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Techniques in Coloproctology Feb 2018Cecal volvulus is a rare clinical entity with an average incidence of 2.8-7.1 per million people per year, accounting for 1-2% of all large bowel obstructions. Cecal... (Review)
Review
BACKGROUND
Cecal volvulus is a rare clinical entity with an average incidence of 2.8-7.1 per million people per year, accounting for 1-2% of all large bowel obstructions. Cecal bascule is the rarest type of cecal volvulus, accounting for 5-20% of all cases. Although several case reports have been published, there is no consensus regarding its diagnosis and treatment. The aim of this study was to review the literature on cecal bascule in order to summarize the etiopathogenesis, clinical features, diagnosis, and treatment options.
METHODS
The PubMed, MEDLINE, and Scopus databases were systematically searched by two independent authors. Cecal bascule was defined as anterior displacement of the distended cecum on the ascending colon without any torsion. The etiopathogenesis, clinical features, diagnosis, and treatment options were analyzed.
RESULTS
Nineteen previously published papers reporting on 26 patients were included. The mean age of patients from previously reported cases was 55.1 ± 19.2 years, and 54% of all patients were males. Presenting symptoms included abdominal pain in 16 (61%), distension in 22 (84%), and vomiting in eight patients (30%). The mean time to diagnosis was 3.6 ± 2.6 days. The extent of surgery varied from cecopexy to right colectomy. There was no postoperative mortality. Cecal bascule recurred one 1 year after index surgery in one patient.
CONCLUSIONS
Cecal bascule is a rare clinical entity, which is mostly encountered in patients with peritoneal adhesions, mobile cecum, bowel dysfunction, and cecal displacement. In patients with recurrent or persistent abdominal pain and distension, cecal bascule should be considered. The majority of these patients require surgical management.
Topics: Cecal Diseases; Cecum; Colectomy; Female; Humans; Intestinal Volvulus; Male; Middle Aged
PubMed: 29159782
DOI: 10.1007/s10151-017-1725-6 -
Ethiopian Journal of Health Sciences Nov 2023Gangrenous sigmoid volvulus has a significant impact on morbidity and mortality. This study was conducted to compare sigmoid resection and primary anastomosis (RPA) with... (Meta-Analysis)
Meta-Analysis Comparative Study Review
BACKGROUND
Gangrenous sigmoid volvulus has a significant impact on morbidity and mortality. This study was conducted to compare sigmoid resection and primary anastomosis (RPA) with sigmoid resection and end colostomy (Hartmann's procedure) for gangrenous sigmoid volvulus.
METHODS
A systematic review and meta-analysis study design was employed to summarize retrospective cohort, prospective cohort, and randomised control trial studies published from inception to march 31, 2023. Searching was performed on Medline, CINAHAL, Web of Science, Google Scholar, the Cochrane Library, and ClinicalTrials.gov to locate eligible articles. Data searching, selection and screening, quality assessment of the included articles, and data extraction were done by two separate reviewers. RevMan 5.4 software with a fixed-effect Mantel-Haenszel model and Stata version 14 were used to analyze the data. The protocol registered on PROSPERO registration website (CRD42023413367).
RESULTS
Ten cohort studies and one randomised control trial with 724 patients were found; all of them were rated as being of moderate quality. The overall mortality after RPA was 15% (95%CI: 11-19%), and after Hartmann's procedure it was 19% (95%CI: 15-23%). Resection and primary anastomosis (RPA) for gangrenous sigmoid volvulus had slightly lower mortality rate than stoma (OR=0.98(95%CI: 0.68-1.42), p=0.07, I=43%), which had no statistically significant difference. Resection and primary anastomosis (RPA) had a slightly higher morbidity rate than Hartmann's procedure (OR=1.01(95%CI: 0.66-1.55), p=0.30, I=18%), which had no statistically significant difference.
CONCLUSION
Sigmoid resection and primary anastomosis (RPA) and Hartmann's procedure had no significant differences in mortality and morbidity for the treatment of gangrenous sigmoid volvulus. Choice of the intervention for gangrenous sigmoid volvulus should be individualized with consideration of different detrimental factors.
Topics: Humans; Intestinal Volvulus; Anastomosis, Surgical; Colostomy; Gangrene; Colon, Sigmoid; Sigmoid Diseases
PubMed: 38784481
DOI: 10.4314/ejhs.v33i6.19 -
ANZ Journal of Surgery Sep 2021Meckel's diverticulum (MD) is the most common congenital malformation in the gastrointestinal tract. Limited up-to-date evidence is available regarding MD in pregnancy....
INTRODUCTION
Meckel's diverticulum (MD) is the most common congenital malformation in the gastrointestinal tract. Limited up-to-date evidence is available regarding MD in pregnancy. We aim to review the available pertinent literature to help support clinical decision making and patient management in the future.
MATERIALS AND METHODS
The search term 'Meckel's diverticulum' was combined with 'pregnant' or 'pregnancy'. Database searches of EMBASE, Medline and PubMed were conducted. All papers published in English from 01/01/1990 to 01/01/2021 were included. Simple statistical analysis (t-test) was performed.
RESULTS
Twenty-seven cases were included. Average age = 26.9 years. Average gestation = 25.1 weeks. Occurrence: first trimester = 3.7%; second trimester = 48.1% and third trimester = 48.1%. Presenting symptoms: abdominal pain 88.9%; nausea/vomiting 59.3%; fever 18.5%; abdominal distension 18.5%; haematochezia 11.1%; constipation 11.1%; haematemesis 3.7%, diarrhoea 3.7% and asymptomatic 3.7%. Mean duration of preceding symptoms = 3.4 days. Diagnostic imaging modalities utilised: ultrasound = 40.7%; CT = 25.9%; MRI = 14.8%; abdominal X-ray = 11.1% and endoscopy = 7.4%. All cases required definite surgical management: laparotomy = 65.4%; laparoscopy = 15.4%; C-section = 19.2% and unreported = 3.8%. Main intra-operative findings: perforated MD = 40.7%; intussusception with MD as a lead point = 11.1%; bleeding MD = 11.1%, inflamed MD = 11.1%; small bowel obstruction = 11.1%; gangrenous MD = 3.7%; volvulus = 3.7% and unspecified = 7.4%. Mean length from ileocolic junction = 51.7 cm. Average length of stay was 7.1 days. T-test (p-value = 0.12) when comparing management strategy. Three maternal complications and two foetal mortalities.
CONCLUSION
MD and associated pathology are difficult to diagnose in the pregnant cohort. Current imaging demonstrates low diagnostic accuracy and a deviation away from recognised nuclear medicine investigations. Surgery appears the definitive management with both open and laparoscopic approaches utilised. Significant maternal morbidity and foetal mortality are associated with this condition.
Topics: Adult; Female; Humans; Intestinal Perforation; Intussusception; Laparoscopy; Laparotomy; Meckel Diverticulum; Pregnancy
PubMed: 34152674
DOI: 10.1111/ans.17014 -
Archives of Disease in Childhood Dec 2021Despite the advantages of ultrasound (US), upper gastrointestinal contrast series (UGI) remains the first-line diagnostic modality in the diagnosis of midgut malrotation... (Meta-Analysis)
Meta-Analysis
CONTEXT
Despite the advantages of ultrasound (US), upper gastrointestinal contrast series (UGI) remains the first-line diagnostic modality in the diagnosis of midgut malrotation and volvulus in children.
OBJECTIVE
Evaluate the diagnostic accuracy of US in the diagnosis of malrotation with or without volvulus in children and adolescents aged 0-21 years, compared with the reference standard (diagnosis by surgery, UGI, CT, MRI, and clinical follow-up individually or as a composite).
DATA SOURCES
We searched the electronic databases Ovid-MEDLINE, Embase, Scopus, CINAHL, and the Cochrane library in October 2019 and updated on 18 August 2020.
STUDY SELECTION
Studies evaluating the diagnostic performance of US for diagnosis of midgut malrotation with or without volvulus in children (0-21 years).
DATA EXTRACTION AND SYNTHESIS
The data were extracted independently by two authors and a bivariate model was used for synthesis.
RESULTS
Meta-analysis of 17 cohort or cross-sectional studies and 2257 participants estimated a summary sensitivity of 94% (95% CI 89% to 97%) and summary specificity of 100% (95% CI 97% to 100%) (moderate certainty evidence) for the use of US for the diagnosis of malrotation with or without midgut volvulus compared with the reference standard. Subgroup analysis and meta-regression revealed better diagnostic accuracy in malrotation not complicated by volvulus, in the neonatal population and enteric fluid administration before US.
CONCLUSIONS
Moderate certainty evidence suggests excellent diagnostic accuracy and coupled with the advantages, a strong case exists for the use of abdominal US as the first-line diagnostic test for suspected midgut malrotation with or without volvulus in children and adolescents.
Topics: Adolescent; Child; Child, Preschool; Cross-Sectional Studies; Digestive System Abnormalities; Female; Humans; Infant; Infant, Newborn; Intestinal Volvulus; Magnetic Resonance Imaging; Male; Sensitivity and Specificity; Ultrasonography
PubMed: 33879472
DOI: 10.1136/archdischild-2020-321082 -
The American Surgeon Feb 2021Laparoscopic approach for malrotation has become more popular for neonates and in cases with volvulus, but its safety and efficacy remains controversial. This study...
BACKGROUND
Laparoscopic approach for malrotation has become more popular for neonates and in cases with volvulus, but its safety and efficacy remains controversial. This study reviewed laparoscopy outcomes in neonate/infant malrotation.
METHODS
Medline/PubMed and Lilacs databases were reviewed. Data from studies published in English/Spanish between 1995 and 2019 were collected. Results are presented as percentages and means/medians; logistic regression was used to study possible associations.
RESULTS
Nineteen papers offered 99 neonates/infants with median age and weight of 10.5 days and 3.5 kg, respectively. Ladd's procedure was performed in 95 (96%) patients and bands' division in 4 (4%); appendectomy was not included in 16 (16.2%) patients, and cecopexy was not performed in all cases. Volvulus was reported in 39 (39.4%) patients. There were 11 conversions (11.1%) and 10 recurrences of symptoms (10.1%) that required reintervention. An association was found between volvulus and recurrence ( = .05) and the need for conversion ( < .01). There were 10 (10.1%) minor complications and no mortality. The median follow-up was 10 months.
DISCUSSION
Laparoscopic approach to malrotation is feasible and safe in hemodynamically stable neonates/infants without intestinal necrosis and is associated with 11% conversion rate and 10% reinterventions. The presence of volvulus is associated with recurrence and conversion. Laparoscopic Ladd's procedure with appendectomy and without cecopexy is the commonly practiced approach that is associated with minor complications.
Topics: Conversion to Open Surgery; Humans; Infant; Infant, Newborn; Intestines; Laparoscopy; Reoperation; Treatment Outcome
PubMed: 32931325
DOI: 10.1177/0003134820951424 -
Pediatric Surgery International Mar 2016Disparity still exists in the outcome of neonatal surgery between high-income countries and low-income and middle-income countries. This study reviews publications on... (Review)
Review
BACKGROUND
Disparity still exists in the outcome of neonatal surgery between high-income countries and low-income and middle-income countries. This study reviews publications on neonatal surgery in Africa over 20 years with a focus on challenges of management, trends in outcome, and potential interventions to improve outcome.
METHODS
We did a literature review by searching PubMed and African Index Medicus for original articles published in any language between January 1995 and September 2014. A data extraction sheet was used to collect information, including type of study, demographics, number of cases, outcome, challenges, and suggestions to improve outcome.
RESULTS
A total of 51 studies from 11 countries met the inclusion criteria. The 16 studies in the first 10 years (1995-2004; group A) were compared with the 35 in the last 10 years (2005-2014; group B). Nigeria (n = 32; 62.7 %), South Africa (n = 7; 13.7 %), Tanzania (n = 2; 3.9 %), and Tunisia (n = 2; 3.9 %) were the predominant sources of the publications, which were retrospective in 38 (74.5 %) studies and prospective in 13 (25.5 %) studies. The mean sample size of the studies was 95.1 (range 5-640). Overall, 4849 neonates were studied, with median age of 6 days (range 1-30 days). Common neonatal conditions reported were intestinal atresia in 28 (54.9 %) studies, abdominal wall defects in 27 (52.9 %), anorectal malformations 25 in (49.0 %), and Hirschsprung's disease, necrotising enterocolitis, and volvulus neonatorum in 23 (45.1 %) each. Mortality was lowest (<3 %) in spina bifida and facial cleft procedures, and highest (>50 %) in emergency neonatal surgeries involving bowel perforation, bowel resection, congenital diaphragmatic hernia, oesophageal atresia, and ruptured omphalocele or gastroschisis. Overall average mortality rate was higher in group A than group B (36.9 vs 29.1 %; p < 0.001), and varied between the groups for some conditions. The major documented challenges were delayed presentation and inadequate facilities in 39 (76.5 %) studies, dearth of trained support personnel in 32 (62.7 %), and absence of neonatal intensive care in 29 (56.9 %). The challenges varied from country to country but did not differ in the two groups.
CONCLUSION
Improvement has been achieved in outcomes of neonatal surgery in Africa in the past two decades, although several of the studies reviewed are retrospective and poorly designed. Cost effective adaptations for neonatal intensive care, improved health-care funding, coordinated neonatal surgical care via regional centres, and collaboration with international partners are potential interventions that could help to address the challenges and further improve outcome.
Topics: Africa; Congenital Abnormalities; Developing Countries; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Outcome Assessment, Health Care; Postoperative Complications
PubMed: 26783085
DOI: 10.1007/s00383-016-3861-x -
International Journal of Surgery Case... 2020Colonic volvulus is defined as a torsion of a part of the colon causing large bowel obstruction by strangulation which may lead to ischemia and then necrosis. The...
INTRODUCTION
Colonic volvulus is defined as a torsion of a part of the colon causing large bowel obstruction by strangulation which may lead to ischemia and then necrosis. The synchronous occurrence of a sigmoid colon and transverse colon volvulus is exceptional. We describe a case of synchronous sigmoid and transverse volvulus in a patient with a qualitative systematic review of this condition.
PRESENTATION OF THE CASE
This is a 74-year-old patient with a history of chronic constipation, who consulted for bowel obstruction. Plain abdominal radiography showed diffuse gas distension of the colon with the absence of rectal gas. An exploratory laparotomy was performed and showed sigmoid colon volvulus associated with synchronous transverse colon volvulus without bowel necrosis. A left hemicolectomy with loop colostomy was performed. The restoration of bowel continuity was done 3 weeks. The post-operative course was uneventful.
DISCUSSION
The occurrence of a simultaneous sigmoid and transverse colonic volvulus is an exceptional situation. Due to the rarity of this clinical entity, the literature concerning its description is sparse and the treatment options are poorly codified. There are no guidelines in the treatment and a tailored approach should be used for each patient.
CONCLUSION
The dual location of strangulation makes this situation a major surgical emergency with a high risk of gangrene and septic shock. Colectomy with delayed anastomosis should be preferred in the treatment.
PubMed: 32979829
DOI: 10.1016/j.ijscr.2020.09.027 -
Acta Paediatrica (Oslo, Norway : 1992) Dec 2018Appendiceal volvulus (AV) and cecal volvulus (CV) are rare conditions and there is no consensus regarding the best surgical approach. This study reviewed CV and AV...
AIM
Appendiceal volvulus (AV) and cecal volvulus (CV) are rare conditions and there is no consensus regarding the best surgical approach. This study reviewed CV and AV management and outcomes in children.
METHODS
PubMed was reviewed from 1990 to 2018 for AV and CV in children and studies published in English were selected by two independent reviewers. This identified 24 papers that provided case reports on 29 children (72% male) with a median age of 10 years.
RESULTS
Abdominal distension and abdominal pain were the most common symptoms and seven children had Cornelia de Lange syndrome. The initial treatment was surgical in 27 cases and endoscopic in 2. In 23 children, variants of cecopexy were performed. There was no mortality. Complications occurred in seven cases: five with sepsis and two with enterocutaneous fistulas. There were three CV recurrences and these were all in cases where cecopexy was not performed.
CONCLUSION
AV and CV are rare paediatric pathologies. Since a quarter of the patients had Cornelia de Lange syndrome, it is paramount to consider CV when abdominal symptoms occur. Complications were minor with prompt management. In order to reduce recurrence, cecopexy is recommended in CV cases and appendectomy in AV cases.
Topics: Cecal Diseases; Child; Humans; Intestinal Volvulus; Postoperative Complications
PubMed: 29949184
DOI: 10.1111/apa.14476 -
Annals of the Royal College of Surgeons... Nov 2020The aim of this systematic review was to appraise the current literature on the use of percutaneous endoscopic colostomy (PEC) as an alternative to major surgery and...
INTRODUCTION
The aim of this systematic review was to appraise the current literature on the use of percutaneous endoscopic colostomy (PEC) as an alternative to major surgery and endoscopic decompression alone for treating sigmoid volvulus in frail, comorbid patients.
METHODS
A systematic literature search of literature published between April 2000 and January 2017 was carried out using the MEDLINE, Embase™ and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases. The search terms were "percutaneous endoscopic colostomy", "PEC", "sigmoidopexy", "sigmoidostomy" and "sigmoid volvulus". The studies identified were screened and those that did not fulfil the inclusion criteria were excluded.
FINDINGS
Seven observational studies and seven case reports (comprising eighty-one patients) were found to match our inclusion criteria. All patients had recurrent sigmoid volvulus and were treated with PEC either with a single PEC tube or with two PEC tubes inserted. Sigmoid volvulus recurred in 10 of the 81 patients; 3 of these individuals developed recurrence with PEC tubes in situ and 7 following tube removal. There were seven deaths after the procedure. The most frequent morbidity associated with PEC tube insertion was site infection (=6).
CONCLUSIONS
Our systematic review highlights the use of PEC as an alternative in managing recurrent sigmoid volvulus in frail, comorbid patients unfit for or refusing surgery, with the best outcomes seen in those patients where two PEC tubes were inserted and remained in situ indefinitely. Further studies are needed to improve the safety and efficacy of the procedure as well as post-procedure care.
Topics: Colon, Sigmoid; Colostomy; Humans; Intestinal Volvulus; Sigmoid Diseases; Sigmoidoscopy
PubMed: 32777932
DOI: 10.1308/rcsann.2020.0162 -
Journal of Pediatric Surgery Oct 2014Comparison of the outcome of newborns with simple (sGS) and complex gastroschisis (cGS: gastroschisis with atresia, necrosis, perforation or volvulus). (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Comparison of the outcome of newborns with simple (sGS) and complex gastroschisis (cGS: gastroschisis with atresia, necrosis, perforation or volvulus).
MATERIALS AND METHODS
We conducted a systematic database search, quality assessment and meta-analyzed relevant articles which evaluated the mortality and morbidity of newborns with cGS versus sGS. Risk ratios (RR) with 95% confidence interval (CI) were reported for categorical data, and the mean difference (MD) was calculated for continuous data. Pooled estimates of RR and MD were computed using generic inverse variance and a random-effects model.
RESULTS
Of 19 identified reports, 13 eligible studies were included. The mortality of infants with cGS (16.67%) was significantly higher than sGS (2.18%, RR: 5.39 [2.42, 12.01], p<0.0001). Significantly different outcome was found for the following parameters: Infants with cGS are started on enteral feedings later and they take longer to full enteral feedings with a subsequent longer duration of parenteral nutrition. Their risk of sepsis, short bowel syndrome and necrotizing enterocolitis is higher. They stay longer in hospital and are more likely to be sent home with enteral tube feedings and parenteral nutrition.
DISCUSSION
Occurring in 17% of infants born with gastroschisis, complex gastroschisis is associated with a significantly increased morbidity and mortality. More research should be focused on this special subgroup of patients, not only on postnatal management, but additionally directing efforts to improve diagnosing and predicting complex gastroschisis prenatally as well as implement any probable fetal intervention to alleviate its disastrous outcome.
Topics: Gastroschisis; Humans; Infant, Newborn; Morbidity; Odds Ratio
PubMed: 25280661
DOI: 10.1016/j.jpedsurg.2014.08.001