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Pediatric Radiology Apr 2021
Topics: Humans; Intestinal Volvulus; Laparotomy; Ultrasonography
PubMed: 33404784
DOI: 10.1007/s00247-020-04919-3 -
Journal of Gastrointestinal Surgery :... Nov 2023Malrotation in children presents with bilious emesis and can be life threatening. Data on adults is lacking.
BACKGROUND
Malrotation in children presents with bilious emesis and can be life threatening. Data on adults is lacking.
METHODS
Single institution, retrospective 20-year data collection on adult (>18 years) and adolescent patients (12-18) with symptomatic malrotation. We evaluated demographics, surgical approach, hospital stay, time to feed, and type of surgeon with descriptive statistics to analyze each group.
RESULTS
Adult (n=17) and adolescent patients (n=8) primarily presented with acute abdominal pain (82% adult, 100% adolescent), and non-bilious emesis (0%), and had elective repair. CT scan was diagnostic for 82% adults and 71% adolescents. Overall, 88% had improvement in symptoms.
CONCLUSION
In this single institution series comparing adults and adolescent patients with malrotation, 88% have resolution of pain after repair, despite atypical presentations. CT scan is diagnostic and laparoscopic approach should be considered.
Topics: Child; Humans; Adult; Adolescent; Retrospective Studies; Vomiting; Abdominal Pain; Abdomen, Acute; Length of Stay; Intestinal Volvulus
PubMed: 37259017
DOI: 10.1007/s11605-023-05718-5 -
The Journal of Pediatrics Apr 2020
Topics: Female; Humans; Infant, Newborn; Intestinal Volvulus; Radiography
PubMed: 31870608
DOI: 10.1016/j.jpeds.2019.11.017 -
QJM : Monthly Journal of the... Sep 2014
Topics: Digestive System Surgical Procedures; Humans; Image Enhancement; Intestinal Volvulus; Male; Mesentery; Middle Aged; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 24554299
DOI: 10.1093/qjmed/hcu038 -
Langenbeck's Archives of Surgery May 2022To analyze the treatment outcomes for sigmoid volvulus (SV) and identify risk factors of complications and mortality. (Observational Study)
Observational Study
PURPOSE
To analyze the treatment outcomes for sigmoid volvulus (SV) and identify risk factors of complications and mortality.
METHODS
Observational study of all consecutive adult patients diagnosed with SV who were admitted from January 2000 to December 2020 in a tertiary university institution for conservative management, urgent or elective surgery. Primary outcomes were 30-day postoperative morbidity, mortality and 2-year overall survival (OS), including analysis of risk factors for postoperative morbidity or mortality and prognostic factors for 2-year OS.
RESULTS
A total of 92 patients were included. Conservative management was performed in 43 cases (46.7%), 27 patients (29.4%) underwent emergent surgery and 22 (23.9%) were scheduled for elective surgery. Successful decompression was achieved in 87.8% of cases, but the recurrence rate was 47.2%. Mortality rates following episodes were higher for conservative treatment than for urgent or elective surgery (37.2%, 22.2%, 9.1%, respectively; p = 0.044). ASA score > III was an independent risk factor for complications (OR = 5.570, 95% CI = 1.740-17.829, p < 0.001) and mortality (OR = 6.139, 95% CI = 2.629-14.335, p < 0.001) in the 30 days after admission. Patients who underwent elective surgery showed higher 2-year OS than those with conservative treatment (p = 0.011). Elective surgery (HR = 2.604, 95% CI = 1.185-5.714, p = 0.017) and ASA score > III (HR = 0.351, 95% CI = 0.192-0.641, p = 0.001) were independent prognostic factors for 2-year OS.
CONCLUSION
Successful endoscopic decompression can be achieved in most SV patients, but with the drawbacks of high recurrence, morbidity and mortality rates. Concurrent severe comorbidities and conservative treatment were independent prognostic factors for morbidity and survival in SV.
Topics: Adult; Decompression, Surgical; Humans; Intestinal Volvulus; Lumbar Vertebrae; Morbidity; Retrospective Studies; Sigmoid Diseases; Treatment Outcome
PubMed: 35028738
DOI: 10.1007/s00423-022-02428-5 -
World Journal of Surgery Jul 2020Intestinal volvulus is a common cause of mechanical intestinal obstruction (MIO) in Africa. Sigmoid volvulus has been well characterized in both high-income and...
BACKGROUND
Intestinal volvulus is a common cause of mechanical intestinal obstruction (MIO) in Africa. Sigmoid volvulus has been well characterized in both high-income and low-income countries, but there is also a predilection for small bowel volvulus in sub-Saharan Africa.
METHODS
An analysis was performed of the Kamuzu Central Hospital Acute Care Surgery Registry from 2013 to 2019 on patients presenting with intestinal volvulus. Bivariate analysis was performed for covariates based on the intestinal volvulus type. Multivariate Poisson regression models estimated the relative risk of volvulus and mortality.
RESULTS
A total of 4352 patients were captured in the registry. Overall, 1037 patients (23.8%) were diagnosed with MIO. Intestinal volvulus accounted for 499 (48.1%) of patients with MIO. Sigmoid volvulus, midgut volvulus, ileosigmoid knotting, and cecal volvulus accounted for 57.7% (n = 288), 19.8% (n = 99), 20.8% (n = 104), and 1.6% (n = 8), respectively. Mean age was 46.8 years (SD 17.2) with a male preponderance (n = 429, 86.0%) and 14.8% (n = 74) mortality. Overall, the most common operations performed were large bowel (n = 326, 74.4%) and small bowel (n = 76, 16.7%) resections with 18.0% (n = 90) ostomy formation. Upon regression modeling, the relative risk for volvulus was 2.7 times higher in men than women after controlling for season and age. There was no statistically significant difference in the relative risk of mortality based on the type of volvulus.
CONCLUSION
Volvulus is a significant cause of primary bowel obstruction in sub-Saharan Africa. Type of intestinal volvulus is not associated increased risk of mortality. Reasons for increases in the incidence of small bowel volvulus are still largely undetermined.
Topics: Adult; Female; Humans; Incidence; Intestinal Obstruction; Intestinal Volvulus; Male; Middle Aged; Retrospective Studies
PubMed: 32100066
DOI: 10.1007/s00268-020-05440-2 -
Journal of Paediatrics and Child Health May 2022Bilious vomiting (BV) in the neonatal period may herald malrotation with life-threatening volvulus. In New South Wales, contrast fluoroscopy is not available in...
AIM
Bilious vomiting (BV) in the neonatal period may herald malrotation with life-threatening volvulus. In New South Wales, contrast fluoroscopy is not available in non-tertiary paediatric centres; therefore, transfer is required. An infant with BV referred to Newborn and Paediatric Emergency Transport Service is prioritised for urgent retrieval to a surgical centre for contrast fluoroscopy and paediatric surgical review. This study analysed how many neonates with BV needed retrieval to prevent bowel loss or to save one life and to identify predictors of malrotation and/or volvulus.
METHODS
All neonatal referrals (<29 days) to Newborn and Paediatric Emergency Transport Service between 31 July 2014 and 31 July 2020 with BV or aspirates were examined. Data on time of onset of BV, time of call for retrieval, vital signs, lactate level and blood glucose at referral, time of arrival at the surgical centre and outcome were analysed.
RESULTS
Of 391 neonates referred with BV, 113 (28.9%) had a surgical cause and 31 (7.9%) had a time-critical malrotation and/or volvulus. All 31 neonates were well at referral with normal vital signs including three neonates who subsequently died. Lactate levels at referral (1-7.5 mmol/L) were not predictive of outcome. The odds of a time-critical diagnosis increased with every day of age (odds ratio = 1.097), heart rate >140 (P = 0.04) and decreased for each kilogram of birthweight (odds ratio 0.475; confidence interval 0.294-0.768).
CONCLUSIONS
Neonates with BV require urgent referral to paediatric surgery and contrast fluoroscopy. Thirteen urgent transfers are required to preserve the bowel integrity and life in one baby.
Topics: Child; Fluoroscopy; Humans; Infant; Infant, Newborn; Intestinal Volvulus; Lactates; Referral and Consultation; Vomiting
PubMed: 34755923
DOI: 10.1111/jpc.15829 -
BMC Gastroenterology Mar 2023The aim of this study is to investigate the clinical characteristics and treatment experience of intestinal volvulus, and to analyze the incidence of adverse events and...
BACKGROUND
The aim of this study is to investigate the clinical characteristics and treatment experience of intestinal volvulus, and to analyze the incidence of adverse events and related risk factors of intestinal volvulus.
METHODS
Thirty patients with intestinal volvulus admitted to the Digestive Emergency Department of Xijing Hospital from January 2015 to December 2020 were selected. The clinical manifestations, laboratory tests, treatment and prognosis were retrospectively analyzed.
RESULTS
A total of 30 patients with volvulus were enrolled in this study, including 23 males (76.7%), with a median age of 52 years (33-66 years). The main clinical manifestations were abdominal pain in 30 cases (100%), nausea and vomiting in 20 cases (67.7%), cessation of exhaust and defecation in 24 cases (80%), and fever in 11 cases (36.7%). The positions of intestinal volvulus were jejunum in 11 cases (36.7%), ileum and ileocecal in 10 cases (33.3%), sigmoid colon in 9 cases (30%). All 30 patients received surgical treatment. Among the 30 patients underwent surgery, 11 patients developed intestinal necrosis. We found that the longer the disease duration (> 24 h), the higher the incidence of intestinal necrosis, and the higher the incidence of ascites, white blood cell count and neutrophil ratio in the intestinal necrosis group were significantly higher than those in the non-intestinal necrosis group (p < 0.05). After treatment, 1 patient died of septic shock after operation, and 2 patients with recurrent volvulus were followed up within 1 year. The overall cure rate was 90%, the mortality rate was 3.3%, and the recurrence rate was 6.6%.
CONCLUSION
Laboratory examination, abdominal CT and dual-source CT are very important for the diagnosis of volvulus in patients with abdominal pain as the main symptom. Increased white blood cell count, neutrophil ratio, ascites and long course of disease are important for predicting intestinal volvulus accompanied by intestinal necrosis. Early diagnosis and timely intervention can save lives and prevent serious complications.
Topics: Male; Humans; Middle Aged; Intestinal Volvulus; Retrospective Studies; Ascites; Colon, Sigmoid; Necrosis; Intestinal Obstruction
PubMed: 36977994
DOI: 10.1186/s12876-023-02699-2 -
Scottish Medical Journal May 2016The cardinal features of bilious vomiting and abdominal distension assist in the diagnosis of malrotation and volvulus, an often fatal condition in the neonate. When...
BACKGROUND AND AIMS
The cardinal features of bilious vomiting and abdominal distension assist in the diagnosis of malrotation and volvulus, an often fatal condition in the neonate. When these symptoms are absent, however, diagnosis becomes trickier. In the older child, these classic symptoms are less likely to occur, or occur at a later stage, meaning these children suffer from a delay in diagnosis and consequently do poorer. There is a need, therefore, to identify the common presenting features in these older children in order to facilitate earlier diagnosis and improve outcomes.
METHODS
We reviewed the current literature (Appendix 1) and then undertook a retrospective study in our own department to explore the presenting complaint, time to diagnosis, intraoperative findings and outcome of all children over the age of 28 days who underwent a Ladd's procedure for malrotation at Royal Hospital for Sick Children, Glasgow (RHSC) between 1998 and 2014.
RESULTS
It was found that children between the ages of 28 days and 15 years are more likely to display signs and symptoms such as chronic abdominal pain and non-bilious vomiting. Their complication rate was found to be significant.
CONCLUSION
Education surrounding the timely diagnosis of malrotation in the post-neonatal child is crucial.
Topics: Abdominal Pain; Adolescent; Child; Child, Preschool; Diagnosis, Differential; Female; Hospitals, Pediatric; Humans; Infant; Intestinal Obstruction; Intestinal Volvulus; Laparotomy; Male; Retrospective Studies; Scotland; Vomiting
PubMed: 27578853
DOI: 10.1177/0036933016649870 -
Balkan Medical Journal Jan 2021Hirschsprung's disease and sigmoid volvulus can sometimes be seen in the same patient.
BACKGROUND
Hirschsprung's disease and sigmoid volvulus can sometimes be seen in the same patient.
AIMS
To investigate the presence of Hirschsprung's disease in patients with sigmoid volvulus and to discuss the diagnosis and treatment methods.
STUDY DESIGN
Systematic review.
METHODS
This systematic review has been reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the methodological quality of systematic reviews guidelines. The PubMed and Scopus databases were scanned using the keywords "Hirschsprung* volvulus*" and "congenital aganglionic megacolon volvulus*". The reference list of the selected studies was reviewed for cross-checking. Two reviewers independently screened the available literature. Only the Hirschsprung's disease cases involving sigmoid volvulus were included, and cases of patients with volvulus in other sites was excluded. There was no restriction with respect to the publication language and type of writing. The primary outcome was morbidity and mortality.
RESULTS
A total of 31 cases were analyzed in 22 articles; 97% of the patients were under the age of 40, 90% were male. There was a statistically significant difference in the necessity for relaparotomy between patients who were scheduled for sigmoid volvulus therapy with the suspicion of Hirschsprung's disease and patients who were treated without suspicion of Hirschsprung's disease (0% vs 37.5%, p=0.02). While there was no postoperative death in cases with suspected Hirschsprung disease, this mortality rate was 25% in cases without suspicion (p = 0.08).
CONCLUSION
Hirschsprung's disease should be excluded with rectal biopsy if a patient with sigmoid volvulus is under 40 years of age and has complaints of constipation from childhood.
Topics: Adult; Aged, 80 and over; Child; Child, Preschool; Female; Hirschsprung Disease; Humans; Infant; Infant, Newborn; Intestinal Volvulus; Male
PubMed: 32856883
DOI: 10.4274/balkanmedj.galenos.2020.2020.4.131