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Josyabhatla R, Tatevian N, Tchakarov AS, Cox CS, Van Arsdall MR. Chronic Diarrhea in an Infant With Malrotation: A Diagnostic Dilemma. JPGN REPORTS 2022; 3:e177. [PMID: 37168912 PMCID: PMC10158313 DOI: 10.1097/pg9.0000000000000177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 01/10/2022] [Indexed: 05/13/2023]
Abstract
In children, diarrhea has a global incidence of 2.7 episodes per child-year and contributes to significant disease burden and mortality in children under 5 years of age. Chronic diarrhea, defined as diarrhea lasting for more than 2 weeks, may be particularly challenging to evaluate and manage in children under 2 years of age. While most have infectious enteritis or cow milk protein intolerance, others have conditions such as malnutrition, anatomic abnormalities, or congenital enteropathies that can be challenging to diagnose and treat. We present here a complex case of chronic diarrhea in an infant and highlight such diagnostic and therapeutic challenges.
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Affiliation(s)
- Rohit Josyabhatla
- From the Department of Pediatrics, Division of Pediatric Gastroenterology, UTHealth McGovern Medical School, Houston, TX
| | - Nina Tatevian
- Department of Pathology and Laboratory Medicine, UTHealth McGovern Medical School, Houston, TX; and
| | - Amanda S. Tchakarov
- Department of Pathology and Laboratory Medicine, UTHealth McGovern Medical School, Houston, TX; and
| | - Charles S. Cox
- Department of Pediatric Surgery, UTHealth McGovern Medical School, Houston, TX
| | - Melissa R. Van Arsdall
- From the Department of Pediatrics, Division of Pediatric Gastroenterology, UTHealth McGovern Medical School, Houston, TX
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Çakmak AM, Boybeyi Türer Ö, Göllü Bahadir G, Türedi B, Ateş U, Yildiz AE, Küçük G, Fitöz ÖS, Ulukol B, Aslan MK, Soyer T, Dindar H. Assessment of developmental and radiological long-term outcomeof children with surgically treated midgut volvulus. Turk J Med Sci 2017; 47:633-637. [PMID: 28425258 DOI: 10.3906/sag-1512-89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 10/21/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM The aim is to evaluate the long-term outcome of asymptomatic patients who underwent surgical correction for midgut volvulus. MATERIALS AND METHODS Seven patients managed surgically for midgut volvulus in the last 3 years were included. Demographic features, symptoms at presentation, diagnoses, surgical procedures, and complications were recorded. Patients were then contacted for follow-up and evaluation of long-term outcomes. General physical conditions, anthropometric parameters, feeding habits, and defecation histories were evaluated. Laboratory examinations were performed. Color Doppler ultrasonography (CDUS) was performed to evaluate blood flow in the superior mesenteric artery (SMA). RESULTS In total, seven patients were identified. The median age at admission was 3 days (0-90 days). Mean age at follow-up was 17 ± 2 months. Growth parameters were normal in all cases. Four patients had low levels of ferritin and transferrin saturation. One patient had microcytic anemia. Another patient had low serum zinc level. One patient who had ileal resection had a high level of steatorrhea in stool examination. In CDUS, SMA blood flow volume was low in all cases. Peak-systolic velocity and resistance index were low in all but one case. CONCLUSION Despite uneventful postoperative courses, all patients operated on for midgut volvulus showed mild laboratory changes and decreased blood flow in the SMA in long-term follow-up.
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Affiliation(s)
- Ahmet Murat Çakmak
- Department of Pediatric Surgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Özlem Boybeyi Türer
- Department of Pediatric Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gülnur Göllü Bahadir
- Department of Pediatric Surgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Bilge Türedi
- Department of Pediatric Surgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ufuk Ateş
- Department of Pediatric Surgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Adalet Elçin Yildiz
- Department of Radiology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Gönül Küçük
- Department of Pediatric Surgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ömer Suat Fitöz
- Department of Radiology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Betül Ulukol
- Department of Pediatrics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | | | - Tutku Soyer
- Department of Pediatric Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hüseyin Dindar
- Department of Pediatric Surgery, Faculty of Medicine, Ankara University, Ankara, Turkey
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Biçer Ş, Çelik A. Duodenal Obstruction Caused by Acute Appendicitis with Intestinal Malrotation in a Child. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:574-6. [PMID: 26317163 PMCID: PMC4554333 DOI: 10.12659/ajcr.894311] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Patient: Male, 14 Final Diagnosis: Duodenal obstruction Symptoms: Bilious vomiting Medication: None Clinical Procedure: Laparotomy Specialty: Surgery
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Affiliation(s)
- Şenol Biçer
- Department of Pediatric Surgery, Erzincan University, Medical School, Erzincan, Turkey
| | - Ali Çelik
- Department of General Surgery, Konya State Hospital, Konya, Turkey
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Patel RV, Jackson P, Zani A, De Coppi P. Laparoscopic management of midgut malrotation and tuberculous peritonitis in an adolescent boy. BMJ Case Rep 2014; 2014:bcr-2013-200714. [PMID: 24969067 PMCID: PMC4078532 DOI: 10.1136/bcr-2013-200714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
An unusual case of miliary plastic peritonitis associated with midgut malrotation in an adolescent in whom various diagnostic investigations, medical management and staged initial laparoscopic diagnostic followed by therapeutic procedure was curative have been presented. Tuberculous miliary plastic peritonitis causes dense adhesions between bowel loops and prevents midgut volvulus in a pre-existing malrotation. Diagnosis can be a challenge and threshold for diagnostic laparoscopy should be low. Interval correction of malrotation by laparoscopy after complete resolution of tuberculosis is easy, safe and effective, and cosmetically more pleasing. Midgut malrotation is a congenital anomaly referring to either lack of or incomplete rotation of fetal axis around the axis of superior mesenteric artery during fetal development. Most patients present with bilious vomiting in the first month of life because of duodenal obstruction or a volvulus. This is an unusual case of midgut malrotation in association with tuberculous peritonitis in an adolescent boy.
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Affiliation(s)
- Ramnik V Patel
- Department of Paediatric Urology, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Paediatric Urology, Great Ormond Street Children's Hospital NHS Trust, London, UK
| | - Paul Jackson
- Department of Paediatric Surgery, GOSH and ICH, London, UK
| | - Augusto Zani
- Department of Paediatric Surgery, GOSH and ICH, London, UK
| | - Paolo De Coppi
- Department of Paediatric Surgery, GOSH and ICH, London, UK
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Sawaguchi M, Jin M, Matsuhashi T, Ohba R, Hatakeyama N, Koizumi S, Onochi K, Tawaraya S, Watanabe N, Uchinami H, Yamamoto Y, Ohnishi H, Mashima H. Duodenocolic fistula caused by a peptic stomal ulcer following distal gastrectomy. Intern Med 2013; 52:1579-83. [PMID: 23857089 DOI: 10.2169/internalmedicine.52.0496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein describe the case of a 51-year-old man with a duodenocolic fistula (DCF) caused by a stomal ulcer. The patient complained of watery diarrhea, dysgeusia and malnutrition. His medical history included distal gastrectomy with Billroth I reconstruction for duodenal ulcer perforation. A combination study using endoscopy and contrast imaging confirmed the presence of DCF. Laparotomic fistulectomy was performed, which resulted in the patient's recovery from diarrhea and malnutrition. The histological findings suggested that the fistula had originated from a stomal ulcer. In patients with chronic watery diarrhea of obscure origin following gastrectomy, DCF is a possible cause of the diarrhea.
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Affiliation(s)
- Masayuki Sawaguchi
- Department of Gastroenterology, Akita University Graduate School of Medicine, Japan
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Zellos A, Zarganis D, Ypsiladis S, Chatzis D, Papaioannou G, Bartsocas C. Malrotation of the intestine and chronic volvulus as a cause of protein-losing enteropathy in infancy. Pediatrics 2012; 129:e515-8. [PMID: 22271689 DOI: 10.1542/peds.2011-0937] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Protein-losing enteropathy in children is caused by intestinal metabolic, inflammatory, or infectious processes, or by lymphatic obstruction (intestinal lymphangiectasia). In this report, a 17-month-old child is presented with protein-losing enteropathy due to intestinal malrotation and chronic midgut volvulus causing lymphatic obstruction and spillage of lymph in the intestine and the peritoneum. This report should alert the pediatrician that intestinal malrotation should be added to the wide list of possible causes of protein-losing enteropathy in children.
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Affiliation(s)
- Aglaia Zellos
- First Department of Pediatrics, University of Athens School of Medicine, Athens, Greece.
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Prasad TRS, Low Y, Tan CE, Jacobsen AS. Swallowed Foreign Bodies in Children: Report of Four Unusual Cases. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2006. [DOI: 10.47102/annals-acadmedsg.v35n1p49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Introduction: Although a majority of ingested foreign bodies (FBs) pass down the gastrointestinal tract spontaneously, those that are sharp, pointed or large in size need removal to avert serious complications. We highlight the urgent need and utility of endoscopic accessories and technical artistry in safe retrieval of FBs in children.
Clinical Picture: Four children had accidentally swallowed a nail, metallic dumbbell, open safety pin and a cushion pin respectively. They were symptom-free and the abdominal plain radiographs revealed foreign body in the stomach in all the cases.
Treatment: Oesophago-gastro-duodenoscopy (OGD) was done in all the patients and could retrieve the nail, metallic dumbbell and open safety pin successfully using a Dormia basket, a polypectomy snare and a pair of rat-tooth forceps respectively. The cushion pin had migrated to the duodeno-jejunal junction within 4 hours of ingestion and necessitated open duodenotomy and retrieval.
Outcome: All patients did well after the procedure with no complications.
Conclusions: Swallowed FBs with pointed or sharp ends or large enough to cross the pylorus and duodenal sweep need removal and in the majority of the cases they can be retrieved by OGD. Sharp or pointed FBs that have crossed the second part of the duodenum necessitate urgent laparotomy for retrieval to prevent complications.
Key words: Complications, Ingestion, Treatment
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Affiliation(s)
| | - Y Low
- KK Women’s and Children’s Hospital, Singapore
| | - CE Tan
- KK Women’s and Children’s Hospital, Singapore
| | - AS Jacobsen
- KK Women’s and Children’s Hospital, Singapore
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Berrocal T, Gayá F, de Pablo L. Aspectos embriológicos, clínicos y radiológicos de la malrotación intestinal. RADIOLOGIA 2005. [DOI: 10.1016/s0033-8338(05)72843-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Romano S, Tortora G, Palomba R, de Stefano G, Merola S, Romano L. MDCT findings of intestinal ischemia due to midgut torsion without small bowel obstruction in a 12-year-old boy. Emerg Radiol 2005; 11:236-8. [PMID: 16133613 DOI: 10.1007/s10140-005-0401-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2004] [Accepted: 12/20/2004] [Indexed: 01/13/2023]
Abstract
Intestinal ischemia in the pediatric age group is a rare occurrence. We describe a case of MDCT findings of ischemia due to midgut torsion without intestinal obstruction in a 12-year-old boy, successfully submitted to surgery without any intestinal resection required.
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Affiliation(s)
- Stefania Romano
- Department of Diagnostic Imaging, A. Cardarelli Hospital, Naples, Italy.
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