1
|
Holubar SD, Nachand D, Lavryk O, Belkovsky M, Brienza R, Mohammed N, Ream J, Hull T, Steele SR, Regueiro M, Cohen BL, Qazi T, Rieder F. 3-Dimensional Pouchography: A Proof-of-Concept Study of a Novel Technique for Visualizing Ileoanal Pouch Anatomy & Morphology in Normal and Mechanical Pouch Complication Patients. J Crohns Colitis 2024:jjae058. [PMID: 38647203 DOI: 10.1093/ecco-jcc/jjae058] [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: 02/10/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Herein, we present a proof-of-concept study of 3-dimensional (3D) pouchography using virtual and printed 3D models of ileal pouch-anal anastomosis (IPAA) in patients with normal pouches and in cases of mechanical pouch complications. MATERIALS & METHODS We performed a retrospective, descriptive case series of a convenience sample of 10 pouch patients with or without pouch dysfunction who had CT scans appropriate for segmentation were identified from our pouch registry. The steps involved in clinician-driven automated 3D reconstruction are presented. RESULTS Three patients who underwent CT imaging and were found to have no primary pouch pathology, and seven patients with known pouch pathology identifiable with 3D reconstruction including pouch strictures, megapouch, pouch volvulus, and twisted pouches underwent 3D virtual modeling; one normal and one twisted pouch were 3D printed. We discovered that 3D pouchography reliably identified staple lines (pouch body, anorectal circular and transverse, and tip of J), the relationship between staple lines, and variations in pouch morphology, and pouch pathology. CONCLUSIONS Three-dimensional reconstruction of IPAA morphology is highly feasible using readily available technology. In our practice, we have found 3D pouchography to be an extremely useful adjunct to diagnose various mechanical pouch complications and improve planning for pouch salvage strategies. Given its ease of use and helpfulness in understanding the pouch structure and function, we have started to routinely integrate 3D pouchography into our clinical pouch referral practice. Further study is needed to formally assess to value of this technique to aid in the diagnosis of pouch pathology.
Collapse
Affiliation(s)
- Stefan D Holubar
- Department of Colon & Rectal Surgery, Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH
| | - Douglas Nachand
- Department of Abdominal Imaging, Imaging Institute, Cleveland Clinic, Cleveland, OH
| | - Olga Lavryk
- Department of Colon & Rectal Surgery, Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH
| | - Mikhael Belkovsky
- Department of Colon & Rectal Surgery, Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH
| | - Rita Brienza
- Department of Colon & Rectal Surgery, Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH
| | - Nour Mohammed
- Department of Biomedical Engineering, Learner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Justin Ream
- Department of Abdominal Imaging, Imaging Institute, Cleveland Clinic, Cleveland, OH
| | - Tracy Hull
- Department of Colon & Rectal Surgery, Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH
| | - Scott R Steele
- Department of Colon & Rectal Surgery, Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH
| | - Miguel Regueiro
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH
| | - Benjamin L Cohen
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH
| | - Taha Qazi
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH
| | - Florian Rieder
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH
| |
Collapse
|
2
|
Abebe TA, Berhe YW, Seid OA, Sefefe WM, Lake LK. A rare case of descending colonic volvulus presenting as large bowel obstruction 19 years after sigmoidectomy and descending colorectal anastomosis. Ann Med Surg (Lond) 2024; 86:2143-2148. [PMID: 38576927 PMCID: PMC10990412 DOI: 10.1097/ms9.0000000000001797] [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: 06/27/2023] [Accepted: 01/25/2024] [Indexed: 04/06/2024] Open
Abstract
Introduction and importance Large bowel obstruction is a common surgical emergency worldwide. Large bowel obstruction secondary to descending colonic volvulus is an extremely rare condition with only few reported cases worldwide. Its extreme rarity is due to its retroperitoneal location and lack of mesentery. Case presentation A 75-year-old male patient with a history of sigmoidectomy and end-to-end descending colorectal anastomosis 19 years previously, presented with failure to pass faeces and flatus of 1 day duration with associated colicky abdominal pain, distension and vomiting. The abdomen was distended but soft and non-tender. Digital rectal examination showed an empty and ballooned rectum. The intraoperative finding was of a 360° counter-clockwise rotated descending colon. Detorsion and extraperitonealization of the descending colon was performed and the patient was successfully discharged. Clinical discussion Volvulus is a twisting of a segment of bowel along its own mesentery. Sigmoid volvulus and caecal volvulus accounts for up to 90% and less than 20% of cases, respectively. Descending colonic volvulus is described in very few case reports. Diagnosis is clinical and confirmed by imaging. Conclusion Descending colonic volvulus is a surgical emergency and an extremely rare cause of large bowel obstruction. Surgical management options include extraperitonealization of the descending colon, diversion colostomy or resection and primary end-to-end anastomosis.
Collapse
Affiliation(s)
| | | | - Oumer Ahmed Seid
- Surgery, School of Medicine, University of Gondar, Gondar, Ethiopia
| | | | | |
Collapse
|
3
|
Manasra ARAA, Alhmoud T, Mesmar Z, Hamaydeh A. Endoscopic-Assisted Percutaneous Sigmoidopexy: New Highlights on Technique and Outcomes. Clin Exp Gastroenterol 2024; 17:25-29. [PMID: 38352171 PMCID: PMC10863492 DOI: 10.2147/ceg.s450262] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/05/2024] [Indexed: 02/16/2024] Open
Abstract
Background Sigmoid volvulus is primarily a disease of the elderly. Case Presentation We describe a case of recurrent sigmoid volvulus in an elderly woman who refused surgery due to the high risk posed by general anesthesia and surgical intervention. She underwent endoscopic-assisted percutaneous sigmoidopexy using only three 2-shot anchor sets. No radiographic observation was necessary during the procedure. Some puncture sites were secured using endoscopic clips. Conclusion Endoscopic-assisted percutaneous sigmoidopexy is increasingly used as an effective alternative to surgical sigmoidopexy when surgery under general anesthesia poses a high risk. Despite clinical improvement and resolution of the recurrent volvulus, after sigmoidopexy patients may continue to experience motility dysfunction and diffuse dilation of the colon for a few weeks, which may correlate with the episodes of obstruction experienced prior to fixation.
Collapse
Affiliation(s)
- Abdel Rahman A Al Manasra
- Department of General Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Tarik Alhmoud
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Zaid Mesmar
- Department of General Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ahmad Hamaydeh
- Department of General Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| |
Collapse
|
4
|
Loria A, Cai X, Gao S, Zhao T, Juviler P, Li Y, Cupertino P, Fleming FJ. Development and validation of multivariable predictive models for recurrence and mortality following nonoperative management of sigmoid volvulus. Colorectal Dis 2024; 26:356-363. [PMID: 38151763 DOI: 10.1111/codi.16849] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/10/2023] [Accepted: 11/13/2023] [Indexed: 12/29/2023]
Abstract
AIM Sigmoid volvulus is a challenging condition, and deciding between elective surgery or expectant management can be complex. The aim of this study was to develop a tool for predicting the risk of recurrent sigmoid volvulus and all-cause mortality within 1 year following initial nonoperative management. METHOD This is a retrospective cohort study using Medicare claims data from 2016 to 2018 of beneficiaries admitted urgently/emergently for volvulus, undergoing colonic decompression and discharged alive without surgery (excluding those discharged to hospice). The primary outcomes were recurrent sigmoid volvulus and all-cause mortality within 1 year. Proportional hazards models and logistic regression were employed to identify risk factors and develop prediction equations, which were subsequently validated. RESULTS Among the 2078 patients managed nonoperatively, 36.1% experienced recurrent sigmoid volvulus and 28.6% died within 1 year. The prediction model for recurrence integrated age, sex, race, palliative care consultations and four comorbidities, achieving area under the curve values of 0.63 in both the training and testing samples. The model for mortality incorporated age, palliative care consultations and nine comorbidities, with area under the curve values of 0.76 in the training and 0.70 in the testing sample. CONCLUSION This study provides a straightforward predictive tool that utilizes easily accessible data to estimate individualized risks of recurrent sigmoid volvulus and all-cause mortality for older adults initially managed nonoperatively. The tool can assist clinicians and patients in making informed decisions about such risks. While the accuracy of the calculator was validated, further confirmation through external validation and prospective studies would enhance its clinical utility.
Collapse
Affiliation(s)
- Anthony Loria
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Xueya Cai
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA
| | - Shan Gao
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA
| | - Tony Zhao
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Peter Juviler
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Yue Li
- Division of Health Policy and Outcomes Research, Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Paula Cupertino
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Fergal J Fleming
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
| |
Collapse
|
5
|
Ballarini L, Stewart J, Fleming K, Matchwick A. Primary small intestinal lymphangiosarcoma in a dog presenting with a segmental partial mesenteric volvulus. J Comp Pathol 2024; 208:37-41. [PMID: 38141386 DOI: 10.1016/j.jcpa.2023.11.003] [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: 05/02/2023] [Revised: 08/02/2023] [Accepted: 11/04/2023] [Indexed: 12/25/2023]
Abstract
A 3-year-old Great Dane presented with a history of chronic vomiting and diarrhoea. Abdominal computed tomography followed by exploratory laparotomy revealed a perforated, segmental partial mesenteric volvulus, affecting an abnormal section of distal jejunum, which was resected. Histopathology and immunohistochemistry results were consistent with jejunal lymphangiosarcoma. This case represents the first report of primary small intestinal lymphangiosarcoma in dogs and the importance of immunohistochemistry for definitive diagnosis.
Collapse
Affiliation(s)
- Laura Ballarini
- Animed Veterinary Hospital, Botley Road, Shedfield, Southampton SO32 2JG, UK.
| | - Jennifer Stewart
- IDEXX Laboratories, Grange House, Sandbeck Way, Wetherby LS22 7DN, UK
| | - Kathryn Fleming
- Anderson Moores Veterinary Specialists, Poles Lane, Hursley, Winchester, Hampshire SO21 2LL, UK
| | | |
Collapse
|
6
|
H S, Puttappa Shivagange S, Sajjan SS, G NS, T HM. When the Gut Took a Wrong Turn to the Right: A Case Report of a Rare Complication of Closed Loop Small Bowel Obstruction With Small Bowel Volvulus in a Right Paraduodenal Hernia With Midgut Malrotation. Cureus 2024; 16:e53342. [PMID: 38435937 PMCID: PMC10907547 DOI: 10.7759/cureus.53342] [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: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Internal hernias constitute 5.8% of all small bowel obstructions. The right paraduodenal hernia is a less common subtype of the paraduodenal hernia. Lack of specific signs and symptoms precludes its clinical diagnosis, which emphasizes the need for computed tomography in diagnosis. We present a case of a 24-year-old male patient with a right paraduodenal hernia and midgut malrotation causing closed loop small bowel obstruction and small bowel volvulus within the hernial sac who underwent laparoscopy-assisted reduction of hernia and adhesiolysis with closure of the peritoneal defect. Since the right paraduodenal hernia is associated with gut malrotation, risk of strangulation, closed-loop obstruction, and rarely volvulus, these patients need prompt radiological diagnosis and surgical intervention.
Collapse
Affiliation(s)
- Samanvitha H
- Department of Diagnostic Radiology, Bangalore Medical College and Research Institute, Bengaluru, IND
- Department of Diagnostic Radiology, People Tree Hospital, Bengaluru, IND
| | - Sushmitha Puttappa Shivagange
- Department of Diagnostic Radiology, Aster CMI Hospital, Bengaluru, IND
- Department of Diagnostic Radiology, Bangalore Medical College and Research Institute, Bangalore, IND
| | - Shantkumar S Sajjan
- Department of Diagnostic Radiology, Bangalore Medical College and Research Institute, Bengaluru, IND
| | - Naveen S G
- Department of General Surgery, Bangalore Medical College and Research Institute, Bengaluru, IND
| | - Harsha M T
- Department of Interventional Radiology, AIl India Institute of Medical Sciences Rishikesh, Rishikesh, IND
- Department of Radiology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| |
Collapse
|
7
|
Tkachuk B, Collins R, Stukalin I, Gupta M, Ng D, Jijon H. Diffuse Jejunal Lipomatosis and Associated Complications. ACG Case Rep J 2023; 10:e01179. [PMID: 37860810 PMCID: PMC10584287 DOI: 10.14309/crj.0000000000001179] [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: 07/06/2023] [Accepted: 09/19/2023] [Indexed: 10/21/2023] Open
Abstract
Small intestinal lipomatosis is a rare condition with a poorly understood epidemiology and pathophysiology. Cases of small intestinal lipomatosis have been documented in multiple countries over the last century, yet little has been published regarding the natural history of this disease. Therapeutic options are largely surgical and based on limited evidence. We report a unique case of diffuse jejunal lipomatosis in a 62-year-old man with complications of small bowel obstruction, small bowel volvulus, jejunal diverticulosis, pneumatosis intestinalis, malnutrition, small intestinal bacterial overgrowth, and intestinal dysmotility developing over a 12-year period.
Collapse
Affiliation(s)
- Bryce Tkachuk
- Division of Internal Medicine, Department of Medicine, University of Calgary, Calgary, Canada
| | | | - Igor Stukalin
- Division of Internal Medicine, Department of Medicine, University of Calgary, Calgary, Canada
| | - Milli Gupta
- Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Canada
| | - Danny Ng
- Department of Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada
| | - Humberto Jijon
- Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Canada
| |
Collapse
|
8
|
Zanchetta M, Inversini D, Pappalardo V, Grappolini N, Morabito M, Gianazza S, Carcano G, Ietto G. Meckel's Diverticulum Causing Ileal Volvulus and Peritonitis after a Recent Appendectomy: A Case Report and Literature Review-We Should Likely Resect an Incidental MD. Life (Basel) 2023; 13:1996. [PMID: 37895380 PMCID: PMC10608533 DOI: 10.3390/life13101996] [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: 09/11/2023] [Revised: 09/24/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023] Open
Abstract
Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract with a 1-3% prevalence in the general population. The surgical management of symptomatic MD is well described in the literature, but there is still no consensus on the indication for prophylactic resection of incidental asymptomatic MD. To address this issue, we extensively reviewed the current literature and report our experience with laparoscopic management of an unusual case of MD causing ileal volvulus and acute peritonitis two weeks after a laparoscopic appendectomy for acute gangrenous appendicitis performed in another hospital. A 50-year-old man presented to the emergency department with acute and severe abdominal pain, vomiting, and constipation. He had undergone a laparoscopic appendectomy for acute appendicitis two weeks before in another hospital. The patient was apyretic, distressed, and seeking an antalgic position. The abdomen was mildly distended and tender, and the Blumberg sign was mildly positive in the central quadrants. The clinical picture deteriorated with fever, peritonismus, and leukocytosis. A CT scan showed an ileo-ileal adhesion near the ileocolic junction and dilatation of the upstream loops with the air-fluid levels. Through an urgent laparoscopy, a necrotic mass, the MD, was wedge-resected, and the surrounding ileal volvulus derotated. The postoperative course was uneventful. There is no definitive consensus on the appropriate management of incidental asymptomatic MD, although several studies have attempted to identify guiding criteria. Features of the MD, the patient's risk factors, clinical presentation, and surgical approach need to be considered to establish definitive guidelines for the management of incidental asymptomatic MD. In the absence of definitive guidelines, personal expertise and judgement are the main resources for the surgeon approaching an incidental asymptomatic MD.
Collapse
Affiliation(s)
- Matteo Zanchetta
- General, Emergency and Transplant Surgery Department, ASST Settelaghi, University of Insubria, 21100 Varese, Italy (M.M.)
| | - Davide Inversini
- General, Emergency and Transplant Surgery Department, ASST Settelaghi, University of Insubria, 21100 Varese, Italy (M.M.)
- Department of Medicine and Innovation Technology, University of Insubria, 21100 Varese, Italy
| | - Vincenzo Pappalardo
- Department of Surgery, Cittiglio-Angera Hospital-ASST Settelaghi, 21100 Varese, Italy
| | - Niccolo Grappolini
- General, Emergency and Transplant Surgery Department, ASST Settelaghi, University of Insubria, 21100 Varese, Italy (M.M.)
| | - Marika Morabito
- General, Emergency and Transplant Surgery Department, ASST Settelaghi, University of Insubria, 21100 Varese, Italy (M.M.)
| | - Simone Gianazza
- General, Emergency and Transplant Surgery Department, ASST Settelaghi, University of Insubria, 21100 Varese, Italy (M.M.)
| | - Giulio Carcano
- General, Emergency and Transplant Surgery Department, ASST Settelaghi, University of Insubria, 21100 Varese, Italy (M.M.)
- Department of Medicine and Innovation Technology, University of Insubria, 21100 Varese, Italy
| | - Giuseppe Ietto
- General, Emergency and Transplant Surgery Department, ASST Settelaghi, University of Insubria, 21100 Varese, Italy (M.M.)
- Department of Medicine and Innovation Technology, University of Insubria, 21100 Varese, Italy
| |
Collapse
|
9
|
Proios I, Grünberg W. Preoperative and Surgical Predictors of the Treatment Outcome of Dairy Cows with Right Abomasal Displacement-A Retrospective Study of 234 Cases. Animals (Basel) 2023; 13:2887. [PMID: 37760287 PMCID: PMC10525481 DOI: 10.3390/ani13182887] [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: 08/12/2023] [Revised: 08/30/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
The displacement of the abomasum to the right (RDA) is a common condition regularly encountered in dairy cows, which requires urgent surgical correction. The survival of the patient primarily depends on early diagnosis and timely treatment, but other factors contributing to the outcome have been discussed in the literature. The objective of this study was to identify preoperative clinical, hematological, as well as intraoperative parameters that are associated with the prognosis of cows with RDA or abomasal volvulus (AV). This retrospective study included patients admitted to a veterinary teaching hospital over a period of 6 years with a diagnosis of RDA or AV. A total of 234 cows were included, of which 193 were discharged after treatment and thus classified as survivors. In contrast, 41 cases died or were euthanized during or after surgery and were categorized as non-survivors. Non-survivors showed more severe dehydration, higher heart rate, lower sodium, as well as higher L-lactate and phosphorus concentration in their blood prior to surgery compared with the survivors. During surgery, the abomasum of non-survivors was markedly dilated and twisted more frequently than in survivors. The results presented here can facilitate the early identification of animals with poor prognosis requiring more intensive peri- and postoperative care.
Collapse
Affiliation(s)
- Ioannis Proios
- Clinic for Cattle, University of Veterinary Medicine Hannover, Foundation, Bischofsholer Damm 15, D-30173 Hannover, Germany
| | - Walter Grünberg
- Clinic for Ruminants and Herd Health Management, Faculty of Veterinary Medicine, Justus-Liebig-University Giessen, Frankfurter Str. 104, D-35392 Giessen, Germany;
| |
Collapse
|
10
|
Menghwani H, Piplani R, Yhoshu E, Jagdish B, Sree BS. Delayed Presentation of Malrotation: Case Series and Literature Review. J Indian Assoc Pediatr Surg 2023; 28:271-277. [PMID: 37635889 PMCID: PMC10455704 DOI: 10.4103/jiaps.jiaps_2_23] [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: 01/04/2023] [Revised: 04/27/2023] [Accepted: 05/19/2023] [Indexed: 08/29/2023] Open
Abstract
Background Intestinal malrotation is a congenital anomaly resulting from abnormal or incomplete rotation and fixation of the midgut during embryogenesis. It commonly presents in the neonatal period (75%) with sudden onset bilious vomiting and rarely beyond infancy (<10%). Aim The aim of the study was to highlight the clinical features, radiological findings, and treatment outcomes of patients with malrotation presenting beyond infancy. Materials and Methods Eleven consecutive cases of delayed presentation of malrotation presented over a period of 5 years (2017-2021). Data were analyzed retrospectively. Results Out of the 11 patients, four were female and seven were male. The age of patients ranged from 14 months to 18 years. Patients beyond infancy present usually with diffuse pain abdomen compared to neonates which present with sudden onset bilious vomiting and therefore difficult to diagnose. Five patients had associated abnormalities such as intussusception or nutcracker syndrome or mesenteric cyst or jejunal stricture or mesenteric lymphadenopathy along with malrotation. Patients underwent ultrasonography, upper gastrointestinal contrast study, and contrast-enhanced computed tomography abdomen to confirm the diagnosis. All patients underwent the Ladd procedure with four requiring resection anastomosis and one requiring excision of the mesenteric cyst. Eight out of eleven patients had favorable outcomes, two develop adhesive intestinal obstruction and required re-exploration, and one had persistent complaints of hematochezia. Conclusion Malrotation beyond infancy is a rare diagnosis. Malrotation in older children is usually not suspected because of the wide range of symptoms. A high index of suspicion on ultrasound or computed tomography is required to demonstrate the reversal of superior mesenteric artery and superior mesenteric vein position and related conditions. Early intervention and treatment can prevent catastrophic events such as intestinal volvulus and intestinal ischemia in these patients.
Collapse
Affiliation(s)
- Himanshu Menghwani
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Rajat Piplani
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Enono Yhoshu
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - B. Jagdish
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Balija Satya Sree
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| |
Collapse
|
11
|
Kreinces J, Robbins AI, Kim DE. Cecal bascule in pregnancy: a case report and review of the literature. J Surg Case Rep 2023; 2023:rjad287. [PMID: 37234082 PMCID: PMC10206289 DOI: 10.1093/jscr/rjad287] [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: 04/19/2023] [Accepted: 05/01/2023] [Indexed: 05/27/2023] Open
Abstract
A 36-year-old female at 36 weeks' gestation presented with right upper quadrant abdominal pain. She had no prior surgeries. Her pregnancy had been uncomplicated up until her presentation. Abdominal ultrasound was negative for cholecystitis or cholelithiasis, and the appendix was not visualized. During the second day of her hospital course, an abdominal magnetic resonance imaging (MRI) was performed revealing dilated small intestine with air-fluid levels and an inverted-appearing, prominent cecum. She was urgently taken to the operating room for cesarean section followed by abdominal exploration. After delivery of the child, a cecal bascule was found, with a severely distended cecum. To our knowledge, this is the first report of a cecal bascule diagnosed by MRI, and the first diagnosis of cecal bascule in a pregnant patient requiring surgical intervention. We discuss the pathophysiology, diagnosis and treatment of cecal bascule and review the current literature of reported cases.
Collapse
Affiliation(s)
- Jason Kreinces
- New York Medical College School of Medicine, Valhalla, NY 10595, USA
| | - Alicia I Robbins
- Department of Obstetrics and Gynecology, Greenwich Hospital, Greenwich, CT 06830, USA
| | - Daniel E Kim
- Correspondence address. Greenwich Hospital, Yale New Haven Health, 5 Perryridge Road, Suite 2-3200, Greenwich, CT 06830, USA. Tel: +1-203-863-4300; Fax: +1-203-863-4310; E-mail:
| |
Collapse
|
12
|
Koppen IJN, Menke LA, Westra WM, Struik F, Mesman S, van Wijk MP, Huisman SA. Fatal gastrointestinal complications in Pitt-Hopkins syndrome. Am J Med Genet A 2023; 191:855-858. [PMID: 36511359 DOI: 10.1002/ajmg.a.63079] [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: 11/04/2022] [Revised: 11/23/2022] [Accepted: 12/05/2022] [Indexed: 12/15/2022]
Abstract
Pitt-Hopkins syndrome (PTHS) is a rare neurodevelopmental disorder caused by mutations of the transcription factor 4 (Tcf4) gene. Individuals with PTHS often suffer from severe abdominal bloating and constipation. In this short communication, we discuss two individuals with PTHS who died unexpectedly due to gastrointestinal complications. We aim to increase awareness among healthcare professionals who care for individuals with PTHS, to ensure adequate screening and management of gastrointestinal symptoms in this population. Moreover, we discuss how fatal gastrointestinal complications may be related to PTHS and provide an overview of the literature.
Collapse
Affiliation(s)
- Ilan J N Koppen
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Leonie A Menke
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Wytske M Westra
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Gastroenterology and Hepatology, Meander Medisch Centrum, Amersfoort, The Netherlands
| | - Femke Struik
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Simone Mesman
- Swammerdam Institute for Life Sciences, FNWI, University of Amsterdam, Amsterdam, The Netherlands
| | - Michiel P van Wijk
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sylvia A Huisman
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Zodiak, Prinsenstichting, Purmerend, The Netherlands
| |
Collapse
|
13
|
Mittal A, DeRoss A, Goldman D, Chen CB, Kay M. Obstructing Sigmoid Volvulus: An Unusual Complication in a Pediatric Patient With Ulcerative Colitis. ACG Case Rep J 2023; 10:e00998. [PMID: 36876286 DOI: 10.14309/crj.0000000000000998] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 01/30/2023] [Indexed: 03/05/2023] Open
Abstract
Acute colonic dilation in pediatric patients with ulcerative colitis (UC) raises a concern for toxic megacolon, but other rare conditions such as sigmoid volvulus may present in a similar manner. We report a rare case of a teenager with UC without prior surgery who developed an obstructing sigmoid volvulus managed with endoscopic detorsion and decompression. Colonic inflammation in patients with UC may result in a volvulus in the absence of other predisposing factors and should be considered in the differential diagnosis of patients with UC who present with obstructive symptoms with an atypical presentation.
Collapse
|
14
|
Takimoto A, Amano H, Sumida W, Shirota C, Yokota K, Makita S, Okamoto M, Ogata S, Takada S, Nakagawa Y, Kato D, Goda Y, Hinoki A, Uchida H. Laparoscopic Duodenal-Caudal Detachment Method: Early Experience of a Novel Technique for Malrotation with Volvulus in Neonates. J Laparoendosc Adv Surg Tech A 2023; 33:220-225. [PMID: 36383112 DOI: 10.1089/lap.2022.0390] [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: 11/17/2022] Open
Abstract
Purpose: A laparoscopic approach for malrotation is feasible and safe in hemodynamically stable neonates without intestinal necrosis; however, volvulus is associated with recurrence and conversion. We developed a novel approach using a laparoscopic duodenal-caudal detachment method to perform the Ladd procedure for neonates with volvulus under the limited view of laparoscopy. This study presents the results, effectiveness, and details of the method. Materials and Methods: In the laparoscopic duodenal-caudal detachment method, we first detached the adhesions around the duodenum, including the Ladd's band. After the adhesions were completely removed, the duodenum was freely drawn caudally, leading to the release of torsion. We retrospectively reviewed the medical records of patients who underwent surgery for malrotation of the volvulus at 30 days of age between January 2014 and September 2021. Results: Seven neonates underwent the laparoscopic duodenal-caudal detachment method and 13 underwent the open Ladd procedure. The new technique was performed in all 7 patients, and there were no conversions or recurrences. The operation time was significantly longer in the laparoscopic procedure group (55 minutes versus 111 minutes; P < .01). Conclusions: Our detorsion method, involving an initial incision of the Ladd's band, is safe and effective for neonates and may lead to an improvement in the conversion rates.
Collapse
Affiliation(s)
- Aitaro Takimoto
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, , Showa, Nagoya, Japan
| | - Hizuru Amano
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, , Showa, Nagoya, Japan
| | - Wataru Sumida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, , Showa, Nagoya, Japan
| | - Chiyoe Shirota
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, , Showa, Nagoya, Japan
| | - Kazuki Yokota
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, , Showa, Nagoya, Japan
| | - Satoshi Makita
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, , Showa, Nagoya, Japan
| | - Masamune Okamoto
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, , Showa, Nagoya, Japan
| | - Seiya Ogata
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, , Showa, Nagoya, Japan
| | - Shunya Takada
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, , Showa, Nagoya, Japan
| | - Youichi Nakagawa
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, , Showa, Nagoya, Japan
| | - Daiki Kato
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, , Showa, Nagoya, Japan
| | - Yosuke Goda
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, , Showa, Nagoya, Japan
| | - Akinari Hinoki
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, , Showa, Nagoya, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, , Showa, Nagoya, Japan
| |
Collapse
|
15
|
Elrod J, Kiwit A, Lenz M, Rohde H, Börnigen D, Alawi M, Mohr C, Pagerols Raluy L, Trochimiuk M, Knopf J, Reinshagen K, Herrmann M, Boettcher M. Midgut Volvulus Adds a Murine, Neutrophil-Driven Model of Septic Condition to the Experimental Toolbox. Cells 2023; 12:cells12030366. [PMID: 36766707 PMCID: PMC9913099 DOI: 10.3390/cells12030366] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Severe infections that culminate in sepsis are associated with high morbidity and mortality. Despite continuous efforts in basis science and clinical research, evidence based-therapy is mostly limited to basic causal and supportive measures. Adjuvant therapies often remain without clear evidence. The objective of this study was to evaluate the septic volvulus ischemia-reperfusion model in comparison to two already established models and the role of neutrophil extacellular traps (NETs) in this model. METHODS The technique of the murine model of midgut volvulus was optimized and was compared to two established models of murine sepsis, namely cecal ligation and puncture (CLP) and intra-peritoneal (i.p.) injection of lipopolysaccharide (LPS). RESULTS Midgut volvulus for 15 min caused a comparable mortality (38%) as CLP (55%) and peritoneal LPS injection (25%) at 48 h. While oxidative stress was comparable, levels of circulating free DNA (cfDNA), and splenic/hepatic and pulmonary translocation of bacteria were decreased and increased, respectively at 48 h. DNases were increased compared to the established models. Proteomic analysis revealed an upregulation of systemic Epo, IL-1b, Prdx5, Parp1, Ccl2 and IL-6 at 48 h in comparison to the healthy controls. DISCUSSION AND CONCLUSION Midgut volvulus is a stable and physiological model for sepsis. Depending on the duration and subsequent tissue damage, it represents a combination of ischemia-reperfusion injury and hyperinflammation.
Collapse
Affiliation(s)
- Julia Elrod
- Department of Pediatric Surgery, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Antonia Kiwit
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Moritz Lenz
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Holger Rohde
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Daniela Börnigen
- Bioinformatics Core, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Malik Alawi
- Bioinformatics Core, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Christoph Mohr
- Department of Pediatric Surgery, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Laia Pagerols Raluy
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Magdalena Trochimiuk
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Jasmin Knopf
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
| | - Konrad Reinshagen
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Martin Herrmann
- Department of Pediatric Surgery, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
| | - Michael Boettcher
- Department of Pediatric Surgery, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
- Correspondence:
| |
Collapse
|
16
|
Lingegowda AP, Amit B, Pillai PR, Chandrayya R. Congenital Transmesenteric Hernia - A Rare Presentation. J Indian Assoc Pediatr Surg 2023; 28:72-74. [PMID: 36910300 PMCID: PMC9997596 DOI: 10.4103/jiaps.jiaps_73_22] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/09/2022] [Accepted: 08/21/2022] [Indexed: 03/14/2023] Open
Abstract
Congenital transmesenteric defect is a rare but serious condition which presents a diagnostic challenge as symptoms and investigations are nonspecific. Here, we present a case with fetal ascites and dilated bowel loops who underwent intervention within 6 h of birth. Laparotomy showed volvulus and gangrene of 45 cm of the distal ileum, which was herniating through mesenteric defect. Timely detection and intervention can help in preventing significant morbidity and mortality. Given the downside to delay of surgical intervention and lack of specific tests, open exploration continues to be the only way to establish a definitive diagnosis of a transmesenteric hernia.
Collapse
Affiliation(s)
| | - B. Amit
- Department of Paediatric Surgery, Sakra World Hospital, Bengaluru, Karnataka, India
| | - Pramod R. Pillai
- Department of Paediatric Surgery, Sakra World Hospital, Bengaluru, Karnataka, India
| | | |
Collapse
|
17
|
Jíšová B, Podhráský M, Hladík P, Vlková M, Lischke R. Volvulus 8 years after bariatric surgery. Rozhl Chir 2023; 102:139-141. [PMID: 37344209 DOI: 10.33699/pis.2023.102.3.139-141] [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] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
INTRODUCTION Bariatric surgery is a widespread branch of surgery because of the increase in obesity in population. It is one way to achieve long-term weight loss effect in obese patients. Like other surgeries, bariatric surgery has many complications including ileus and volvulus in small intestine. It is an acute state in surgery and usually leads to a revision surgery. CASE REPORT 58 years old woman who underwent mini-gastric bypass in 2014. She was admitted to our department because of manifestation of ileus on the second day after TEP of the hip joint. There was a typical sign of volvulus on the CT scan. She was operated on the same day. The reinsertion of enteroenteroanastomosis and denotation of the small intestine, desufflation of the large intestine, and reconstruction of new enteroenteroanastomosis was needed. After the surgery, the patient was without any complications. The bowel function recovery was slower postoperatively. CONCLUSION Diagnosis of volvulus is not easy because of non-specific clinical symptoms. In this case report, the volvulus occurred 8 years after the primary surgery. Symptoms developed because of paralytic ileus after hip replacement.
Collapse
|
18
|
Muacevic A, Adler JR, Prakash S, Vijayakumar C, Kumbhar U. Volvulus of the Transverse Colon Herniated Through Drain Site. Cureus 2023; 15:e34151. [PMID: 36843726 PMCID: PMC9949558 DOI: 10.7759/cureus.34151] [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: 01/24/2023] [Indexed: 01/25/2023] Open
Abstract
Herniation of the transverse colon and volvulus of it occurring through the previous surgical drain site, presenting as intestinal obstruction, has never been reported. We present an 80-year-old female who complained of abdominal swelling for 10 years. She started developing pain abdomen for 10 days and obstipation for three days. Abdominal examination showed a tender mass in the right lumbar region, with all borders being distinct, and there was no cough impulse. There is a lower midline scar from the previous laparotomy and a small scar over the swelling (drain site). Imaging studies were diagnostic of large bowel obstruction due to the herniation and volvulus of the transverse colon through the previous surgical drain site. She underwent laparotomy, derotation of transverse colon with hernia reduction, and onlay meshplasty. She had an uneventful postoperative course and was discharged.
Collapse
Affiliation(s)
- Alexander Muacevic
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - John R Adler
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | | | | | | |
Collapse
|
19
|
Chen Y, Wang J, Wang M, Zheng X, Li J. Small bowel intussusception caused by a serrated adenoma: a case report. J Int Med Res 2022; 50:3000605221144902. [PMID: 36545786 PMCID: PMC9793040 DOI: 10.1177/03000605221144902] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The case was a 17-year-old young woman with a one-year history of recurrent abdominal pain and discomfort. B-scan ultrasonography identified intussusception and contrast-enhanced computed tomography of the pelvis revealed volvulus. A laparoscopic procedure was planned to identify the reason for the intussusception and obstruction. Intraoperatively, the intussusception was found to be caused by a cauliflower-shaped polypoid tumor measuring approximately 4 × 3 cm. Postoperative pathological examination identified the tumor to be a traditional serrated adenoma of the small intestine, which is rare and has atypical clinical manifestations. If unexplained abdominal pain or gastrointestinal bleeding occurs and an abdominal mass cannot be accurately located, laparoscopic or open surgery should be performed immediately. Early surgery is the most effective and reliable way of securing a prompt diagnosis and a favorable prognosis.
Collapse
Affiliation(s)
| | - Jiwei Wang
- Jiwei Wang, Department of General Surgery,
Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, 149
Dalian Road, Huichuan District, Zunyi City, Guizhou Province 563000, China.
| | | | | | | |
Collapse
|
20
|
Muacevic A, Adler JR. Caecal Volvulus, Untwisting the Twisted: A Case Report and Literature Review. Cureus 2022; 14:e30961. [PMID: 36465206 PMCID: PMC9711929 DOI: 10.7759/cureus.30961] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 01/25/2023] Open
Abstract
Caecal volvulus is an uncommon surgical condition affecting mostly females in their second and third decade of life. It is of vital importance that the general surgeon recognises, resuscitates, diagnoses, and effectively treats these cases in a timely manner to maximise the chance of a positive outcome for the patient. Whilst there are several types of caecal volvulus, the treatment involves, in most cases, surgical intervention. There is a wide variety of surgical interventions that can be performed, ranging from caecopexy or fixation to lateral wall to performing a right hemicolectomy with primary ileocolic anastomosis. There are several factors that influence this decision and can also be based on an individual surgeon's expertise and experience. We present a case of a 21-year-old female who presented to our Emergency Department with lower abdominal pain, nausea, and vomiting. She was diagnosed with caecal volvulus with the aid of CT imaging, following which she underwent laparotomy in which caecal volvulus was noted. She underwent appendicectomy and caecopexy and was discharged after an uneventful recovery on post-operative day five and remains well on follow-up.
Collapse
|
21
|
Muacevic A, Adler JR. Ileosigmoid Knotting: A Case Series. Cureus 2022; 14:e32003. [PMID: 36589183 PMCID: PMC9797762 DOI: 10.7759/cureus.32003] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 11/30/2022] Open
Abstract
Ileosigmoid knotting is a rare case of intestinal obstruction that later leads to bowel necrosis. This is more common in males than females and seen more in areas with increased rates of sigmoid volvulus. The main clinical presentations are abdominal distention, abdominal pain and tenderness, vomiting, and obstipation. Definitive diagnosis is challenging due to its rarity and overlapping symptoms with other more common abdominal conditions. Delay in diagnosis and management can lead to peritonitis, necrosis of the bowel, sepsis, and eventually septic shock. Surgeons should consider ileosigmoid knotting in cases of acute abdomen, as it requires fast decision-making and intervention for a good prognosis. We present two cases of ileosigmoid knotting presenting with acute abdomen requiring emergent laparotomy with resection of necrotic bowel.
Collapse
|
22
|
Şık N, Uzun A, Öztürk A, Aydın E, Zeki Karakuş O, Duman M, Yılmaz D. Uncommon presentation of Meckel's diverticulum in a child with decompensated hypovolemic shock. ULUS TRAVMA ACIL CER 2022; 28:1031-1034. [PMID: 35775669 PMCID: PMC10493833 DOI: 10.14744/tjtes.2020.39887] [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: 09/01/2020] [Accepted: 11/03/2020] [Indexed: 11/20/2022]
Abstract
Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract and may cause serious complications such as intestinal obstruction, gastrointestinal hemorrhage, or inflammation with/without perforation, which can present with non-spe-cific symptoms and signs. We report on the case of a 2.5-year-old boy admitted to our emergency department in poor condition, with compatible signs of decompensated hypovolemic shock. This case finally resulted in intestinal volvulus and internal hernia, a very rare combination of two complications of MD, as determined in the operating room.
Collapse
Affiliation(s)
- Nihan Şık
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylül University Faculty of Medicine, İzmir-Türkiye
| | - Aslıhan Uzun
- Department of Pediatrics, Dokuz Eylül University Faculty of Medicine, İzmir-Türkiye
| | - Ali Öztürk
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylül University Faculty of Medicine, İzmir-Türkiye
| | - Efil Aydın
- Department of Pediatric Surgery, Dokuz Eylül University Faculty of Medicine, İzmir-Türkiye
| | - Osman Zeki Karakuş
- Department of Pediatric Surgery, Dokuz Eylül University Faculty of Medicine, İzmir-Türkiye
| | - Murat Duman
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylül University Faculty of Medicine, İzmir-Türkiye
| | - Durgül Yılmaz
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylül University Faculty of Medicine, İzmir-Türkiye
| |
Collapse
|
23
|
Bonadio W. Cecal Volvulus in a Teenaged Patient. J Pediatr 2022; 245:238. [PMID: 35301020 DOI: 10.1016/j.jpeds.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 11/20/2022]
|
24
|
Oral H, Türkyılmaz Z, Karabulut R, Kaya C, Dayanır D, Karakaya C, Sonmez K. Protective Effects of Hydrogen-Rich Saline on Experimental Intestinal Volvulus in Rats. J INVEST SURG 2022; 35:1427-1433. [PMID: 35331073 DOI: 10.1080/08941939.2022.2056273] [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: 10/18/2022]
Abstract
BACKGROUND Intestinal volvulus can cause morbidity and mortality. Surgical reduction, on the other hand, could result in ischemia-reperfusion (I/R) injury. Hydrogen rich saline solution (HRSS neutralizes free radicals in the body. This study aimed to investigate the effects of HRSS in I/R injury in experimental intestinal volvulus in rats. METHODS Thirty rats were randomly allocated into 5 groups. All procedures were done under general anesthesia and sterile conditions in each animal. Five ml/kg of saline and HRSS were administered intraperitoneally (ip) in Sham (Group 1) and HRSS (Group 2) groups, respectively. Groups 3, 4, and 5 constituted the study groups in which volvulus was created in a 5-cm- long ileal segment 2 cm proximal to the ileocecal valve. After 2 hours the volvuli were reduced and following 2 hours of reperfusion, these segments were removed. In volvulus-I/R group (Group 3) no additional procedure was done. HRSS was administered shortly before reperfusion (reduction of the volvulus) in Treatment I (Group 4) and 1 h before experimental volvulus in Treatment II (Group 5) groups. Blood and intestinal tissue samples were obtained from all rats at the 4th hour. Both tissue and blood total oxidant (TOS) and antioxidant status (TAS) levels were determined and tissue histomorphologies were studied. Oxidative stress indices (TOS ÷ TAS) (OSI) were calculated. RESULTS Tissue TOS and OSI levels and histomorphological injury scores were statistically lower in treatment groups than I/R group, whereas blood TOS and OSI levels were similar between the groups. CONCLUSIONS This study provides biochemical and histomorphological evidence that HRSS prevents intestinal damage in I/R injury caused by volvulus.
Collapse
Affiliation(s)
- Hayrunnisa Oral
- Departments of Pediatric Surgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Zafer Türkyılmaz
- Departments of Pediatric Surgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ramazan Karabulut
- Departments of Pediatric Surgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Cem Kaya
- Departments of Pediatric Surgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Duygu Dayanır
- Histology and Embryology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Cengiz Karakaya
- Medical Biochemistry, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Kaan Sonmez
- Departments of Pediatric Surgery, Gazi University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
25
|
Curmi A, Cuschieri R. Cecal Bascule in a COVID-19 Positive Patient: Case Report. Surg J (N Y) 2022; 8:e108-11. [PMID: 35252568 DOI: 10.1055/s-0042-1743527] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/24/2022] [Indexed: 10/29/2022] Open
Abstract
Cecal volvulus is an uncommon cause of acute intestinal obstruction accounting for around 10% of intestinal volvuli. There are three main variants of cecal volvuli including the axial, loop, and bascule types. Diagnosis is confirmed via a computed tomography scan and surgery is the mainstay treatment due to a high risk of morbidity and mortality. Here we report a rare presentation of cecal volvulus in a COVID-19 positive patient that was complicated by an anastomotic leak.
Collapse
|
26
|
Abstract
BACKGROUND Sigmoid volvulus (SV), the wrapping of the sigmoid colon around itself, is a rare intestinal obstruction form world-wide. For this reason, the physiopathology of SV, particularly the precipitating factors, are not clearly identified. The aim of this study is to evaluate the precipitating factors in SV. METHODS The clinical records of consecutive 416 patients with SV were reviewed prospectively from January 1986 to July 2020. As a control, the records of consecutive 100 patients with non-volvulus intestinal obstruction were reviewed prospectively in the past 24 months. The premorbid symptoms including acute diarrhea, sudden and excessive body motions, overeating after a prolonged starvation, coughing spell, and labor was evaluated. RESULTS Among the premorbid symptoms, 1-5-day interval of diarrhea (42 patients, 10.1%, p<0.05), harvesting activation (35 patients, 8.4%, p<0.05), and overeating after Ramadan fasting (31 patients, 7.5%, p<0.05) were found to be statistically significant precipitating factors in SV. CONCLUSION Although there are few studies about the precipitating factors of SV in the literature, increased bowel motility, excessive body motions, and overeating following a prolonged starvation look like the precipitating factors in the development of SV.
Collapse
Affiliation(s)
- Esra Dişçi
- Department of General Surgery, Atatürk University Faculty of Medicine, Erzurum-Turkey
| | | |
Collapse
|
27
|
Tuler S, Kaur J, Dasanu CA. Cecal volvulus associated with carfilzomib use for al amyloidosis. J Oncol Pharm Pract 2022:10781552221074719. [PMID: 35089100 DOI: 10.1177/10781552221074719] [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: 11/17/2022]
Abstract
INTRODUCTION Proteasome inhibitors have emerged as quintessential therapies for light-chain (AL) amyloidosis and multiple myeloma in the last decade. While these agents are highly effective, reports have also documented toxicities affecting various organ systems. Whereas gastrointestinal (GI) toxicities are a relatively common occurrence with proteasome inhibitors, severe GI complications are exceedingly rare. CASE REPORT We describe a unique case of a patient with AL amyloidosis who developed cecal volvulus after four weeks of treatment with carfilzomib. This severe GI manifestation has not been previously described in the literature. MANAGEMENT AND OUTCOME The patient required right hemicolectomy. After clinical recovery, she restarted reduced-dose carfilzomib. She did not have any severe GI side effects following dose reduction, and continues with the current treatment regimen to the present day. DISCUSSION/CONCLUSION The causality between volvulus and the treatment with carfilzomib was probable, with a documented score of 6 on the Naranjo probability nomogram. The exact mechanism behind this effect of carfilzomib has yet to be elucidated.
Collapse
Affiliation(s)
- Shahaf Tuler
- Department of Medicine, 541618Eisenhower Health, Rancho Mirage, CA, USA
| | - Jaspreet Kaur
- Department of Medicine, 541618Eisenhower Health, Rancho Mirage, CA, USA
| | - Constantin A Dasanu
- Lucy Curci Cancer Center, 541618Eisenhower Health, Rancho Mirage, CA, USA.,UC San Diego Health, San Diego, CA, USA
| |
Collapse
|
28
|
Hosokawa T, Nemoto H, Tanami Y, Ishimaru T, Kawashima H. Ultrasound to assess complications due to intra-abdominal lymphatic malformation. Pediatr Int 2022; 64:e14954. [PMID: 35112441 DOI: 10.1111/ped.14954] [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: 05/13/2021] [Revised: 07/26/2021] [Accepted: 08/11/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Takahiro Hosokawa
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Hidehiko Nemoto
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yutaka Tanami
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Tetsuya Ishimaru
- Department of Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroshi Kawashima
- Department of Surgery, Saitama Children's Medical Center, Saitama, Japan
| |
Collapse
|
29
|
Abstract
Background: Sigmoid volvulus (SV) is the twisting of the sigmoid colon around itself. Endoscopy both helps diagnosis and provides treatment in the absence of peritonitis or perforation in SV. Nevertheless, there are some controversies or limitations on this subject. The aim of this study is to evaluate the current role of the endoscopic decompression in the treatment of SV. Materials and Methods: The clinical records of 1040 patients with SV treated over a 55-year period from June 1966 to July 2021 were reviewed retrospectively until June 1986 and prospectively thereafter. For each case, preoperational parameters, treatment options, and prognosis were noted. Results: Endoscopic decompression was tried in 748 patients (71.9%). The procedure was successful in 585 cases (83.2%), whereas unsuccessful in 118 (16.8%) of 703 patients (94.0%) with viable bowel. The mortality rate was 0.5% (4 patients), the morbidity rate was 1.9% (14 patients), the early recurrence rate was 5.5% (32 patients), whereas the mean hospitalization period was 34.6 hours (range: 24-96 hours). Conclusions: Despite some controversies or limitations in some subjects including the strategy in ischemic or gangrenous cases, the factors affecting the success, kind of the used instruments, technical details of the application, role of the flatus tubes, and the specific topics such as SV in childhood or pregnancy, endoscopic decompression is the first-line therapy in selected patients with SV.
Collapse
|
30
|
Kubo Y, Torikai M, Ibara S. A cystic jejunal duplication under the liver confused with a choledochal cyst. Pediatr Int 2021; 63:1390-1392. [PMID: 34363710 DOI: 10.1111/ped.14613] [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: 11/02/2020] [Revised: 01/04/2021] [Accepted: 01/15/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Yuichi Kubo
- Department Neonatology, Kagoshima City Hospital, Kagoshima, Japan
| | - Motofumi Torikai
- Department Neonatology, Kagoshima City Hospital, Kagoshima, Japan
| | - Satoshi Ibara
- Department Neonatology, Kagoshima City Hospital, Kagoshima, Japan
| |
Collapse
|
31
|
Abstract
Benign tumours of vascular and lymphatic origin are known as lymphangiomas. In this report, we present a case of a 26-year-old lady admitted with symptoms of small bowel obstruction. Her computed tomography (CT) scan showed a well-defined mass in the small bowel mesentery associated with small bowel volvulus. Segmental resection of the bowel, including the mass, was performed. Microscopic examination and immunohistochemistry of the specimen were consistent with lymphangioma of the small bowel mesentery.
Collapse
Affiliation(s)
| | - Suad Nassif
- General Surgery, North Manchester General Hospital, Manchester, GBR
| | - Yazan Alkurdi
- General Surgery, North Manchester General Hospital, Manchester, GBR
| | - Moustafa Mansour
- General Surgery, North Manchester General Hospital, Manchester, GBR
| |
Collapse
|
32
|
Khaled C, Akl M, Moussallem T. A Unique Case of Small Bowel Internal Hernia and Volvulus Caused by a Hamartoma. Surg J (N Y) 2021; 7:e209-e211. [PMID: 34414262 PMCID: PMC8370791 DOI: 10.1055/s-0041-1733832] [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: 10/16/2020] [Accepted: 04/07/2021] [Indexed: 11/04/2022] Open
Abstract
This study depicts the case of a young female presenting with intestinal obstruction. Surgery uncovered a small bowel hamartoma that has caused a transmesenteric internal hernia and volvulus. As far as we know, this is unheard of before, as all three mentioned entities are very rare. The study also covers a literature review of cases of internal hernia with volvulus and stresses over the need for urgent diagnosis and management.
Collapse
Affiliation(s)
- Charif Khaled
- Department of General Surgery, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Michel Akl
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Toufic Moussallem
- Department of General Surgery, General and Laparoscopic Surgeon, Sacred Heart Hospital, Beirut, Lebanon
| |
Collapse
|
33
|
Abstract
Lymphangioma is a benign malformation of the lymphatic system. It usually affects the neck, head, and rarely, the abdomen. Volvulus is a serious condition, which occurs as a result of bowel twisting around itself or around the mesentery leading to severe consequences such as obstruction. The most common cause of volvulus in children is malrotation. We report a rare case of a 2-year-old boy who was brought by his parents to the emergency room with the complaint of constipation for 5 days and vomiting for the last 4 days. Examination and plain abdominal X-ray suggested intestinal obstruction. Furthermore, ultrasonography indicated the presence of a cyst and dilatation of the bowel. On exploratory laparotomy, an ileal volvulus caused by cystic lymphangioma developed on the mesenteric wall and associated with ileal and jejunal dilatation was observed. The diseased segments were resected in addition to 5cm before and after the cystic lymphangioma to prevent recurrence.
Collapse
Affiliation(s)
- Shoog F Alfadhel
- Medical Student, Faculty of Medicine, King Saud Bin Abdulaziz University for Health Sciences KSAU-HS, Riyadh, Kingdom of Saudi Arabia
| | - Abdulmajeed A Alghamdi
- Medical Intern, Faculty of Medicine, Al-Baha University, Riyadh, Kingdom of Saudi Arabia
| | - Saif A Alzahrani
- Medical Intern, Faculty of Medicine, Al-Baha University, Riyadh, Kingdom of Saudi Arabia
| |
Collapse
|
34
|
Abstract
Acute colonic pseudo-obstruction (ACPO) and volvulus are two disease processes that affect the colon causing abdominal distension and may necessitate operation intervention. ACPO may be associated with multiple comorbidities, infectious diseases, and cardiac dysfunction. It may be treated with conservative management including endoscopic decompression or neostigmine. If the distension is not addressed, high mortality may result if peritonitis develops. Volvulus most commonly occurs in the sigmoid colon or cecum. If left-sided, endoscopic decompression may resolve the obstruction if detorsion is successful, although sigmoid colectomy should be performed during the admission. If cecal volvulus is identified, right hemicolectomy should be performed.
Collapse
Affiliation(s)
- Joshua Underhill
- Department of General Surgery, Rush University Medical Center, Chicago, Illinois
| | - Emily Munding
- Department of General Surgery, Rush University Medical Center, Chicago, Illinois
| | - Dana Hayden
- Department of General Surgery, Rush University Medical Center, Chicago, Illinois
| |
Collapse
|
35
|
Abstract
Cecal volvulus is a rare complication of malfixation anomalies and intestinal malrotation in children. Only few cases have been reported. The rarity of the condition, frequently leads to diagnostic delay and complications. The best option for cecal volvulus repair remains unclear. Our aim is to increase the awareness of surgeons about cecal volvulus and to discuss its management.
Collapse
Affiliation(s)
- Mohamed Oulad Saiad
- Department of Pediatric Surgery, Mother and Child Unit, School of Medicine, University Hospital Mohamed VI, Cadi Ayyad University, Marrakesh, Morocco
| | - Najoua Aballa
- Department of Pediatric Surgery, Mother and Child Unit, School of Medicine, University Hospital Mohamed VI, Cadi Ayyad University, Marrakesh, Morocco
| |
Collapse
|
36
|
Green T, Chen D, Mishael T, Shen O. A unique sonographic presentation of prenatal volvulus associated with malrotation. Clin Case Rep 2021; 9:e04525. [PMID: 34257993 PMCID: PMC8259922 DOI: 10.1002/ccr3.4525] [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: 02/02/2021] [Revised: 05/18/2021] [Accepted: 06/01/2021] [Indexed: 11/21/2022] Open
Abstract
This is a unique case of prenatal diagnosis of bowel malrotation suspected by an abnormal course of the duodenum. Early detection of volvulus was enabled, leading to timely intervention and a favorable outcome.
Collapse
Affiliation(s)
- Tamar Green
- Department of Obstetrics and GynecologyFaculty of MedicineShaare Zedek Medical CenterHebrew University of JerusalemJerusalemIsrael
| | - Daniela Chen
- Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Tali Mishael
- Department of Obstetrics and GynecologyFaculty of MedicineShaare Zedek Medical CenterHebrew University of JerusalemJerusalemIsrael
| | - Ori Shen
- Department of Obstetrics and GynecologyFaculty of MedicineShaare Zedek Medical CenterHebrew University of JerusalemJerusalemIsrael
| |
Collapse
|
37
|
Ahmed M, Elkahly M, Gorski T, Mahmoud A, Essien F. Meckel's Diverticulum Strangulation. Cureus 2021; 13:e14817. [PMID: 34094771 PMCID: PMC8171988 DOI: 10.7759/cureus.14817] [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] [Accepted: 05/03/2021] [Indexed: 11/05/2022] Open
Abstract
Meckel's diverticulum is the most common congenital anomaly of the small intestine. It is a true diverticulum containing all layers of the intestinal wall and results from the incomplete resolution of the omphalomesenteric duct. The majority of the cases are asymptomatic; however, diagnostic challenges arise when it becomes inflamed, causes gastrointestinal hemorrhage, intestinal obstruction, or when it protrudes through a potential abdominal opening (Littre's hernia). We present a rare case of strangulated Meckel's diverticulum as a result of axial torsion presenting with right lower quadrant abdominal pain.
Collapse
Affiliation(s)
| | | | - Tito Gorski
- Surgery, Southwest Healthcare System, Murrieta, USA
| | - Ahmed Mahmoud
- Surgery, Riverside Community Hospital, Riverside, USA
| | | |
Collapse
|
38
|
Sapalidis K, Sevva C, Magra V, Manaki V, Koulouris C, Roulia P, Katsaounis A, Vasileiou D, Pantea S, Kesisoglou I. Internal Hernia and Volvulus in an Adult Male Caused by Meckel's Diverticulum: A Case Report. ACTA ACUST UNITED AC 2021; 57:443. [PMID: 34063707 DOI: 10.3390/medicina57050443] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 11/16/2022]
Abstract
Background: Meckel’s diverticulum is a common congenital abnormality of the gastrointestinal tract encountered in about 1–3% of the general population. Although most patients remain asymptomatic, a minority will experience serious complications such as acute abdomen, haemorrhage or obstructive ileus. Of all patients presenting with symptoms of obstruction due to Meckel’s diverticulum 7–18% is due to volvulus. Case Report: A 39-year-old male with multiple previous episodes of obstructive ileus presented with an acute abdomen. An exploratory laparotomy was performed in order to reveal the cause of the obstruction. An internal hernia with ileal volvulus and a Meckel’s diverticulum was found, which was later confirmed by histopathological examination. Conclusion: Meckel’s diverticulum is a rare cause of acute abdomen and obstructive ileus which should be considered when the symptoms date back to childhood. The difficulty of preoperative diagnosis dictates the need for exploratory laparoscopy or laparotomy as diagnostic tools.
Collapse
|
39
|
Morera-Grau A, Membrilla-Fernández E, González-Castillo AM, Pelegrina-Manzano A, Guerrero-Ortiz MA, Téllez-Marquès C, Pons-Fraguero MJ, Guzmán-Ahumada J, Pera-Román M, Sancho-Insenser JJ. Caecal volvulus and jejunostomy: challenging diagnostic. J Surg Case Rep 2021; 2021:rjab148. [PMID: 33927877 PMCID: PMC8068471 DOI: 10.1093/jscr/rjab148] [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: 03/10/2021] [Accepted: 03/26/2021] [Indexed: 11/29/2022] Open
Abstract
Caecal volvulus represent the 20–40% of colonic volvulus, being the second most frequent localization. It causes intestinal occlusion symptomatology (nausea, vomiting, abdominal distension). We present a case of 45-year-old women with feeding jejunostomy tube due to connatal anoxia. She arrives at A&E after 12 h of vomits and abdominal pain. The CT scan shows a small intestine dilation that suggested a small intestine volvulus. A laparotomy is performed showing a caecal volvulus, so ileo-cequectomy with primary anastomosis is performed. After several complications, she was discharged after 60 days of hospital stay. Caecal volvulus can be challenging to diagnose by clinic, because it can be hardly differenced from other intestinal occlusion causes. CT scan can be useful to reach the diagnostic and see signs of tissue suffering. In contrast with sigma volvulus, endoscopic treatment has not shown any benefit to solve it.
Collapse
Affiliation(s)
- A Morera-Grau
- General Surgery Department, Hospital del Mar, Barcelona, Spain
| | - E Membrilla-Fernández
- General Surgery Department, Hospital del Mar, Barcelona, Spain.,Surgery Department, Autonomous University of Barcelona, Barcelona, Spain
| | - A M González-Castillo
- General Surgery Department, Hospital del Mar, Barcelona, Spain.,Surgery Department, Autonomous University of Barcelona, Barcelona, Spain
| | | | | | | | | | - J Guzmán-Ahumada
- General Surgery Department, Hospital del Mar, Barcelona, Spain.,Surgery Department, Autonomous University of Barcelona, Barcelona, Spain
| | - M Pera-Román
- General Surgery Department, Hospital del Mar, Barcelona, Spain.,Surgery Department, Autonomous University of Barcelona, Barcelona, Spain
| | - J J Sancho-Insenser
- General Surgery Department, Hospital del Mar, Barcelona, Spain.,Surgery Department, Autonomous University of Barcelona, Barcelona, Spain
| |
Collapse
|
40
|
Fatemizadeh R, Gollins L, Hagan J, Debuyserie A, King K, Vogel AM, Van Buren KL, Hair AB, Premkumar MH. In neonatal-onset surgical short bowel syndrome survival is high, and enteral autonomy is related to residual bowel length. JPEN J Parenter Enteral Nutr 2021; 46:339-347. [PMID: 33881791 DOI: 10.1002/jpen.2124] [Citation(s) in RCA: 1] [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] [Indexed: 12/26/2022]
Abstract
BACKGROUND In an era of improved management and treatment options, this study aims to describe the long-term outcomes and factors predictive of outcomes of neonatal-onset intestinal failure (IF) due to surgical short bowel syndrome (SBS). METHODS Retrospective, single-center cohort study of infants born between January 2011 and December 2018 with inclusion criteria: <44 weeks postmenstrual age at SBS diagnosis, <28 days on admission, parenteral nutrition dependence >60 days, and documented intestinal resection. Primary outcomes included survival and achievement of enteral autonomy (EA). Data analysis utilized Fisher.s exact test, Kruskal-Wallis test, survival analysis methods, Cox proportional hazards regression, linear regression and logistic regression. RESULTS Ninety-five patients (males 56%) were studied with median follow-up of 38 months (IQR 19, 59). Survival at last follow-up was 96%, and EA was achieved in 85%. Forty-eight patients had documented residual bowel length (RBL) with median length of 49 cm (IQR 36, 80). Survival in patients with RBL of <30cm (n = 8), 30-59cm (n = 19), and >60cm (n = 21) was 100%, 95%, and 95% respectively. Shorter RBL was associated with longer time to achieve EA (p = 0.007), but not with survival (p = 0.81). Delay in achieving EA was associated with absence of ileocecal valve (p = 0.002) and bloodstream infections (p < 0.001). Peak conjugated bilirubin correlated with increased mortality (p = 0.002). CONCLUSION Overall high rate of survival and achievement of EA was found in neonatal onset IF due to SBS. EA but not survival was correlated with RBL. Ileocecal valve, bloodstream infections, and conjugated bilirubin levels were the other predictive factors of outcomes.
Collapse
Affiliation(s)
- Roxana Fatemizadeh
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Laura Gollins
- Clinical Nutrition Services, Texas Children's Hospital, Houston, Texas, USA
| | - Joseph Hagan
- Section of Neonatal-Perinatal Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Anne Debuyserie
- Section of Neonatal-Perinatal Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Kristi King
- Clinical Nutrition Services, Texas Children's Hospital, Houston, Texas, USA
| | - Adam M Vogel
- Division of Pediatric Surgery, Department of Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Kristin L Van Buren
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Amy B Hair
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Muralidhar H Premkumar
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| |
Collapse
|
41
|
Mensah KT, Kwarase R, Laari S, Thompson WNA. Midgut malrotation with volvulus discovered at an emergency caesarean section for placental abruption. Ghana Med J 2021; 55:88-92. [PMID: 38322395 PMCID: PMC10665259 DOI: 10.4314/gmj.v55i1.14] [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] [Indexed: 02/08/2024] Open
Abstract
Adult midgut malrotation with volvulus (AMMV) is an uncommon presentation which may be found incidentally during abdominal radiologic investigations or at laparotomy. We report a case of AMMV and small bowel gangrene in a 35-year-old Gravida four, Para three at 39 weeks, 4 days gestation who presented with a short history of worsening abdominal pain, repeated vomiting and abdominal wall guarding. Emergency caesarean section performed on account of a suspected placental abruption incidentally revealed a long segment of non-viable small intestine. Subsequent midline laparotomy disclosed a midgut malrotation with volvulus and bowel gangrene. This resulted in a 4.6m resection of non-viable small bowel with Ladd's procedure. The patient developed moderate symptoms of short bowel syndrome in the post-operative period which was successfully managed non-operatively. This case report represents a rare diagnosis, in the West-African sub-region, of an adult midgut malrotation with volvulus mimicking a third trimester obstetric emergency. Funding None declared.
Collapse
Affiliation(s)
- Kofi T Mensah
- Agogo Presbyterian Hospital, Box 27, Agogo, Ashanti-Akim, Ghana
| | - Raphael Kwarase
- Agogo Presbyterian Hospital, Box 27, Agogo, Ashanti-Akim, Ghana
| | | | | |
Collapse
|
42
|
Boussaidane S, Samlali A, Hamri A, Narjis Y, Benelkhaiat BR. Ileosigmoid knot in a patient with Down syndrome: a unique surgical emergency. Pan Afr Med J 2021; 38:8. [PMID: 33520077 PMCID: PMC7825375 DOI: 10.11604/pamj.2021.38.8.27407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/12/2020] [Accepted: 12/17/2020] [Indexed: 11/18/2022] Open
Abstract
The ileosigmoid knot (ISK) or double ileosigmoid volvulus is a wrapping of the small intestine around the base of the sigmoid colon. We report an unusual case in the digestive surgery department of the Ibn Tofail Hospital of CHU Mohammed VI Marrakech of a 28-year-old man with Down's syndrome who presented with symptoms and signs of intestinal obstruction. Abdominal CT scan revealed a whirl sing and significant distension of the sigmoid loop. Exploratory laparotomy revealed ISK resulting in gangrene of ileum and sigmoid colon. The surgical procedure was a necrotic digestive segments resection, with a double-barrelled ileostomy and a Hartmann procedure. One month afterwards, the patient was operated on to reestablish of the continuity. Through this observation and a review of the literature we define the diagnostic, therapeutic and prognosis aspects of this rare clinical entity.
Collapse
Affiliation(s)
- Said Boussaidane
- Department of General Surgery, Ibn Tofail Hospital, Mohamed VI University Hospital, Cadi Ayad University, Marrakech, Morocco
| | - Abderrahim Samlali
- Department of General Surgery, Ibn Tofail Hospital, Mohamed VI University Hospital, Cadi Ayad University, Marrakech, Morocco
| | - Asma Hamri
- Department of General Surgery, Ibn Tofail Hospital, Mohamed VI University Hospital, Cadi Ayad University, Marrakech, Morocco
| | - Youssef Narjis
- Department of General Surgery, Ibn Tofail Hospital, Mohamed VI University Hospital, Cadi Ayad University, Marrakech, Morocco
| | - Benomar Ridouan Benelkhaiat
- Department of General Surgery, Ibn Tofail Hospital, Mohamed VI University Hospital, Cadi Ayad University, Marrakech, Morocco
| |
Collapse
|
43
|
Daggett A, Loeber S, Le Roux AB, Beaufrere H, Doss G. Computed tomography with Hounsfield unit assessment is useful in the diagnosis of liver lobe torsion in pet rabbits (Oryctolagus cuniculus). Vet Radiol Ultrasound 2020; 62:210-217. [PMID: 33340204 DOI: 10.1111/vru.12939] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 07/02/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 11/30/2022] Open
Abstract
Clinical signs of liver lobe torsion in rabbits are often nonspecific and mimic those that are also generally detected with gastrointestinal stasis. Nonspecific clinical signs may result in pursuit of full-body imaging such as computed tomography (CT). The aim of this multicenter, retrospective, case series study was to describe CT findings of liver lobe torsion in a group of rabbits. Computed tomography studies of six rabbits with confirmed liver lobe torsion by surgery or necropsy were evaluated. The caudate liver lobe was affected in six out of six rabbits and was enlarged, rounded, hypoattenuating, heterogeneous, and minimally to noncontrast enhancing, with scant regional peritoneal effusion. Precontrast, mean Hounsfield units (HU) of the torsed liver lobe (39.3 HU [range, 24.4-48.1 HU]) were lower than mean HU of normal liver (55.1 HU [range, 49.6-60.8 HU]), with a mean torsed:normal HU ratio of 0.71 (range, 0.49-0.91). Postcontrast, mean HU of the torsed liver lobe (38.4 HU [range, 19.7-48.9 HU]) were also lower than mean HU of normal liver (108.4 HU [range, 84.5-142.0 HU]), with a lower postcontrast mean torsed:normal HU ratio of 0.35 (range, 0.14-0.48) compared to precontrast. Mean HU of torsed liver lobes had little difference pre- and postcontrast (postcontrast HU 1.0 times the average precontrast HU [range, 0.81-1.1]), and contrast enhancement of the torsed liver lobes was on average 50% lower than in normal liver. Liver lobe torsion should be considered in rabbits with an enlarged, hypoattenuating, heterogeneous, minimally to noncontrast enhancing liver lobe, particularly the caudate lobe, and scant regional peritoneal effusion.
Collapse
Affiliation(s)
- Alexis Daggett
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Samantha Loeber
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Alexandre B Le Roux
- Department of Diagnostic Imaging, The Animal Medical Center, New York, New York
| | - Hugues Beaufrere
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Grayson Doss
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| |
Collapse
|
44
|
Coco D, Leanza S. Giant hiatal hernia. Pan Afr Med J 2020; 37:86. [PMID: 33244349 PMCID: PMC7680243 DOI: 10.11604/pamj.2020.37.86.26141] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 09/19/2020] [Indexed: 12/03/2022] Open
Affiliation(s)
- Danilo Coco
- Department of General Surgery, Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Silvana Leanza
- Department of General Surgery, Carlo Urban Hospital, Jesi, Ancona, Italy
| |
Collapse
|
45
|
Shah R, Klumpp L, Negron-Diaz J, Carmain T, Jordan J. Transverse colon volvulus in a patient with autism. J Surg Case Rep 2020; 2020:rjaa284. [PMID: 32934786 PMCID: PMC7479646 DOI: 10.1093/jscr/rjaa284] [Citation(s) in RCA: 2] [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: 06/30/2020] [Accepted: 07/06/2020] [Indexed: 11/13/2022] Open
Abstract
Transverse colon volvulus is an extremely rare cause of bowel obstruction with approximately 100 cases reported in literature. Transverse colon volvulus presents with signs and symptoms of large bowel obstruction, but it can become a surgical emergency due to bowel infarction or peritonitis. We present a rare case of transverse colon volvulus in a 36-year-old male patient with severe autism. We hope this case report will raise awareness of this disease.
Collapse
Affiliation(s)
- Rony Shah
- Department of Internal Medicine, Citrus Memorial Hospital, Inverness, FL 34452, USA
| | - Linda Klumpp
- Department of Internal Medicine, Citrus Memorial Hospital, Inverness, FL 34452, USA
| | - Juan Negron-Diaz
- Department of Internal Medicine, Citrus Memorial Hospital, Inverness, FL 34452, USA
| | - Torr Carmain
- Department of Surgery, Citrus Memorial Hospital, Inverness, FL 34452, USA
| | - Jeffrey Jordan
- Department of Internal Medicine, Citrus Memorial Hospital, Inverness, FL 34452, USA
| | | |
Collapse
|
46
|
Abstract
RATIONALE Duodenal atresia in association with situs inversus abdominus is extremely rare. Care should be taken when selecting appropriate surgical methods, and caution should be exercised during the surgery to avoid misdiagnosis and mistreatment. With prompt recognition of the condition, the surgical procedure should be performed in a timely manner to achieve positive results. PATIENT CONCERNS A newborn affected by situs inversus abdominus associated with duodenal atresia, midgut malrotation, and volvulus. DIAGNOSIS Congenital duodenal atresia with situs inversus abdominis. INTERVENTIONS Diamond-shaped duodenoduodenostomy with appendectomy was performed, with the release of Ladd band and correction of the malrotation. OUTCOMES The baby boy is thriving well with no abdominal complaints at 4 years of surgical follow-up. LESSONS Although several theories are put forward to clarify this matter, the proper cause of duodenal atresia is not well defined. Clinical symptoms and examinations can assist diagnosis, the definitive cause should be ascertained by surgical approach. And the operating surgeon must be aware of the "mirror anatomy" to prevent unnecessary injuries. Additionally, long-term prognosis for duodenal atresia are very good, therefore, careful attention in postoperative management are important in such a case.
Collapse
Affiliation(s)
- Shuai Qiang
- 10th Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Meili Fan
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University
| | - Qingbo Cui
- Department of Pediatric Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhaozhu Li
- Department of Pediatric Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yu Zhou
- 10th Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Qiang Li
- 10th Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Fengyong Li
- 10th Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| |
Collapse
|
47
|
Nguyen HN, Sammer MB, Bales B, Cano MC, Trout AT, Dillman JR, Hayatghaibi SE. Time-Driven Activity-Based Cost Comparison of Three Imaging Pathways for Suspected Midgut Volvulus in Children. J Am Coll Radiol 2020; 17:1563-1570. [PMID: 32697960 DOI: 10.1016/j.jacr.2020.06.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 05/04/2020] [Revised: 06/12/2020] [Accepted: 06/20/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To use time-driven activity-based costing to compare the costs of pathways for evaluating suspected pediatric midgut volvulus using either fluoroscopic upper gastrointestinal examination (UGI) or focused abdominal ultrasound (US). METHODS Process maps were created through patient shadowing, medical record review, and frontline staff interviews. Using time-driven activity-based costing methodology, practical capacity cost rates were calculated for personnel, equipment, and facility costs. Supply costs were included at institutional purchase prices. The cost of each process substep was determined by multiplying step-specific capacity costs by the median time required for each step, and substep costs were summed to generate total pathway cost. Multivariate sensitivity analyses were performed applying minimum and maximum labor costs. Assuming UGI would be used to troubleshoot nondiagnostic US, a break-even analysis was performed to determine the cost impact of varying frequencies of UGI on the total cost of the US-based pathway. RESULTS Process maps were created from 105 (48 girls, 57 boys) patient encounters. Base case pathway times were 90 min (UGI) and 55 min (US). Base case cost for UGI was $282.74 (range: $170.86-$800.82) when performed by a radiology practitioner assistant and $545.66 (range: $260.97-$1,974.06) when performed by a radiologist. Base case cost for US was $155.67 (range: $122.94-$432.29) when performed by a sonographer and $242.64 (range: $147.46-$1,330.05) when performed by a radiologist. For a US-based pathway, the total cost break-even pathway mix (percent UGI required for troubleshooting) was 57%. CONCLUSION US can be a faster and less costly alternative to UGI in pediatric patients with suspected midgut volvulus.
Collapse
Affiliation(s)
- HaiThuy N Nguyen
- Department of Radiology, Texas Children's Hospital, Houston, Texas; Department of Radiology, Baylor College of Medicine, Houston, Texas
| | - Marla B Sammer
- Department of Radiology, Texas Children's Hospital, Houston, Texas; Department of Radiology, Baylor College of Medicine, Houston, Texas
| | - Brandy Bales
- Department of Radiology, Texas Children's Hospital, Houston, Texas
| | - Melissa C Cano
- Department of Radiology, Texas Children's Hospital, Houston, Texas
| | - Andrew T Trout
- Director, Clinical Research, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jonathan R Dillman
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio; Associate Chair, Research, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Shireen E Hayatghaibi
- Department of Radiology, Texas Children's Hospital, Houston, Texas; University of Texas, School of Public Health, Houston, Texas.
| |
Collapse
|
48
|
Abstract
Although the results of a laparoscopic repair of a paraesophageal hernia are convincing and accepted, controversies still persist regarding indications for elective repair, the need for a concurrent fundoplication, the use of mesh, and the need for a Collis gastroplasty. This article is a description of our surgical approach to the patient with a paraesophageal hernia in need of a repair.
Collapse
Affiliation(s)
- Anahita Jalilvand
- Department of General Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Ciro Andolfi
- Department of Surgery, University of Chicago, Prizker School of Medicine, Chicago, Illinois, USA
| | - P Marco Fisichella
- Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
49
|
Johnson LM, Holcombe SJ, Shearer TR, Watson V, Gandy J, Southwood LL, Lynch TM, Schroeder EL, Fogle CA, Sordillo LM. Multicenter Placebo-Controlled Randomized Study of Ethyl Pyruvate in Horses Following Surgical Treatment for ≥ 360° Large Colon Volvulus. Front Vet Sci 2020; 7:204. [PMID: 32373640 PMCID: PMC7187886 DOI: 10.3389/fvets.2020.00204] [Citation(s) in RCA: 2] [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: 02/04/2020] [Accepted: 03/27/2020] [Indexed: 11/13/2022] Open
Abstract
Identifying therapies that mitigate ischemic colonic injury and improve mucosal healing and intestinal viability are crucial to improving survival in horses with ≥360° large colon volvulus (LCV). Ethyl pyruvate is the ethyl ester of pyruvate with diverse pharmacologic effects that limit ischemic injury and hasten intestinal mucosal repair in preclinical rodents, sheep and swine models. The objective of this study was to determine the effects of ethyl pyruvate on systemic indices of colon viability, expression of inflammatory genes in whole blood, morbidity and survival after surgical correction of LCV compared to controls. Horses received either 150 mg/kg ethyl pyruvate in 1 liter lactated Ringer's solution (LRS) or 1 liter LRS intravenously (IV) every 6 h for 24 h following surgical recovery for correction of LCV. Colic duration, perioperative heart rate (HR), packed cell volume (PCV), total solids (TS), blood L-lactate concentration, surgical time, intraoperative episodes of hypoxemia and hypotension, expression of inflammatory cytokine genes, fecal consistency and survival to hospital discharge were compared between ethyl pyruvate treated horses and controls. Twenty-two horses, 12 receiving ethyl pyruvate and 10 controls, were enrolled in the study. Ethyl pyruvate was safely administered to horses following surgical correction of LCV. No significant effects of ethyl pyruvate on post-operative variables, including survival, were found. Seven of 12 ethyl pyruvate treated horses and 5/10 controls survived to hospital discharge. Higher HR, PCV and blood L-lactate concentration at the time of hospital admission, P = 0.005, 0.01, 0.04, respectively, 24 h after surgery, P = 0.001, 0.03, 0.02, respectively, were associated with death. Heart rate, P = 0.005, 48 h after surgery was associated with death. Ethyl pyruvate was safely administered to horses following correction of LCV with no apparent adverse events but was not associated with improved post-operative outcomes including survival. A larger, randomized control trial is needed to fully evaluate the effectiveness of ethyl pyruvate. A major limitation of this investigation is the small sample size, making the study underpowered and creating a high possibility of type II error.
Collapse
Affiliation(s)
- Lindsey M Johnson
- Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, MI, United States
| | - Susan J Holcombe
- Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, MI, United States
| | - Tara R Shearer
- Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, MI, United States
| | - Victoria Watson
- Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing, MI, United States
| | - Jeffery Gandy
- Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, MI, United States
| | - Louise L Southwood
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, PA, United States
| | - Tymothy M Lynch
- Peterson and Smith Equine Hospital, Ocala, FL, United States
| | - Eric L Schroeder
- The Ohio State University, Department of Veterinary Clinical Sciences, Columbus, OH, United States
| | - Callie A Fogle
- Department of Clinical Sciences, North Carolina State University, Raleigh, NC, United States
| | - Lorraine M Sordillo
- Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, MI, United States
| |
Collapse
|
50
|
Patil T, Pacheco JM, Dimou A, Purcell WT, Rossi C, Bunn PA, Doebele RC, Camidge DR, Ferrigno L. Cecal Volvulus as a Rare Complication of Osimertinib Dosed at 160 mg in Patients With EGFR-Mutant Non-small Cell Lung Cancer. Front Oncol 2020; 10:510. [PMID: 32351892 PMCID: PMC7174901 DOI: 10.3389/fonc.2020.00510] [Citation(s) in RCA: 2] [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: 11/22/2019] [Accepted: 03/23/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Osimertinib is a 3rd-generation tyrosine kinase inhibitor (TKI) that blocks the epidermal growth factor receptor (EGFR) in non-small lung cancer (NSCLC) and has dramatically improved outcomes for patients with EGFR mutations. While gastrointestinal complications such as diarrhea have been reported with EGFR inhibitors (due to off-target interactions with EGFR receptors within the gut lining), cecal volvulus is an extremely rare complication in advanced malignancy. To date, there are no reported cases associating cecal volvulus with any EGFR TKIs. Case Presentation: In this case series, we present three cases of cecal volvulus among patients with EGFR-positive NSCLC patients treated with osimertinib dosed at double the standard 80 mg dose (160 mg daily). No patient was receiving concurrent chemotherapy or bevacizumab at the time of this described complication. In two cases where pathology was available for review, peritoneal carcinomatosis or intra-abdominal spread was not observed. In a retrospective evaluation of 101 patients treated with osimertinib in our institution, there was a statistically significant difference in the incidence of cecal volvulus among patients receiving osimertinib at 160 mg vs. patients receiving the 80 mg dose (27 vs. 0%; p < 0.001). Conclusions: To our knowledge, these are the first cases to highlight a potentially important and serious gastrointestinal complication associated with the 160 mg dose of osimertinib.
Collapse
Affiliation(s)
- Tejas Patil
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Jose M Pacheco
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Anastasios Dimou
- Division of Medical Oncology, Mayo Clinic, Aurora, CO, United States
| | - William T Purcell
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Candice Rossi
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Paul A Bunn
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Robert C Doebele
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, United States
| | - D Ross Camidge
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Lisa Ferrigno
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, United States
| |
Collapse
|