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Yadav DK, Shah SK, Poudel S, Parajuli B, Bhattarai A, Adhikari D. Ileosigmoidal knotting: a case report and literature review of a rare cause of acute abdomen in children. J Surg Case Rep 2024; 2024:rjae142. [PMID: 38476453 PMCID: PMC10930186 DOI: 10.1093/jscr/rjae142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 02/18/2023] [Indexed: 03/14/2024] Open
Abstract
Ileosigmoidal knotting (ISK) is a rare, possibly fatal cause of intestinal obstruction. ISK is a compound volvulus that is more common in Africa and Asia. ISK is mostly seen in adults, pediatric cases reported in the literature are much rarer. In this report, we present the first reported case of ISK in a pediatric patient from Nepal. An 8-year-old male child presented with symptoms of abdominal pain, vomiting, and obstipation. The abdomen was distended with generalized tenderness. Erect abdominal X-ray showed multiple air-fluid levels. Intraoperatively, gangrenous ileum loops were entangled around the sigmoid, and resection of the gangrenous ileum and sigmoid was performed. An end-to-end colo-colic anastomosis from the descending colon to the remaining sigmoid with a double-loop ileostomy was performed. Pediatric ISK is a rare fatal form of intestinal obstruction that progresses quickly to gangrene. Clinical signs and symptoms are nonspecific, making preoperative diagnosis challenging.
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Affiliation(s)
- Dipak K Yadav
- Department of General Surgery, Nobel Medical College Teaching Hospital, Kanchanbari, Biratnagar-4, Morang 56613, Nepal
| | - Sanjay K Shah
- Department of General Surgery, Nobel Medical College Teaching Hospital, Kanchanbari, Biratnagar-4, Morang 56613, Nepal
| | - Saurav Poudel
- Department of General Surgery, Nobel Medical College Teaching Hospital, Kanchanbari, Biratnagar-4, Morang 56613, Nepal
| | - Bivusha Parajuli
- Department of General Surgery, Nobel Medical College Teaching Hospital, Kanchanbari, Biratnagar-4, Morang 56613, Nepal
| | - Amit Bhattarai
- Department of General Surgery, Nobel Medical College Teaching Hospital, Kanchanbari, Biratnagar-4, Morang 56613, Nepal
| | - Dinesh Adhikari
- Department of General Surgery, Nobel Medical College Teaching Hospital, Kanchanbari, Biratnagar-4, Morang 56613, Nepal
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Romano G, Frediani S, Aloi IP, Bertocchini A, Pardi V, Accinni A, Inserra A. Case Report: An unusual case of wide ileoileal intussusception associated with intestinal volvulus in a 8-months-old infant. Front Pediatr 2024; 12:1363731. [PMID: 38434726 PMCID: PMC10904457 DOI: 10.3389/fped.2024.1363731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Introduction Midgut volvulus and intussusception are prevalent paediatric abdominal emergencies. To the best of our knowledge, this is the first reported case of a connection between intestinal volvulus and a massive intussusception. Case report An 8-month-old male infant was brought to the emergency room with a history of abdominal pain and vomiting for <24 h. On physical examination, the child appeared restless and was found to have a circumferential hard mass of approximately 4 cm in diameter in the epigastric region. Upon admission, laboratory results showed a C-reactive protein level of 0.4 mg/dl, LDH level of 351 U/L, mild leukocytosis with a white blood cell count of 12 × 103 /µl, and 67% neutrophils. A physical exam was significant for abdominal distention, hyperresonance in percussion, and a palpable, painful epigastric mass. The findings of the operation included a dilated and ischemic intestinal loop, approximately 25 cm from the ileocecal valve, twisted upon itself for three turns. After de-rotation, an extensive occluding ileo-ileal invagination with an ischemic intestinal loop was identified, and a length of approximately 55-60 cm of the distal ileum, including the ischemic segment, was resected. Discussion This is the first reported case of a connection between intestinal volvulus and a massive intussusception. Currently, only two reported cases describe the connection between volvulus and intussusception, which are insufficient to establish a direct link between the two clinical conditions.
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Affiliation(s)
| | - Simone Frediani
- Department of General Surgery, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Kim J, Yoo SY, Jeon TY, Kim JH. [Malrotation and Midgut Volvulus in Children: Diagnostic Approach, Imaging Findings, and Pitfalls]. J Korean Soc Radiol 2024; 85:124-137. [PMID: 38362395 PMCID: PMC10864163 DOI: 10.3348/jksr.2023.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/16/2023] [Accepted: 06/20/2023] [Indexed: 02/17/2024]
Abstract
Malrotation and midgut volvulus are surgical emergencies that commonly occur within the first month of life. The classic symptom is acute bilious vomiting, while nonspecific symptoms such as recurrent abdominal pain may be present in older children. Malrotation can be associated with duodenal obstruction caused by an abnormal peritoneal fibrous band or congenital anomalies, such as an annular pancreas or a preduodenal portal vein. Volvulus can lead to bowel ischemia and a life-threatening condition, thus prompt and accurate diagnosis is crucial. Diagnosis can be made through upper gastrointestinal series, ultrasonography, and CT, with ultrasonography being preferred as a screening tool due to its rapid and accurate diagnosis, without radiation exposure, in children. This pictorial essay discusses the key imaging findings and diagnostic approaches for malrotation and midgut volvulus, as well as diagnostic pitfalls based on actual cases.
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Gashoot K, Kashbour MO, Abuhlaiga M. Midgut Volvulus in Disguise: Acute Abdomen in Early Pregnancy. Cureus 2023; 15:e50955. [PMID: 38249175 PMCID: PMC10800149 DOI: 10.7759/cureus.50955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
Small bowel obstruction (SBO) in pregnancy is a challenging diagnosis. Case rarity, non-specific presentations, and the non-practicality of using X-ray/gamma-ray imaging modalities in pregnancy contribute to the increased difficulty in timely diagnosing midgut volvulus during pregnancy, thereby increasing maternal and fetal morbidity. We report a case of midgut volvulus in a 39-year-old lady, gravida 3, para 2, with two previous cesarean sections. Her only presenting complaint was abdominal pain for three days with no other associated symptoms. The case was successfully diagnosed using magnetic resonance imaging (MRI) and subsequently treated surgically by segmental resection with side-to-side ileocecal anastomosis, thereby saving the mother and fetus. Clinicians should have a low threshold of suspicion of the varied causes of SBO in pregnancy, particularly in patients with prior abdominopelvic surgeries. Imaging is central to preoperative diagnosis, and MRI has gained popularity with safety and accuracy comparable to computed tomography. Management aims at minimizing maternal and fetal morbidity and mortality.
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Affiliation(s)
- Khalid Gashoot
- Diagnostic Radiology, Tripoli Central Hospital, Tripoli, LBY
- Radiology, Tripoli University, Tripoli, LBY
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Rivera Fernández RR, Cancel Artau KJ, Añeses Gonzalez CR, Correa Rivas MS, Diaz EC, Justiniano VO, del Río JL. Neurofibromatosis Type I Presenting with Incomplete Ileal Volvulus in a Pediatric Patient. Am J Case Rep 2023; 24:e918041. [PMID: 37571808 PMCID: PMC10427934 DOI: 10.12659/ajcr.918041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/09/2023] [Accepted: 10/31/2019] [Indexed: 08/13/2023]
Abstract
BACKGROUND Neurofibromatosis 1 is a neurocutaneous disorder with multisystemic manifestations. When patients are lacking overt cutaneous manifestations, diagnosis may be delayed and may complicate diagnosis and management of atypical presentations of this disease. It is thus important to strive to obtain relevant and/or complete history to arrive at the appropriate diagnosis. Furthermore, maintaining an index of suspicion in cases of vague abdominal pain may guide the clinician in establishing the correct diagnosis of mesenteric plexiform neurofibroma in the setting of known/presumed neurofibromatosis 1 patients presenting with acute and/or chronic vague abdominal symptoms. CASE REPORT This is a case of a teenage boy who presented with acute, vague abdominal pain over a period of 2 weeks. Laboratory tests and physical exam findings in primary and secondary care settings were unremarkable, and thus the patient was discharged home only to continue with abdominal pain, thus seeking additional medical care. After admission to our facility and exhaustive history taking, physical examination, and imaging, a prospective diagnosis of neurofibromatosis with mesenteric neurofibroma was made. Upon surgical exploration, a mesenteric mass with corresponding volvulized, ischemic small bowel was removed. Histopathology confirmed a plexiform neurofibroma. The patient recovered adequately and was discharged home without complications. CONCLUSIONS This case highlights the importance of exhaustive history taking to obtain an accurate diagnosis as well as the importance of a high index of clinical suspicion for mesenteric neurofibromatosis in patients with presumed or known neurofibromatosis and presenting with vague abdominal symptoms.
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Affiliation(s)
| | | | | | - Maria S. Correa Rivas
- Department of Pathology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Edgardo Cintron Diaz
- Department of Surgery, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | | | - Jose Lara del Río
- Department of Diagnostic Radiology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
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S D, Singh SK, Das A, Katragadda S, Mishra A. Adult Midgut Malrotation With Chronic Volvulus With Superior Mesenteric Artery (SMA) Thrombosis: A Recherche. Cureus 2023; 15:e43754. [PMID: 37727196 PMCID: PMC10506661 DOI: 10.7759/cureus.43754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 09/21/2023] Open
Abstract
Intestinal malrotation is primarily a surgical condition of neonates due to abnormal intestinal rotation during fetal development. Usually, the presentation is immediately after birth. Adult midgut malrotation is rare and primarily detected at laparotomy or incidental radiological imaging for various conditions. We report a sporadic case of a 35-year-old male who presented to the surgical outpatient department (OPD) complaining of dull aching abdominal pain after taking meals for two months. He was able to tolerate a liquid diet only and able to carry out his routine work comfortably. In imaging studies, it was found to be a case of midgut malrotation with volvulus and superior mesenteric artery (SMA) thrombosis with collaterals without features of intestinal obstruction. The patient underwent diagnostic laparoscopy, and a midgut volvulus was identified with Ladd's bands. He underwent exploratory laparotomy with Ladd's procedure. Postoperatively symptoms were resolved, and the patient was discharged in stable condition. If intestinal malrotation presents in adults, it is challenging to diagnose it as it presents with atypical symptoms like chronic vague abdominal pain and weight loss. Often radiological correlation is essential to diagnose such patients. For surgical intervention, a laparoscopic approach is considered better in expert hands. Even though the disease has a chronic course, a high index of suspicion should arise when treating such cases of intestinal malrotation in an adult male. Timely surgery can do miracles and prevent catastrophic complications.
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Affiliation(s)
- Dhivakar S
- General Surgery, All India Institute of Medical Sciences, Rishikesh, IND
| | - Sudhir K Singh
- General Surgery, All India Institute of Medical Sciences, Rishikesh, IND
| | - Asish Das
- General Surgery, All India Institute of Medical Sciences, Rishikesh, IND
| | - Sanjay Katragadda
- General Surgery, All India Institute of Medical Sciences, Rishikesh, IND
| | - Ashish Mishra
- General Surgery, All India Institute of Medical Sciences, Rishikesh, IND
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Montironi R, Tosto V, Quintili D, Crescenzi D, Battistoni GI, Cobellis G, Giannubilo SR, Ciavattini A. Antenatal Diagnosis and Management of Fetal Intestinal Volvulus: Case Series and Literature Review. J Clin Med 2023; 12:4790. [PMID: 37510904 PMCID: PMC10381374 DOI: 10.3390/jcm12144790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/16/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Fetal intestinal volvulus is a rare condition that can lead to hemorrhage, bowel necrosis, and urgent surgical treatment after birth. Thus, prompt diagnosis and treatment are essential to avoiding fetal or neonatal demise. Prenatal ultrasound is a keystone tool in the diagnostic course. However, sonographic findings tend to be non-specific, with limited understanding of the pathophysiology behind their atypical presentation. With a literature review and a case series, we aim to optimize the antenatal diagnosis and management of this rare but life-threatening condition. Six cases from our institution were retrospectively analyzed over 12 years. A literature review was conducted until December 2022. A total of 300 articles matched the keyword "Fetal volvulus", and 52 studies were eligible for the review. Our 6 cases are added to the 107 cases reported in the literature of fetal intestinal volvulus with antenatal ultrasound assessment and without associated gastroschisis or omphalocele. Several prenatal symptoms and ultrasound markers, even if not specific, were more frequently reported. Different experiences of management were described regarding follow-up, the timing of delivery, the mode of delivery, and surgery outcomes. This paper highlights the importance of suspecting and assessing fetal volvulus at routine ultrasound scans, describing the most frequent antenatal presentations and management in order to improve fetal and neonatal outcomes.
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Affiliation(s)
- Ramona Montironi
- Clinical Sciences Department, Obstetrics and Gynecology Section, Università Politecnica delle Marche, Via Filippo Corridoni 11, 60123 Ancona, Italy
| | - Valentina Tosto
- Obstetrics and Gynecology Unit, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147 Genova, Italy
| | - Dayana Quintili
- Clinical Sciences Department, Obstetrics and Gynecology Section, Università Politecnica delle Marche, Via Filippo Corridoni 11, 60123 Ancona, Italy
| | - Daniele Crescenzi
- Clinical Sciences Department, Obstetrics and Gynecology Section, Università Politecnica delle Marche, Via Filippo Corridoni 11, 60123 Ancona, Italy
| | - Giovanna Irene Battistoni
- Clinical Sciences Department, Obstetrics and Gynecology Section, Università Politecnica delle Marche, Via Filippo Corridoni 11, 60123 Ancona, Italy
| | - Giovanni Cobellis
- Clinical Sciences Department, Pediatric Surgery Section, Università Politecnica delle Marche, Via Filippo Corridoni 11, 60123 Ancona, Italy
| | - Stefano Raffaele Giannubilo
- Clinical Sciences Department, Obstetrics and Gynecology Section, Università Politecnica delle Marche, Via Filippo Corridoni 11, 60123 Ancona, Italy
| | - Andrea Ciavattini
- Clinical Sciences Department, Obstetrics and Gynecology Section, Università Politecnica delle Marche, Via Filippo Corridoni 11, 60123 Ancona, Italy
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Mengistu S, Asnake M, Hassen S, Mekonnen B. Synchronous Volvulus of Ascending and Transverse Colon. Int Med Case Rep J 2023; 16:397-400. [PMID: 37408755 PMCID: PMC10319287 DOI: 10.2147/imcrj.s413600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/27/2023] [Indexed: 07/07/2023] Open
Abstract
Introduction Colonic volvulus is the torsion of a part of the colon causing large bowel obstruction by strangulation, which may lead to ischemia and then necrosis. Synchronous colonic volvulus is extremely rare; even if there are some case reports on synchronous colonic volvulus, there are no reported cases of synchronous ascending and transverse colon volvulus in the medical literature to our knowledge. Case Presentation A 25-year-old girl with a previous history of epilepsy presented with a one-day duration of abdominal cramps with associated symptoms of vomiting of bilious matter, failure to pass faeces, and flatus of the same duration. The patient underwent surgical intervention, and ascending and transverse volvulus were discovered. Conclusion In spite of ascending and transverse colon volvulus rarity, we advised including these in the differential diagnosis of patients associated with large bowel obstruction.
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Affiliation(s)
- Sisay Mengistu
- Department of Surgery, College of Medicine and health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Molla Asnake
- School of Medicine, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Suleman Hassen
- Department of Surgery, College of Medicine and health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Biruk Mekonnen
- School of Medicine, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
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Fernandez Trokhimtchouk T, Flores LF, Morillo Cox Á, Gordillo A, Crespo Martinez JK. Intestinal Nonrotation and Cecal Volvulus: A Unique Combination of Rare Pathologies. Cureus 2023; 15:e39761. [PMID: 37398727 PMCID: PMC10311458 DOI: 10.7759/cureus.39761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Intestinal nonrotation and cecal volvulus are rare clinical entities, and their coexistence is exceptionally uncommon. We present a case of a 41-year-old male patient with symptomatic intestinal nonrotation and associated cecal volvulus. Diagnostic imaging played a crucial role in recognizing the conditions and guiding surgical intervention. The patient underwent laparotomy and right hemicolectomy with a favorable postoperative course. This case highlights the challenges in diagnosing and managing these rare conditions. Further studies are needed to optimize the management strategies for this unique combination of pathologies.
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Affiliation(s)
| | - Luis F Flores
- General Surgery, Universidad Internacional del Ecuador/Axxis Hospital, Quito, ECU
| | - Álvaro Morillo Cox
- General Surgery, Universidad Internacional del Ecuador/Axxis Hospital, Quito, ECU
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Yeh J, Ashi AA, Hernandez J, Seaver C. An Unusual Combination of Arthrogryposis, Gastroschisis, Cecal Volvulus, and Malignant Hyperthermia in a Young Woman: A Case Report. Am J Case Rep 2023; 24:e938031. [PMID: 36635941 PMCID: PMC9847307 DOI: 10.12659/ajcr.938031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The purpose of this study is to discuss a patient with a history of conditions, including arthrogryposis, gastroschisis, and malignant hyperthermia, who presented with cecal volvulus requiring urgent surgical intervention. CASE REPORT A 29-year-old woman with a history of arthrogryposis, gastroschisis, malignant hyperthermia, and multiple childhood abdominal surgeries presents to the Emergency Department (ED) with 2 days of abdominal pain and bloody diarrhea. A CT abdomen/pelvis revealed findings concerning for a cecal volvulus. The patient was premedicated and monitored closely by the anesthesia team due to her history of malignant hyperthermia. She underwent an exploratory laparotomy, where a dilated cecum and proximal ascending colon were found to be completely volvulized around the mesentery. Manual bowel detorsion was performed, which resulted in reperfusion of the ischemic-appearing bowel, which then appeared viable. She recovered well after the procedure and was discharged on postoperative day 5. CONCLUSIONS This case highlights a patient who presented with a combination of 4 findings: arthrogryposis, gastroschisis, malignant hyperthermia, and cecal volvulus. With arthrogryposis reported to be associated with gastroschisis and malignant hyperthermia, this report not only corroborates this association, but also aims to draw attention to the fact that these conditions have potential to occur jointly with cecal volvulus. Given the patient's history of gastroschisis requiring extensive abdominal surgeries that contribute as risk factors for cecal volvulus, it is possible there may be other arthrogryposis patients who present with cecal volvulus similar to that seen in this patient.
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Affiliation(s)
- Justin Yeh
- Department of Translational Medicine, Herbert Wertheim College of Medicine at Florida International University, Miami, FL, USA
| | - Amro Al Ashi
- Department of Translational Medicine, Herbert Wertheim College of Medicine at Florida International University, Miami, FL, USA
| | - Jennifer Hernandez
- Division of General Surgery, Memorial Healthcare System, Pembroke Pines, FL, USA,Corresponding Author: Jennifer Hernandez, e-mail:
| | - Christopher Seaver
- Department of Translational Medicine, Herbert Wertheim College of Medicine at Florida International University, Miami, FL, USA,Division of General Surgery, Memorial Healthcare System, Pembroke Pines, FL, USA
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Wen CC, Kuo TC, Lee HC, Yeung CY, Chan WT, Jiang CB, Sheu JC, Wang NL, Hsu CH, Weng SC, Tseng YJ. Coexisting gastrointestinal and hepatobiliary tract anomalies in omphalocele and gastroschisis: A twenty-year experience in a single tertiary medical center. Pediatr Neonatol 2022; 63:468-473. [PMID: 35641386 DOI: 10.1016/j.pedneo.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/30/2022] [Accepted: 03/10/2022] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Omphalocele and gastroschisis are the two most common congenital abdominal wall defects; however, no previous study has focused on gastrointestinal and hepatobiliary tract malformations in these two conditions. This study aimed to investigate the demographic characteristics, coexisting congenital gastrointestinal and hepatobiliary tract anomalies, hospital course, and outcomes of patients with gastroschisis and omphalocele. METHODS This is retrospective chart review of all patients admitted to one tertiary medical center in Taiwan between January 1, 2000 and June 30, 2020 with a diagnosis of gastroschisis or omphalocele. The medical records were reviewed to obtain demographic data regarding coexisting gastrointestinal and hepatobiliary tract anomalies and outcomes. RESULTS Of the 51 patients included, 21 had gastroschisis and 30 had omphalocele. Gastroschisis was associated with a significantly younger maternal age and a higher incidence of small for gestational age. Of the 30 patients with omphalocele, twelve had associated gastrointestinal and hepatobiliary anomalies. Seven of the 21 patients with gastroschisis had gastrointestinal anomalies, and none had hepatobiliary anomalies. Among the omphalocele patients, three (10%) had documented malrotation, and one developed midgut volvulus. Among gastroschisis patients, four patients (19%) had malrotation, and two developed midgut volvulus. There were no statistically significant differences in postoperative complications or mortality rates between those with and without gastrointestinal/hepatobiliary tract anomalies. CONCLUSION The diversity of coexisting gastrointestinal and hepatobiliary tract anomalies is higher in the omphalocele than in gastroschisis. In addition, we demonstrate that patients with gastroschisis or omphalocele have a higher rate of intestinal malrotation and midgut volvulus.
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Affiliation(s)
- Chen-Chen Wen
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan; Department of Pediatrics, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan
| | - Tien-Chueh Kuo
- The Metabolomics Core Laboratory, Centers of Genomic and Precision Medicine, National Taiwan University, Taipei, Taiwan
| | - Hung-Chang Lee
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan
| | - Chun-Yan Yeung
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan; MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Wai-Tao Chan
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan; MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Chuen-Bin Jiang
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Jin-Cherng Sheu
- Department of Pediatric Surgery, Mackay Memorial Hospital, Taipei, Taiwan
| | - Nien-Lu Wang
- Department of Pediatric Surgery, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chyong-Hsin Hsu
- Department of Neonatology, MacKay Children's Hospital, Taipei, Taiwan
| | - Shu-Chao Weng
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan.
| | - Yufeng Jane Tseng
- The Metabolomics Core Laboratory, Centers of Genomic and Precision Medicine, National Taiwan University, Taipei, Taiwan; Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan; Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan.
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Takahashi J, Mori-Yoshimura M, Ariga H, Sato N, Nishino I, Takahashi Y. Diagnostic Yield of Chilaiditi's Sign in Advanced-Phase Late-Onset Pompe Disease. J Neuromuscul Dis 2022; 9:619-627. [PMID: 35964201 DOI: 10.3233/jnd-220792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Chilaiditi's sign (CS), hepatodiaphragmatic interposition of the intestine, was caused by morphological abnormalities such as diaphragmatic atrophy, intestinal dilation, and liver atrophy. The sign is potentially important due to associations with clinically recurrent abdominal pain or even colonic volvulus. Late-onset Pompe disease (LOPD) could have the high prevalence of CS because of widened hepatodiaphragmatic space, following diaphragmatic atrophy, and the abnormal dilation of intestine caused by glycogen accumulation in smooth muscle of intestine. Our aim was to investigate the prevalence of CS in LOPD, and to identify the risk factors of CS in LOPD patients. METHODS Medical records of genetically confirmed patients of Pompe disease at the National Center Hospital, National Center of Neurology and Psychiatry were retrospectively reviewed. We evaluated CS using chest X-ray (CXR) and abdominal CT and assessed the prevalence of CS in LOPD patients. We also divided the patients into two groups, CS and non-CS group, and evaluated the factor associated with CS compared to clinical variables between groups. RESULTS Three of seven (43%) were detected in CS. CS group (P5-7) and non-CS group (P1-4) were obtained. In comparison of clinical variables, the severity of atrophy in right diaphragms was significantly higher in CS than non-CS groups (p = 0.029). Also, the frequency of abnormal position of right diaphragm and liver, and abnormally dilated bowel was seen in all of CS patients, but none of non-CS patient (p = 0.029, each). CONCLUSION In LOPD patients, the prevalence of CS was much higher of 43%, compared to healthy groups, or even in similarly respiratory muscle impaired neuromuscular diseases. The anatomically abnormal position of diaphragm and liver, atrophy and fat infiltration of diaphragms, and abnormally dilated bowel were significantly associated with CS in LOPD. We should pay more attention to CXR or abdominal CT as follow up in LOPD patients.
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Affiliation(s)
- Junichiro Takahashi
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Japan
| | - Madoka Mori-Yoshimura
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Japan
| | - Hajime Ariga
- Department of Gastroenterology and Hepatology, National Center Hospital, National Center of Neurology and Psychiatry, Japan
| | - Noriko Sato
- Department of Radiology, National Center Hospital, National Center of Neurology and Psychiatry, Japan
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Japan
| | - Yuji Takahashi
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Japan
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13
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Maya‐Enero S, Prat‐Ortells J, Martín‐Solé O, De Haro‐Jorge I, Pertierra‐Cortada À, Iriondo‐Sanz M. Distinguishing outcomes of neonatal intestinal volvulus: Review of our experience over the last 20 years. Acta Paediatr 2022; 111:284-290. [PMID: 34704280 DOI: 10.1111/apa.16167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/29/2021] [Accepted: 10/25/2021] [Indexed: 12/01/2022]
Abstract
AIM There are two types of intestinal volvulus: midgut (MGV) and segmental (SV). Patients with different types of intestinal volvulus are often included in the same case series, which may affect the perception of how severe "intestinal volvuli" are. We aimed to compare both types of intestinal volvulus. METHODS This is a retrospective observational study including all patients with MGV and SV up to 28 days of life admitted to a tertiary hospital in Spain over a 20-year-period (1999-2019). A comparison between groups and a logistic regression model for mortality were done. RESULTS We identified 32 patients: 23 MGV and 9 SV. Malrotation was exclusive of MGV. Prenatal diagnosis, cystic fibrosis, and intestinal resection were significantly more frequent in SV. Surgery was performed at a significantly lower age in SV. The mortality observed in acute MGV with intestinal compromise (41.7%) is four times higher than the mortality of SV (11.1%). The overall mortality of all MGV patients (21.7%) is almost twice that of SV. Mortality was best predicted by the presence of hemodynamic instability (OR 27.5 95% CI 2.50-302.17; p = 0.007). CONCLUSION SV and MGV have a different clinical presentation. Hemodynamic instability is the major risk factor for death.
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Affiliation(s)
- Silvia Maya‐Enero
- Department of Neonatology Service of Pediatrics, Hospital del Mar Universitat Autònoma de Barcelona Barcelona Spain
| | - Jordi Prat‐Ortells
- Service of Pediatric Surgery Hospital Sant Joan de DéuUniversitat de Barcelona Barcelona Spain
| | - Oriol Martín‐Solé
- Service of Pediatric Surgery Hospital Sant Joan de DéuUniversitat de Barcelona Barcelona Spain
| | - Irene De Haro‐Jorge
- Service of Pediatric Surgery Hospital Sant Joan de DéuUniversitat de Barcelona Barcelona Spain
| | | | - Martín Iriondo‐Sanz
- Service of Neonatology Hospital Sant Joan de DéuUniversitat de Barcelona Barcelona Spain
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14
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Yan J, Wang L, Xie C, Peng C, Pang W, Chen Y. Preoperative complications in children with mesenteric lymphatic malformations: Incidence, risk factors and outcomes. Front Pediatr 2022; 10:1033897. [PMID: 36245723 PMCID: PMC9557770 DOI: 10.3389/fped.2022.1033897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/16/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Preoperative complications of mesenteric lymphatic malformations (ML) in children are various and complex. We aim to analyze the incidences and risk factors of three major preoperative complications (hemorrhage of the cyst, infection of the cyst and intestinal volvulus) in ML patients, and explore their influence on the outcomes. METHODS This retrospective cohort study enrolled ML patients undergoing surgery at Beijing Children's Hospital between June 2016 and June 2022 and classified them according to different preoperative complications, preoperative hemorrhage or infection, and preoperative intestinal volvulus. The groups were examined and compared according to sex, age at admission, presenting symptoms, laboratory examinations, imaging examinations, preoperative treatments, cyst characteristics, surgical details, perioperative clinical data, and follow-up. Logistic regression analysis was performed to identify the independent risk factors for preoperative hemorrhage or infection, and preoperative intestinal volvulus. RESULTS Of the 104 enrolled ML patients, 27 (26.0%) had preoperative hemorrhage or infection, and 22 (21.2%) had preoperative intestinal volvulus. Univariate analysis showed that patients with preoperative hemorrhage or infection had a higher rate of ML in the mesocolon (44.4 vs. 23.4%, p < 0.038) and larger cysts (10 vs. 8 cm, p = 0.042) than patients without preoperative hemorrhage or infection. Multivariable logistic regression analysis found that the location (OR, 3.1; 95% CI, 1.1-8.6; p = 0.026) and size of the cyst (≥7.5 cm) (OR, 6.2; 95% CI, 1.6-23.4; p = 0.007) were independent risk factors for preoperative hemorrhage or infection. Preoperative intestinal volvulus was only found in ML at the intestinal mesentery. Further analysis showed that ML in the jejunal mesentery was an independent risk factor for preoperative intestinal volvulus (OR, 3.3; 95% CI, 1.1-10.0; p = 0.027). Patients with preoperative hemorrhage or infection spent more on hospitalization costs than patients without preoperative hemorrhage or infection (3,000 vs. 2,674 dollars, p = 0.038). CONCLUSIONS ML patients should be treated as soon as possible after diagnosis. The location and size of the cyst were independent risk factors for preoperative hemorrhage or infection. ML in the jejunal mesentery was an independent risk factor for preoperative intestinal volvulus.
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Affiliation(s)
- Jiayu Yan
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Li Wang
- Department of Emergency Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Chuanping Xie
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Chunhui Peng
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Wenbo Pang
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yajun Chen
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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15
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Ikoma S, Yano K, Harumatsu T, Muto M, Ieiri S. Left paraduodenal hernia with intestinal volvulus mimicking midgut volvulus. Pediatr Int 2022; 64:e14964. [PMID: 35112444 DOI: 10.1111/ped.14964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/22/2021] [Accepted: 08/17/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Shinichiro Ikoma
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Keisuke Yano
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Toshio Harumatsu
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Mitsuru Muto
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Satoshi Ieiri
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
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16
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Mise N, Terui K, Mitsunaga T, Ohara Y, Hishiki T. Delivery time of two cases of fetal intestinal volvulus. Pediatr Int 2022; 64:e15137. [PMID: 35468244 DOI: 10.1111/ped.15137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/05/2022] [Accepted: 01/17/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Naoko Mise
- Department of Pediatric Surgery, Matsudo City General Hospital, Chiba, Japan.,Department of Pediatric Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Keita Terui
- Department of Pediatric Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Tetsuya Mitsunaga
- Department of Pediatric Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.,Department of Pediatric Surgery, Chiba Kaihin Municipal Hospital, Chiba, Japan
| | - Yukiko Ohara
- Department of Pediatric Surgery, Matsudo City General Hospital, Chiba, Japan.,Department of Pediatric Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Tomoro Hishiki
- Department of Pediatric Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
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17
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Castle C, Beasley SW, Taghavi K. Access to emergency paediatric surgery for testicular torsion or intestinal volvulus in New Zealand: A system perspective. J Paediatr Child Health 2022; 58:146-151. [PMID: 34375478 DOI: 10.1111/jpc.15684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 11/30/2022]
Abstract
AIM The risk of organ loss is increased in children with testicular torsion or intestinal volvulus if surgical management is not expedient. The current retrospective study aims to review the time-course from first symptom to 'knife to skin' in these conditions, to determine where delays occur and facilitate a systems approach to better manage these children. METHODS One hundred consecutive paediatric cases of scrotal exploration for presumed testicular torsion, and 100 neonatal cases presenting with possible malrotation/volvulus were analysed to evaluate the exact time-course of events from admission to surgery. RESULTS (i) Scrotal exploration: the median time from onset of symptoms to presentation was 12 h (interquartile range (IQR): 5-48 h). In children over 5 years of age, 36% (33/93) were transferred from an external district service area. (ii) Malrotation/volvulus: the median duration of symptoms prior to arrival/assessment was 12 h (IQR: 4-24 h). The median cumulative in-hospital time was over 6 h (368 min, IQR: 247-634 min). CONCLUSIONS Time to presentation contributes significantly to testicular ischaemic time. This delay to timely surgical intervention is multi-factorial, and must be addressed at a public health level. Support and training in the management of testicular torsion should be provided to all adult surgeons/trainees that may care for these children. In general, this condition is best managed at the presenting hospital whenever appropriate expertise is available. Novel pathways that streamline care may improve efficiency at an institutional level. Addressing issues of access to specialised neonatal surgery is more vexed on account of the tyranny of distance, and the pre-requisite level of surgical expertise required.
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Affiliation(s)
- Cameron Castle
- Department of Paediatric Surgery, Child Health Service, Wellington Regional Hospital, Wellington, New Zealand
| | - Spencer W Beasley
- Department of Paediatric Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Kiarash Taghavi
- Department of Paediatric Surgery, Child Health Service, Wellington Regional Hospital, Wellington, New Zealand.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
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18
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Abstract
Cecal bascule is a form of volvulus resulting from upward and anterior cecal folding, and accounts for 0.01% of adult large bowel obstructions. With a competent ileocecal valve, cecal bascule may progress to closed loop obstruction, ischemia, gangrene, or perforation. Failure to treat cecal bascule has a mortality of 50%. Nonoperative management includes nasogastric and colonoscopic decompression, with a 95% failure rate. The gold standard is right hemicolectomy with a near nonexistent recurrence rate. Severe gastrointestinal complications following cardiothoracic surgery may lead to increased morbidity, length of stay, and mortality. Here, we present the first reported case of cecal bascule following cardiac surgery.
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Affiliation(s)
- Angela M Johnson
- Department of Anesthesia and Perioperative Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Soon Park
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Francis T Lytle
- Department of Anesthesia and Perioperative Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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19
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Bollard KA, Valsenti G, Healey D, Murdoch J. The adequacy of fluoroscopic upper gastrointestinal studies for suspected intestinal volvulus in a tertiary care centre vs. secondary centres: A regional multicentre study. J Med Imaging Radiat Oncol 2021; 65:293-300. [PMID: 33634557 DOI: 10.1111/1754-9485.13156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/11/2021] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Early diagnosis and treatment of intestinal volvulus are important to reduce morbidity. A fluoroscopic upper GI study is the gold standard for diagnosis and may be performed in a secondary or tertiary care centre prior to surgery. It is important the reporting radiologist is confident in the findings. We aim to assess whether there is any difference in confidence and study quality between paediatric and general radiologists who work in secondary or tertiary care centres. METHODS Retrospective review of initial radiology reports and blinded review of the study images by paediatric radiologists. RESULTS A total of 277 children underwent a fluoroscopic study for intestinal volvulus over a four-year period. The majority were performed at a tertiary care centre, by paediatric radiologists. The confidence of initial reporting was higher in paediatric than general radiologists despite whether they worked in a secondary or tertiary care centre (P-value < 0.001). On retrospective review, studies performed by paediatric radiologists were rated as having a higher confidence in identifying the location of the duodenojejunal flexure. General radiologists tended to have a slightly higher rate of repeat studies but still low at 2.2%. Despite this, there was no significant difference in the diagnosis rates and secondary centre general radiologists excluded malrotation in 62% of studies likely reducing transfer rates. CONCLUSION Confidence in initial reporting and on review of the duodenojejunal flexure location in suspected intestinal volvulus is higher in paediatric radiologists compared with general radiologists, although diagnosis rates are no different.
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Affiliation(s)
- Kate Amelia Bollard
- Department of Radiology, Wellington Regional Hospital, Wellington, New Zealand
| | - Gianluca Valsenti
- Department of Radiology, Wellington Regional Hospital, Wellington, New Zealand
| | - David Healey
- Department of Radiology, Wellington Regional Hospital, Wellington, New Zealand
| | - Jean Murdoch
- Department of Radiology, Wellington Regional Hospital, Wellington, New Zealand
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20
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Shimizu T, Yokomine M, Yoshizato T, Araki K, Higashidate N, Saikusa M, Ushijima K. Difficulty in prenatal diagnosis of the volvulus of the small intestine: A peculiar clinical course of two cases with massive bowel dilatation and loss of peristalsis. J Obstet Gynaecol Res 2021; 47:1903-1908. [PMID: 33590600 DOI: 10.1111/jog.14706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/25/2021] [Accepted: 01/30/2021] [Indexed: 11/27/2022]
Abstract
We report two cases of fetal intestinal volvulus (jejunum in case A, ileum in case B) with massive bowel dilatation and loss of peristalsis, which suddenly appeared in the third trimester. The bowel was dilated to different sizes and there were various echogenic patterns of the intestines in case A and a sausage-like appearance in case B. Case A developed polyhydramnios, whereas case B did not. Among 47 cases of fetal intestinal volvulus (29 articles) in which 32 were diagnosed prenatally, almost all cases with a prenatal diagnosis showed "whirlpool sign" or "coffee bean sign" by sonography and/or findings indicating intestinal hemorrhage. Even without these findings, the presence of dilatation of the intestines and loss of peristalsis occurring in the third trimester were diagnostic clues. The presence of different sizes and various patterns of bowel dilation and hydramnios may be helpful for predicting the involved site of intestinal volvulus.
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Affiliation(s)
- Takahiro Shimizu
- Department of Obstetrics and Gynecology, School of Medicine, Kurume University, Kurume, Japan
| | - Masato Yokomine
- Department of Obstetrics and Gynecology, School of Medicine, Kurume University, Kurume, Japan
| | - Toshiyuki Yoshizato
- Department of Obstetrics and Gynecology, School of Medicine, Kurume University, Kurume, Japan
| | - Kenshiro Araki
- Department of Obstetrics and Gynecology, School of Medicine, Kurume University, Kurume, Japan
| | - Naruki Higashidate
- Department of Pediatric Surgery, School of Medicine, Kurume University, Kurume, Japan
| | - Mamoru Saikusa
- Department of Pediatrics, School of Medicine, Kurume University, Kurume, Japan
| | - Kimio Ushijima
- Department of Obstetrics and Gynecology, School of Medicine, Kurume University, Kurume, Japan
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21
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Talebzadeh H, Andalib S, Andalib MM. Congenital intestinal volvulus with episodes of pain for long period of time: case report. Gastroenterol Hepatol Bed Bench 2021; 14:174-177. [PMID: 33968345 PMCID: PMC8101513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The incidence of intestinal volvulus as a cause of abdominal pain is rare in adults and normally presents during infancy. Approximately 90% of patients with volvulus are diagnosed within the first year of life, 80% of whom are diagnosed within the first month of life. The current case was a 34-year-old pregnant woman who was admitted to the hospital due to self-limited episodes of epigastric pain from a young age. The patient complained that the pains had recently worsened. Further clinical investigation led us to invasive intervention due to signs of obstruction, and the patient was transferred to the operating room. The case represents a rare incidence of intestinal volvulus in an adult and its complications through pregnancy.
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Affiliation(s)
- Hamid Talebzadeh
- Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahrzad Andalib
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Masoud Andalib
- Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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22
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Abstract
BACKGROUND Laparoscopic approach for malrotation has become more popular for neonates and in cases with volvulus, but its safety and efficacy remains controversial. This study reviewed laparoscopy outcomes in neonate/infant malrotation. METHODS Medline/PubMed and Lilacs databases were reviewed. Data from studies published in English/Spanish between 1995 and 2019 were collected. Results are presented as percentages and means/medians; logistic regression was used to study possible associations. RESULTS Nineteen papers offered 99 neonates/infants with median age and weight of 10.5 days and 3.5 kg, respectively. Ladd's procedure was performed in 95 (96%) patients and bands' division in 4 (4%); appendectomy was not included in 16 (16.2%) patients, and cecopexy was not performed in all cases. Volvulus was reported in 39 (39.4%) patients. There were 11 conversions (11.1%) and 10 recurrences of symptoms (10.1%) that required reintervention. An association was found between volvulus and recurrence (P = .05) and the need for conversion (P < .01). There were 10 (10.1%) minor complications and no mortality. The median follow-up was 10 months. DISCUSSION Laparoscopic approach to malrotation is feasible and safe in hemodynamically stable neonates/infants without intestinal necrosis and is associated with 11% conversion rate and 10% reinterventions. The presence of volvulus is associated with recurrence and conversion. Laparoscopic Ladd's procedure with appendectomy and without cecopexy is the commonly practiced approach that is associated with minor complications.
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Affiliation(s)
- Karina M da Costa
- 9762 Department of Pediatric Surgery, Chelsea Children's Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, London, UK.,42487 Division of Pediatric Surgery, Department of Pediatrics, Regional University Hospital of Maringá, State University of Maringá, Maringá, Brazil
| | - Amulya K Saxena
- 9762 Department of Pediatric Surgery, Chelsea Children's Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, London, UK
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23
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Kerkeni Y, Hannachi W, Hamzaoui M. Volvulus with intestinal malrotation hiding a near-total intestinal aganglionosis: Case report. J Neonatal Perinatal Med 2019; 13:431-433. [PMID: 31771072 DOI: 10.3233/npm-180083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Total colonic aganglionosis occurring together with malrotation is a rare occurrence and may pose diagnostic and management dilemmas for the pediatric surgeon. We report the case of a new born, who was operated at the age of three days for malrotation with volvulus, treated by Ladd procedure. Postoperatively, we noticed persistent abdominal distension and emission of a small amount of meconium every 4 to 5 days. The barium enema showed a non-functional microcolon. Surgical exploration on the 24th day found an ileo-ileal transition zone located 60 cm distal to the ligament of Treitz. Extemporaneous biopsies from the colon and mid-ileum confirmed the absence of ganglion cells. We performed an ileostomy at 50 cm from duodeno-jejunal flexure. Unfortunately, the patient succumbed to nosocomial infection at 33 days of age.This case was a challenging scenario for us where a diagnosis of complicated malrotation had obscured the Hirschsprung's disease.
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Affiliation(s)
- Y Kerkeni
- Department of Pediatric Surgery "A", Children Hospital "Bechir Hamza" of Tunis, Tunisia Université de Tunis El Manar, Tunis, Tunisia
| | - W Hannachi
- Department of Pediatric Surgery "A", Children Hospital "Bechir Hamza" of Tunis, Tunisia Université de Tunis El Manar, Tunis, Tunisia
| | - M Hamzaoui
- Department of Pediatric Surgery "A", Children Hospital "Bechir Hamza" of Tunis, Tunisia Université de Tunis El Manar, Tunis, Tunisia
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24
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Abstract
Small bowel volvulus is a rare clinical entity which presents as recurrent intermittent abdominal pain after consumption of food. Although the entity is well described in the literature, diagnosis is often difficult due to its clinical presentation being similar to mesenteric ischemia. Herein we present the case of a 44-year-old male who presented to us with this condition.
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Affiliation(s)
- Tushar Patial
- General Surgery, Indira Gandhi Medical College, Shimla
| | - Sahil Chaddha
- Medical Student, Drexel University College of Medicine
| | - Namit Rathore
- General Surgery, Indira Gandhi Medical College, Shimla
| | - Vishal Thakur
- General Surgery, Indira Gandhi Medical College, Shimla
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25
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Abstract
Intestinal volvulus on mesenteric cysticum lymphangioma (CL) is rare in children. The clinical picture is not very suggestive. We report a case of intestinal volvulus on CL in a 7-year-old girl after an abdominal trauma. Resection and anastomosis were made. The confirmation diagnosis was done by anatomopathological examination. Early diagnosis of intra-abdominal CL will allow avoiding complication.
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Affiliation(s)
- Yacaria Coulibaly
- Department of Surgery at the Teaching Hospital Gabriel Touré, Mali, Mali
| | - Soumaila Keita
- Department of Surgery at the Teaching Hospital Point G, Bamako, Mali
| | - Aliou Doumbia
- Department of Surgery at the Teaching Hospital Gabriel Touré, Mali, Mali
| | - Adegne Togo
- Department of Surgery at the Teaching Hospital Gabriel Touré, Mali, Mali
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26
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Koch C, Taghavi K, Hamill J, Mirjalili SA. Redefining the projectional and clinical anatomy of the duodenojejunal flexure in children. Clin Anat 2015; 29:175-82. [PMID: 26378736 DOI: 10.1002/ca.22625] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/05/2015] [Accepted: 09/11/2015] [Indexed: 11/12/2022]
Abstract
The duodenojejunal flexure (DJF) is an important surgical landmark that enables the pediatric surgeon to establish whether normal intestinal rotation has occurred. The degree of variation in the position of the DJF has not been studied in the pediatric population, and there have been only limited studies on adults. The aim of the present study was to determine the position and relationships of the DJF in infants and children utilizing cross-sectional imaging. Computer tomography scans of 120 children were divided into three age groups and systematically analyzed. The DJF position was measured in relation to the vertebral body level, midline, anterior-posterior distance from the vertebral body, transpyloric plane, and mesenteric vessels. The position of the third part of the duodenum and the length of the mesenteric root were also determined. There was considerable variation in the DJF position with respect to the above landmarks in all three age groups. The vertebral body level of the DJF was centered on L1, but ranged between T11 and L3. In 3% of children with normal rotation the SMA/SMV relationship was abnormal. The third part of the duodenum was consistently found to be retromesenteric. The length of the mesenteric root ranged from 7 to 22 cm, and generally lengthened with increasing age. Owing to its variable position in infants and children, the DJF on its own may not be a reliable landmark for establishing normal intestinal rotation. Assessing for normal rotation is multifaceted and further comparative studies are required to characterize the anatomical features of normal and abnormal rotation.
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Affiliation(s)
- Christine Koch
- Department of Radiology, Auckland City Hospital, New Zealand
| | - Kiarash Taghavi
- Department of Pediatric Surgery, Wellington Hospital, New Zealand
| | - James Hamill
- Department of Pediatric Surgery, Starship Hospital, Auckland, New Zealand
| | - S Ali Mirjalili
- Department of Anatomy with Radiology, University of Auckland, New Zealand
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27
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Horesh N, Pery R, Amiel I, Shwaartz C, Speter C, Guranda L, Gutman M, Hoffman A. Volvulus and bowel obstruction in ATR-X syndrome-clinical report and review of literature. Am J Med Genet A 2015; 167A:2777-9. [PMID: 26174613 DOI: 10.1002/ajmg.a.37252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 06/26/2015] [Indexed: 11/11/2022]
Abstract
Alpha thalassemia-mental retardation, X-linked (ATR-X) syndrome is a rare genetic disorder with a variety of clinical manifestations. Gastrointestinal symptoms described in this syndrome include difficulties in feeding, regurgitation and vomiting which may lead to aspiration pneumonia, abdominal pain, distention, and constipation. We present a 19-year-old male diagnosed with ATR-X syndrome, who suffered from recurrent colonic volvulus that ultimately led to bowel necrosis with severe septic shock requiring emergent surgical intervention. During 1 year, the patient was readmitted four times due to poor oral intake, dehydration and abdominal distention. Investigation revealed partial small bowel volvulus which resolved with non-operative treatment. Small and large bowel volvulus are uncommon and life-threatening gastrointestinal manifestations of ATR-X patients, which may contribute to the common phenomenon of prolonged food refusal in these patients.
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Affiliation(s)
- Nir Horesh
- Department of Surgery and Transplantation, Chaim Sheba Medical Center (affiliated with the Faculty of medicine, University of Tel Aviv, Tel Aviv, Israel), Tel-Hashomer, Ramat Gan, Israel
| | - Ron Pery
- Department of Surgery and Transplantation, Chaim Sheba Medical Center (affiliated with the Faculty of medicine, University of Tel Aviv, Tel Aviv, Israel), Tel-Hashomer, Ramat Gan, Israel
| | - Imri Amiel
- Department of Surgery and Transplantation, Chaim Sheba Medical Center (affiliated with the Faculty of medicine, University of Tel Aviv, Tel Aviv, Israel), Tel-Hashomer, Ramat Gan, Israel
| | - Chaya Shwaartz
- Department of Surgery and Transplantation, Chaim Sheba Medical Center (affiliated with the Faculty of medicine, University of Tel Aviv, Tel Aviv, Israel), Tel-Hashomer, Ramat Gan, Israel
| | - Chen Speter
- Department of Surgery and Transplantation, Chaim Sheba Medical Center (affiliated with the Faculty of medicine, University of Tel Aviv, Tel Aviv, Israel), Tel-Hashomer, Ramat Gan, Israel
| | - Larisa Guranda
- Department of Surgery and Transplantation, Chaim Sheba Medical Center (affiliated with the Faculty of medicine, University of Tel Aviv, Tel Aviv, Israel), Tel-Hashomer, Ramat Gan, Israel
| | - Mordechai Gutman
- Department of Surgery and Transplantation, Chaim Sheba Medical Center (affiliated with the Faculty of medicine, University of Tel Aviv, Tel Aviv, Israel), Tel-Hashomer, Ramat Gan, Israel
| | - Aviad Hoffman
- Department of Surgery and Transplantation, Chaim Sheba Medical Center (affiliated with the Faculty of medicine, University of Tel Aviv, Tel Aviv, Israel), Tel-Hashomer, Ramat Gan, Israel
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Pai A, Park JJ, Marecik SJ, Prasad LM. Midgut volvulus presenting with acute chylous peritonitis. Clin Case Rep 2014; 2:159-61. [PMID: 25356277 PMCID: PMC4184655 DOI: 10.1002/ccr3.88] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 01/31/2014] [Accepted: 02/20/2014] [Indexed: 12/03/2022] Open
Abstract
Key Clinical message Midgut volvulus can rarely present with acute chylous peritonitis. Common etiologies for chylous ascites need to be excluded before this diagnosis is made. Correction of the volvulus and peritoneal lavage suffice as treatment.
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Affiliation(s)
- Ajit Pai
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital 1775 Dempster St., Park Ridge, Illinois, 60068
| | - John J Park
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital 1775 Dempster St., Park Ridge, Illinois, 60068
| | - Slawomir J Marecik
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital 1775 Dempster St., Park Ridge, Illinois, 60068
| | - Leela M Prasad
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital 1775 Dempster St., Park Ridge, Illinois, 60068
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29
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Turbeville AM, Richardson WS. Guess the case. Ochsner J 2013; 13:565-568. [PMID: 24358010 PMCID: PMC3865840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
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Begeman L, St Leger JA, Blyde DJ, Jauniaux TP, Lair S, Lovewell G, Raverty S, Seibel H, Siebert U, Staggs SL, Martelli P, Keesler RI. Intestinal volvulus in cetaceans. Vet Pathol 2012; 50:590-6. [PMID: 23150643 DOI: 10.1177/0300985812465327] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intestinal volvulus was recognized as the cause of death in 18 cetaceans, including 8 species of toothed whales (suborder Odontoceti). Cases originated from 11 institutions from around the world and included both captive (n = 9) and free-ranging (n = 9) animals. When the clinical history was available (n = 9), animals consistently demonstrated acute dullness 1 to 5 days prior to death. In 3 of these animals (33%), there was a history of chronic gastrointestinal illness. The pathological findings were similar to those described in other animal species and humans, and consisted of intestinal volvulus and a well-demarcated segment of distended, congested, and edematous intestine with gas and bloody fluid contents. Associated lesions included congested and edematous mesentery and mesenteric lymph nodes, and often serofibrinous or hemorrhagic abdominal effusion. The volvulus involved the cranial part of the intestines in 85% (11 of 13). Potential predisposing causes were recognized in most cases (13 of 18, 72%) but were variable. Further studies investigating predisposing factors are necessary to help prevent occurrence and enhance early clinical diagnosis and management of the condition.
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Affiliation(s)
- L Begeman
- Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, 3584 CL Utrecht, Netherlands.
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Samuel JC, Akinkuotu A, Msiska N, Cairns BA, Muyco AP, Charles AG. Re-examining treatment strategies for sigmoid volvulus: An analysis of treatment and outcomes in Lilongwe, Malawi. Glob j Surg 2010; 1:149-153. [PMID: 22570523 PMCID: PMC3345201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION: Sigmoid volvulus is a common surgical emergency in many regions of the world, with significant morbidity and mortality. The aims of this study were to (a) summarize outcomes and (b) define a treatment algorithm for sigmoid volvulus in our setting. EXPERIMENTAL: Five year (2003-2008) retrospective review of sigmoid volvulus cases at Kamuzu Central Hospital, in Lilongwe, Malawi. RESULTS AND DISCUSSION: There were 239 cases of sigmoid volvulus identified. Cases were mostly seen in males (91.7%), with a median age of 50 (range 18-86). Gangrene was noted in 36.7% of cases. Mesosigmoidopexy (36%), Hartmann's procedure (33%), and resection and anastomosis (23%) were the most common procedures. There was seasonal variation with more cases seen in the harvest months of March and April. The major complications noted were recurrence (5 of 6 recurrences after mesosigmoidopexy / plasty) and anastomotic leakage after resection and anastomosis (2 in gangrenous, and 2 in non-gangrenous sigmoid volvulus). CONCLUSIONS: Gangrenous sigmoid volvulus is best managed with Hartmann's procedure. Non-gangrenous sigmoid volvulus is best managed with resection and anastomosis, unless there are risk factors for anastomotic leakage, in which case the surgeon should consider mesosigmoidopexy with non-absorbable suture.
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Affiliation(s)
- Jonathan C Samuel
- Department of Surgery, Univ. of North Carolina, 4050 Burnett-Womack Bldg, CB 7050, Chapel Hill, North Carolina 27599, USA
- Department of Surgery, Kamuzu Central Hospital, PO Box 149, Lilongwe, Malawi
| | - Adesola Akinkuotu
- Department of Surgery, Univ. of North Carolina, 4050 Burnett-Womack Bldg, CB 7050, Chapel Hill, North Carolina 27599, USA
| | - Nelson Msiska
- Department of Surgery, Kamuzu Central Hospital, PO Box 149, Lilongwe, Malawi
| | - Bruce A Cairns
- Department of Surgery, Univ. of North Carolina, 4050 Burnett-Womack Bldg, CB 7050, Chapel Hill, North Carolina 27599, USA
| | - Arturo P Muyco
- Department of Surgery, Kamuzu Central Hospital, PO Box 149, Lilongwe, Malawi
| | - Anthony G Charles
- Department of Surgery, Univ. of North Carolina, 4050 Burnett-Womack Bldg, CB 7050, Chapel Hill, North Carolina 27599, USA
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Morin M, Sauvageau R, Phaneuf JB, Teuscher E, Beauregard M, Lagacé A. Torsion of abdominal organs in sows: a report of 36 cases. Can Vet J 1984; 25:440-2. [PMID: 17422483 PMCID: PMC1790698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Necropsy records of 36 sows with torsion of abdominal organs involving individually the stomach, the spleen, a liver lobe or the intestine were reviewed for the years 1970 to 1983, and the age, the clinical signs and the gross lesions were recorded. These acute abdominal accidents were characterized clinically by sudden death. Dry sows from large breeding units were affected. Twenty-six cases were diagnosed between January 1981 and December 1983 while only ten cases had been seen between 1970 and 1980. Gastric torsion was the most common condition (40% of the cases) and the other three conditions were equally represented (20% each). Management practises that could be responsible for the apparent increase in occurrence of this problem are discussed.
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