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Long B, Easter J, Koyfman A. High risk and low incidence diseases: Pediatric digestive volvulus. Am J Emerg Med 2024; 82:153-160. [PMID: 38908340 DOI: 10.1016/j.ajem.2024.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 06/10/2024] [Accepted: 06/12/2024] [Indexed: 06/24/2024] Open
Abstract
INTRODUCTION Pediatric digestive volvulus is a serious condition that carries with it a high rate of morbidity and mortality. OBJECTIVE This review highlights the pearls and pitfalls of pediatric digestive volvulus, including the presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION Pediatric digestive volvulus is a deadly condition most commonly associated with malrotation. It occurs when the stomach or small intestine twists on itself, resulting in ischemia and potentially strangulation with necrosis and perforation. Presentation differs based on the gastrointestinal (GI) segment affected, degree of twisting, and acuity of the volvulus. Gastric volvulus most commonly presents with retching with or without nonbilious emesis and epigastric distension with pain, while midgut volvulus typically presents with bilious emesis in infants. Patients with GI necrosis and perforation may present with hemodynamic compromise and peritonitis. If suspected, emergent consultation with the pediatric surgery specialist is necessary, and if this is not available, transfer to a center with a pediatric surgeon is recommended. Imaging includes plain radiography, ultrasound, or upper GI series, while treatment includes resuscitation, administration of antibiotics, and emergent surgical decompression and detorsion of the involved segments. CONCLUSION An understanding of pediatric digestive volvulus and its many potential mimics can assist emergency clinicians in diagnosing and managing this deadly disease.
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Affiliation(s)
- Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
| | - Joshua Easter
- Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
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Dominy M, Sofer M, Slaby M, Slemmons L, Smith N, Kashmer D, Cawley D. Gut Malrotation in a Human Cadaver: Exploration Into the Prevention and Screening of Undiagnosed Malrotation in Adults. Cureus 2024; 16:e62318. [PMID: 38882224 PMCID: PMC11177272 DOI: 10.7759/cureus.62318] [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: 12/15/2023] [Accepted: 06/10/2024] [Indexed: 06/18/2024] Open
Abstract
Malrotation is a congenital anomaly that results from the abnormal rotation of the gut during fetal development. Malrotation may be missed in early life and can present later with non-specific, chronic abdominal symptoms and decreased quality of life and in some cases can lead to serious bowel complications. Most adult cases are discovered incidentally on imaging or during surgery. An 82-year-old male cadaver was identified as having probable malrotation of the intestines. The performance of a previous surgical procedure could not be confirmed due to a lack of medical and surgical history. The cadaver dissection raised the question regarding the screening modalities used to reliably identify malrotations in infants and adults. Implementing a standardized reliable screening tool in infants or adults complaining of chronic abdominal pain could largely reduce the incidence of undiagnosed malrotation. Along with the development of a screening tool, increasing understanding of the clinical presentation of malrotation in adults could help identify undiagnosed cases earlier, which can reduce morbidity and mortality in these patients.
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Affiliation(s)
- Madison Dominy
- Department of Biomedical Research and Affairs, Edward Via College of Osteopathic Medicine, Auburn, USA
| | - Mandeville Sofer
- Department of Biomedical Research and Affairs, Edward Via College of Osteopathic Medicine, Auburn, USA
| | - Meredith Slaby
- Department of Biomedical Research and Affairs, Edward Via College of Osteopathic Medicine, Auburn, USA
| | - Lindsay Slemmons
- Department of Biomedical Research and Affairs, Edward Via College of Osteopathic Medicine, Auburn, USA
| | - Nathan Smith
- Department of Biomedical Research and Affairs, Edward Via College of Osteopathic Medicine, Auburn, USA
| | - David Kashmer
- Department of Surgery and Simulation, Edward Via College of Osteopathic Medicine, Auburn, USA
| | - Daniel Cawley
- Department of Biomedical Research and Affairs, Edward Via College of Osteopathic Medicine, Auburn, USA
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Asbah M, Shrateh ON, Ashqar H, Musleh A, Abbadi K, Amro W. Waugh syndrome: A rare coexistence of intussusception and intestinal malrotation: Case report and literature review. Int J Surg Case Rep 2024; 116:109411. [PMID: 38394938 PMCID: PMC10944001 DOI: 10.1016/j.ijscr.2024.109411] [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: 01/15/2024] [Revised: 02/12/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Waugh's syndrome, characterized by the concurrent presence of acute intussusception and gut malrotation, is a rare clinical entity. The relationship between these conditions is not well-explored, and the true incidence may be underreported. CASE PRESENTATION A 4 month old male infant, with an uneventful medical history, presented to the pediatric emergency department due to irritability and rectal bleeding lasting one day. The infant had a history of bilious vomiting and dark bloody rectal discharge. Physical examination revealed a hypoactive, dehydrated child with a palpable mass in the left lower abdomen. Abdominal ultrasound indicated Colo-colonic intussusception, and attempts at hydrostatic reduction were unsuccessful. Subsequent CT scan revealed malrotation with ileo-Colo-rectal intussusception. The patient underwent a two-step operation, involving manual reduction and Ladd's procedure, with a successful recovery and no post-surgical complications. CLINICAL DISCUSSION Reviewing the cases, we explore the unique features of Waugh's syndrome, its diverse age presentation, and the challenges in timely diagnosis. Diagnostic modalities, including abdominal ultrasound and contrast studies, are discussed, emphasizing the importance of recognizing malrotation in conjunction with intussusception for appropriate management. CONCLUSION Our experience highlights the potential underrecognition of Waugh's syndrome and emphasizes the need for a high index of suspicion. The rarity of laparoscopic interventions in documented cases is noted, emphasizing the prevailing reliance on open surgical approaches. A call for prospective studies is made to determine the actual incidence of intussusception in intestinal malrotation cases and to enhance understanding for optimal patient management.
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Affiliation(s)
- Malvina Asbah
- Department of General Surgery, Palestinian Medical Complex (PMC), Ramallah, Palestine
| | - Oadi N Shrateh
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Hadeel Ashqar
- Department of Radiology, Palestinian Medical Complex (PMC), Ramallah, Palestine
| | - Asil Musleh
- Department of General Surgery, Palestinian Medical Complex (PMC), Ramallah, Palestine
| | - Khaled Abbadi
- Department of General Surgery, Palestinian Medical Complex (PMC), Ramallah, Palestine.
| | - Wael Amro
- Department of Pediatric Surgery, Palestinian Medical Complex (PMC), Ramallah, Palestine
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Sabac D, Briatico D, Fitzgerald P. Assessment of care timelines in intestinal malrotation with volvulus: A retrospective chart review. J Pediatr Surg 2023; 58:834-837. [PMID: 36805138 DOI: 10.1016/j.jpedsurg.2023.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND Patients with intestinal malrotation with volvulus (MWV) may suffer bowel ischemia, which can be correlated with the timing of surgical intervention. The purpose of this study was to identify and assess time-blocks in the care of patients from initial physician assessment (IPA) to surgical intervention to highlight potential opportunities for improvement. METHODS Retrospective chart review of patients with MWV presenting to McMaster Children's Hospital between January 1st, 2000 and December 31st, 2020 (n = 31). Demographic data and time-blocks of care were identified and analyzed (p < 0.05 considered significant). All times were reported as medians. RESULTS 22 males (71%) and 9 females (29%) were identified; median age was 9.8 d. IPA to incision was 10.7hrs and surgical consult to incision was 3.4hrs. Time to incision for patients <1 y was not significantly different than those >1 y (10.5hrs vs 10.7hrs, p = 0.737). The use of ultrasound did not significantly affect time to incision (7.9hrs vs 12.0hrs, p = 0.128). For patients requiring resection or having pan-necrosis there was no significant difference in time from IPA (10.9hrs vs 10.5hrs, p = 0.238) or surgical consult to incision (4.0hrs vs 3.3hrs, p = 0.808). CONCLUSION Time from IPA to surgical consult and time from surgical consult to surgical intervention represented the largest proportions of time. Age, use of ultrasound, and need for resection or having pan-necrosis did not significantly affect the time to incision. This data may be used to inform opportunities for expediting the management of patients with MWV once they have presented to a physician. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Denise Sabac
- Bachelor of Health Sciences (Honours) Program, McMaster University, Hamilton, Canada; McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Canada
| | - Daniel Briatico
- McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Canada; Division of Pediatric General Surgery, Department of Surgery, McMaster University, Hamilton, Canada
| | - Peter Fitzgerald
- McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Canada; McMaster Children's Hospital, Hamilton, Canada.
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Saurya S, Sherwani P, Sharma G, Saxena S. Spectrum of Clinical and Radiological Presentation of Midgut Malrotation in Children and Adolescents: Case Series. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2022. [DOI: 10.1055/s-0042-1749674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Midgut malrotation is usually present in the early neonatal period with intestinal obstruction and bilious vomiting. However, sometimes it may present later in childhood and adolescence with atypical features and then may remain undiagnosed for long, adversely affecting the growth and development of the child. Here we describe three cases of intestinal malrotation with various atypical presentation and imaging findings.
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Affiliation(s)
- Saurya Saurya
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Poonam Sherwani
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Garima Sharma
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sudhir Saxena
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Raju AS, Benjamin AT, Seppey R, Lambrakis P. Congenital intestinal malrotation with abdominal cocoon and duodenal stricture in an adult. ANZ J Surg 2022; 92:2751-2752. [PMID: 35128777 DOI: 10.1111/ans.17534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Abdus Salam Raju
- Acute Care Surgery Unit, Liverpool Hospital, Sydney, New South Wales, Australia
| | | | - Romain Seppey
- Acute Care Surgery Unit, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Paul Lambrakis
- Acute Care Surgery Unit, Liverpool Hospital, Sydney, New South Wales, Australia.,School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Sanlorenzo LA, Grossarth S, Weitkamp JH. Case 3: Abdominal Distention in a Preterm Infant. Neoreviews 2021; 21:e411-e413. [PMID: 32482704 DOI: 10.1542/neo.21-6-e411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Lauren A Sanlorenzo
- Mildred Stahlman Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | | | - Joern-Hendrik Weitkamp
- Mildred Stahlman Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
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Son J, Lee S, Kim W, Jung SM, Jeon TY, Yoo SY, Kim JH, Seo JM. Abnormal Orientation of the Superior Mesenteric Vessels Detected in Asymptomatic Infants: What Is Its Destiny? Front Pediatr 2021; 9:665448. [PMID: 34178885 PMCID: PMC8226012 DOI: 10.3389/fped.2021.665448] [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: 02/08/2021] [Accepted: 05/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Ultrasonography (USG) has been described as an alternative diagnostic tool for malrotation that evaluates the orientation of the superior mesenteric vessels. However, literature concerning the management of patients who do not have abdominal symptoms is limited. We aimed to review the clinical course of infants showing abnormal orientation of the superior mesenteric vessels on USG who were asymptomatic at the time of diagnosis. Methods: Seventy asymptomatic infants with abnormal orientation of the superior mesenteric vessels in a single center between 2014 and 2018 were retrospectively analyzed. Results: The 70 patients, 21 underwent upper gastrointestinal series (UGIS) and 11 underwent abdominal surgery for other surgical conditions. Among the 32 (45.7%) patients who underwent UGIS or abdominal surgery, 11 were proven to have malrotation. Of the 38 (54.3%) patients who did not undergo UGIS or abdominal surgery, six patients were too unstable to undergo UGIS, five died due to cardiac complications, and the remaining patient developed midgut volvulus and died 3 days after emergency surgery. The remaining 32 patients who did not undergo UGIS or abdominal surgery were discharged without additional tests, and all were asymptomatic until their last follow-up. In the multivariate analysis, history of heart surgery and the presence of more than three anomalies were significantly associated with malrotation. Conclusion: A significant number of malrotation were diagnosed in asymptomatic infants with abnormal orientation of the superior mesenteric vessels on USG. Infants with major cardiac or multiple anomalies need special attention and should undergo UGIS in a promptly manner to confirm malrotation.
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Affiliation(s)
- Joonhyuk Son
- Department of Pediatric Surgery, Hanyang University College of Medicine, Seoul, South Korea
| | - Sanghoon Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Wontae Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Soo-Min Jung
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Tae Yeon Jeon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - So-Young Yoo
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ji Hye Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jeong-Meen Seo
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Lv X, Chen H, Sun X, Zhou L, Lu C, Li H. Assessment of plasma microRNAs in congenital intestinal malrotation. Mol Med Rep 2020; 22:3289-3298. [PMID: 32945457 PMCID: PMC7453532 DOI: 10.3892/mmr.2020.11395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 07/20/2020] [Indexed: 12/15/2022] Open
Abstract
Intestinal malrotation in newborns often requires urgent surgical treatment, especially in the presence of volvulus. Therefore, early-stage diagnosis is critical. In the present study, differentially expressed plasma microRNAs (miRNAs) were screened for in patients with intestinal malrotation using high-throughput Illumina sequencing, and validated using reverse transcription-quantitative PCR. Receiver operating characteristic curve (ROC) analysis was conducted to evaluate their specificity, sensitivity and assess their diagnostic value for intestinal malrotation. Bioinformatics analysis was performed to investigate the functions associated with the dysregulated miRNAs. A profile consisting of 28 differentially expressed plasma miRNAs was obtained, of which nine were verified to exhibit significantly altered expression. According to a ROC analysis, four of these could represent novel early-stage, non-invasive biomarkers for intestinal malrotation. Bioinformatics analysis demonstrated that the differentially expressed miRNAs were predominantly involved in ‘metal ion transmembrane transporter activity’ and ‘calcium-dependent protein binding’, which may be related to the ‘endocytosis’ pathway. In conclusion, significantly differentially expressed plasma miRNAs were identified in congenital intestinal malrotation and their potential roles were described. These differentially expressed miRNAs may serve as biomarkers of intestinal malrotation and improve early diagnosis for this condition.
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Affiliation(s)
- Xiurui Lv
- Department of Pediatric Surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, P.R. China
| | - Huan Chen
- Department of Pediatric Surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, P.R. China
| | - Xinhe Sun
- Department of Pediatric Surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, P.R. China
| | - Lingling Zhou
- Department of Pediatric Surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, P.R. China
| | - Changgui Lu
- Department of Pediatric Surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, P.R. China
| | - Hongxing Li
- Department of Pediatric Surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, P.R. China
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Nwokoro CC, Emmanuel EA, Olatunji AA, Salami BA, Amosu LO, Ogundele IO. Malrotation of the midgut associated with horseshoe kidney presenting as gastric outlet obstruction in a 15-year-old boy. Afr J Paediatr Surg 2020; 17:122-126. [PMID: 33342849 PMCID: PMC8051629 DOI: 10.4103/ajps.ajps_92_17] [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] [Indexed: 11/04/2022] Open
Abstract
Malrotation occurs in approximately 1 in 500 live births. However, the true incidence of malrotation is unknown since many asymptomatic patients fail to present. Approximately 90% of patients with malrotation are diagnosed within the 1st year of life. Eighty per cent of them are diagnosed within the 1st month of life. Nevertheless, there are recent reports of manifestations later in life both as emergency conditions and more chronic gastrointestinal symptoms. The relationship between malrotation and horseshoe kidney has not been fully understood, but few case reports have highlighted their occurrence in the same patient. The mode of presentation of this case and its association with a horseshoe kidney is the reason for this report. This was a case of malrotation associated with horseshoe kidney. He had exploratory laparotomy and Ladd's procedure. Malrotation is associated with horseshoe kidney which presented as gastric outlet obstruction. He responded well to treatment after Ladd's procedure.
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Affiliation(s)
- Chigbundu Collins Nwokoro
- Department of Surgery, Paedaitric Surgery Unit, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
| | - E A Emmanuel
- Department of Anaesthesia and Intensive Care, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
| | - A A Olatunji
- Department of Radiology, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
| | - B A Salami
- Department of Surgery, Paedaitric Surgery Unit, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
| | - L O Amosu
- Department of Surgery, Paedaitric Surgery Unit, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
| | - I O Ogundele
- Department of Surgery, Paedaitric Surgery Unit, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
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Dehaini H, Nasser Eldine R, Doughan S, Khalifeh M, Khasawneh H, Hussain H, Sbaity E. Presentation of intestinal malrotation and midgut volvulus in adults: Case report & literature review. Int J Surg Case Rep 2020; 73:27-30. [PMID: 32629217 PMCID: PMC7338997 DOI: 10.1016/j.ijscr.2020.06.066] [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: 05/16/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Malrotation is considered a newborn disease. This case report sheds light on the rare, but possible late presentation of malrotation in adulthood, which if missed, can leave the patient in a detrimental state. PRESENTATION OF CASE 28-year-old female presented in critical state with acute abdomen. Computed tomography abdomen/pelvis showed midgut volvulus, requiring urgent laparotomy. The patient's bowels were discolored, yet they normalized upon detorsion, except for a small portion, which was equivocal and left for observation. Ladd's bands were excised, and the abdomen was closed with Bogota bag for re-exploration. The patient underwent two more laparotomies to observe the intestinal segment until it was back to normal. Ladd procedure was then completed, and an absorbable mesh was applied. Follow-up of 20 months has been uneventful, except for a small, asymptomatic, incisional hernia. DISCUSSION Malrotation in adults is often missed due to its subacute, nonspecific presentation. It is often diagnosed by CT abdomen, which shows inversion or vertical positioning of the superior mesenteric vessels. Symptomatic, but stable patients, can undergo laparoscopic Ladd procedure, which carries the benefit of less length of stay. While an incidental malrotation can be prophylactically operated on, correcting asymptomatic malrotation beyond age of 20 is ineffective and possibly harmful. CONCLUSION Intestinal malrotation presenting in an adult should be on the differential diagnosis when dealing with abdominal pain, especially in the context of small bowel obstruction in a virgin abdomen. It is vital to consider a patient's age prior to prophylactically operate on malrotation discovered incidentally.
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Affiliation(s)
- Hassan Dehaini
- Division of General Surgery, Department of Surgery, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
| | - Rakan Nasser Eldine
- Division of Vascular & Endovascular Surgery, Department of Surgery, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
| | - Samer Doughan
- Division of General Surgery, Department of Surgery, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
| | - Mohammad Khalifeh
- Division of General Surgery, Department of Surgery, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
| | - Hala Khasawneh
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
| | - Hero Hussain
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
| | - Eman Sbaity
- Division of General Surgery, Department of Surgery, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
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Botchway E, Tshifularo N, Human M. Mesenteric cyst as a presentation of chronic midgut volvulus in a 12 year old boy. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2019.101351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Right in Our Own Backyard. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2019. [DOI: 10.1016/j.cpem.2019.100741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Sakimura Y, Kitamura H, Inaki N, Bando H. The recurrence of colonic volvulus due to nonrotation after intestinal resection in adulthood: a case report. Surg Case Rep 2019; 5:147. [PMID: 31637559 PMCID: PMC6803607 DOI: 10.1186/s40792-019-0710-x] [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: 06/02/2019] [Accepted: 09/27/2019] [Indexed: 11/10/2022] Open
Abstract
Background Intestinal nonrotation is a rare congenital condition that causes fatal colonic volvulus at any age. Once volvulus attack occurs, radical surgical therapy is required for treatment and the prevention of recurrence. This report describes the case of an adult female patient with a recurrence of cecum volvulus due to intestinal nonrotation after transverse colon resection for colonic volvulus. Case presentation A 27-year-old female visited our emergency room (ER) with intermittent abdominal pain and nausea. Enhanced computed tomography (CT) showed enlargement of the level of the ascending and transverse colon and an obstruction with a whirlpool sign at the transverse colon. The small intestine was distributed on the right side of the abdominal cavity, and the large intestine occupied the left side. She was diagnosed with volvulus with intestinal nonrotation, and emergency surgery was performed. Surgical examination indicated that the ascending colon to the transverse colon was not fixed to the retroperitoneum, and the transverse colon was rotated 180° clockwise. The axis of the volvulus was a mesenteric adhesion of the transverse colon. The involved transverse colon was resected, and the intestine was reconstructed by functional end-to-end anastomosis (FEEA). Six years after the initial surgery, the patient presented to the ER with abdominal fullness and lower abdominal pain. Enhanced CT revealed that the cecum, ascending colon, and remaining transverse colon were dilated with an obstruction. The appendix was located in the left upper abdominal cavity. The clinical diagnosis was cecal volvulus with intestinal nonrotation. An emergency laparotomy revealed that the cecum was rotated 180° clockwise. The terminal ileum to the remaining transverse colon was resected, and FEEA was performed. Seven months later, she suffered obstruction of the intestine caused by an operative adhesion, and conservative treatment was successful. The patient has had no abdominal symptoms for one and a half years so far. Conclusions Surgeons should realize that nonrotation of the intestines induces volvulus in adulthood and should familiarize themselves with its clinical findings, appropriate treatment, and prognosis. Even after surgical treatment, awareness of the recurrence of volvulus should be maintained to avoid a late diagnosis.
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Affiliation(s)
- Yusuke Sakimura
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, 2-1 Kuratuki Higashi, Kanazawa, Ishikawa, 9208530, Japan.
| | - Hirotaka Kitamura
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, 2-1 Kuratuki Higashi, Kanazawa, Ishikawa, 9208530, Japan
| | - Noriyuki Inaki
- Department of Surgery, Juntendo Urayasu Hospital, Juntendo University, 2-1-1, Tomioka, Urayasu-shi, Chiba, 2790021, Japan
| | - Hiroyuki Bando
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, 2-1 Kuratuki Higashi, Kanazawa, Ishikawa, 9208530, Japan
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Midgut malrotation complicated by small bowel obstruction in an 80-year-old woman: A case report. Int J Surg Case Rep 2019; 63:89-93. [PMID: 31574456 PMCID: PMC6796602 DOI: 10.1016/j.ijscr.2019.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 08/23/2019] [Accepted: 09/08/2019] [Indexed: 12/19/2022] Open
Abstract
Intestinal malrotation results from anomalies in embryological midgut rotation. Malrotation usually presents early in life, with rare cases reported in adulthood. Ladd procedure remains the mainstay of definitive treatment. Radiologic findings have a role in early detection and correction of malrotation.
Introduction Midgut malrotation results from abnormalities in the 270-degree counterclockwise rotation of the midgut around the axis of the superior mesenteric artery during embryological development, and classically presents early in life with symptoms of intestinal obstruction. Nevertheless, adult cases have occasionally been reported. Presentation of case An 80-year-old female with no surgical history was brought to our emergency department for acutely altered mental status. On exam, her abdomen was distended and diffusely tender to palpation. Computed tomography (CT) scan of the abdomen and pelvis showed a dilated loop of jejunum with evidence of mesenteric twist concerning for closed-loop small bowel obstruction. The patient was taken for exploratory laparotomy and was found to have Ladd bands and other findings suggestive of intestinal malrotation. A Ladd procedure was performed and the patient remained under observation. She experienced intermittent abdominal distension and bilious nasogastric tube output, but subsequent CT scans revealed no evidence of obstruction. She was discharged following clinical improvement and ability to tolerate a diet. Discussion Malrotation of the small bowel exists on a spectrum depending on the embryologic stage during which anomalous rotation occurs. Classic findings on CT imaging (including abnormal mesenteric vasculature, right-sided duodenojejunal junction, whirlpool signs, and left-sided ascending colon) can provide clues to the existence of malrotation. Conclusion Although malrotation is rare in adults, clinical and radiologic findings play an important role in the correct diagnosis of adult malrotation for appropriate and timely intervention.
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16
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Priyadarshi A, Rogerson S, Hinder M, Tracy M. Neonatologist performed point-of-care bowel ultrasound: Is the time right? Australas J Ultrasound Med 2018; 22:15-25. [PMID: 34760532 DOI: 10.1002/ajum.12114] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction This review acquaints neonatal clinicians using point-of-care ultrasound with a range of pathological bowel ultrasound findings, with the aim to promote utility of this skill as a diagnostic assessment tool in diseased neonatal intestinal states. Overview A range of normal and pathological bowel ultrasound findings are illustrated with case examples from our neonatal intensive care unit. The technical challenges of lack of familiarity with sonographic appearance of bowel (healthy and diseased), occurrence of gas artefacts and requirements of high-resolution linear transducer probes are described to allow the development of skills amongst neonatologists trained in point-of-care ultrasound. Plain abdominal radiography continues to remain the standard investigation to differentiate benign bowel states such as continuous positive airway pressure (CPAP) belly syndrome in preterm infants from life-threatening pathological intestinal states such as necrotising enterocolitis. Although plain radiography is the gold standard modality in the evaluation of neonatal diseased bowel states, real-time point-of-care bowel ultrasound performed in conjunction can provide valuable information on bowel peristalsis, bowel wall thickness and bowel vascularity. Abnormal configuration of superior mesenteric vessels on colour Doppler can alert the clinician to the diagnosis of neonatal intestinal malrotation-a time critical emergency. Conclusion Further research is needed to explore true-negative and true-positive predictive values of bowel ultrasound. However, with expansion of knowledge, appropriate training of techniques, neonatologists will be able to enhance their diagnostic acumen by performing point-of-care bowel ultrasound in conjunction with plain radiography in the evaluation of broad array of neonatal intestinal states.
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Affiliation(s)
- Archana Priyadarshi
- Neonatal Intensive Care Unit Westmead Hospital PO Box 533 Wentworthville New South Wales 2145 Australia.,Department of Paediatrics and Child Health Sydney University Westmead New South Wales Australia
| | - Sheryle Rogerson
- The Royal Women's Hospital Locked Bag 300 Grattan St & Flemington Rd Parkville Victoria 3052 Australia
| | - Murray Hinder
- Neonatal Intensive Care Unit Westmead Hospital PO Box 533 Wentworthville New South Wales 2145 Australia.,Faculty of Engineering and Information Technologies BMET Institute Sydney University Sydney New South Wales Australia
| | - Mark Tracy
- Neonatal Intensive Care Unit Westmead Hospital PO Box 533 Wentworthville New South Wales 2145 Australia.,Department of Paediatrics and Child Health Sydney University Westmead New South Wales Australia
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Mimics of malrotation on pediatric upper gastrointestinal series: a pictorial review. Abdom Radiol (NY) 2018; 43:2246-2254. [PMID: 29500650 DOI: 10.1007/s00261-018-1537-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Intestinal malrotation is a continuum of congenital anomalies due to lack of rotation or incomplete rotation of the fetal intestine around the superior mesenteric artery axis. The abnormal bowel fixation (by mesenteric bands) or absence of fixation of portions of the bowel increases the risk of bowel obstruction, acute or chronic volvulus, and bowel necrosis. The clinical presentation of patients with malrotation without, with intermittent, or with chronic volvulus can be problematic, with an important minority presenting late or having atypical or chronic symptoms, such as intermittent vomiting, abdominal pain, duodenal obstruction, or failure to thrive. The diagnosis is heavily reliant on imaging. Upper GI series remain the gold standard with the normal position of the duodenojejunal junction lateral to the left-sided pedicles of the vertebral body, at the level of the duodenal bulb on frontal views and posterior (retroperitoneal) on lateral views. However, a variety of conditions might influence the position of the duodenojejunal junction, potentially leading to a misdiagnosis of malrotation. Such conditions include improper technique, gastric over distension, splenomegaly, renal or retroperitoneal tumors, liver transplant, small bowel obstruction, the presence of properly or malpositioned enteric tubes, and scoliosis. All of these may cause the duodenojejunal junction to be displaced. We present a series of cases highlighting conditions that mimic malrotation without volvulus to increase the practicing radiologist awareness and help minimize interpretation errors.
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Judit Machnitz A, Reid JR, Acord MR, Khwaja AB, Biko DM, Ayyala RS, Anupindi SA. MRI of the bowel - beyond inflammatory bowel disease. Pediatr Radiol 2018; 48:1280-1290. [PMID: 30078046 DOI: 10.1007/s00247-018-4166-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/20/2018] [Accepted: 05/22/2018] [Indexed: 02/06/2023]
Abstract
MR enterography is traditionally used to evaluate inflammatory bowel disease (IBD) both at initial presentation and at follow-up. MR enterography can also be used to evaluate non-IBD conditions such as polyps or other masses of the gastrointestinal tract. In this article, we emphasize how to recognize bowel conditions beyond IBD on conventional abdominal MRI without a specific enterographic technique. In this overview we discuss common and uncommon pediatric bowel conditions beyond IBD seen on MRI including infectious and inflammatory conditions, congenital diseases and tumor and tumor-like conditions. Radiologists should become familiar with the salient imaging features of these bowel conditions to help guide management.
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Affiliation(s)
- A Judit Machnitz
- Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Janet R Reid
- Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Michael R Acord
- Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Asef B Khwaja
- Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - David M Biko
- Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Rama S Ayyala
- Department of Radiology, Morgan Stanley Children's Hospital, New York Presbyterian, Columbia School of Medicine, New York, NY, USA.,Department of Diagnostic Imaging, Rhode Island Hospital - Hasbro Children's Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Sudha A Anupindi
- Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA.
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Khan YA, Yadav SK, Elkholy A. Waugh's Syndrome: Report of Two Children with Intussusception. European J Pediatr Surg Rep 2017; 5:e29-e31. [PMID: 28761799 PMCID: PMC5533607 DOI: 10.1055/s-0037-1604264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 06/10/2017] [Indexed: 11/04/2022] Open
Abstract
Waugh's syndrome (WS) is the rare association of intussusception and intestinal malrotation. We present two such cases in a 5-month-old infant and a 9-year-old girl. Both patients presented with intussusception and were diagnosed with malrotation during workup and surgical exploration. We conclude that the possibility of intestinal malrotation must be taken into consideration while managing children with intussusception.
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Affiliation(s)
- Yousuf Aziz Khan
- Department of Paediatric Surgery, Ibn Sina Specialized Surgical Hospital, Al-Sabah Health Region, Safat, Kuwait, Kuwait, Kuwait
| | - Sunil Kumar Yadav
- Department of Paediatric Surgery, Ibn Sina Specialized Surgical Hospital, Al-Sabah Health Region, Safat, Kuwait, Kuwait, Kuwait
| | - Ashraf Elkholy
- Department of Paediatric Surgery, Ibn Sina Specialized Surgical Hospital, Ibn Sina Hospital Ministry of Health, Kuwait, Kuwait, Kuwait.,Department of Pediatric Surgery, Kasr Elaini School of Medicine Cairo University, Kasr Elainy Faculty of Medicine, Cairo, Cairo, Egypt
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20
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Abstract
Abdominal pain is a common complaint that leads to pediatric patients seeking emergency care. The emergency care provider has the arduous task of determining which child likely has a benign cause and not missing the devastating condition that needs emergent attention. This article reviews common benign causes of abdominal pain as well as some of the cannot-miss emergent causes.
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Affiliation(s)
- Jeremiah Smith
- Department of Emergency Medicine, Carolinas Medical Center, 1000 Blythe Boulevard, MEB Floor 3, Charlotte, NC 28203, USA.
| | - Sean M Fox
- Emergency Medicine Residency Program, Department of Emergency Medicine, Carolinas Medical Center, 1000 Blythe Boulevard, MEB Floor 3, Charlotte, NC 28203, USA
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21
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Abstract
Intestinal rotation abnormality (IRA) predisposes to lethal midgut volvulus. An understanding of intestinal development illustrates the process of normal intestinal rotation and fixation. An appreciation of the clinical presentation and consequences of missed IRA will enhance clinical suspicion and timely evaluation. Selecting the appropriate imaging modality to diagnose IRA requires an understanding of the benefits and limitations of each. The Ladd's procedure continues to be the appropriate surgical treatment for IRA with or without volvulus. Laparoscopy has emerged as an option for the diagnosis and treatment of IRA. Populations in which IRA is always associated, but a Ladd's procedure rarely required, include patients with congenital diaphragmatic hernia and abdominal wall defects. Prevalence of IRA is higher in children with congenital heart disease and heterotaxy syndrome; asymptomatic patients require multidisciplinary consideration of the risks and benefits of screening for IRA, whether a Ladd's procedure is required, and the timing thereof. [Pediatr Ann. 2016;45(7):e247-e250.].
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Horsch S, Albayrak B, Tröbs RB, Roll C. Volvulus in term and preterm infants - clinical presentation and outcome. Acta Paediatr 2016; 105:623-7. [PMID: 26991742 DOI: 10.1111/apa.13403] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 01/14/2016] [Accepted: 03/11/2016] [Indexed: 01/26/2023]
Abstract
AIM Our aim was to assess if term and preterm infants with volvulus showed different patterns with regard to pathogenesis, clinical presentation and outcome. METHODS We reviewed the medical records and imaging data of infants aged less than six months with volvulus treated in a single surgical referral centre from 2006-2013. RESULTS Volvulus was diagnosed in 19 infants, with no anatomical anomaly in three of the 12 preterm infants and one of the seven term infants. Most cases (74%) presented during the first eight days of life. Later presentations occurred exclusively in preterm infants, with only one of the five having no anatomic anomalies. Bilious vomiting was the leading symptom in six of the seven term infants, while the symptoms in preterm infants were rather nonspecific. Intestinal necrosis, with the need for bowel resection, occurred in one term (14%) infant and nine (75%) preterm infants. CONCLUSION The clinical presentation and outcome of volvulus differed between preterm and term infants, but the rate and distribution of underlying anomalies did not differ. Symptoms in preterm infants were often nonspecific and led to a delay in diagnosis. This might have contributed to the higher rate of intestinal necrosis in preterm infants.
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Affiliation(s)
- Sandra Horsch
- Deparment of Neonatology and Pediatric Intensive Care; Vest Children's Hospital Datteln; University of Witten-Herdecke; Datteln Germany
| | - Bilge Albayrak
- Deparment of Neonatology and Pediatric Intensive Care; Vest Children's Hospital Datteln; University of Witten-Herdecke; Datteln Germany
| | - Ralf-Bodo Tröbs
- Deparment of Pediatric Surgery; Marien-Hospital Herne; Ruhr-University of Bochum; Herne Germany
| | - Claudia Roll
- Deparment of Neonatology and Pediatric Intensive Care; Vest Children's Hospital Datteln; University of Witten-Herdecke; Datteln Germany
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Abstract
The small intestine is a complex organ system that is vital to the life of the individual. There are a number of congenital anomalies that occur and present most commonly in infancy; however, some may not present until adulthood. Most congenital anomalies of the small intestine will present with obstructive symptoms while some may present with vomiting, abdominal pain, and/or gastrointestinal bleeding. Various radiologic procedures can aid in the diagnosis of these lesions that vary depending on the particular anomaly. Definitive therapy for these congenial anomalies is surgical, and in some cases, surgery needs to be performed urgently. The overall prognosis of congenital anomalies of the small intestine is very good and has improved with improved medical management and the advent of newer surgical modalities. The congenital anomalies of the small intestine reviewed in this article include malrotation, Meckel's diverticulum, duodenal web, duodenal atresia, jejunoileal atresia, and duplications.
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Affiliation(s)
- Grant Morris
- Department of Pediatrics, Geisinger Clinic, 100 N. Academy Avenue, Danville, PA, 17822, USA
| | - Alfred Kennedy
- Department of Pediatric Surgery, Geisinger Clinic, 100 N. Academy Avenue, Danville, PA, 17822, USA
| | - William Cochran
- Department of Pediatric Gastroenterology, Geisinger Clinic, 100 N. Academy Avenue, Danville, PA, 17822, USA.
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Wu C, Chen C, Chia S, Wang C, Huang H, Tsai M. X-Ray Quiz: A Full-Term Newborn with Bloody Stool. HONG KONG J EMERG ME 2016. [DOI: 10.1177/102490791602300108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Cw Wu
- Ditmanson Medical Foundation Chia-Yi Christian Hospital, Department of Emergency Medicine, Chiayi, Taiwan
| | - Cm Chen
- Ditmanson Medical Foundation Chia-Yi Christian Hospital, Department of Emergency Medicine, Chiayi, Taiwan
| | - St Chia
- Ditmanson Medical Foundation Chia-Yi Christian Hospital, Department of Emergency Medicine, Chiayi, Taiwan
| | - Cm Wang
- Ditmanson Medical Foundation Chia-Yi Christian Hospital, Department of Emergency Medicine, Chiayi, Taiwan
- Chang Gung University of Science and Technology, College of Nursing, Tao-Yuan, Taiwan Wang
| | - Hj Huang
- Ditmanson Medical Foundation Chia-Yi Christian Hospital, Department of Emergency Medicine, Chiayi, Taiwan
| | - Mj Tsai
- Ditmanson Medical Foundation Chia-Yi Christian Hospital, Department of Emergency Medicine, Chiayi, Taiwan
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Diagnosis of pediatric gastric, small-bowel and colonic volvulus. Pediatr Radiol 2016; 46:130-8. [PMID: 26394623 DOI: 10.1007/s00247-015-3445-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 06/11/2015] [Accepted: 07/15/2015] [Indexed: 10/23/2022]
Abstract
Digestive volvulus affects the stomach, small bowel and mobile segments of the colon and often has a developmental cause. Reference radiologic examinations include upper gastrointestinal contrast series for gastric volvulus, possibly with ultrasonography for small-bowel volvulus, and contrast enema for colonic volvulus. Treatment is usually surgical. This pictorial essay describes the embryological development and discusses the clinical and radiologic presentation of volvulus, depending on location, and details the appropriate radiologic examinations.
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Malrotation of midgut in adults, an unsuspected and neglected condition--An analysis of 64 consensus confirmed cases. Indian J Gastroenterol 2015; 34:426-30. [PMID: 26759264 DOI: 10.1007/s12664-015-0596-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 10/14/2015] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Malrotation of midgut is considered to be a condition of childhood. This study evaluated malrotation in adults with recurrent abdominal pain (RAP). METHODS Sixty-four consensus-confirmed cases of intestinal malrotation were reviewed. The diagnosis was based on radiological criteria, and the consensus was arrived at by at least three of the five authors in any individual case. RESULTS Abnormal duodenojejunal junction (DJJ) was a consensus finding in 64 cases referred for RAP. Most were in their fourth decade of life, and 12 were beyond 60 years. Besides RAP, intolerance to food was the next common symptom. Acute intestinal obstruction was seen in 16. Forty-two of 64 patients consented for surgery. Ladd's procedure was the commonest. All patients who underwent surgery were symptom free except for two, of which, one had liver cyst and the other had hernia. Of those who refused surgery (22), all had continued symptoms and 10 patients took alternative therapies. On follow up of initially unwilling patients (for surgery) with abnormal DJJ, only eight consented for surgery; three underwent open Ladd's procedure, and one had laparoscopic Ladd's done. CONCLUSION Malrotation is not uncommon as a cause of RAP in adults.
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Neonatal midgut volvulus: Spectrum of findings at color Doppler sonography. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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