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Khlevner J, Patel D, Rodriguez L. Pediatric Neurogastroenterology and Motility Disorders: What Role Does Endoscopy Play? Gastrointest Endosc Clin N Am 2023; 33:379-399. [PMID: 36948752 DOI: 10.1016/j.giec.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Although pediatric neurogastroenterology and motility (PNGM) disorders are prevalent, often debilitating, and remain challenging to diagnose and treat, this field has made remarkable progress in the last decade. Diagnostic and therapeutic gastrointestinal endoscopy emerged as a valuable tool in the management of PNGM disorders. Novel modalities such as functional lumen imaging probe, per-oral endoscopic myotomy, gastric-POEM, and electrocautery incisional therapy have changed the diagnostic and therapeutic landscape of PNGM. In this review, the authors highlight the emerging role of therapeutic and diagnostic endoscopy in esophageal, gastric, small bowel, colonic, and anorectal disorders and disorders of gut and brain axis interaction.
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Affiliation(s)
- Julie Khlevner
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University Vagelos College of Physicians and Surgeons, Gastrointestinal Motility Center, NewYork Presbyterian Morgan Stanley Children's Hospital, 622 West 168th Street, PH 17, New York, NY 11032, USA.
| | - Dhiren Patel
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Saint Louis University School of Medicine, SSM Cardinal Glennon Children's Medical Center, 1465 South Grand Boulevard, St Louis, MO 63104, USA
| | - Leonel Rodriguez
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Yale New Haven Children's Hospital, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
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Can Infant Dyschezia Be a Suspect of Rectosigmoid Redundancy? CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9071097. [PMID: 35884080 PMCID: PMC9320059 DOI: 10.3390/children9071097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/20/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022]
Abstract
Infant dyschezia is a functional gastrointestinal disorder that occurs in children less than nine months of age. This disorder causes much anxiety among parents who consult different physicians when suspecting major intestinal problems. The aim of this study is to verify whether infant dyschezia involves an anatomic abnormality (redundancy) of the colon. In this retrospective study (48 months) we analyzed all the children younger than 9 months who came to our attention through the suspicion of gastrointestinal abnormality (Hirschsprung’s disease, anorectal malformations, colonic disorders or constipation). They all had a complete medical history, clinical examination and diagnostic tests, such as blood samples, suction rectal biopsy, a study of stool characteristics and, finally, a contrast enema. In cases with infant dyschezia, different colonic sizes and rectosigmoid length were measured, which created a ratio with the diameter of the second lumbar vertebra. These values were compared with those reported in the literature as normal for the age of one year. Of the 24 patients evaluated (mean age 4 months), 9 were excluded for different diagnoses (aganglionic megacolon, hypothyroidism, constipation). The comparison of the ratios obtained in the remaining 15 cases showed a significantly higher rectosigmoid length (redundancy) in children with dyschezia, 18.47 vs. 9.75 (p < 0.001). The rectosigmoid redundancy, a congenital anomaly already reported as a cause of refractory constipation, may be present in children with infant dyschezia.
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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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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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Bhandari TR, Shahi S. Volvulus of sigmoid colon in a challenged adolescent: An unusual case report. Ann Med Surg (Lond) 2019; 44:26-28. [PMID: 31297192 PMCID: PMC6598602 DOI: 10.1016/j.amsu.2019.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/03/2019] [Accepted: 06/11/2019] [Indexed: 12/29/2022] Open
Abstract
Sigmoid volvulus is very uncommon cause of intestinal obstruction in pediatrics population withhigh rate of mortality. To date, few cases of sigmoid volvulus in children and association with several condition has been reported in literature, of them very few cases are with mental disability. We report a challenged (mentally disabled) 14-year old adolescent boy presented asan emergency with feature of complete bowel obstruction. Abdominal X-rays shows dilated loop of large bowel with inverted U shaped. Volvulus of sigmoid colon was found during laparotomy and successfully managed with resection of a redundant colon with colocolic end to end anastomosis. Sigmoid volvulus is relatively uncommon in children as compared to adults. Surgeons should be attentive of this rare entity, cause of large bowel obstruction to allow for early diagnosis and to enable better patient outcomes by reducing the morbidity and mortality.
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Affiliation(s)
- Tika Ram Bhandari
- Department of General Surgery, People's Dental College and Hospital, Kathmandu, Nepal.,Formerly Department of General Surgery, Universal College of Medical Sciences, Bhairahawa, Nepal
| | - Sudha Shahi
- Department of ENT Head and Neck Surgery, National Academy of Medical Sciences, Kathmandu, Nepal
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Zarokosta M, Piperos Τ, Zoulamoglou M, Theodoropoulos P, Nikou E, Flessas I, Boumpa E, Bonatsos V, Noussios G, Mariolis-Sapsakos T. Anomalous course of the sigmoid colon and the mesosigmoid encountered during colectomy. A case report of a redundant loop of sigmoid colon. Int J Surg Case Rep 2018; 46:20-23. [PMID: 29655020 PMCID: PMC6000771 DOI: 10.1016/j.ijscr.2018.02.041] [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: 01/29/2018] [Revised: 02/22/2018] [Accepted: 02/24/2018] [Indexed: 01/14/2023] Open
Abstract
Introduction Sigmoid colon constitutes a part of the large intestine that presents several congenital anatomic variations. In particular, the presence of a redundant loop of sigmoid colon is of tremendous importance for surgeons, obstetricians and radiologists, since it is closely related to multiple pathological conditions and functional implications of the neighboring anatomical structures. PRESENTATION OF CASE An unusual anatomic variation in position and length of the sigmoid colon and its mesocolon was unexpectedly detected during right hemicolectomy to a 67-year-old Caucasian male patient due to colon cancer. The operation was uneventful. A meticulous review of the literature was conducted as well. DISCUSSION A redundant loop of sigmoid colon may go unnoticed or it might lead to urinary, digestive and vascular complications. Its presence is associated with acute and chronic pathological conditions, sigmoid volvulus and serious confusions in radiological diagnosis and instrumentation. CONCLUSION Surgeons' thorough knowledge concerning this rare anatomic variation is fundamental and crucial in order to establish a correct diagnosis and assert the appropriate management when performing operations including pelvis and abdomen.
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Affiliation(s)
- Maria Zarokosta
- University Department of Surgery, General and Oncologic Hospital of Kifissia, "Aristotles", Athens, Greece; Anatomy and Histology Laboratory, School of Nursing, University of Athens, Athens, Greece.
| | - Τheodoros Piperos
- University Department of Surgery, General and Oncologic Hospital of Kifissia, "Aristotles", Athens, Greece; Anatomy and Histology Laboratory, School of Nursing, University of Athens, Athens, Greece
| | - Menelaos Zoulamoglou
- University Department of Surgery, General and Oncologic Hospital of Kifissia, "Aristotles", Athens, Greece
| | - Panagiotis Theodoropoulos
- University Department of Surgery, General and Oncologic Hospital of Kifissia, "Aristotles", Athens, Greece
| | - Euthumios Nikou
- University Department of Surgery, General and Oncologic Hospital of Kifissia, "Aristotles", Athens, Greece
| | - Ioannis Flessas
- University Department of Surgery, General and Oncologic Hospital of Kifissia, "Aristotles", Athens, Greece; Anatomy and Histology Laboratory, School of Nursing, University of Athens, Athens, Greece
| | - Eleni Boumpa
- University Department of Surgery, General and Oncologic Hospital of Kifissia, "Aristotles", Athens, Greece; Anatomy and Histology Laboratory, School of Nursing, University of Athens, Athens, Greece
| | - Vasileios Bonatsos
- University Department of Surgery, General and Oncologic Hospital of Kifissia, "Aristotles", Athens, Greece
| | - George Noussios
- Department of Physical Education and Sports Sciences, "Aristotles", University of Thessaloniki, Serres, Greece
| | - Theodoros Mariolis-Sapsakos
- University Department of Surgery, General and Oncologic Hospital of Kifissia, "Aristotles", Athens, Greece; Anatomy and Histology Laboratory, School of Nursing, University of Athens, Athens, Greece
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Haider F, Al Asheeri N, Ayoub B, Abrar E, Khamis J, Isa H, Nasser H, Al Hashimi F. Sigmoid volvulus in children: a case report. J Med Case Rep 2017; 11:286. [PMID: 29110733 PMCID: PMC5674852 DOI: 10.1186/s13256-017-1440-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 08/28/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Sigmoid volvulus is frequently reported in the "volvulus belt" (Middle East, Africa, the Indian subcontinent, Turkey, and South America) and is the third leading cause of large bowel obstruction in North America. It is an uncommon problem in children and adolescents, and is rarely considered a diagnosis in this group. A high index of suspicion is necessary to diagnose sigmoid volvulus in children. CASE PRESENTATION We present a 13-year-old Arabian girl who came with features suggestive of intestinal obstruction. Plain abdominal film revealed classic omega (coffee bean) sign of sigmoid volvulus. The volvulus was successfully decompressed by means of a rectal tube in our emergency department. The next day during the same admission the volvulus recurred and was successfully decompressed by endoscopy. She was discharged home on her parents' request; she presented again 1 month later. This time the volvulus could not be decompressed non-operatively, so she underwent sigmoidectomy with primary anastomosis. Postoperatively she developed paralytic ileus that resolved after 10 days. Following that she did well and was discharged home. She is still free of symptoms 1 year after the resection. CONCLUSIONS Sigmoid volvulus is an uncommon problem in children and adolescents, and is rarely considered a diagnosis in this group as a cause of intestinal obstruction. Pediatric surgeons should maintain a high index of suspicion, in order not to miss this important diagnosis, as any delay in instituting treatment has a devastating effect on morbidity as well as mortality. Early diagnosis and prompt treatment confer an excellent prognosis.
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Affiliation(s)
- Fayza Haider
- Pediatric Surgery Unit-Department of Surgery, Salmaniya Medical Complex, P.O. Box 12, Manama, Bahrain. .,Salmaniya Medical Complex, 12, Manama, Bahrain.
| | - Nabeel Al Asheeri
- Pediatric Surgery Unit-Department of Surgery, Salmaniya Medical Complex, P.O. Box 12, Manama, Bahrain
| | - Barrak Ayoub
- Pediatric Surgery Unit-Department of Surgery, Salmaniya Medical Complex, P.O. Box 12, Manama, Bahrain
| | - Eizat Abrar
- Pediatric Surgery Unit-Department of Surgery, Salmaniya Medical Complex, P.O. Box 12, Manama, Bahrain
| | - Jawad Khamis
- Department of Medicine, Salmaniya Medical Complex, Manama, Bahrain
| | - Hasan Isa
- Department of Pediatrics, Salmaniya Medical Complex, Manama, Bahrain
| | - Husain Nasser
- Department of Radiology, Salmaniya Medical Complex, Manama, Bahrain
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Parolini F, Orizio P, Bulotta AL, Garcia Magne M, Boroni G, Cengia G, Torri F, Alberti D. Endoscopic management of sigmoid volvulus in children. World J Gastrointest Endosc 2016; 8:439-43. [PMID: 27358669 PMCID: PMC4919692 DOI: 10.4253/wjge.v8.i12.439] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 04/19/2016] [Accepted: 05/17/2016] [Indexed: 02/05/2023] Open
Abstract
Sigmoid volvulus (SV) is extremely uncommon in children and is usually associated with a long-standing history of constipation or pseudo-obstruction. An early diagnosis and management are crucial in order to prevent the appearance of hemorrhagic infarction of the twisted loop, avoiding further complications such as necrosis, perforation and sepsis. In patients with no evidence of peritonitis or ischemic bowel, treatment starts with resuscitation and detorsion of the SV, accomplished by means of sigmoidoscopy and concomitant rectal tube placement. The bowel is then prepared and surgery is undertaken electively during the same hospitalization. We report a detailed review of the literature focusing on technical details, risks and benefits of endoscopic management of SV in childhood.
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