in fit patients.
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15
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Maya‐Enero S, Prat‐Ortells J, Martín‐Solé O, De Haro‐Jorge I, Pertierra‐Cortada À, Iriondo‐Sanz M. Distinguishing outcomes of neonatal intestinal volvulus: Review of our experience over the last 20 years. Acta Paediatr 2022; 111:284-290. [PMID: 34704280 DOI: 10.1111/apa.16167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/29/2021] [Accepted: 10/25/2021] [Indexed: 12/01/2022]
Abstract
AIM There are two types of intestinal volvulus: midgut (MGV) and segmental (SV). Patients with different types of intestinal volvulus are often included in the same case series, which may affect the perception of how severe "intestinal volvuli" are. We aimed to compare both types of intestinal volvulus. METHODS This is a retrospective observational study including all patients with MGV and SV up to 28 days of life admitted to a tertiary hospital in Spain over a 20-year-period (1999-2019). A comparison between groups and a logistic regression model for mortality were done. RESULTS We identified 32 patients: 23 MGV and 9 SV. Malrotation was exclusive of MGV. Prenatal diagnosis, cystic fibrosis, and intestinal resection were significantly more frequent in SV. Surgery was performed at a significantly lower age in SV. The mortality observed in acute MGV with intestinal compromise (41.7%) is four times higher than the mortality of SV (11.1%). The overall mortality of all MGV patients (21.7%) is almost twice that of SV. Mortality was best predicted by the presence of hemodynamic instability (OR 27.5 95% CI 2.50-302.17; p = 0.007). CONCLUSION SV and MGV have a different clinical presentation. Hemodynamic instability is the major risk factor for death.
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Affiliation(s)
- Silvia Maya‐Enero
- Department of Neonatology Service of Pediatrics, Hospital del Mar Universitat Autònoma de Barcelona Barcelona Spain
| | - Jordi Prat‐Ortells
- Service of Pediatric Surgery Hospital Sant Joan de DéuUniversitat de Barcelona Barcelona Spain
| | - Oriol Martín‐Solé
- Service of Pediatric Surgery Hospital Sant Joan de DéuUniversitat de Barcelona Barcelona Spain
| | - Irene De Haro‐Jorge
- Service of Pediatric Surgery Hospital Sant Joan de DéuUniversitat de Barcelona Barcelona Spain
| | | | - Martín Iriondo‐Sanz
- Service of Neonatology Hospital Sant Joan de DéuUniversitat de Barcelona Barcelona Spain
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16
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Jejunal volvulus within an inguinal hernia sac like as an extremely rare cause of acute mechanical gastrointestinal obstruction in adults: First literature report. Int J Surg Case Rep 2022; 91:106757. [PMID: 35149283 PMCID: PMC8858751 DOI: 10.1016/j.ijscr.2022.106757] [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] [Received: 12/17/2021] [Revised: 01/02/2022] [Accepted: 01/06/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction and importance Small bowel volvulus (SBV) represents a rare and life-threatening cause of gastrointestinal obstruction among adults. SBV can be classified as primary and secondary subtypes. Preoperative diagnosis of SBV is a challenge because of the absence of pathognomonic clinical, radiographic and laboratory findings. Surgery represents the correct treatment of SBV. Case presentation A 69-year-old Caucasian male presented to the Emergency Department with a two-day history of abdominal pain, inability to pass gas or stool, nausea, vomiting. Physical examination revealed abdominal distension, generalized abdominal pain without guarding or rebound tenderness, a partially reducible and painless right inguinal hernia. Laboratory tests reported neutrophilic leukocytosis. Abdominal computed tomography revealed massive gastroduodenal dilatation with pneumoperitoneum and small bowel loops in the right inguinal sac. The patient underwent exploratory laparotomy: a jejunal volvulus (JV) located within the right inguinal hernia sac, causing gastrointestinal obstruction, was devolvulated and a right prosthetic inguinal hernia repair was also performed. The patient was discharged on the 10th postoperative day. Clinical discussion Secondary SBV is due to any congenital or acquired lesions and rarely occurs among adults in Western countries. This is the first literature report of a JV located within an inguinal hernia sac causing gastrointestinal obstruction. Conclusion Secondary JV represents an extremely rare abdominal emergency necessitating early diagnosis to prevent the development of intestinal ischemia, bowel necrosis and peritonitis. Diagnosis of JV needs a high index of suspicion and may be facilitated by imaging, often it is made intraoperatively. Surgery represents the appropriate treatment of JV. Jejunal volvulus (JV) represents a rare cause of gastrointestinal obstruction among adults. Diagnosis is a challenge because of the absence of specific clinical presentation, pathognomonic radiographic and laboratory findings. Abdominal contrast-enhanced computed tomography (CECT) remains the most relevant imaging modality for diagnosis. Early diagnosis and early surgical intervention are the keys for the successful management of JV.
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17
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ATAMANALP SS. Sigmoid volvulus: Comorbidity with neurological diseases. CUKUROVA MEDICAL JOURNAL 2021. [DOI: 10.17826/cumj.975864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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18
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Atamanalp SS, Disci E, Atamanalp CT, Atamanalp RS. Spontaneous Detorsion of Sigmoid Volvulus in a patient with Nineteen-Volvulus episode history: A rare outcome of an extremely rare clinical entity. Pak J Med Sci 2021; 37:2029-2031. [PMID: 34912439 PMCID: PMC8613068 DOI: 10.12669/pjms.37.7.4703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/05/2021] [Indexed: 11/16/2022] Open
Abstract
Sigmoid volvulus (SV) recurrence more than 10 times is an extremely rare clinical entity and spontaneous detorsion is a rare outcome of SV. In this paper, we report a case with 19 previous SV attacks, in last of which spontaneous detorsion occurred. Such a multiple-episode history as well as an unexpected recovery was unique in a 1,036-case clinical profession of Ataturk University with SV over a 54.5-year period.
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Affiliation(s)
- Sabri Selcuk Atamanalp
- Prof. Sabri Selcuk Atamanalp, MD. Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Esra Disci
- Esra Disci, MD. Assistant Professor, Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Cansu Tatar Atamanalp
- Cansu Tatar Atamanalp, MD. Assistant, Department of Pediatrics, Haseki Education and Research Hospital, Istanbul, Turkey
| | - Refik Selim Atamanalp
- Refik Selim Atamanalp, MD. Assistant, Department of Pathology, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
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19
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Atamanalp SS. Endoscopic Decompression of Sigmoid Volvulus: Review of 748 Patients. J Laparoendosc Adv Surg Tech A 2021; 32:763-767. [PMID: 34748412 DOI: 10.1089/lap.2021.0613] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Sigmoid volvulus (SV) is the twisting of the sigmoid colon around itself. Endoscopy both helps diagnosis and provides treatment in the absence of peritonitis or perforation in SV. Nevertheless, there are some controversies or limitations on this subject. The aim of this study is to evaluate the current role of the endoscopic decompression in the treatment of SV. Materials and Methods: The clinical records of 1040 patients with SV treated over a 55-year period from June 1966 to July 2021 were reviewed retrospectively until June 1986 and prospectively thereafter. For each case, preoperational parameters, treatment options, and prognosis were noted. Results: Endoscopic decompression was tried in 748 patients (71.9%). The procedure was successful in 585 cases (83.2%), whereas unsuccessful in 118 (16.8%) of 703 patients (94.0%) with viable bowel. The mortality rate was 0.5% (4 patients), the morbidity rate was 1.9% (14 patients), the early recurrence rate was 5.5% (32 patients), whereas the mean hospitalization period was 34.6 hours (range: 24-96 hours). Conclusions: Despite some controversies or limitations in some subjects including the strategy in ischemic or gangrenous cases, the factors affecting the success, kind of the used instruments, technical details of the application, role of the flatus tubes, and the specific topics such as SV in childhood or pregnancy, endoscopic decompression is the first-line therapy in selected patients with SV.
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20
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Atamanalp SS. Comments on "Endoscopic Management of Sigmoid Volvulus in a Debilitated Population: What Relevance?". GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2021; 28:374-375. [PMID: 34604473 DOI: 10.1159/000512073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 09/25/2020] [Indexed: 11/19/2022]
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21
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Alavi K, Poylin V, Davids JS, Patel SV, Felder S, Valente MA, Paquette IM, Feingold DL. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Colonic Volvulus and Acute Colonic Pseudo-Obstruction. Dis Colon Rectum 2021; 64:1046-1057. [PMID: 34016826 DOI: 10.1097/dcr.0000000000002159] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Karim Alavi
- University of Massachusetts Medical School, Worcester, Massachusetts
| | | | - Jennifer S Davids
- University of Massachusetts Medical School, Worcester, Massachusetts
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22
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Mongold S, Inman B, Long B, Cibrario A, Bridwell RE. Sigmoid volvulus after trauma, an uncommon twist: A case report. Am J Emerg Med 2021; 52:269.e3-269.e5. [PMID: 34511286 DOI: 10.1016/j.ajem.2021.08.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/10/2021] [Accepted: 08/17/2021] [Indexed: 12/13/2022] Open
Abstract
Sigmoid volvulus occurs when a portion of sigmoid colon twists around its blood supply at the base of the mesentery, causing ischemia and necrosis. In developed nations, this is most commonly a condition of elderly, bed-bound, chronically constipated individuals. However, this condition may occur after blunt abdominal trauma, especially in individuals with underlying anatomic derangements from the aforementioned conditions. We present a unique case of sigmoid volvulus in a patient with no pre-existing abdominal complaints or surgical history, who sustained blunt traumatic injuries when she was struck by a motor vehicle. Prompt recognition of this deadly condition by emergency clinicians facilitated rapid surgical correction and mitigated further morbidity and mortality.
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Affiliation(s)
- Sarah Mongold
- Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States.
| | - Brannon Inman
- Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States
| | - Brit Long
- Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States
| | - Amber Cibrario
- Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States
| | - Rachel E Bridwell
- Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States
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23
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Hong JT. Current Opinion on Prucalopride in Gastroparesis and Chronic Constipation Treatment: A Focus on Patient Selection and Safety. Ther Clin Risk Manag 2021; 17:601-615. [PMID: 34135588 PMCID: PMC8197617 DOI: 10.2147/tcrm.s269330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/27/2021] [Indexed: 12/12/2022] Open
Abstract
Prucalopride is a third-generation, highly selective 5-hydroxytryptamine 4 (5-HT4) receptor agonist. Many recent studies indicate prucalopride may play an important role in various motility disorders. The aim of this study was to investigate safety and patient selection considerations when using prucalopride as gastroparesis and chronic constipation treatment. We systematically searched PubMed, Embase, the Cochrane Central Register and ClinicalTrials.gov, and we reviewed all studies that evaluated prucalopride for the treatment of gastroparesis and chronic idiopathic constipation in adults. Prucalopride is an effective and safe option based on all the studies currently conducted. Thus, it may be the first-line treatment in the future. Prucalopride has the potential to be useful in the treatment of functional constipation and other forms of gastrointestinal diseases (eg, gastroparesis). Through the research on this potential, prucalopride is expected to be a useful and versatile option for treating gastrointestinal diseases in the future.
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Affiliation(s)
- Ji Taek Hong
- Division of Gastroenterology, Department of Medicine, Ewha Womans University College of Medicine, Seoul, Korea
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24
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Atamanalp SS. Comments on "Surgical Management of Sigmoid Volvulus: A Multicenter Observational Study". Ann Coloproctol 2021; 37:73-74. [PMID: 33979906 PMCID: PMC8134924 DOI: 10.3393/ac.2021.01.27] [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: 01/05/2021] [Accepted: 01/27/2021] [Indexed: 11/26/2022] Open
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25
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Atamanalp SS. Commentary on 'Evaluating outcomes of primary anastomosis versus Hartmann's procedure in sigmoid volvulus: A retrospective-cohort study'. Ann Med Surg (Lond) 2021; 64:102172. [PMID: 33898023 PMCID: PMC8053888 DOI: 10.1016/j.amsu.2021.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/03/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Sabri Selcuk Atamanalp
- Department of General Surgery, Faculty of Medicine, Ataturk University, 25040, Erzurum, Turkey
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26
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Joshi P, Kim CH, Das D, Reid B, Mar PL. Twists and Turns: An Unusual Intra-Abdominal Cause of Heart Failure. Am J Med 2021; 134:e44-e45. [PMID: 32628913 DOI: 10.1016/j.amjmed.2020.05.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Parth Joshi
- Saint Louis University School of Medicine, St. Louis, MO
| | - Chu Hyun Kim
- Saint Louis University School of Medicine, St. Louis, MO
| | - Debapria Das
- Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO
| | - Benjamin Reid
- Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO
| | - Philip L Mar
- Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO.
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27
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Lourenço S, Pereira AM, Guimarães M, Nora M. Gastric Volvulus: A Complication of Hiatal Hernia. Cureus 2020; 12:e11123. [PMID: 33240716 PMCID: PMC7682922 DOI: 10.7759/cureus.11123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Gastric volvulus is a rare but potentially life-threatening condition, with difficult diagnosis. We present a case report of a demented woman aged 65 years that attended the emergency department with epigastric pain and vomiting for the past 10 days. The chest plain revealed a retrocardiac air-filled mass and the abdomino-pelvic computed tomography confirmed the diagnosis of gastric volvulus. The patient was admitted. A nasogastric tube was introduced, antibiotics and parenteric nutrition were started and the patient didn't eat anything. The patient was operated at fifth day of admission by laparoscopy. There weren't signs of gastric necrosis, so the stomach was mobilized for its natural position on abdominal cavity, the hiatal defect was closed and a Nissen fundoplicature was performed. The post operative period was uneventful and the patient was discharged on the third post-operative day, without any complication. This case illustrates a sub acute presentation form of gastric volvulus and a differed minimally invasive approach attending at the patient's clinical stability.
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Affiliation(s)
- Sara Lourenço
- General Surgery, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, PRT
| | - Ana Marta Pereira
- General Surgery, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, PRT
| | - Marta Guimarães
- General Surgery, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, PRT
| | - Mário Nora
- General Surgery, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, PRT
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28
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Shokraneh K, Johnson J, Cabrera G, Kalivoda EJ. Emergency Physician-Performed Bedside Ultrasound of Gastric Volvulus. Cureus 2020; 12:e9946. [PMID: 32968605 PMCID: PMC7505670 DOI: 10.7759/cureus.9946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Gastric volvulus (GV) is a seldomly encountered life-threatening condition that necessitates rapid diagnosis in the emergency department (ED). The diagnosis of GV is traditionally established with cross-sectional imaging and/or endoscopy with surgical confirmation. The potential role of point-of-care ultrasound (POCUS) as a bedside tool to support the early identification of GV by emergency physicians (EPs) has not been thoroughly investigated. This case report describes the expeditious diagnosis and ED management of acute GV by implementing EP-performed POCUS into critical decision making.
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Affiliation(s)
- Keyon Shokraneh
- Emergency Medicine, Hospital Corporation of America Healthcare West Florida Graduate Medical Education Consortium/University of South Florida Morsani College of Medicine, Brandon Regional Hospital, Brandon, USA
| | - Jordan Johnson
- Emergency Medicine, Hospital Corporation of America Healthcare West Florida Graduate Medical Education Consortium/University of South Florida Morsani College of Medicine, Brandon Regional Hospital, Brandon, USA
| | - Gabriel Cabrera
- Emergency Medicine, Hospital Corporation of America Healthcare West Florida Graduate Medical Education Consortium/University of South Florida Morsani College of Medicine, Brandon Regional Hospital, Brandon, USA
| | - Eric J Kalivoda
- Emergency Medicine, Hospital Corporation of America Healthcare West Florida Graduate Medical Education Consortium/University of South Florida Morsani College of Medicine, Brandon Regional Hospital, Brandon, USA
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29
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Pandit N, Kumar A, Yadav TN, Irfan QA, Gautam S, Awale L. Diagnosing gastric volvulus in chest X-ray: report of three cases. J Surg Case Rep 2020. [DOI: 10.1093/jscr/rjaa229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Gastric volvulus is a rare abnormal rotation of the stomach along its axis. It is a surgical emergency, hence requires prompt diagnosis and treatment to prevent life-threatening gangrenous changes. Hence, a high index of suspicion is required in any patients presenting with an acute abdomen in emergency. The entity can present acutely with pain abdomen and vomiting, or as chronic with non-specific symptoms. Chest X-ray findings to diagnose it may be overlooked in patients with acute abdomen. Here, we report three patients with gastric volvulus, where the diagnosis was based on the chest X-ray findings, confirmed with computed tomography, and managed successfully with surgery.
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Affiliation(s)
- Narendra Pandit
- Division of Surgical Gastroenterology, Department of Surgery, B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Abhijeet Kumar
- Department of Surgery, B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Tek Narayan Yadav
- Division of Surgical Gastroenterology, Department of Surgery, B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Qamar Alam Irfan
- Department of Surgery, B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Sujan Gautam
- Division of Surgical Gastroenterology, Department of Surgery, B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Laligen Awale
- Division of Surgical Gastroenterology, Department of Surgery, B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
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30
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Comments on 'Recurrent sigmoid volvulus in a patient with Parkinson's disease'. Clin Auton Res 2020; 30:593. [PMID: 32592070 DOI: 10.1007/s10286-020-00707-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/20/2020] [Indexed: 10/24/2022]
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31
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Bappayya S, Tsai HH, Bui H. Intermittent caecal volvulus: a rare cause of right iliac fossa pain in patients with previous right oophorectomy. ANZ J Surg 2020; 90:2577-2579. [PMID: 32353203 DOI: 10.1111/ans.15946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/17/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Shaneel Bappayya
- Department of Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Hao-Hsuan Tsai
- Department of Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Hai Bui
- Department of Surgery, Western Health, Melbourne, Victoria, Australia
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32
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Hosokawa T, Hosokawa M, Tanami Y, Sato Y, Ishimaru T, Tanaka Y, Kawashima H, Oguma E. Use of ultrasound findings to predict bowel ischemic changes in pediatric patients with intestinal volvulus. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:683-692. [PMID: 31642550 DOI: 10.1002/jum.15145] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/29/2019] [Accepted: 09/15/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Early diagnosis and prompt surgical intervention are important to prevent intestinal necrosis in patients with volvulus. The purpose of this study was to determine which ultrasound (US) findings may predict bowel ischemic changes in pediatric patients with intestinal volvulus. METHODS Thirty-one pediatric patients with surgically proven intestinal volvulus were retrospectively reviewed. We compared the demographics and US findings (eg, superior mesenteric artery collapse, ascites, echogenic ascites, and degree of intestinal twist) between patients with and without bowel ischemic changes during surgery. Data are presented as median and range. The Fisher exact test, Mann-Whitney U test, and Wilcoxon signed rank sum test were used for statistical analyses. RESULTS Eleven patients had bowel ischemic changes. Significant differences existed between patients with and without ischemic changes for age (2 days [range, 0-137 days] versus 6.5 days [range, 2-1618 days]; P = .02), superior mesenteric artery collapse (present/absent, 10/1 versus 9/11 patients; P = .02), the presence of ascites (present/absent, 8/3 versus 6/14 patients; P = .03), and intestinal twist degree on US imaging (540° [range, 180°-720°] versus 360° [range, 180°-720°]; P = .02). The groups did not significantly differ for sex, the time from the US examination to the operation, or echogenic ascites. The intestinal twist degree insignificantly differed between US and surgical findings (360° [range, 180°-720°] versus 360° [range, 0°-1080°]; P = .36). CONCLUSIONS The presence of superior mesenteric artery collapse, ascites, and a large intestinal twist on US imaging were significant predictors of intestinal ischemic changes. Pediatric surgeons should perform prompt surgical interventions in cases of volvulus with these US findings.
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Affiliation(s)
- Takahiro Hosokawa
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Mayumi Hosokawa
- Department of Pediatrics, Saitama City Hospital, Saitama, Japan
| | - Yutaka Tanami
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yumiko Sato
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | | | - Yujiro Tanaka
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Eiji Oguma
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
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33
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Atamanalp SS. "Sigmoid volvulus sonrası tanı konulan diyafram evantrasyonu ve çoklu organ anomali birlikteliği' makalesi üzerine tartışmalar. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.550671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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34
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Tsang CLN, Joseph CT, De Robles MSB, Putnis S. Primary Small Bowel Volvulus: An Unusual Cause of Small Bowel Obstruction. Cureus 2019; 11:e6465. [PMID: 32025394 PMCID: PMC6977574 DOI: 10.7759/cureus.6465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We present the case of a 78-year-old female who presented to the emergency department with small bowel obstruction in a virgin abdomen. Although the patient did not have peritonism and biochemical investigations did not reveal alarming features of ischemia, an abdominal computed tomography (CT) scan was suggestive of small bowel volvulus (SBV), and operative exploration was pursued. No obvious cause was identified aside from hard stools throughout the colon and a diagnosis of primary SBV was determined. She was subsequently discharged symptom-free on day seven post-operatively. She re-presented on day 10 post-operatively with a similar history, examination, and abdominal CT findings suggestive of SBV recurrence. Her volvulus slowly resolved post administration of rectal enemas and did not require any further operative intervention; she was discharged on day eight of re-admission (day 19 post-operatively) with no recurrence of her symptoms on a regular diet. In this article, we discuss the management of SBV.
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Affiliation(s)
| | | | | | - Soni Putnis
- Colorectal Surgery, The Wollongong Hospital, Wollongong, AUS
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35
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Jervis MJ, Candeias R, Duro E, Pereira LG, Caratão F. Chronic gastric volvulus-Case report of an uncommon diagnosis. Int J Surg Case Rep 2019; 66:139-142. [PMID: 31841973 PMCID: PMC6920226 DOI: 10.1016/j.ijscr.2019.11.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/16/2019] [Indexed: 01/18/2023] Open
Abstract
Chronic gastric volvulus is an uncommon condition. The diagnosis of a chronic gastric volvulus requires a high index of suspicion. Surgical repair should be done to prevent an acute complication, associated with higher morbidity and mortality.
Introduction Gastric volvulus is an uncommon condition that results from the torsion of the stomach upon its axis. Although rare, it can present as an acute medical emergency, therefore its diagnosis should not be overlooked. In this article we aim to present a case of a patient with chronic gastric volvulus operated in our hospital. We also aim to discuss this condition. Presentation of case We report the case of a 61 year old, healthy male, referred to surgical consultation complaining of epigastric discomfort and postprandial fullness. The diagnostic workup showed a mesentero-axial volvulus of the stomach. He was operated electively: reduction of volvulus, Nissen fundoplication and gastropexy was performed, with resolution of symptoms. Discussion There are several predisposing factors for the development of a gastric volvulus. It is classified according to the axis upon the rotation of the stomach occurs. The treatment of gastric volvulus may differ in the acute or chronic setting. Conclusion Diagnosis of a chronic gastric volvulus requires a high index of suspicion. Surgical repair should be done to prevent an acute complication.
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Affiliation(s)
- M J Jervis
- Local Health Unit of the Lower Alentejo, General Surgery Department. Rua Dr. António Ferreira Covas Lima, 7801-849, Beja, Portugal.
| | - R Candeias
- Local Health Unit of the Lower Alentejo, General Surgery Department. Rua Dr. António Ferreira Covas Lima, 7801-849, Beja, Portugal.
| | - E Duro
- Local Health Unit of the Lower Alentejo, General Surgery Department. Rua Dr. António Ferreira Covas Lima, 7801-849, Beja, Portugal.
| | - L G Pereira
- Local Health Unit of the Lower Alentejo, General Surgery Department. Rua Dr. António Ferreira Covas Lima, 7801-849, Beja, Portugal.
| | - F Caratão
- Local Health Unit of the Lower Alentejo, General Surgery Department. Rua Dr. António Ferreira Covas Lima, 7801-849, Beja, Portugal.
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36
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Bong CY, Yuide PJ, Burstow MJ, Chua TC. Sigmoid volvulus: mischief from a gravid uterus. ANZ J Surg 2019; 90:1173-1174. [PMID: 31628707 DOI: 10.1111/ans.15466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/20/2019] [Accepted: 08/22/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Christopher Y Bong
- Department of Surgery, Logan Hospital, Metro South Health, Logan City, Queensland, Australia
| | - Peter J Yuide
- Department of Surgery, Logan Hospital, Metro South Health, Logan City, Queensland, Australia
| | - Matthew J Burstow
- Department of Surgery, Logan Hospital, Metro South Health, Logan City, Queensland, Australia
| | - Terence C Chua
- Department of Surgery, Logan Hospital, Metro South Health, Logan City, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
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Catena F, De Simone B, Coccolini F, Di Saverio S, Sartelli M, Ansaloni L. Bowel obstruction: a narrative review for all physicians. World J Emerg Surg 2019; 14:20. [PMID: 31168315 PMCID: PMC6489175 DOI: 10.1186/s13017-019-0240-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/10/2019] [Indexed: 12/13/2022] Open
Abstract
Small and large bowel obstructions are responsible for approximately 15% of hospital admissions for acute abdominal pain in the USA and ~ 20% of cases needing acute surgical care. Starting from the analysis of a common clinical problem, we want to guide primary care physicians in the initial management of a patient presenting with acute abdominal pain associated with intestinal obstruction.
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Affiliation(s)
- Fausto Catena
- 1Emergency and Trauma Surgery Department, Parma University Hospital, Via Gramsci 14, 43126 Parma, Italy
| | - Belinda De Simone
- 1Emergency and Trauma Surgery Department, Parma University Hospital, Via Gramsci 14, 43126 Parma, Italy
| | | | | | | | - Luca Ansaloni
- Emergency and Trauma Surgery Department, Cesena Hospital, Cesena, Italy
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Lupon E, Labbe F, Nini E, Sondji S. Hirschsprung disease in an adult with intestinal malrotation and volvulus: an exceptional association. J Med Case Rep 2019; 13:124. [PMID: 31030669 PMCID: PMC6487523 DOI: 10.1186/s13256-019-2020-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 02/18/2019] [Indexed: 12/13/2022] Open
Abstract
Background Hirschsprung disease is a neonatal discovery in almost all cases, and the association of Hirschsprung disease in adults with symptomatic intestinal malrotation is unusual. This combination delays diagnosis and can lead to mistake in surgical strategy. Case presentation A 43-year-old patient with a history of colectomy for colonic inertia and megadolichocolon was admitted to the Carcassonne Hospital emergency room for a volvulus of small bowel obstruction in a chronic intestinal obstruction context with episodes of acute, variable-looking occlusive syndromes. Intestinal malrotation was discovered during surgical small bowel detorsion. The acute occlusion syndrome recurred after the procedure. In view of the unfavorable evolution, an emptying of the dilated small bowel and a discharge ileostomy upstream of the rectum were performed. In the face of postoperative improvement, rectal manometry and deep full parietal rectal biopsies made it possible to highlight the diagnosis of Hirschsprung disease. The patient thus had functional acute occlusive syndromes and chronic occlusion due to Hirschsprung disease of attenuated form and acute organic occlusive syndromes related to her incomplete common mesentery. Conclusions This rare association, which may be responsible for delayed diagnostic and therapeutic wandering, highlights the importance of performing manometry and deep full parietal biopsies before a colectomy for colonic inertia, as well as the possibility of suggesting a common Hirschsprung disease and/or mesentery in an adult with multiple occlusive syndromes of variable appearance.
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Affiliation(s)
- Elise Lupon
- Department of Plastic Surgery, University Toulouse III Paul Sabatier, 1 Avenue du Pr jean Poulhes, 31400, Toulouse, France.
| | - François Labbe
- Department of Visceral Surgery, Carcassonne Hospital, 1060 Chemin de la Madeleine, 111000, Carcassonne, France
| | - Emile Nini
- Department of Visceral Surgery, Carcassonne Hospital, 1060 Chemin de la Madeleine, 111000, Carcassonne, France
| | - Sixte Sondji
- Department of Visceral Surgery, Carcassonne Hospital, 1060 Chemin de la Madeleine, 111000, Carcassonne, France
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