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Kazumori H, Sato T. Ileus tube-assisted endoscopic detorsion as a useful initial management for cecal volvulus in a patient with septic shock. Endoscopy 2024; 56:E334-E335. [PMID: 38594007 PMCID: PMC11003802 DOI: 10.1055/a-2291-9675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Affiliation(s)
- Hideaki Kazumori
- Department of Gastroenterology, Matsue Seikyo General Hospital, Matsue, Japan
| | - Takashi Sato
- Department of Surgery, Matsue Seikyo General Hospital, Matsue, Japan
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2
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Chauhan S, Shinde RK, Jain Y. Navigating Abdominal Volvulus: A Comprehensive Review of Management Strategies. Cureus 2024; 16:e57978. [PMID: 38738029 PMCID: PMC11086050 DOI: 10.7759/cureus.57978] [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] [Received: 03/20/2024] [Accepted: 04/10/2024] [Indexed: 05/14/2024] Open
Abstract
Abdominal volvulus represents a critical condition characterized by the abnormal twisting of the GI tract, potentially leading to obstruction and vascular compromise. Prompt recognition and appropriate management are essential to prevent complications and improve patient outcomes. This comprehensive review examines the anatomy, pathophysiology, clinical presentation, and diagnostic evaluation of, and management strategies for abdominal volvulus. Non-operative techniques, including detorsion and decompression, as well as surgical interventions, such as laparoscopic and open approaches, are discussed. Additionally, the importance of multidisciplinary collaboration and postoperative care is emphasized. Despite significant advancements, unresolved issues remain, necessitating further research to refine diagnostic and therapeutic approaches. Future directions, including exploring emerging technologies, offer promise for enhancing the management of this challenging condition. Overall, this review provides clinicians with valuable insights into the optimal management of abdominal volvulus, aiming to improve patient outcomes and enhance clinical practice.
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Affiliation(s)
- Simran Chauhan
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Raju K Shinde
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Yashraj Jain
- General Surgery, Rajshree Nursing Home, Ashoknagar, IND
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3
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Ramanathan B, Ramachandran V, Tan K. A Case Report of Appendicitis Causing Cecal Volvulus: A Rare Occurrence. Cureus 2024; 16:e58505. [PMID: 38765396 PMCID: PMC11101983 DOI: 10.7759/cureus.58505] [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: 04/16/2024] [Indexed: 05/22/2024] Open
Abstract
This case report presents a fascinating scenario involving a 60-year-old female who was diagnosed with cecal volvulus secondary to appendicitis. The patient's initial presentation included a three-day history of periumbilical pain accompanied by reduced oral intake and an inability to pass stool. Through a systematic approach involving detailed history-taking, comprehensive physical examinations, and pertinent imaging studies, a precise diagnosis of cecal volvulus induced by appendicitis was established. Subsequently, the patient underwent a timely operation, leading to a successful resolution of her condition and a remarkably swift recovery post-surgery. This unique case prompts a deeper exploration into the incidence and management of this rare phenomenon, where the seemingly unrelated condition of appendicitis precipitated a cecal volvulus. Given the unusual nature of this presentation, it underscores the importance of considering atypical etiologies in patients presenting with signs and symptoms of bowel obstruction. This discussion aims to shed light on the diagnostic challenges, treatment strategies, and outcomes associated with this intriguing interplay of pathologies, offering valuable insights for clinicians encountering similar cases in their practice.
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Affiliation(s)
| | | | - Kimberley Tan
- Department of Surgery, Lyell McEwin Hospital, Adelaide, AUS
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4
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Alhelal A, Assiri AM, Alqarni AA, Tamim A, Mohammad YM. A Case of Necrotic Colonic Volvulus in Cerebral Palsy With Severe Scoliosis. Cureus 2024; 16:e56743. [PMID: 38650790 PMCID: PMC11033219 DOI: 10.7759/cureus.56743] [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: 03/22/2024] [Indexed: 04/25/2024] Open
Abstract
Cerebral palsy (CP) is a neurodevelopmental disorder that affects motor function and is often accompanied by secondary musculoskeletal issues. Severe scoliosis, a lateral curvature of the spine over 40 degrees, poses a significant challenge for individuals with CP, impacting their mobility and overall well-being. While the association between scoliosis and gastrointestinal complications is acknowledged, the occurrence of colonic volvulus with necrosis in the context of CP and severe scoliosis is rare and complex. This case report emphasizes the importance of clinical awareness in managing gastrointestinal complications in patients with CP and severe scoliosis. An 11-year-old female presented with gastroenteritis and a concurrent viral upper respiratory tract infection. She experienced complications such as greenish vomiting, hematemesis, abdominal distention, and constipation. The patient has a medical history of epilepsy and was diagnosed with quadriplegic CP at four months old due to viral meningitis. She is currently on anti-epileptic medications and receives regular follow-ups with neurology. Severe lumbar scoliosis of more than 50 degrees Cobb angle is also noted. Physical examination revealed dehydration, bilious content in nasogastric tube (NGT) aspiration, tender abdomen, and an empty digital rectal examination. Some laboratory findings showed elevated levels of erythrocyte sedimentation rate (ESR), prothrombin time (PT), blood urea nitrogen (BUN), and sodium, while albumin levels were decreased, and white blood cell (WBC) count was mildly elevated. Abdominal computed tomography (CT) with contrast showed a distended ascending colon with air and swirling of the mesentery. The distal half of the large bowel was not dilated, and fecal matter was present. The small bowel appeared to be collapsed, and there was moderate free fluid in the peritoneal cavity, indicating colonic volvulus involving the proximal large bowel. The patient underwent surgery, which involved deflating and removing the distended colon, resecting the gangrenous colon, and performing an ilio-sigmoid anastomosis to restore gastrointestinal continuity. Postoperatively, the patient received close monitoring in the pediatric intensive care unit (PICU), received total parenteral nutrition (TPN) for five days, gradually progressed feeding, and showed overall improvement in her condition. In conclusion, this case report highlights a rare occurrence of colonic volvulus in a patient with CP and severe scoliosis. It emphasizes the complex relationship between neurological and musculoskeletal disorders in gastrointestinal complications. A multidisciplinary approach is important for optimal management. It shows the importance of musculoskeletal factors in patients with neurological conditions. Overall, it contributes to the medical literature and emphasizes tailored management strategies for gastrointestinal issues in such patients.
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Affiliation(s)
- Abdullah Alhelal
- Pediatric Surgery, Abha Maternity and Children Hospital, Abha, SAU
| | - Ali M Assiri
- Pediatric Surgery, Saudi Ministry of Health, Abha, SAU
| | - Anas A Alqarni
- Medicine and Surgery, College of Medicine, University of Bisha, Bisha, SAU
| | - Abdulrazak Tamim
- Pediatric Surgery, Abha Maternity and Children Hospital, Abha, SAU
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5
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Babatola AO, Ige JT, Adeniyi AT, Abidoye IA, Joseph O, Olorunfunmi J, Ilori BF, Komolafe AK, Olatunya OS. Anasarca as a manifestation of childhood volvulus: Diagnostic and management challenges in an 11-year old Nigerian boy. CASPIAN JOURNAL OF INTERNAL MEDICINE 2023; 14:138-142. [PMID: 36741491 PMCID: PMC9878898 DOI: 10.22088/cjim.14.1.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 02/05/2021] [Accepted: 12/06/2021] [Indexed: 02/07/2023]
Abstract
Background Small intestine volvulus occurs more commonly among younger children. It often poses diagnostic challenges when it occurs in older children and adults. For good clinical outcomes, it is essential to have prompt presentation, diagnosis and early intervention. Anasarca is not a common clinical manifestation of small intestine volvulus. Case Presentation We report this unusual presentation of small intestine volvulus in an 11-year old Nigerian boy who first presented only with anasarca. While being investigated for the cause of the anasarca, he developed features of acute abdomen thought to be spontaneous bacteria peritonitis initially. He had surgery where the diagnosis of small intestine volvulus was made. Conclusion The diagnosis and management of both anasarca and small intestine volvulus could be fraught with challenges. It is possible that anasarca can be the first manifestation of small intestine volvulus.
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Affiliation(s)
- Adefunke Olarinre Babatola
- Department of Pediatrics and Child Health, Ekiti State University Teaching Hospital, Ado Ekiti, Ekiti State, Nigeria,Correspondence: Adefunke Olarinre Babatola, Department of Pediatrics and Child Health, Ekiti State University Teaching Hospital, Ado Ekiti, Ekiti State, Nigeria. E-mail: , Tel: +2348035682315
| | - Joshua Taye Ige
- Department of Surgery, Ekiti State University Teaching Hospital, Ado Ekiti, Ekiti State, Nigeria
| | - Adewuyi Temidayo Adeniyi
- Department of Pediatrics and Child Health, Ekiti State University Teaching Hospital, Ado Ekiti, Ekiti State, Nigeria
| | - Ibukun Anuoluwa Abidoye
- Department of Radiology, Afe Babalola University/Multisystem Hospital, Ado Ekiti, Ekiti State, Nigeria
| | - Olarewaju Joseph
- Department of Surgery, Ekiti State University Teaching Hospital, Ado Ekiti, Ekiti State, Nigeria
| | - Joshua Olorunfunmi
- Department of Surgery, Ekiti State University Teaching Hospital, Ado Ekiti, Ekiti State, Nigeria
| | - Benjamin Folorunsho Ilori
- Department of Pediatrics and Child Health, Ekiti State University Teaching Hospital, Ado Ekiti, Ekiti State, Nigeria
| | - Akinwumi Kolawole Komolafe
- Department of Pediatrics and Child Health, Ekiti State University Teaching Hospital, Ado Ekiti, Ekiti State, Nigeria
| | - Oladele Simeon Olatunya
- Department of Pediatrics and Child Health, Ekiti State University Teaching Hospital, Ado Ekiti, Ekiti State, Nigeria
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6
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Korkut E, Peksoz R, Disci E, Atamanalp SS. Factors affecting recurrence in sigmoid volvulus. Pak J Med Sci 2023; 39:150-153. [PMID: 36694777 PMCID: PMC9842996 DOI: 10.12669/pjms.39.1.6882] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/29/2022] [Accepted: 10/25/2022] [Indexed: 11/15/2022] Open
Abstract
Objectives Recurrence is a relatively common outcome following endoscopic decompression in sigmoid volvulus (SV). This study aims to evaluate the factors affecting recurrence in SV. Methods In 434 patients with SV treated between June 1986 and January 2022, probable recurrence-affecting factors including age, age of SV onset, gender, dietary habit, defecation habit, altitude of living area, and SV attack count were analyzed in prospectively collected data. Results Of 434 patients, 111 (25.6%) had recurrent SV with mean 1.6 ± 2.3 of volvulus episodes (range: 1-21 attacks). SV recurrence demonstrated a significant linear increase with age (14.3%, 17.1%, 21.5%, and 29.9%, respectively, in young, middle aged, mature, and elderly patients, p < 0.001). Recurrent SV was also significantly higher in male gender (28.5% vs 12.7%, p = 0.004), high-fiber diet habit (32.9% vs 17.7%, p < 0.001), and living at high altitude (26.9% vs 12.5%, p = 0.047). Although SV recurrence was higher in patients with chronic constipation, the difference was not significant (36.7% vs. 20.3%, p = 0.594). When compared with that of the patients with mature onset or elderly onset patients, SV attack count was significantly higher in young-onset cases (1.3 ± 0.9 and 1.1 ± 0.3 vs 4.6 ± 6.9, p < 0.001). Conclusion Elderliness, early-onset, maleness, high-fiber diet habit, high altitude, and most likely chronic constipation may be the practical clinical parameters of recurrent SV. These parameters, as well as the presence of previous SV episode history, must be considered in the decision-making process in the elective treatment of SV.
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Affiliation(s)
- Ercan Korkut
- Ercan Korkut MD, Assistant Professor, Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Rifat Peksoz
- Rifat Peksoz MD, Assistant Professor, 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
| | - Sabri Selcuk Atamanalp
- Sabri Selcuk Atamanalp MD, Professor, Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
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7
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Atamanalp SS, Peksöz R, Dişçi E. Sigmoid Volvulus and Ileosigmoid Knotting: An Update. Eurasian J Med 2022; 54:91-96. [PMID: 36655451 PMCID: PMC11163360 DOI: 10.5152/eurasianjmed.2022.22310] [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: 09/05/2022] [Accepted: 11/07/2022] [Indexed: 01/19/2023] Open
Abstract
Sigmoid volvulus and ileosigmoid knotting are uncommon intestinal obstructions, which generally affect adult males. The etiology is multifactorial. Volvulus triad including abdominal pain/tenderness, distention, and obsti pation/constipation is the common clinical presentation. Although x-ray radiography helps with diagnosis, the current diagnostic procedure is computed tomography or magnetic resonance imaging in addition to flexible endoscopy in sigmoid volvulus. Endoscopic decompression is the primary treatment except for the presence of bowel gangrene and peritonitis in sigmoid volvulus, while such conditions and also ileosigmoid knotting require emergency surgery. The prognosis is relatively poor under these adverse circumstances and in ileosigmoid knotting.
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Affiliation(s)
| | - Rıfat Peksöz
- Department of General Surgery, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Esra Dişçi
- Department of General Surgery, Atatürk University Faculty of Medicine, Erzurum, Turkey
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8
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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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9
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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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10
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Belle S. Endoscopic Decompression in Colonic Distension. Visc Med 2021; 37:142-148. [PMID: 33981755 DOI: 10.1159/000514799] [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: 10/17/2020] [Accepted: 01/27/2021] [Indexed: 01/10/2023] Open
Abstract
Background Acute colonic distension is a medical emergency with high morbidity and mortality. Clinically important causes of colonic distension are acute colonic pseudo-obstruction, colonic volvulus, and malignant obstruction. Endoscopic decompression is one established therapeutic strategy. Summary This therapeutic review will give an overview of possible therapeutic strategies based on the recently published literature, focusing on endoscopic decompression and summarizing the other therapeutic possibilities. The review discusses separately the therapeutic options of acute colonic pseudo-obstruction, colonic volvulus, and malignant obstruction, providing an evidence-based orientation for clinical use. Key Messages Endoscopic decompression of colonic distension is an established therapy with high clinical success. The technique and its position in the therapy sequence differ depending on the medical condition, the trigger of the colonic distension, and the local expertise.
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Affiliation(s)
- Sebastian Belle
- Department of Internal Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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11
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Lee K, Oh HK, Cho JR, Kim M, Kim DW, Kang SB, Kim HJ, Park HC, Shin R, Heo SC, Ryoo SB, Park KJ. Surgical Management of Sigmoid Volvulus: A Multicenter Observational Study. Ann Coloproctol 2020; 36:403-408. [PMID: 33486909 PMCID: PMC7837394 DOI: 10.3393/ac.2020.03.23] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/23/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose This study aimed to evaluate real-world clinical outcomes from surgically treated patients for sigmoid volvulus. Methods Five tertiary centers participated in this retrospective study with data collected from October 2003 through September 2018, including demographic information, preoperative clinical data, and information on laparoscopic/open and elective/emergency procedures. Outcome measurements included operation time, postoperative hospitalization, and postoperative morbidity. Results Among 74 patients, sigmoidectomy was the most common procedure (n = 46), followed by Hartmann’s procedure (n = 23), and subtotal colectomy (n = 5). Emergency surgery was performed in 35 cases (47.3%). Of the 35 emergency patients, 34 cases (97.1%) underwent open surgery, and a stoma was established for 26 patients (74.3%). Elective surgery was performed in 39 cases (52.7%), including 21 open procedures (53.8%), and 18 laparoscopic surgeries (46.2%). Median laparoscopic operation time was 180 minutes, while median open surgery time was 130 minutes (P < 0.001). Median postoperative hospitalization was 11 days for laparoscopy and 12 days for open surgery. There were 20 postoperative complications (27.0%), and all were resolved with conservative management. Emergency surgery cases had a higher complication rate than elective surgery cases (40.0% vs. 15.4%, P = 0.034). Conclusion Relative to elective surgery, emergency surgery had a higher rate of postoperative complications, open surgery, and stoma formation. As such, elective laparoscopic surgery after successful sigmoidoscopic decompression may be the optimal clinical option.
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Affiliation(s)
- Keunchul Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Heung-Kwon Oh
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jung Rae Cho
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Minhyun Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Duck-Woo Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sung-Bum Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyung-Jin Kim
- Department of Surgery, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Hyoung-Chul Park
- Department of Colorectal Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Rumi Shin
- Department of Surgery, Seoul Metropolitan GovernmentSeoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Chul Heo
- Department of Surgery, Seoul Metropolitan GovernmentSeoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Bum Ryoo
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyu Joo Park
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Synchronous Volvulus of the Transverse Colon and Cecum Associated with Scleroderma and Lupus. Radiol Case Rep 2020; 16:273-277. [PMID: 33299508 PMCID: PMC7708656 DOI: 10.1016/j.radcr.2020.11.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 11/11/2020] [Indexed: 12/28/2022] Open
Abstract
Colonic volvulus may infrequently occur in the transverse colon, and synchronous double volvulus is a rarely reported phenomenon in the literature. Additionally, intestinal volvulus is a rare but serious complication that has been reported in scleroderma and systemic lupus erythematosus (SLE) patients. We report a 26-year-old patient with a history of scleroderma-SLE overlap syndrome who presented with an acute abdomen. CT imaging revealed a transverse colon volvulus and a cecal bascule (cecal volvulus). To our knowledge, this is the first reported case of synchronous double volvulus of the transverse colon and cecum. Additionally, this is the second reported case of transverse colon volvulus occurring in a patient with scleroderma and the first case in a patient with scleroderma-SLE overlap syndrome.
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Esmat HA. Sigmoid volvulus in a teenager, successfully managed with endoscopic detorsion: An unusual case report and review of the literature. Int J Surg Case Rep 2020; 77:875-879. [PMID: 33395915 PMCID: PMC7732972 DOI: 10.1016/j.ijscr.2020.11.152] [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: 11/20/2020] [Accepted: 11/29/2020] [Indexed: 11/26/2022] Open
Abstract
Sigmoid volvulus is an uncommon cause of bowel obstruction in children and teenagers. Early diagnosis and timely definitive treatment can prevent complications. Endoscopic detorsion is the initial treatment of choice in sigmoid volvulus in the absence of complications. Elective surgery with sigmoid resection and primary anastomosis is mandatory to prevent a recurrence.
Introduction Sigmoid volvulus (SV) occurs due to torsion of a dilated sigmoid colon around its mesenteric axis. This causes venous and arterial blood flow obstruction with progressive bowel ischemia, necrosis, and perforation if left untreated. In pediatric surgical practice volvulus of the sigmoid colon remains a rare occurrence and only a few isolated case reports and case series have been reported. The author presents herein a case of SV in a 19-year-old male. Case report A 19-year-old male was presented to the emergency service of our hospital complaining of abdominal pain, constipation, nausea, and vomiting for 4 days. Radiologic imaging showed the features of the sigmoid volvulus. Endoscopic detorsion was applied and the patient underwent elective surgery for anterior sigmoid resection to prevent the recurrence. Discussion Sigmoid volvulus, first described by von Rokitansky in 1836 and remains a major cause of colonic intestinal obstruction in adults, which results from twisting of the sigmoid colon on its mesentery. The median age in children at presentation is 7 years, ranging from 4 h to 18 years. Conclusion Sigmoid volvulus is an uncommon cause of bowel obstruction in teenagers and should be included in the differential diagnosis of young patients present with abdominal pain and absolute constipation. Early diagnosis and timely definitive treatment can prevent complications. Endoscopic detorsion is the initial treatment of choice in the absence of complications. However, elective surgery with sigmoid resection and primary anastomosis is mandatory to prevent a recurrence.
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Affiliation(s)
- Habib Ahmad Esmat
- Department of Radiology, Kabul University of Medical Sciences, Kabul, Afghanistan; Fellow of Radiology at EGE University Hospital, Izmir, Turkey.
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14
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Purcell LN, Reiss R, Mabedi C, Gallaher J, Maine R, Charles A. Characteristics of Intestinal Volvulus and Risk of Mortality in Malawi. World J Surg 2020; 44:2087-2093. [PMID: 32100066 PMCID: PMC7272273 DOI: 10.1007/s00268-020-05440-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Intestinal volvulus is a common cause of mechanical intestinal obstruction (MIO) in Africa. Sigmoid volvulus has been well characterized in both high-income and low-income countries, but there is also a predilection for small bowel volvulus in sub-Saharan Africa. METHODS An analysis was performed of the Kamuzu Central Hospital Acute Care Surgery Registry from 2013 to 2019 on patients presenting with intestinal volvulus. Bivariate analysis was performed for covariates based on the intestinal volvulus type. Multivariate Poisson regression models estimated the relative risk of volvulus and mortality. RESULTS A total of 4352 patients were captured in the registry. Overall, 1037 patients (23.8%) were diagnosed with MIO. Intestinal volvulus accounted for 499 (48.1%) of patients with MIO. Sigmoid volvulus, midgut volvulus, ileosigmoid knotting, and cecal volvulus accounted for 57.7% (n = 288), 19.8% (n = 99), 20.8% (n = 104), and 1.6% (n = 8), respectively. Mean age was 46.8 years (SD 17.2) with a male preponderance (n = 429, 86.0%) and 14.8% (n = 74) mortality. Overall, the most common operations performed were large bowel (n = 326, 74.4%) and small bowel (n = 76, 16.7%) resections with 18.0% (n = 90) ostomy formation. Upon regression modeling, the relative risk for volvulus was 2.7 times higher in men than women after controlling for season and age. There was no statistically significant difference in the relative risk of mortality based on the type of volvulus. CONCLUSION Volvulus is a significant cause of primary bowel obstruction in sub-Saharan Africa. Type of intestinal volvulus is not associated increased risk of mortality. Reasons for increases in the incidence of small bowel volvulus are still largely undetermined.
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Affiliation(s)
- Laura N Purcell
- Department of Surgery, University of North Carolina School of Medicine, 4008 Burnett Womack Building, Chapel Hill, NC, 7228, USA
| | - Rachel Reiss
- Department of Surgery, University of North Carolina School of Medicine, 4008 Burnett Womack Building, Chapel Hill, NC, 7228, USA
| | - Charles Mabedi
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Jared Gallaher
- Department of Surgery, University of North Carolina School of Medicine, 4008 Burnett Womack Building, Chapel Hill, NC, 7228, USA
| | - Rebecca Maine
- Department of Surgery, University of North Carolina School of Medicine, 4008 Burnett Womack Building, Chapel Hill, NC, 7228, USA
| | - Anthony Charles
- Department of Surgery, University of North Carolina School of Medicine, 4008 Burnett Womack Building, Chapel Hill, NC, 7228, USA.
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.
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15
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Endoscopic Detorsion Results in Sigmoid Volvulus: Single-Center Experience. Emerg Med Int 2020; 2020:1473580. [PMID: 32455020 PMCID: PMC7243014 DOI: 10.1155/2020/1473580] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 03/24/2020] [Indexed: 02/07/2023] Open
Abstract
Endoscopic detorsion is the first-line recommended treatment modality in sigmoid volvulus patients who have no peritoneal irritation signs on admission. In this paper, we present the results of endoscopic detorsion procedures applied at the time of presentation with the diagnosis of sigmoid volvulus and review the current literature about this topic.
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Godosis D, Kepertis C, Demiri C, Lambropoulos V, Spyridakis I. Sigmoid volvulus in a 10-year-old male: A case report and review of the literature. Pediatr Rep 2020; 12:8476. [PMID: 32308972 PMCID: PMC7160857 DOI: 10.4081/pr.2020.8476] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 02/24/2020] [Indexed: 01/20/2023] Open
Abstract
Sigmoid volvulus in children is a potentially disastrous situation, still remaining rare in terms of occurrence. We hereby present a case report of a 10-year-old male, having admitted in our department complaining about abdominal pain, who finally proved to suffer from sigmoid volvulus.
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Affiliation(s)
- Dimitrios Godosis
- Second Pediatric Surgery Department, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Chrysostomos Kepertis
- Second Pediatric Surgery Department, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Charikleia Demiri
- Second Pediatric Surgery Department, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassilis Lambropoulos
- Second Pediatric Surgery Department, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Spyridakis
- Second Pediatric Surgery Department, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Abdulla HA, Hamza E, Dhaif A. Transverse colon volvulus in a patient with sickle cell disease. BMJ Case Rep 2019; 12:12/3/e228863. [PMID: 30852505 DOI: 10.1136/bcr-2018-228863] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Although colonic volvulus is a relatively rare cause of large bowel obstruction, accounting for up to 5% of all cases of intestinal obstruction, transverse colon volvulus is extremely uncommon compared with volvulus of the sigmoid colon or caecum and is responsible for only 3% of all reported cases. We report an unusual case of spontaneous volvulus of the transverse colon in a young man with sickle cell disease who underwent resection with primary anastamosis. Having a high index of suspicion and early operative intervention allowed for this patient to have an uneventful postoperative course.
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Affiliation(s)
| | - Eman Hamza
- Department of General Surgery, King Hamad University Hospital, Busaiteen, Bahrain
| | - Ali Dhaif
- Department of Surgery, Salmaniya Medical Complex, Manama, Bahrain
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Atamanalp SS, Disci E, Atamanalp RS. Sigmoid volvulus: Comorbidity with sigmoid gangrene. Pak J Med Sci 2019; 35:288-290. [PMID: 30881440 PMCID: PMC6408625 DOI: 10.12669/pjms.35.1.295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 01/05/2019] [Indexed: 11/23/2022] Open
Abstract
Sigmoid volvulus (SV) is the wrapping of the sigmoid colon around its mesentery, and sigmoid gangrene is a catastrophic complication of SV. Although the diagnosis of SV is generally not difficult, unfortunately, most of the clinical, laboratory and radiological signs are not pathognomonic in demonstrating sigmoid gangrene. The treatment of gangrenous SV requires emergency surgery. Sigmoid gangrene worsens the prognosis of SV by doubling the mortality rate.
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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
| | - Refik Selim Atamanalp
- Refik Selim Atamanalp, MD. Assistant Professor, Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
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Atamanalp SS. Ileosigmoid knotting: One of the largest single-center series. Pak J Med Sci 2018; 34:671-675. [PMID: 30034437 PMCID: PMC6041517 DOI: 10.12669/pjms.343.14893] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 05/28/2018] [Indexed: 11/15/2022] Open
Abstract
Ileosigmoid knotting (ISK) is the wrapping of the ileum or sigmoid colon around the base of the other structure, causing a double-loop intestinal obstruction. The disease generally presents as an intestinal obstruction with volvulus triad, including abdominal pain/tenderness, distention, and obstipation. Abdominal X-ray findings are not pathognomonic, and computerized tomography (CT) and magnetic resonance imaging (MRI) are more useful in the diagnosis. A patient with ISK generally requires an emergency laparotomy following resuscitation. Based on the viability of the ileum and sigmoid colon, different resectional or non-resectional surgical techniques may be used. In this report, one of the largest single-center ISK series in the world, an eighty-case series, is concisely presented.
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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
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20
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Atamanalp SS, Atamanalp RS. Determination of patients requiring elective surgery following successful endoscopic detorsion in sigmoid volvulus. Pak J Med Sci 2017; 33:1528-1530. [PMID: 29492092 PMCID: PMC5768858 DOI: 10.12669/pjms.336.13921] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Sigmoid volvulus (SV) is an unusual type of colonic obstruction, in which the sigmoid colon wraps around itself. As a rule, SV is decompressed via endoscopy in uncomplicated cases, while surgery is required in complicated cases. However, the recurrence rate following endoscopic detorsion is relatively high, with a relatively high mortality rate. Consequently, as a prophylactic procedure to prevent recurrence, elective surgery is suggested in some patients. Nevertheless, the selection criteria are open to questioning. In this report, we evaluate those criteria based on the broad experience of our clinic, and suggest elective surgery in patients in ASA classes I-III.
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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
| | - Refik Selim Atamanalp
- Refik Selim Atamanalp, English Medicine Program Faculty of Medicine, Ataturk University, Erzurum, Turkey
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Atamanalp SS. Sigmoid volvulus: the first one thousand-case single center series in the world. Eur J Trauma Emerg Surg 2017; 45:175-176. [PMID: 29079918 DOI: 10.1007/s00068-017-0859-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 09/30/2017] [Indexed: 11/30/2022]
Affiliation(s)
- S S Atamanalp
- Department of General Surgery, Faculty of Medicine, Ataturk University, 25040, Erzurum, Turkey
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