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Gebretsion MT, Mergiyaw YA, Shumargaw AT. Spleno-Sigmoid Knotting - An Unfamiliar Cause of Intestinal Obstruction. Am J Emerg Med 2024; 78:241.e1-241.e3. [PMID: 38402100 DOI: 10.1016/j.ajem.2024.02.027] [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: 01/25/2024] [Accepted: 02/18/2024] [Indexed: 02/26/2024] Open
Abstract
INTRODUCTION Spleno-sigmoid knotting is the twisting of the spleen around the sigmoid colon, causing obstruction of the sigmoid colon. It is an uncommon cause of intestinal obstruction. To our knowledge, there has been no previous case report of spleno-sigmoid knotting before our case. CASE REPORT Here, we present the case of an 18-year-old female patient who visited the surgical emergency outpatient department with diffuse and progressive abdominal pain lasting for one and a half days. She also experienced obstipation and frequent episodes of vomiting of ingested matter. Upon initial evaluation, she exhibited tachycardia and tachypnea, and her abdomen was grossly distended with diffuse direct and rebound tenderness. Further investigation revealed significant leukocytosis with neutrophil predominance. Emergency laparotomy was performed with a possible diagnosis of generalized peritonitis secondary to gangrenous sigmoid volvulus, which revealed gangrenous spleno-sigmoid knotting. DISCUSSION Various types of intestinal knots have been reported, with ileo-sigmoid knots being the most common and ileo-ileal knots being the rarest. Wandering spleen is a rare congenital anomaly with a variable clinical presentation ranging from asymptomatic to mild abdominal pain or acute abdomen due to torsion or acute pancreatitis. It can also cause intestinal obstruction, which may be the initial presentation. CONCLUSION In patients presenting with acute abdominal pain and features of bowel obstruction, the possibility of spleno-sigmoid knotting should be considered, and early intervention should be instituted to prevent gangrenous progression and sepsis.
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Affiliation(s)
| | - Yimam Ali Mergiyaw
- Department of Surgery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Kedoin C, Muto M, Nagano A, Matsui M, Sugita K, Baba T, Miyoshi K, Masuya R, Murakami M, Yano K, Onishi S, Harumatsu T, Yamada W, Yamada K, Matsukubo M, Kawano T, Kuda M, Nakame K, Torikai M, Ieiri S. Notable Clinical Differences Between Neonatal and Post-Neonatal Intestinal Malrotation: A Multicenter Review in Southern Japan. J Pediatr Surg 2024; 59:566-570. [PMID: 38145920 DOI: 10.1016/j.jpedsurg.2023.11.020] [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: 11/09/2023] [Accepted: 11/20/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Most cases of intestinal malrotation appear in neonates with bilious vomiting due to midgut volvulus, whereas in cases that develop beyond infancy, the initial symptoms vary. This study investigated the clinical features of these two populations and identified issues that should be considered in daily practice. METHODS A retrospective chart review was conducted from January 1, 2010, to December 31, 2022. Data on patients with intestinal malrotation were collected in an anonymized fashion from five pediatric surgical hub facilities in the Southern Kyushu and Okinawa areas of Japan. RESULTS Of the 80 subjects, 57 (71.3%) were neonates (Group N) and 23 (28.7%) were infants and schoolchildren (Group I). The frequencies of initial symptoms, such as abdominal distention (Group N: 19.3% vs. Group I: 13.0%), bilious vomiting (59.6% vs. 43.5%), and hematochezia (8.8% vs. 21.7%), were not skewed by the age of onset (p = 0.535, 0.087, and 0.141, respectively). Midgut volvulus was significantly more frequent in Group N (71.9% [41/57] vs. 34.8% [8/23]; p = 0.005), while the degree of torsion was greater in group I (median 360° [interquartile range: 180-360°] vs. 450° [360-540°]; p = 0.029). Although the bowel resection rate was equivalent (7.0% [4/57] vs. 4.3% [1/23]; p = 1.000), half of the patients in Group N presented with 180° torsion. The neonatal intestine has been highlighted as being more susceptible to ischemia than that in older children. CONCLUSIONS The incidence of midgut volvulus is higher in neonates than in older children. Even relatively mild torsion can cause ischemic bowel changes during the neonatal period. LEVEL OF EVIDENCE LEVEL III.
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Affiliation(s)
- Chihiro Kedoin
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Mitsuru Muto
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan.
| | - Ayaka Nagano
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Mayu Matsui
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Koshiro Sugita
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Tokuro Baba
- Department of Digestive and General Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kina Miyoshi
- Department of Pediatric Surgery, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan
| | - Ryuta Masuya
- Division of the Gastrointestinal, Endocrine, and Pediatric Surgery, Department of Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Masakazu Murakami
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Keisuke Yano
- Department of Neonatology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan
| | - Shun Onishi
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Toshio Harumatsu
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Waka Yamada
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Koji Yamada
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Makoto Matsukubo
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Takafumi Kawano
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Masaaki Kuda
- Department of Digestive and General Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kazuhiko Nakame
- Division of the Gastrointestinal, Endocrine, and Pediatric Surgery, Department of Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Motofumi Torikai
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Satoshi Ieiri
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
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Low YX, Teo YM, Lee YY, Nyo YL, Loh DL, Mali VP. Navigating Inconclusive Upper-Gastrointestinal Series in Infantile Bilious Vomiting: A Case Series on Intestinal Malrotation. Am J Case Rep 2024; 25:e943056. [PMID: 38483097 PMCID: PMC10949343 DOI: 10.12659/ajcr.943056] [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: 11/02/2023] [Revised: 01/26/2024] [Accepted: 01/17/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Bilious vomiting in a child potentially portends the dire emergency of intestinal malrotation with volvulus, necessitating prompt surgical management, with differentials including small-bowel atresia, duodenal stenosis, annular pancreas, and intussusception. Although the upper-gastrointestinal series (UGI) is the diagnostic investigation of choice, up to 15% of the studies are inconclusive, thereby posing a diagnostic challenge. CASE REPORT We report a case series of 3 children referred for bilious vomiting, whose initial UGI was inconclusive and who were eventually confirmed to have intestinal malrotation at surgery. The first child was a female born at 37 weeks with antenatally diagnosed situs inversus and levocardia, who developed bilious vomiting on day 1 of life. The duodenojejunal flexure (DJ) could not be visualized on the UGI because of faint opacification on first pass of the contrast and subsequent overlap with the proximal jejunal loops. The second child was a male born at 36 weeks, presenting at age 4 months with bilious vomiting of 2 days duration. The third child was a female born at 29 weeks, presenting with bilious aspirates on day 3 of life. UGI for all 3 showed persistent hold-up of contrast at the proximal duodenum with no opacification of the distal duodenum or small bowel.Adjunctive techniques during the UGI and ultrasound examination helped achieve a preoperative diagnosis of malrotation in these children. CONCLUSIONS Application of diagnostic adjuncts to an inconclusive initial UGI may help elucidate a preoperative diagnosis of intestinal malrotation in infantile bilious vomiting.
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Affiliation(s)
- Yi Xian Low
- Department of Diagnostic Imaging, National University Hospital, Singapore City,Singapore
| | - Yi Ming Teo
- Department of Diagnostic Imaging, National University Hospital, Singapore City,Singapore
| | - Yang Yang Lee
- Department of Paediatric Surgery, Khoo Teck Puat – National University Children’s Medical Institute, National University Hospital, Singapore City, Singapore
| | - Yoke Lin Nyo
- Department of Paediatric Surgery, Khoo Teck Puat – National University Children’s Medical Institute, National University Hospital, Singapore City, Singapore
| | - Dale Lincoln Loh
- Department of Paediatric Surgery, Khoo Teck Puat – National University Children’s Medical Institute, National University Hospital, Singapore City, Singapore
| | - Vidyadhar Padmakar Mali
- Department of Paediatric Surgery, Khoo Teck Puat – National University Children’s Medical Institute, National University Hospital, Singapore City, Singapore
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Gionfriddo TB, Georoff T, Baker K, Ialeggio D, Hinshaw K, Toddes B, Trupkiewicz JG. INTESTINAL TYMPANY AND VOLVULUS IN CENTRAL AMERICAN RIVER TURTLES ( DERMATEMYS MAWII). J Zoo Wildl Med 2024; 55:224-234. [PMID: 38453507 DOI: 10.1638/2021-0109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2023] [Indexed: 03/09/2024] Open
Abstract
Ten cases of small intestinal tympany with or without volvulus were documented in Central American river turtles (Dermatemys mawii). These turtles were under managed care at the Philadelphia Zoo in Philadelphia, PA, USA, with one case followed after transfer to a different institution. The primary clinical presentation was abnormal buoyancy in nearly all cases (9/10) and anorexia in two cases (2/10). Five of 10 turtles with suspected or radiographically confirmed small intestinal tympany recovered (5/10), whereas five cases (5/ 10) resulted in death or euthanasia. In all fatal cases (5/5), small intestinal volvulus was identified at gross necropsy, with concurrent colonic volvulus identified in 2/5 cases. Other notable necropsy findings were hepatic lipidosis (3/5) and thrombosis of intestinal or renal vasculature (2/5). In all fatal cases (5/5), there was short (1 to 2 days) clinical progression from abnormal buoyancy to death or euthanasia. In the majority of cases (6/10), an abrupt change in diet, notably the overfeeding of fresh fruit or excessive amounts of mulberry (Morus spp.) browse, or ingestion of indigestible foreign material, occurred prior to presentation. Temporary suboptimal environmental temperatures were suspected prior to the onset of clinical signs in 4/10 cases. Optimal husbandry conditions including nutrition and environmental temperature appear vital to preventing this condition. Recognition of early clinical signs of this condition, such as abnormal buoyancy and anorexia, and environmental correction or medical therapy, may prevent fatality and result in a better outcome in these cases.
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Affiliation(s)
| | - Tim Georoff
- The Philadelphia Zoo, Philadelphia, PA 19104-1196, USA
| | - Kendra Baker
- The Philadelphia Zoo, Philadelphia, PA 19104-1196, USA
- The National Aquarium, Baltimore, MD 21202, USA
| | | | - Keith Hinshaw
- The Philadelphia Zoo, Philadelphia, PA 19104-1196, USA
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Braun U, Gerspach C, Volz C, Hilbe M, Nuss K. Small intestinal volvulus in 47 cows. Can Vet J 2024; 65:267-277. [PMID: 38434172 PMCID: PMC10880405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Objective To describe the findings, treatment, and outcome of small intestinal volvulus (SIV) in 47 cows. Animals and procedure Retrospective analysis of medical records. Comparison of the findings for 18 surviving and 29 non-surviving cows. Results The most common abnormal vital signs were tachycardia (68.0%), tachypnea (59.6%), and decreased rectal temperature (51.1%). Signs of colic occurred in 66.0% of cows in the study. Rumen motility was reduced or absent in 93.6% of cows, and intestinal motility in 76.6%. Clinical signs on ballottement and/or percussion and simultaneous auscultation were positive on the right side in 78.7% of cows. Transrectal examination showed dilated small intestines in 48.9% of cows. The rectum contained little or no feces in 93.6% of cows. The principal laboratory abnormalities were hypocalcemia (74.1%), hypokalemia (73.8%), azotemia (62.8%), hypermagnesemia (61.6%), and hemoconcentration (60.0%). The principal ultrasonographic findings were dilated small intestines (87.1%) and reduced or absent small intestinal motility (85.2%). Forty-one of the 47 cows underwent right flank laparotomy and the SIV was reduced in 21 cows. When comparing the clinical and laboratory findings of 18 surviving and 29 non-surviving cows, the groups differed significantly with respect to severely abnormal general condition (16.7 versus 37.9%), rumen stasis (22.2 versus 79.3%), intestinal atony (16.7 versus 48.3%), serum urea concentration (6.5 versus 9.8 mmol/L), and serum magnesium concentration (0.98 versus 1.30 mmol/L). In summary, 38.3% of the cows were discharged and 61.7% were euthanized before, during, or after surgery. Conclusion and clinical relevance An acute course of disease, little or no feces in the rectum, and dilated small intestines were characteristic of SIV in this study population.
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Affiliation(s)
- Ueli Braun
- Department of Farm Animals (Braun, Gerspach, Volz, Nuss) and Institute of Veterinary Pathology (Hilbe), Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, CH-8057 Zurich, Switzerland
| | - Christian Gerspach
- Department of Farm Animals (Braun, Gerspach, Volz, Nuss) and Institute of Veterinary Pathology (Hilbe), Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, CH-8057 Zurich, Switzerland
| | - Claudia Volz
- Department of Farm Animals (Braun, Gerspach, Volz, Nuss) and Institute of Veterinary Pathology (Hilbe), Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, CH-8057 Zurich, Switzerland
| | - Monika Hilbe
- Department of Farm Animals (Braun, Gerspach, Volz, Nuss) and Institute of Veterinary Pathology (Hilbe), Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, CH-8057 Zurich, Switzerland
| | - Karl Nuss
- Department of Farm Animals (Braun, Gerspach, Volz, Nuss) and Institute of Veterinary Pathology (Hilbe), Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, CH-8057 Zurich, Switzerland
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Yin MD, Hao LL, Li G, Li YT, Xu BL, Chen XR. Adult-onset congenital intestinal malrotation: A case report and literature review. Medicine (Baltimore) 2024; 103:e37249. [PMID: 38394530 DOI: 10.1097/md.0000000000037249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Intestinal malrotation is an infrequent congenital anomaly primarily observed in neonates, and adult-onset cases are exceedingly rare. Studies on adult congenital intestinal malrotation are limited. METHODS A case with congenital intestinal malrotation is reported in our study. The clinical data were collected and the treatment process and effect were evaluated. RESULTS A 45-year-old female who had been experiencing vomiting for over 40 years was admitted to our hospital. According to the result of CT scan, intestinal volvulus accompanied by bowel obstruction was suspected. Then laparoscopic examination was applied to the patient and was ultimately diagnosed with adult congenital intestinal malrotation. We performed Ladd's procedure combined with gastrojejunostomy and Braun anastomosis. The patient recovered well and was successfully discharged from the hospital on the 13th day after surgery. After a 6-month follow-up, the symptom of vomiting was significantly alleviated and body weight was gained for 10 kg. She was very satisfied with the treatment. CONCLUSION Adult congenital intestinal malrotation is a rare disease that is often misdiagnosed owing to nonspecific clinical manifestations. Therefore, awareness about this condition should be enhanced. Surgery remains the cornerstone of treatment for this disease. Combining gastrojejunostomy and Braun anastomosis with the traditional Ladd procedure can optimize surgical outcomes.
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Affiliation(s)
- Meng-Di Yin
- Linyi People's Hospital, Jinzhou Medical University, Linyi 276000, China
| | - Li-Liang Hao
- Department of Gastrointestinal Surgery, Linyi People's Hospital, Linyi 276000, China
| | - Guang Li
- Department of Gastrointestinal Surgery, Linyi People's Hospital, Linyi 276000, China
| | - Yu-Tao Li
- Department of Gastrointestinal Surgery, Linyi People's Hospital, Linyi 276000, China
| | - Bao-Li Xu
- Department of Gastrointestinal Surgery, Linyi People's Hospital, Linyi 276000, China
| | - Xin-Rui Chen
- Department of Gastrointestinal Surgery, Linyi People's Hospital, Linyi 276000, China
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Satheakeerthy S, Leow P, Hall B, Yen DA, Fischer J. Outcomes for sigmoid volvulus managed with and without early definitive surgery: 20-year experience in a tertiary referral centre. ANZ J Surg 2024; 94:169-174. [PMID: 37626456 DOI: 10.1111/ans.18671] [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: 03/24/2023] [Revised: 08/13/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Sigmoid volvulus is rare in Western countries. Patients at risk of sigmoid volvulus are often older with significant co-morbidity. Without sigmoid colectomy there is a high recurrence rate, but indications for surgery are controversial. METHODS A retrospective observational study was conducted by reviewing clinical records of patients admitted to Waikato Hospital 1 January 2000 to 1 January 2020 with a diagnosis of sigmoid volvulus. Patient characteristics, clinical features, investigations, management, and outcomes were recorded. RESULTS One hundred and thirty-two patients (87 male) were included with 203 volvulus episodes. Median age 76 years, median Charlson co-morbidity index (CCI) 4. Median follow-up 11 years. 44/132 (33.3%) had surgery during the index admission, two had elective surgery and the remainder had planned non-operative management. 73/132 (55.3%) had surgery at any stage. 42/86 (48.8%) patients managed non-operatively recurred; 66.7% of recurrences were within 6 months. Forty-three (32.6%) died within 12 months of index admission; 28 (21.2%) died during an admission for volvulus. On univariate analysis higher age and abnormal vital signs were associated with inpatient and 12-month mortality; higher CCI was associated with 12-month mortality. On multi-variate analysis increasing age in years was associated with increased risk of death (HR 1.089 [1.052-1.128, P < 0.001]). Normal vital signs at presentation were associated with decreased risk of death (HR 0.147 [0.065-0.334, P < 0.001]). CONCLUSION Sigmoid colectomy should be considered at index presentation with sigmoid volvulus. Half of patients managed non-operatively recurred, with two-thirds recurring within 6 months. The mortality rate remains high for subsequent volvulus episodes.
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Affiliation(s)
| | - Priscilla Leow
- Department of General Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Benjamin Hall
- Department of General Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Damien Ah Yen
- Department of General Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Jesse Fischer
- Department of General Surgery, Waikato Hospital, Hamilton, New Zealand
- Department of Surgery, University of Auckland, New Zealand
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Naddouri J, Khouah R, Sekkat H, Bakali Y, EL Alaoui MM, Raiss M, Sabbah F, Hrora A. Small bowel obstruction in adults, Ladd's band is an exceptional cause: a case report. Pan Afr Med J 2024; 47:34. [PMID: 38586070 PMCID: PMC10998253 DOI: 10.11604/pamj.2024.47.34.36435] [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: 07/21/2022] [Accepted: 01/09/2024] [Indexed: 04/09/2024] Open
Abstract
Malrotation of the gut is a congenital anomaly of foetal intestinal rotation and it's principally discovered in early childhood as acute intestinal obstruction. This condition is veritably rare and constantly silent in adults. Intestinal malrotation in adults is frequently asymptomatic and is diagnosed as a casual finding during a radiological examination performed for other reasons. Infrequently, it can be diagnosed in adults, associated with an acute abdomen. Adult patients rarely present with acute midgut volvulus or internal hernias caused by Ladd's bands. We present a case of an admitted 18-year-old female with a small bowel obstruction due to an intestinal volvulus complicating intestinal malrotation in the presence of Ladd's band. Laparotomic Ladd's procedure was performed successfully with division of Ladd's band, adhesiolysis, appendicectomy, and reorientation of the small bowel on the right and the cecum and colon on the left of the abdominal cavity; the postoperative evolution was favorable. Although it is a rare pathology, it should be kept in mind in cases of patients presenting small bowel obstruction.
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Affiliation(s)
- Jaouad Naddouri
- Department of Digestive and General Surgery, Department of Surgery C, University Hospital Center Ibn Sina, Rabat, Morocco
| | - Rachid Khouah
- Department of Digestive and General Surgery, Department of Surgery A, Lucien Hussel Hospital Center, Vienne, France
| | - Hamza Sekkat
- Department of Digestive and General Surgery, Department of Surgery C, University Hospital Center Ibn Sina, Rabat, Morocco
| | - Younes Bakali
- Department of Digestive and General Surgery, Department of Surgery C, University Hospital Center Ibn Sina, Rabat, Morocco
| | - Mouna M'hamdi EL Alaoui
- Department of Digestive and General Surgery, Department of Surgery C, University Hospital Center Ibn Sina, Rabat, Morocco
| | - Mohamed Raiss
- Department of Digestive and General Surgery, Department of Surgery C, University Hospital Center Ibn Sina, Rabat, Morocco
| | - Farid Sabbah
- Department of Digestive and General Surgery, Department of Surgery C, University Hospital Center Ibn Sina, Rabat, Morocco
| | - Abdelmalek Hrora
- Department of Digestive and General Surgery, Department of Surgery C, University Hospital Center Ibn Sina, Rabat, Morocco
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Pattanaik SK, Pattanaik P, Nanda BK. Compound volvulus: ileosigmoid knot. BMJ Case Rep 2024; 17:e258253. [PMID: 38238160 PMCID: PMC10806837 DOI: 10.1136/bcr-2023-258253] [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] [Indexed: 01/23/2024] Open
Abstract
Compound volvulus, also known as ileosigmoid knot, is a rare cause of intestinal obstruction due to twisting of the small bowel around the large bowel or vice-versa. It poses a diagnostic dilemma due to the presence of features of closed-loop obstruction of both the small and large bowel. Being a surgical emergency due to the rapid progression to gangrene of involved segments leading to septicaemia, early suspicion of the disease entity, adequate resuscitation and prompt treatment are the need of the hour. Three cases encountered and managed in our setting are described here with a review of the literature.
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Affiliation(s)
- Sushila Kumar Pattanaik
- Surgery, Fakir Mohan Medical College & Hospital, Balasore, Odisha, India
- Surgery, Sriram Chandra Bhanja Medical College and Hospital, Cuttack, Odisha, India
| | - Prasoon Pattanaik
- Surgery, Sriram Chandra Bhanja Medical College and Hospital, Cuttack, Odisha, India
| | - Binaya Kumar Nanda
- Surgery, Sriram Chandra Bhanja Medical College and Hospital, Cuttack, Odisha, India
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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.
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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
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11
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Huerta CT, Quinn K, Kodia K, Perez EA, Rico C, Díez R, Aguado P, Carro MA, Fuentes EJ. Management of Recurrent Sigmoid Volvulus in the Pediatric Population. Am Surg 2023; 89:6309-6311. [PMID: 36878189 DOI: 10.1177/00031348231160843] [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] [Indexed: 03/08/2023]
Abstract
Sigmoid volvulus is a rare etiology of bowel obstruction in the pediatric population that can be easily misdiagnosed, leading to delayed treatment and potential complications. Given that sigmoid volvulus is a common cause of bowel obstruction in the adult population and the significant lack of literature on its management in children, treatment strategies for pediatric patients often follow standardized protocols for adults. We report the case of a 15-year-old boy who presented with recurrent episodes of sigmoid volvulus over a 1-month period. Computed tomography demonstrated a sigmoid volvulus without evidence of ischemia or bowel infarction. Colonoscopy demonstrated a descending megacolon, and bowel transit studies demonstrated normal transit time. Acute episodes were managed conservatively with colonoscopic decompression. After a complete study, laparoscopic sigmoidectomy was performed. This work demonstrates the importance of early recognition and treatment of sigmoid volvulus in the pediatric population to limit recurrent episodes.
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Affiliation(s)
- Carlos Theodore Huerta
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kirby Quinn
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Karishma Kodia
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eduardo A Perez
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Clara Rico
- University Hospital Fundacion Jimenez Diaz, Madrid, Spain
| | - Ricardo Díez
- University Hospital Fundacion Jimenez Diaz, Madrid, Spain
| | - Pablo Aguado
- University Hospital Fundacion Jimenez Diaz, Madrid, Spain
| | - Miguel A Carro
- University Hospital Fundacion Jimenez Diaz, Madrid, Spain
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12
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Kim A, Roberson JL, Maguire LH, Jian B, Saur NM. Eosinophilic Myenteric Ganglionitis Presenting as Sigmoid Volvulus: A Brief Report. Am Surg 2023; 89:5021-5023. [PMID: 37501639 DOI: 10.1177/00031348231191198] [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] [Indexed: 07/29/2023]
Abstract
Eosinophilic myenteric ganglionitis (EMG) is a rare pathologic finding within the Auerbach myenteric plexus characterized by eosinophilic infiltration on light microscopy. The plexus's ultimate obliteration results in chronic intestinal pseudo-obstruction (CIPO). EMG is almost exclusively seen in the pediatric population. The diagnosis of EMG is made through full-thickness rectal biopsy and EMG is not detectable through routine screening measures such as imaging or colonoscopy. The current treatment modality for this disorder is not standardized, and has often been treated with systemic steroids given its eosinophilic involvement. This case presents a 73-year-old male with chronic constipation presenting with new obstipation in the setting of recent orthopedic intervention requiring outpatient opioids. Admission radiographs were consistent with sigmoid volvulus. Following endoscopic detorsion, exploratory laparotomy revealed diffuse colonic dilation and distal ischemia requiring a Hartmann's procedure. Surgical pathology revealed EMG, increasing the complexity of subsequent surgical decision-making after his urgent operation.
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Affiliation(s)
- Alyson Kim
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Jeffrey L Roberson
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Lillias H Maguire
- Division of Colon and Rectal Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Corporal Michael J. Crescenz Memorial Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Bo Jian
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Nicole M Saur
- Division of Colon and Rectal Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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13
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Zambito MP, Teicher EJ. Duodenal Volvulus due to Duodenum Inversum. Am Surg 2023; 89:4881-4883. [PMID: 33861662 DOI: 10.1177/00031348211011111] [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] [Indexed: 11/16/2022]
Abstract
Duodenum inversum, or inverted duodenum, is a rare congenital disorder resulting in an abnormal position of the third and/or fourth portions of the duodenum. Most patients are asymptomatic, but others can experience pain, nausea, vomiting, peptic ulcer disease, pancreatitis, and even intestinal obstruction. In this case, we report a patient who presented with acute abdominal pain and vomiting. He was diagnosed with duodenal volvulus and obstruction due to duodenum inversum. After failing nonoperative management, the patient was successfully treated with surgical resection.
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Affiliation(s)
- Mario P Zambito
- Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA, USA
| | - Erik J Teicher
- Trauma Acute Care Surgery, Inova Fairfax Hospital, Department of Surgery, Virginia Commonwealth School of Medicine, Richmond, VA, USA
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14
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Eshel Fuhrer A, Doyev R, Koppelmann T, Shiran SI, Herzlich J, Mandel D, Sukhotnik I, Marom R. Upper gastrointestinal series in healthy neonates with bilious vomiting-is it still obvious? A retrospective observational study. Acta Paediatr 2023; 112:1870-1876. [PMID: 37266967 DOI: 10.1111/apa.16861] [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: 01/31/2023] [Revised: 05/18/2023] [Accepted: 05/29/2023] [Indexed: 06/03/2023]
Abstract
AIM Demand for upper gastrointestinal contrast series (UGI) to investigate bilious vomiting (BV) has increased in recent years, mostly due to greater awareness of the need to rule out malrotation and midgut volvulus (MGV). We aimed to examine predictive value of clinical parameters in the management of healthy neonates presenting with BV and re-assess the role of UGI in their management. METHODS A retrospective cohort study including medical, imaging and surgical data of neonates who underwent UGI due to BV. RESULTS A total of 157 term neonates, eight neonates (5.1%) had confirmed surgical diagnosis of malrotation, five of them had malrotation with MGV, including two neonates who underwent extensive intestinal resection due to necrosis. Neonates with a combination of abnormal plain radiograph and abdominal distention had 10 times higher odds of malrotation diagnosis, adjusting for age at first BV (p = 0.017). Neonates with a combination of abnormal plain radiograph, abdominal distention and abdominal tenderness had 25 times higher odds of MGV (p = 0.002). CONCLUSION This study reaffirms the role of UGI as the current main diagnostic tool for malrotation and MGV. Physical examination and plain radiograph findings can help but cannot substitute UGI study.
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Affiliation(s)
- Audelia Eshel Fuhrer
- Department of Pediatric Surgery, Dana-Dwek Children's hospital, Tel Aviv Sourasky medical center, Tel Aviv, Israel
| | - Reut Doyev
- Department of Pediatrics, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Tal Koppelmann
- Department of Pediatric Surgery, Dana-Dwek Children's hospital, Tel Aviv Sourasky medical center, Tel Aviv, Israel
| | - Shelly I Shiran
- Division of Pediatric Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Jacky Herzlich
- Department of Neonatology, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dror Mandel
- Department of Neonatology, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Igor Sukhotnik
- Department of Pediatric Surgery, Dana-Dwek Children's hospital, Tel Aviv Sourasky medical center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronella Marom
- Department of Neonatology, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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15
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Rivera Fernández RR, Cancel Artau KJ, Añeses Gonzalez CR, Correa Rivas MS, Diaz EC, Justiniano VO, del Río JL. Neurofibromatosis Type I Presenting with Incomplete Ileal Volvulus in a Pediatric Patient. Am J Case Rep 2023; 24:e918041. [PMID: 37571808 PMCID: PMC10427934 DOI: 10.12659/ajcr.918041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/09/2023] [Accepted: 10/31/2019] [Indexed: 08/13/2023]
Abstract
BACKGROUND Neurofibromatosis 1 is a neurocutaneous disorder with multisystemic manifestations. When patients are lacking overt cutaneous manifestations, diagnosis may be delayed and may complicate diagnosis and management of atypical presentations of this disease. It is thus important to strive to obtain relevant and/or complete history to arrive at the appropriate diagnosis. Furthermore, maintaining an index of suspicion in cases of vague abdominal pain may guide the clinician in establishing the correct diagnosis of mesenteric plexiform neurofibroma in the setting of known/presumed neurofibromatosis 1 patients presenting with acute and/or chronic vague abdominal symptoms. CASE REPORT This is a case of a teenage boy who presented with acute, vague abdominal pain over a period of 2 weeks. Laboratory tests and physical exam findings in primary and secondary care settings were unremarkable, and thus the patient was discharged home only to continue with abdominal pain, thus seeking additional medical care. After admission to our facility and exhaustive history taking, physical examination, and imaging, a prospective diagnosis of neurofibromatosis with mesenteric neurofibroma was made. Upon surgical exploration, a mesenteric mass with corresponding volvulized, ischemic small bowel was removed. Histopathology confirmed a plexiform neurofibroma. The patient recovered adequately and was discharged home without complications. CONCLUSIONS This case highlights the importance of exhaustive history taking to obtain an accurate diagnosis as well as the importance of a high index of clinical suspicion for mesenteric neurofibromatosis in patients with presumed or known neurofibromatosis and presenting with vague abdominal symptoms.
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Affiliation(s)
| | | | | | - Maria S. Correa Rivas
- Department of Pathology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Edgardo Cintron Diaz
- Department of Surgery, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | | | - Jose Lara del Río
- Department of Diagnostic Radiology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
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16
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Hadala A, Lavallée J. Partial volvulus, entrapment, and extraluminal obstruction of the jejunum in a cat. Can Vet J 2023; 64:742-746. [PMID: 37529392 PMCID: PMC10352039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
A 2-year-old, spayed female, domestic shorthair cat was presented in compensated hypovolemic shock after 24 h of anorexia, vomiting, and lethargy. An enterotomy had been performed at 9 mo of age to remove a foreign body. Due to inconclusive findings on abdominal imaging, an exploratory laparotomy was done. An adhesion at the root of the mesentery, likely associated with the previous surgery, had resulted in partial volvulus, entrapment, and extraluminal obstruction of the jejunum. Transection of the adhesion allowed repositioning of the bowel without the need for resection. The cat was discharged from the hospital 7 d postoperatively. Adhesions have not previously been reported to cause small bowel volvulus in cats. Key clinical message: Abdominal adhesions as a cause of clinical disease in cats have apparently not been reported. This case report demonstrates how malposition of the gastrointestinal tract, secondary to adhesions, should be included as a differential diagnosis for feline patients presenting with acute abdomens. Previous abdominal surgery is a risk factor for development of adhesions. This case emphasized the importance of Halsted's principles of surgery to reduce the risk of postoperative adhesions, even in species not predisposed to forming adhesions.
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Affiliation(s)
- Ashley Hadala
- Western Veterinary Specialists, 1802 10th Avenue SW, Calgary, Alberta T3C 0J8
| | - Justin Lavallée
- Western Veterinary Specialists, 1802 10th Avenue SW, Calgary, Alberta T3C 0J8
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17
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Martinez SA, Fligor SC, Tsikis S, Short M, Corcoran KE, Rogers A, Gura KM, Puder M. IMPOWER: a national patient-generated registry for intestinal malrotation exploring diagnosis, treatment, and surgical outcomes. Orphanet J Rare Dis 2023; 18:113. [PMID: 37170358 PMCID: PMC10176693 DOI: 10.1186/s13023-023-02722-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 05/05/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Intestinal malrotation is a rare congenital condition with potentially devastating consequences due to potential volvulus and massive intestinal necrosis. Diagnosis is often delayed and long-term symptoms following surgical correction are poorly characterized. We developed the Intestinal Malrotation Patient Outcomes and WEllness Registry (IMPOWER), a national patient-generated registry (PGR), to capture data related to presenting symptoms, testing, diagnosis, treatment, and follow-up of individuals diagnosed with malrotation. IMPOWER captures patient-reported information from adult patients and parents/caregivers of children diagnosed with malrotation at the time of enrollment and at ongoing 6-month intervals. We present baseline characteristics of patients enrolled during the first two months of the registry. RESULTS Within the first two months, 354 patients with malrotation enrolled in IMPOWER, and 191 (53.9%) completed all baseline assessments. Nearly 90% of the 119 pediatric participants and 37.7% of the 72 adult participants experienced symptoms prior to diagnosis. Vomiting was the predominant symptom for pediatric participants compared to abdominal pain in adults. Yellow bilious emesis was more commonly reported than green, and volvulus at diagnosis occurred in 70% of pediatric and 27% of adult participants. One-third of pediatric participants had a bowel resection as part of their initial surgical procedure, resulting in 23.4% with diagnosed short bowel syndrome. More than 60% of pediatric and 80% of adult registrants reported gastrointestinal symptoms that persisted throughout the first year following their initial operation. Approximately 25% of registrants reported visiting four or more gastroenterologists for management of ongoing symptoms. CONCLUSIONS Fewer than half of pediatric patients presented with the "classic" presentation of green bilious colored emesis. Yellow bilious emesis was more commonly reported, and chronic gastrointestinal symptoms (i.e., abdominal pain, reflux, constipation, diarrhea) and feeding intolerance were common following surgical procedures for malrotation. This novel PGR highlights the need for a multicenter prospective registry to characterize the natural history and develop consistent standards of care related to the diagnosis, treatment, and long-term care for patients with malrotation.
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Affiliation(s)
- Sydney A Martinez
- University of Oklahoma Health Sciences Center, 801 NE 13th St., Oklahoma City, OK, 73104, USA.
| | - Scott C Fligor
- Vascular Biology Program and the Department of Surgery, Boston Children's Hospital, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Savas Tsikis
- Vascular Biology Program and the Department of Surgery, Boston Children's Hospital, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Meagan Short
- Intestinal Malrotation Foundation, Arrington, TN, 37014, USA
| | - Katie E Corcoran
- West Virginia University, 29 Beechurst Ave, Morgantown, WV, 26505, USA
| | - Amy Rogers
- Intestinal Malrotation Foundation, Arrington, TN, 37014, USA
| | - Kathleen M Gura
- Harvard Medical School, Boston, MA, 02115, USA
- Department of Pharmacy and Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Mark Puder
- Vascular Biology Program and the Department of Surgery, Boston Children's Hospital, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
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18
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Yang J, Trivedi A, Zuberi J. Tension pneumothorax in a patient with Covid-19 pneumonia initially misdiagnosed as volvulus. J PAK MED ASSOC 2023; 73:681-683. [PMID: 36932782 DOI: 10.47391/jpma.5269] [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] [Indexed: 03/09/2023]
Abstract
Tension pneumothorax is a condition that can present with a myriad of symptoms, including chest pain, shortness of breath, rapid breathing, and tachycardia. If left untreated, these signs and symptoms can progress to shock causing haemodynamic collapse and even death. At times, it may be difficult to identify tension pneumothorax. We present the case of a 59-year-old male with a prolonged initial hospital course that eventually led to a diagnosis of tension pneumothorax with the use of CT scans rather than traditional X-rays. This case reinforces the idea that clinicians should have a wide differential diagnosis in mind when dealing with vague symptoms and should not hesitate to use different diagnostic modalities to help confirm a diagnosis.
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Affiliation(s)
- James Yang
- Department of Surgery, St. Joseph's University Medical Center, Paterson, United States of America
| | - Aakash Trivedi
- Department of Surgery, St. Joseph's University Medical Center, Paterson, United States of America
| | - Jamshed Zuberi
- Department of Surgery, St. Joseph's University Medical Center, Paterson, United States of America
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19
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Zouari M, Ben Ameur H, Ben Saad N, Kraiem N, Rhaiem W, Mhiri R. Cecal Volvulus: An Uncommon Diagnosis in a Child with Down's Syndrome. Arch Iran Med 2023; 26:117-118. [PMID: 37543932 PMCID: PMC10685901 DOI: 10.34172/aim.2023.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/10/2022] [Indexed: 08/08/2023]
Affiliation(s)
- Mohamed Zouari
- Department of Pediatric Surgery, Hedi-Chaker Hospital, Sfax, Tunisia
- Research Laboratory “Developmental and Induced Diseases” (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Hana Ben Ameur
- Department of Pediatric Surgery, Hedi-Chaker Hospital, Sfax, Tunisia
- Research Laboratory “Developmental and Induced Diseases” (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Nesrine Ben Saad
- Department of Pediatric Surgery, Hedi-Chaker Hospital, Sfax, Tunisia
- Research Laboratory “Developmental and Induced Diseases” (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Najoua Kraiem
- Department of Pediatric Surgery, Hedi-Chaker Hospital, Sfax, Tunisia
- Research Laboratory “Developmental and Induced Diseases” (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Wiem Rhaiem
- Department of Pediatric Surgery, Hedi-Chaker Hospital, Sfax, Tunisia
- Research Laboratory “Developmental and Induced Diseases” (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Riadh Mhiri
- Department of Pediatric Surgery, Hedi-Chaker Hospital, Sfax, Tunisia
- Research Laboratory “Developmental and Induced Diseases” (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
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20
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Abdulmuttaleb AT, Al-Habbal Z, Ahmed F. Caecal volvulus in a 35-year-old man: a case report. Pan Afr Med J 2023; 44:37. [PMID: 37034486 PMCID: PMC10080308 DOI: 10.11604/pamj.2023.44.37.37403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/17/2023] [Indexed: 01/21/2023] Open
Abstract
Caecal volvulus is a rare cause of mechanical bowel obstruction (1-1.5%) that carries a high mortality rate if diagnosis or surgical intervention is delayed. We report a 35-year-old man who presented with acute colicky abdominal pain, vomiting, and constipation for the past 18 hours. A plain abdominal X-ray showed distended large bowel loops with two large well-defined air-fluid levels superimposed on each other, suggestive of caecal volvulus. The patient underwent emergency laparotomy, and the intraoperative finding confirmed the diagnosis of gangrenous extended caecal volvulus, which involves the terminal ileum, cecum, and the whole of the ascending colon. A right hemicolectomy was performed, and bowel continuity was restored by primary ileotransverse anastomosis. The patient recovered without complications and was discharged on postoperative day 6. In conclusion, caecal volvulus is a rare cause of adult intestinal obstruction. Early diagnosis and surgical intervention can prevent perforation and reduce morbidity related to volvulus perforation.
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Affiliation(s)
- Abdulrahman Tawfeeq Abdulmuttaleb
- Department of Surgery, Al-Thawra Private Hospital, Taiz, Yemen
- Corresponding author: Abdulrahman Tawfeeq Abdulmuttaleb, Department of Surgery, Al-Thawra Private Hospital, Taiz, Yemen.
| | - Zakareya Al-Habbal
- Department of Surgery, School of Medicine, University of Kurdistan, Erbil, Iraq
| | - Faisal Ahmed
- Department of Urology, School of Medicine, Ibb University of Medical Sciences, Ibb, Yemen
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21
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Loria A, Jacobson T, Melucci AD, Bartell N, Nabozny MJ, Temple LK, Fleming FJ. Sigmoid volvulus: Evaluating identification strategies and contemporary multicenter outcomes. Am J Surg 2023; 225:191-197. [PMID: 35934559 DOI: 10.1016/j.amjsurg.2022.07.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/09/2022] [Revised: 07/15/2022] [Accepted: 07/26/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND There is limited epidemiologic data on sigmoid volvulus (SV) from non-endemic regions. Therefore, we performed a multicenter study to report contemporary outcomes and appraise literature-based methods that pair diagnostic and procedural codes to identify SV. METHOD Using an automated search for patients with 'volvulus' in our system from 2011 to 2021, we reviewed electronic charts to clarify the diagnosis, automatically replicate three strategies to identify SV, and retrieved 6-month outcomes. RESULTS Of 895 patients, 109 had SV. Literature-based strategies poorly identified SV. At the index admission, patients underwent endoscopic reduction alone (33%), emergent (16.5%), semi-elective (34%), or elective (16.5%) surgery. Endoscopic reduction alone had high recurrence rates and delayed surgery was associated with worse outcomes. CONCLUSION Literature-based strategies to identify SV suffer from misclassification bias which affects patient counseling. In this large series, one-third of patients do not undergo during their index admission despite improved outcomes with earlier surgery.
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Affiliation(s)
- Anthony Loria
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA; Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA.
| | - Tricia Jacobson
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Alexa D Melucci
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA; Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Nicholas Bartell
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, NY, 146242, USA
| | - Michael J Nabozny
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Larissa K Temple
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA; Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Fergal J Fleming
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA; Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA
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22
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Totikov ZV, Totikov VZ, Remizov OV, Epkhiev AA. [Small bowel volvulus due to a giant mesenteric lipoma]. Khirurgiia (Mosk) 2023:122-125. [PMID: 37707342 DOI: 10.17116/hirurgia2023091122] [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] [Indexed: 09/15/2023]
Abstract
Mesenteric lipomas are very rare. They are asymptomatic in most cases, but some patients can develop certain complications such as small bowel volvulus and acute small bowel obstruction. We report a 78-year-old patient with giant mesenteric lipoma complicated by jejunum volvulus and acute small bowel obstruction. The patient underwent laparotomy, en-bloc resection of small bowel, mesentery and lipoma followed by side-to-side anastomosis.
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Affiliation(s)
- Z V Totikov
- North Ossetian State Medical Academy, Vladikavkaz, Russia
| | - V Z Totikov
- North Ossetian State Medical Academy, Vladikavkaz, Russia
| | - O V Remizov
- North Ossetian State Medical Academy, Vladikavkaz, Russia
| | - A A Epkhiev
- North Ossetian State Medical Academy, Vladikavkaz, Russia
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23
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Kaur S, Cai P, Sankar A, Sarkar R. A rare case of intestinal malrotation in pregnancy resulting in hemicolectomy postnatally. Ceska Gynekol 2023; 88:114-118. [PMID: 37130737 DOI: 10.48095/cccg2023114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
INTRODUCTION Small and large bowel obstruction secondary to volvulus on the background of intestinal malrotation is a very rare occurrence, especially in pregnancy. This can be associated with significant feto-maternal morbidity and mortality. CASE REPORT We report a case of a pregnant lady who developed symptoms of subacute intestinal obstruction during the 2nd trimester of pregnancy and was subsequently dia-gnosed with intestinal malrotation on imaging. Though she had symptoms of abdominal pain and constipation persisting for 9 long weeks during pregnancy, there was no evidence of definite intestinal obstruction or volvulus on her abdominal magnetic resonance imaging. She underwent a caesarean section at 34 weeks of pregnancy due to worsening abdominal pain. Postnatally, she was dia-gnosed with midgut volvulus on a computer tomography scan, leading to obstruction of both small and large bowels and needed an emergency laparotomy and right hemicolectomy. CONCLUSION The case highlights the importance of timely dia-gnosis and prompt management of intestinal obstruction in pregnancy with a multidisciplinary team approach.
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Camacho-Aguilera JF, Calderón-Vieyra A. [Cecal volvulus: one case and literature review]. Rev Med Inst Mex Seguro Soc 2022; 60:591-598. [PMID: 36049083 PMCID: PMC10395989] [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] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Cecal volvulus is a rare disease that causes intestinal obstruction. It has various congenital and acquired risk factors. It is frequently associated with abnormal cecal fixation, and it is caused by torsion of the cecum in one of its three axes. It is not different from other causes of intestinal obstruction, but a delay in its diagnosis can lead to ischemia, necrosis and colon perforation. Its management depends on the viability of the tissues, ranging from untwisting and cecopexy to hemicolectomy with or without anastomosis. We present a case of caecal volvulus (caecal bascule) and review the literature as well. CLINICAL CASE 43-year-old female, who was admitted to an emergency department with data of intestinal obstruction. A simple tomography of the abdomen was performed, where a dilated colon and an image that resembles an inverted coffee bean were identified. An exploratory laparotomy was performed, identifying a bascule-type cecal volvulus, without vascular compromise. Devolvulation, decompression through appendectomy, and caecopexy were performed. After the surgical event, the patient recovered without incident and was discharged with adequate controls by external consultation. CONCLUSIONS Cecal volvulus is a cause of intestinal obstruction with a low incidence, which is why early recognition and treatment are key to avoiding the complications that its evolution entails. This type of disease should be among our differential diagnoses, since treatment is surgical and delay leads to a high mortality rate.
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Affiliation(s)
- José Francisco Camacho-Aguilera
- Instituto Mexicano del Seguro Social, Hospital General de Zona No. 3, Servicio de Cirugía General. San Juan del Río, Querétaro, México
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Zhao H, Wu L, Yang B, Shang H. Midgut malrotation presenting with hyperemesis gravidarum: A case report. Medicine (Baltimore) 2022; 101:e29670. [PMID: 35905251 PMCID: PMC9333550 DOI: 10.1097/md.0000000000029670] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Midgut malrotation is a rare congenital abnormality resulting from failure of complete intestinal rotation and subsequent fixation during early fetal development. There appeared to be no obvious symptoms in most patients, and a few patients may exhibit symptoms similar to hyperemesis gravidarum, such as nausea and vomiting. Here, we present a case of midgut malrotation presenting as hyperemesis gravidarum. PATIENT CONCERNS A 27-year-old woman with an intrauterine pregnancy of 27 + 6 weeks complained of severe nausea and vomiting for 2 weeks. DIAGNOSIS Magnetic resonance imaging showed obvious dilatation in the proximal part of the duodenum and gastric cavity and the absence of a duodenal path dorsal to the superior mesenteric artery, which was diagnosed as midgut malrotation. INTERVENTIONS Considering that the patient's vital signs were stable, without manifestation of peritonitis or the risks of surgery to the fetus, conservative treatment was adopted. Unfortunately, the fetus developed severe hydrocephalus at 32 weeks. The patient and her family decided to abandon the fetus, and a mid-trimester-induced abortion was performed. OUTCOMES The related symptoms completely disappeared after delivery, and the relevant examination after discharge also confirmed the presence of midgut malrotation without gastrointestinal discomfort within 1 year after delivery. LESSONS Midgut malrotation can be considered as a differential diagnosis of hyperemesis gravidarum. Conservative treatment under close monitoring is desirable in pregnant women diagnosed with midgut malrotation.
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Affiliation(s)
- Hongjiang Zhao
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
- Department of Gynecology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Linzhen Wu
- Department of Obstetrics, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Bin Yang
- Department of Radiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hongkai Shang
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
- Department of Gynecology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Hongkai Shang, Department of Gynecology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China. (e-mail: )
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Anadolulu Aİ, Gerçel G, Kocaman OH. Rare cecum pathologies as a cause of acute abdomen in children. ULUS TRAVMA ACIL CER 2022; 28:249-253. [PMID: 35485572 PMCID: PMC10493532 DOI: 10.14744/tjtes.2020.79357] [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: 07/17/2020] [Accepted: 12/01/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND We aimed to present cecum pathologies which are the cause of acute abdomen. METHODS Between January 2015 and June 2019, patients that were operated with the diagnosis of acute abdomen and patients with the primary cecum pathologies were evaluated retrospectively. RESULTS There were eight patients, five males and three females. The mean age was 7.2±2.9 years. Complaints were abdominal pain and vomiting in all patients. Physical examination was consistent with acute abdomen. In the imaging studies, the preliminary diagnosis was considered as two patients had acute appendicitis, two had invagination (one due to Meckel diverticulum and one with mesenteric cyst), two had ileus, one had perforated appendicitis, and one had cecum diverticulum. In surgery, five patients had cecum mass, one had cecum diverticulitis, one had cecum volvulus, and one had inflamed necrotic cecum. All patients underwent cecum resection and ileocolonic anastomosis. Histopathologic examination was resulted as Burkitt's lymphoma in three patients, cecum diverticulum in two, duplication of cecum in one, tuberculosis of cecum in one, and gangrenous necrosis due to volvulus in one patient. The mean follow-up period was 25 months (2 months-4 years). Follow-up was uneventful. CONCLUSION Primary cecum pathologies are very rare. This leads to lack of standardization in treatment planning. Considering the patients with malignancy in the series, ileocolonic anastomosis with cecum resection is an adequate and appropriate treatment option in children with primary cecum pathology.
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Affiliation(s)
- Ali İhsan Anadolulu
- Department of Pediatric Surgery, Mehmet Akif İnan Training and Research Hospital, Şanlıurfa-Turkey
| | - Gonca Gerçel
- Department of Pediatric Surgery, ŞanlıurfaTraining and Research Hospital, Şanlıurfa-Turkey
| | - Osman Hakan Kocaman
- Department of Pediatric Surgery, Harran University Faculty of Medicine, Şanlıurfa-Turkey
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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.
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Affiliation(s)
- Esra Dişçi
- Department of General Surgery, Atatürk University Faculty of Medicine, Erzurum-Turkey
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28
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Greenbaum R, Koyama A. Malrotation With Midgut Volvulus in an Adolescent Male. Pediatr Emerg Care 2022; 38:e1082-e1084. [PMID: 35226634 DOI: 10.1097/pec.0000000000002659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Malrotation and midgut volvulus are conditions commonly described in infants, typically diagnosed within the first month of life. We present an unusual occurrence of high-grade obstruction because of malrotation and volvulus in an adolescent male. His symptoms at presentation, abdominal pain and vomiting, were similar to previous episodes in which he had been diagnosed with constipation or viral gastroenteritis and discharged home. His main criteria for admission for this occurrence were related to his degree of dehydration.
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Affiliation(s)
| | - Atsuko Koyama
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
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29
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Torre A, Amado A, Graça S, Póvoa A. Caecum volvulus as a late presentation of intestinal malrotation in an adult: a challenging diagnosis. BMJ Case Rep 2022; 15:e247645. [PMID: 35110291 PMCID: PMC8811584 DOI: 10.1136/bcr-2021-247645] [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] [Accepted: 12/31/2021] [Indexed: 11/04/2022] Open
Abstract
Intestinal malrotation is usually diagnosed in early childhood. It results from failure of the normal gut rotation during embryological development. We present a case of a 62-year-old woman with a delayed presentation of an intestinal malrotation. She was admitted in the emergency department with an acute intestinal obstruction. Exploratory laparotomy revealed Ladd's band with caecum volvulus and intestinal malrotation. Ladd's procedure and right hemicolectomy were performed with uneventful recovery. Since both caecum volvulus and intestinal malrotation are rare events, particularly in adulthood, clinical diagnosis is challenging. Our aim is to increase the awareness of surgeons about this rare association as a cause of acute intestinal obstruction.
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Affiliation(s)
- Ana Torre
- General Surgery Department, Centro Hospitalar Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
| | - Andreia Amado
- General Surgery Department, Centro Hospitalar Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
| | - Susana Graça
- General Surgery Department, Centro Hospitalar Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
| | - Antónia Póvoa
- General Surgery Department, Centro Hospitalar Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
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30
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Svetanoff WJ, Srivatsa S, Diefenbach K, Nwomeh BC. Diagnosis and management of intestinal rotational abnormalities with or without volvulus in the pediatric population. Semin Pediatr Surg 2022; 31:151141. [PMID: 35305800 DOI: 10.1016/j.sempedsurg.2022.151141] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Intestinal malrotation is a congenital anomaly that can be associated with midgut volvulus, requiring an emergent operation in order to maintain blood supply to the compromised intestine. It results from an abnormal rotation of the intestines, leading to three types of malrotation. Non-rotation is complete failure of the intestines to rotate, while the most common configuration is associated with the cecum in the mid-upper abdomen, close to a malpositioned duodenal-jejunal (DJ) flexure. This configuration has a narrow mesentery that has a high risk of volvulus. The final form of malrotation is incomplete rotation, where the DJ flexure and cecum are malpositioned, but the mesentery is not narrowed. The benefits of performing a Ladd's procedure for these individuals is controversial. Workup for malrotation should be considered in all patients who present with abdominal pain/distention and bilious emesis. An upper gastrointestinal contrast study is 93-100% sensitive and will show a corkscrew appearance when a volvulus is present. While the basic tenets of the Ladd's procedure have not changed and include detorsion of a volvulus, adhesiolysis of Ladd's bands and broadening of the mesentery, how this is accomplished and in whom are controversial. Laparoscopic Ladd's is associated with shorter hospital stays but also has a higher incidence of recurrent volvulus compared to an open approach. Patients with heterotaxy syndrome also represent a controversial group with some studies showing no difference in post-operative complications despite a higher mortality due to underlying cardiac disease, while other studies show a low incidence of volvulus and question the need for Ladd's in those who are asymptomatic. This review highlights the major aspects of diagnosing and treating malrotation, including the pathophysiology, workup, surgical options and areas of controversy.
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Affiliation(s)
- Wendy Jo Svetanoff
- Division of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205
| | - Shachi Srivatsa
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, 43210
| | - Karen Diefenbach
- Division of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205; Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, 43210
| | - Benedict C Nwomeh
- Division of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205; Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, 43210.
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Alavi K, Poylin V, Davids JS, Patel SV, Felder S, Valente MA, Paquette IM, Feingold DL. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Colonic Volvulus and Acute Colonic Pseudo-Obstruction. Dis Colon Rectum 2021; 64:1046-1057. [PMID: 34016826 DOI: 10.1097/dcr.0000000000002159] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Karim Alavi
- University of Massachusetts Medical School, Worcester, Massachusetts
| | | | - Jennifer S Davids
- University of Massachusetts Medical School, Worcester, Massachusetts
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32
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Snapshot quiz 20/10. Br J Surg 2020; 107:1594. [PMID: 33280105 DOI: 10.1002/bjs.12006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/25/2020] [Indexed: 11/06/2022]
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33
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Cerrina A, Murru FM, Conte M, Agrusti A, Germani C, Schleef J, Pederiva F. Infant With Inconsolable Cryinge. Ann Emerg Med 2021; 77:e58-e59. [PMID: 33349375 DOI: 10.1016/j.annemergmed.2020.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Alessia Cerrina
- Pediatric Surgery, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste, Italy
| | - Flora M Murru
- Radiology, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste, Italy
| | - Mariasole Conte
- University of Trieste, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste, Italy
| | - Anna Agrusti
- University of Trieste, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste, Italy
| | - Claudio Germani
- Emergency Department, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste, Italy
| | - Jurgen Schleef
- Pediatric Surgery, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste, Italy
| | - Federica Pederiva
- Pediatric Surgery, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste, Italy
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34
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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.
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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
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35
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Rincon-Sanchez RAM, Ramirez-Barranco R. [Intestinal malrotation in adults diagnosed after presentation of post polypectomy syndrome in the cecum: report of a case]. Rev Gastroenterol Peru 2020; 40:185-187. [PMID: 32876637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Intestinal malrotation is a congenital anomaly of intestinal rotation and fixation, diagnosed infrequently in adulthood. We report the presence of intestinal malrotation in a previously asymptomatic adult patient with changes in bowel habit in the last 6 months after a colonoscopy is performed with evidence of a polyp in the cecum, after resection presenting acute abdominal pain in the left iliac fossa that allows imaging to confirm the diagnostic.
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36
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Erikci VS. Primary Segmental Intestinal Volvulus in a Neonate. Indian Pediatr 2019; 56:1056-1057. [PMID: 31884441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Primary segmental intestinal volvulus is a rare disease with an aggressive clinical course. Early diagnosis and prompt management prevents life-threatening necrosis and perforation. A 1-day-old newborn girl with this disorder is reported to emphasize the presentation, imaging findings and management.
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Affiliation(s)
- Volkan Sarper Erikci
- Saglik Bilimleri University, Department of Pediatric Surgery, Tepecik Training Hospital, Izmir, Turkey.
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37
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38
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Tejera Hernández AA, Betancort Rivera N, Pérez Alonso E, Hernández Hernández JR. Sigmoid volvulus due to Chagas disease. Emergencias 2019; 30:437-438. [PMID: 30638352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
| | - Néstor Betancort Rivera
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Insular de Gran Canaria, España
| | - Esteban Pérez Alonso
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Insular de Gran Canaria, España
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Song J, Ge Z, Liu Y, Yin J, Yao H, Zhang Z. Gastrointestinal motility should be emphasized after laparotomy treatment for complete small intestinal volvulus in older adults: A case report. Medicine (Baltimore) 2019; 98:e16365. [PMID: 31335682 PMCID: PMC6709113 DOI: 10.1097/md.0000000000016365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Complete small intestinal volvulus is a rare entity in adults, unlike partial intestinal volvulus. Although prompt surgical intervention is the mainstay of treatment, attention should also be paid to recovery of intestinal function postoperatively. Ignoring this issue during the postoperative recovery process can have serious consequences. We report the case of an 82-year-old woman with complete small intestinal volvulus at the root of the superior mesenteric vessel. PATIENTS CONCERNS The patient was admitted for acute onset (22 hours) of abdominal pain and distention. Nausea and vomiting also developed during this period. DIAGNOSES Abdominal physical examination was suspicious for peritoneal irritation. Computed tomography scan showed anticlockwise swirl of the mesenteric vessels at the lower margin of the pancreas with distension of the entire small intestine. A complete small intestinal volvulus was diagnosed. INTERVENTIONS Laparotomy and detorsion of the volvulus were performed after early diagnosis. OUTCOMES The patient developed intestinal wall edema because of ischemic-reperfusion damage. She exhibited severe abdominal distention and absent intestinal motility. Two days later, she went into septic shock; she died 19 days after surgical intervention. LESSONS Because complete small intestinal volvulus involves the entire intestine, ischemic-reperfusion intestinal damage after detorsion may be severe and can predict prognosis.
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40
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Affiliation(s)
| | - Andrew Shelton
- Stanford University School of Medicine, Stanford, California
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41
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Fagan PV, Dickson S, Henderson N, Kodeda K. Rare cause of chronic bowel obstruction in the setting of malrotation and omental agenesis. N Z Med J 2019; 132:71-73. [PMID: 31220068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Paul Vb Fagan
- SET Trainee, Royal Australasian College of Surgeons; Registrar, Department of General Surgery, Taranaki Base Hospital, New Plymouth
| | - Sam Dickson
- Registrar, Department of General Surgery, Taranaki Base Hospital, New Plymouth
| | - Nigel Henderson
- General Surgeon, Department of General Surgery, Taranaki Base Hospital, New Plymouth
| | - Karl Kodeda
- General Surgeon, Department of General Surgery, Taranaki Base Hospital, New Plymouth; Associate Professor of Surgery, Sahlgrenska Academy, Gothenburg, Sweden
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Xiao-Ming A, Jin-Jing L, Li-Chen H, Lu-Lu H, Xiong Y, Hong-Hai Z, Nian-Yin Y. A huge completely isolated duplication cyst complicated by torsion and lined by 3 different mucosal epithelial components in an adult: A case report. Medicine (Baltimore) 2018; 97:e13005. [PMID: 30383655 PMCID: PMC6221613 DOI: 10.1097/md.0000000000013005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
RATIONALE Intestinal or enteric duplication (ED) does exit as a rare congenital malformation of the gastrointestinal system clinically. It is a separate entity, but can be communicated with the gastrointestinal tract. It is characterized by a well-developed muscular wall and lumen endowed with ectopic mucosa, simulating a portion of normal bowel. A completely isolated duplication cyst (CIDC) refers to an extremely uncommon variant of ED, which is secluded from the alimentary tract and possesses its own exclusive blood supply. Surgical procedure is the treatment of choice, because most often, a definitive diagnosis can only be confirmed intraoperatively. PATIENT CONCERNS A 20-year-old male patient presented with a 10-day history of intermittent episodes of abdominal pain. The pain evolved from dull into progressive and intolerable, accompanied by vomiting, nausea, and abdominal distention. DIAGNOSES Closed-loop small-bowel obstruction with volvulus. INTERVENTIONS The patient underwent an emergency exploratory laparotomy. OUTCOMES A huge CIDC was observed upon operation, which was affixed to the mesentery with only a narrow base, just like a pedicle; 720° counterclockwise twisting around its base was definitely noted, provoking the compromised blood supply. Complete excision of the cyst was performed along its base safely without violating the intestinal tract. Furthermore, the ectopic mucosa of the cyst exhibited 3 different epithelial lining components histopathologically. LESSONS Clinicians should be aware of the possibility of the existence of a duplication and raise a high index of suspicion in case of equivocal diagnosis, particularly in adult population. A low threshold for surgical management should be recommended in order to prevent lethal outcomes.
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43
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Matsuo K, Inoue M, Shirai Y, Kataoka T, Kagota S, Taniguchi K, Lee SW, Uchiyama K. Primary small bowel mesentery de-differentiated liposarcoma causing torsion with no recurrence for 5 years: A case report and review of the literature. Medicine (Baltimore) 2018; 97:e13446. [PMID: 30508962 PMCID: PMC6283127 DOI: 10.1097/md.0000000000013446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Liposarcoma (LPS) is a rare malignant soft-tissue tumor. Management of LPS is relatively difficult, because there are no characteristic symptoms, or biomarkers, nor any established effective treatment. Hence, the report of the accumulation of each LPS case is necessary. We experienced an extremely rare case of torsion caused by a primary small bowel mesentery LPS. PATIENT'S CONCERN A 70-year-old male consulted our hospital with the complaints of abdominal pain and sudden vomiting. DIAGNOSIS No lump could be palpated, and tumor markers tested were within normal limits. However, computed tomography revealed an intestinal obstruction caused by torsion of the small bowel due to an LPS tumor. INTERVENTIONS After decompression of the intestinal obstruction by use of an ileus tube, surgical treatment was performed with rapidity. OUTCOME The torsion was found to be caused by the tumor that originated from the small bowel mesentery. The tumor was resected along with a portion of the small bowel. The growth of adipose tissues of various sizes and containing atypical cells was detected by histopathological examination. Also, immunohistochemical examination resulted in positive immuno-reactions for MDM2, CDK4, and p16INK4, which indicated the tumor to be a de-differentiated LPS. The patient was discharged on postoperative day 14 without any complications, and no recurrence of the tumor was observed at 5 years after the operation. LESSONS LPS should be considered in differential diagnosis of bowel torsion, and careful management is required because of the high possibility of recurrence. Patients should be followed carefully for at least 5 years, and further accumulation of data will be required in order to establish the appropriate management of LPS.
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Affiliation(s)
- Kentaro Matsuo
- Department of General and Gastroenterological Surgery, Osaka Medical College, Daigaku-machi, Takatsuki
| | - Masaya Inoue
- Department of Gastroenterological Surgery, Katsuragi Hospital, Kishiwada, Osaka
| | - Yasutsugu Shirai
- Department of Gastroenterological Surgery, Katsuragi Hospital, Kishiwada, Osaka
| | - Tatsuki Kataoka
- Department of Diagnostic Pathology, Kyoto University Graduate School of Medical Science, Shogoin Kawahara-cho, Sakyo-ku Kyoto
| | - Shuji Kagota
- Department of General and Gastroenterological Surgery, Osaka Medical College, Daigaku-machi, Takatsuki
| | - Kohei Taniguchi
- Department of General and Gastroenterological Surgery, Osaka Medical College, Daigaku-machi, Takatsuki
- Translational Research Program, Osaka Medical College, Daigaku-machi, Takatsuki, Osaka, Japan
| | - Sang-Woong Lee
- Department of General and Gastroenterological Surgery, Osaka Medical College, Daigaku-machi, Takatsuki
| | - Kazuhisa Uchiyama
- Department of General and Gastroenterological Surgery, Osaka Medical College, Daigaku-machi, Takatsuki
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Anand U, Kumar R, Priyadarshi RN, Kumar B, Kumar S, Singh VP. Comparative study of intestinal malrotation in infant, children, and adult in a tertiary care center in India. Indian J Gastroenterol 2018; 37:545-549. [PMID: 30535747 DOI: 10.1007/s12664-018-0914-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 07/12/2018] [Accepted: 10/24/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Intestinal malrotation (IM) is an uncommon condition and has varied presentation in different age groups. The study was aimed to evaluate differences in the clinical presentation, diagnosis, treatment, and outcome of IM in infants, children, and adults. METHODS Data were collected from records of 79 patients with IM. Based on the age of presentation, these patients were categorized into three age groups: infants (up to 1 year), children (1-18 years), and adults (> 18 years). Follow up data were analyzed during 8 to 16 year after corrective surgery. RESULTS The overall age of presentation ranged from 8 days to 60 years. Twenty-eight, 29, and 22 patients belonged to the infant, children, and adult groups, respectively. The classical presentation of IM (bilious vomiting) was significantly higher in the infant compared to the children and adult groups (100% vs. 62% vs. 9.8%; p < 0.001). All infants presented with acute symptoms. However, children and adults had subacute or chronic presentations, respectively. The incidence of volvulus was significantly higher in the infant group than other two groups, (100% vs. 41% vs. 10%; p < 0.001). Doppler ultrasound was highly accurate in infants (100%), whereas contrast-enhanced computed tomography (CECT) abdomen was found to be most useful in adults. Postoperative complications were more common in adults. CONCLUSION Intestinal malrotation can present in patients of any age group. An increased awareness about the atypical presentations of this condition among adults may reduce the time to accurate diagnosis of this disease.
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Affiliation(s)
- Utpal Anand
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, AIIMS Road, No. 1, Phulwari Sharif, Patna, 801 507, India.
| | - Ramesh Kumar
- Department of Gastroenterology, All India Institute of Medical Sciences, AIIMS Road, No. 1, Phulwari Sharif, Patna, 801 507, India
| | - Rajeev N Priyadarshi
- Department of Radiodiagnosis, All India Institute of Medical Sciences, AIIMS Road, No. 1, Phulwari Sharif, Patna, 801 507, India
| | - Bindey Kumar
- Department of Pediatric Surgery, All India Institute of Medical Sciences, AIIMS Road, No. 1, Phulwari Sharif, Patna, 801 507, India
| | - Sanjay Kumar
- Department of Surgical Gastroenterology, Indira Gandhi Institute of Medical Sciences, Bailey Road, Raja Bazar, Sheikhpura, Patna, 800 014, India
| | - Vijay Prakash Singh
- Department of Gastroenterology, Patna Medical College and Hospital, Ashok Rajpath Road, Patna University Campus, Patna, 800 001, India
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Hsu YC, Hsu LS, Huang WS, Weng JC, Chen CW. Short bowel syndrome caused by laparoscopic loop enterostomy of the jejunum in an adult with undiagnosed intestinal malrotation: A case report. Medicine (Baltimore) 2018; 97:e12712. [PMID: 30290673 PMCID: PMC6200473 DOI: 10.1097/md.0000000000012712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
RATIONALE Failure to recognize intestinal malrotation in adults can cause complications during surgeries, especially those with a limited operative field. We report a case of short bowel syndrome caused by mistaken creation of a loop enterostomy in the jejunum due to undiagnosed intestinal malrotation. PATIENT CONCERNS A 72-year-old man underwent a laparoscopic right hemicolectomy and ileocolostomy because of complicated diverticulitis. Six days after the surgery, he received laparoscopic exploration because of anastomotic leak, and a laparoscopic loop ileostomy was also performed as a protective diversion stoma. One month after surgery, he complained of severe diarrhea from the enterostomy after food and water intake. An upper gastrointestinal and small bowel series revealed that the duodenojejunal junction (DJJ) did not cross the midline and there was a short distance between the DJJ and the enterostomy in the right lower quadrant. DIAGNOSES Short bowel syndrome caused by mistaken creation of a loop enterostomy in the jejunum due to undiagnosed intestinal malrotation. INTERVENTIONS Total parental nutrition was used and the loop enterostomy was closed 3 months after the initial surgery. OUTCOMES The patient was discharged uneventfully 2 weeks after the loop enterostomy. LESSONS Intestinal malrotation in adults is often encountered during routine radiological examinations. However, it may cause complications during surgery if ignored. Radiologists should keep in mind that complications may occur if a complete presurgical evaluation of intestinal malrotation is not performed, and surgeons should take caution when performing surgeries, especially those with a limited operative field.
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Affiliation(s)
- Yin-Chen Hsu
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, Chiayi
- Chang Gung University College of Medicine, Taoyuan
| | - Li-Sheng Hsu
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, Chiayi
- Chang Gung University College of Medicine, Taoyuan
- Department of Biomedical Engineering, National Cheng Kung University, Tainan
| | - Wen-Shih Huang
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital Chiayi Branch, Chiayi
- Department of Medicine, College of Medicine, Chang Gung University
| | - Jun-Cheng Weng
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi
| | - Chien-Wei Chen
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, Chiayi
- Chang Gung University College of Medicine, Taoyuan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
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46
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Bailey KS, Lundstrom E, Borgstrom D. Cecal Volvulus: An Evolving Disease. Am Surg 2018; 84:e418-e419. [PMID: 30454520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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47
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Uhlich RM, Hu P, Jensen J, Holliday C, Barnes SL. Reverse Malrotation: An Uncommon Presentation of Abdominal Pain. Am Surg 2018; 84:e309-e311. [PMID: 30401052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Rindi M Uhlich
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Kadiri JA, Frasure SE, Kimberly HH. Adult Female with Abdominal Pain. J Emerg Med 2018; 54:e59-e60. [PMID: 29102091 DOI: 10.1016/j.jemermed.2017.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 08/04/2017] [Accepted: 09/14/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Juwarat A Kadiri
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sarah E Frasure
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Heidi H Kimberly
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Moore GP, Byrne A, Davila J, Sarfi E, Bettolli M. Worsening anemia associated with volvulus in a stable neonate with intestinal obstruction. J Neonatal Perinatal Med 2018; 11:417-422. [PMID: 30584174 DOI: 10.3233/npm-17118] [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] [Indexed: 06/09/2023]
Abstract
Intrauterine intestinal obstruction complicated by midgut volvulus is a serious life-threatening diagnosis. Immediate surgical intervention is generally the course of action upon diagnosis to prevent morbidity and mortality. We report a case of intrauterine intestinal obstruction where the neonate then presented with an unusual onset of volvulus within the first 12 hours of life. The patient was born with generalized edema, a distended abdomen, and pallor. Unlike many cases, the patient did not present with typical signs of volvulus. Diagnostic imaging preceding delivery and the stable postnatal clinical course did not offer a justification for immediate laparotomy. Less than 24 hours later, the patient's hemoglobin significantly dropped leading to an emergent laparotomy. Findings included a volvulus of the terminal ileum and large amounts of intraluminal blood. Our case report includes an analysis of clinical observations that should be considered so that patients presenting with similar signs receive earlier surgical intervention.
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Affiliation(s)
- G P Moore
- Division of Neonatology, Children's Hospital of Eastern Ontario, Canada
- Faculty of Medicine, University of Ottawa, Canada
| | - A Byrne
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Canada
| | - J Davila
- Faculty of Medicine, University of Ottawa, Canada
- Department of Medical Imaging, Children's Hospital of Eastern Ontario, Canada
| | - E Sarfi
- Department of Medical Imaging, Children's Hospital of Eastern Ontario, Canada
| | - M Bettolli
- Faculty of Medicine, University of Ottawa, Canada
- Department of Surgery, Children's Hospital of Eastern Ontario, Canada
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50
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Abstract
This study is to prospectively evaluate the efficiency of sonography for volvulus diagnosis in neonates with clinically suspected intestinal malrotation.A total of 83 patients with suspected intestinal malrotation who underwent detailed abdominal sonography and upper gastrointestinal contrast study were included. Malrotation was characterized by inversion of the superior mesenteric artery (SMA) and superior mesenteric vein (SMV) in sonographic examination. The "whirlpool sign" of Color Doppler Sonography was recognized as a characteristic for malrotation with volvulus. The degrees of rotation of the SMV winding around SMA were also detected by sonography. Surgery was performed in patients with sonography diagnosed malrotation.A total of 39 patients were sonographically diagnosed as malrotation which was subsequently confirmed by surgery. The sensitivity and positive predictive value of the sonographic diagnosis were both 100% (39/39). The sensitivity, specificity and accuracy of "whirlpool sign" for the detection of midgut volvulus were 95.2% (20/21), 88.9% (16/18), and 92.3% (36/39), respectively. Greater degrees of rotation (equal or greater than 720°) showed higher risk (odds ratio, 5.0; P < .01) for intestinal necrosis occurrence.Sonography is more accurate in diagnosing suspected malrotation than upper gastrointestinal contrast study. Specific sonographic "whirlpool sign" related to volvulus may be used as a potential indicator for intestinal necrosis. In addition, sonography can exclude malrotation and may help the diagnosis of other diseases, such as annular pancreas and duodenal atresia.
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