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Abdominal Radiology (New York) Jul 2016
Review
Topics: Digestive System Abnormalities; Humans; Intestinal Volvulus; Mesenteric Artery, Superior; Mesenteric Veins; Radiography, Abdominal; Tomography, X-Ray Computed
PubMed: 26920004
DOI: 10.1007/s00261-016-0688-9 -
Current Opinion in Pediatrics Jun 2015At present, there is a debate as to the management of malrotation in pediatric patients. This review highlights recent literature including the role of laparoscopy, and... (Review)
Review
PURPOSE OF REVIEW
At present, there is a debate as to the management of malrotation in pediatric patients. This review highlights recent literature including the role of laparoscopy, and the management of asymptomatic patients with and without congenital cardiac disease.
RECENT FINDINGS
Symptomatic patients are still recommended to undergo open Ladd's procedure. Laparoscopic Ladd's procedure in asymptomatic patients confers a shorter time to tolerating feeds, shorter length of stay, and a decreased rate of bowel obstruction and other complications. It may, however, carry a higher risk of postoperative volvulus. Diagnostic laparoscopy is recommended in asymptomatic patients in whom the diagnosis is uncertain on upper gastrointestinal imaging. Asymptomatic patients with congenital heart disease may be managed with initial observation or operation, based upon individualized risk benefit assessment. If an elective Ladd's procedure is performed, it should take place after palliative cardiac operations have resulted in stable cardiac function. Screening upper gastrointestinal studies in heterotaxy patients may be unnecessary as the reported rates of volvulus in recent studies are low.
SUMMARY
Laparoscopic Ladd's procedure may be an acceptable alternative to an open procedure for asymptomatic patients. Observation of asymptomatic patients with congenital cardiac disease is a reasonable alternative in selected patients.
Topics: Child; Digestive System Abnormalities; Heart Defects, Congenital; Humans; Intestinal Volvulus; Laparoscopy; Postoperative Complications; Reoperation; Risk Assessment; Treatment Outcome
PubMed: 25888146
DOI: 10.1097/MOP.0000000000000215 -
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 -
Seminars in Ultrasound, CT, and MR Dec 2014Intestinal malrotation is a congenital abnormal fixation of the bowel that predisposes to life threatening midgut volvulus. Most events of midgut volvulus occur in the... (Review)
Review
Intestinal malrotation is a congenital abnormal fixation of the bowel that predisposes to life threatening midgut volvulus. Most events of midgut volvulus occur in the first month of life with decreased risk with age. The most typical presentation is bilious vomiting. Upper gastrointestinal series is the study of choice for diagnosis of malrotation. For optimal results, the study should be well planned with meticulous attention to technique. In equivocal cases, small bowel follow-through study and ultrasound can be performed.
Topics: Female; Humans; Infant; Infant, Newborn; Intestinal Volvulus; Magnetic Resonance Imaging; Male; Tomography, X-Ray Computed
PubMed: 25454052
DOI: 10.1053/j.sult.2014.08.004 -
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 -
The American Journal of Emergency... Nov 2021Thyroid storm is an unusually rare but life-threatening pediatric occurrence, carrying significant mortality. Skewed towards the adolescent population, thyroid...
Thyroid storm is an unusually rare but life-threatening pediatric occurrence, carrying significant mortality. Skewed towards the adolescent population, thyroid decompensation occurs due to inciting factors ranging from infection, trauma, surgery, burns, medications, direct thyroid trauma, and rarely volvulus. Emergent care focuses on both reversing the inciting event as well as quelling the metabolic hyperactivity associated with thyroid storm. In review of the available literature, this case is the first to date of thyroid storm secondary to malrotation with midgut volvulus in a previously euthyroid adolescent patient.
Topics: Abdominal Pain; Adolescent; Female; Humans; Intestinal Volvulus; Pediatrics; Thyroid Crisis; Tomography, X-Ray Computed
PubMed: 33926769
DOI: 10.1016/j.ajem.2021.04.064 -
Pediatric Emergency Care Mar 2022Malrotation and midgut volvulus are conditions commonly described in infants, typically diagnosed within the first month of life. We present an unusual occurrence of...
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.
Topics: Abdominal Pain; Adolescent; Constipation; Hospitalization; Humans; Infant; Intestinal Volvulus; Male; Vomiting
PubMed: 35226634
DOI: 10.1097/PEC.0000000000002659 -
ANZ Journal of Surgery May 2018Caecal bascule is a rare condition characterized by the inferior pole of the caecum folding on a horizontal axis antero-superiorly towards the ascending colon,... (Review)
Review
BACKGROUND
Caecal bascule is a rare condition characterized by the inferior pole of the caecum folding on a horizontal axis antero-superiorly towards the ascending colon, potentially causing obstruction. An unusual variant of volvulus, diagnosis is challenging due to its obscurity. We present the experience of an Australian tertiary-referral hospital with the diagnosis/management of caecal bascule, and review cases reported in the literature to raise awareness of this uncommon diagnosis.
METHODS
Medical records of patients diagnosed with caecal bascule during 2001-2016 were reviewed. Data relating to their presentation, investigations, management and outcomes were obtained. A literature search was conducted through PubMed and Medline databases.
RESULTS
Caecal bascule was diagnosed in four patients (median age: 60.5 (range: 48-75) years, two females). Patients presented with abdominal pain (4/4), distension (3/4), vomiting (3/4) and confusion (1/4) over a 1- to 4-day period. Computed tomography identified caecal displacement in three cases, and bascule was diagnosed at laparotomy in all cases. All patients underwent right hemicolectomy, with primary ileo-colic anastomosis in three cases and formation of Abcarian stoma in one case. Median length of stay was 15.5 days (range: 10-24), with no mortality. Fifteen cases of caecal bascule have been reported in the literature to date, with authors suggesting resection as definitive treatment.
CONCLUSION
Correct diagnosis of caecal bascule requires a high index of suspicion and avoids delay of appropriate management. Recent operation, particularly laparoscopic cholecystectomy, may be contributing factors. Resection is recommended, a sentiment echoed by reported cases in the literature.
Topics: Aged; Australia; Cecal Diseases; Female; Humans; Intestinal Volvulus; Male; Middle Aged; Retrospective Studies; Risk Factors
PubMed: 28318090
DOI: 10.1111/ans.13898 -
The Journal of Surgical Research Jan 2015This is a single-center case series about the rare condition of volvulus without malposition and/or malrotation (VWM) in preterm babies. We focus on diagnostic...
BACKGROUND
This is a single-center case series about the rare condition of volvulus without malposition and/or malrotation (VWM) in preterm babies. We focus on diagnostic difficulties, and our results should help to distinguish VWM as a distinct entity different from classical volvulus and segmental volvulus.
MATERIALS AND METHODS
Medical chart review of infants with VWM from 2003-2012 was used.
RESULTS
A total of 15 patients were identified. All of them had volvulus in the absence of intestinal malposition or other associated intestinal pathologies. All patients were born prematurely. Emergency laparotomy was necessary in all 15 patients. Two groups were identified. Group 1 includes four patients with typical signs of meconium obstruction of prematurity (MOP). Small bowel resection was only necessary in one of these four patients, all survived without residual intestinal lesions. Group 2 consists of 11 patients without signs of MOP-small bowel resection and temporary enterostomy were necessary in all these children. Four patients presented with pneumatosis intestinalis on the abdominal plain film, suggesting necrotizing enterocolitis. Although two infants died, the survivors showed complete recovery.
CONCLUSIONS
VWM is a distinct disease of prematurity. When associated with MOP, VWM has a favorable outcome of treatment. In contrast, VWM occurring in the absence of signs of meconium obstruction requires small bowel resection. VWM primarily affects the top of the midgut (ileum). Because of absent malposition, presentation of VWM may be uncharacteristic. Pneumatosis intestinalis in advanced VWM may lead to diagnostic difficulties and a delay in treatment.
Topics: Databases, Factual; Diagnosis, Differential; Digestive System Surgical Procedures; Enterostomy; Gestational Age; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Intestinal Obstruction; Intestinal Volvulus; Intestine, Small; Meconium
PubMed: 25266606
DOI: 10.1016/j.jss.2014.08.043 -
Journal of Medical Case Reports Oct 2021Gallbladder volvulus is a rare pathology first reported by Wendel in 1898. Although the main pathological process associated with gallbladder volvulus is not known,...
BACKGROUND
Gallbladder volvulus is a rare pathology first reported by Wendel in 1898. Although the main pathological process associated with gallbladder volvulus is not known, there is clinical evidence suggesting that lack of gallbladder adhesions to the liver leads to an eventual twisting around the cystic bile duct (a process that seems to favor older female populations).
CASE PRESENTATION
In this report, an 81-year-old Caucasian elderly female presented to the emergency department with acute/severe right upper quadrant pain, which was also accompanied by an elevated leukocyte count. Relevant imaging showed a distended gallbladder with gallbladder wall thickening and a dilated common bile duct. The patient was subsequently admitted to the hospital for acute cholecystitis and scheduled for surgery the next day. Upon laparoscopic surgery, the gallbladder was black and gangrenous with no visible adhesions to the liver. Further inspection demonstrated that the gallbladder had twisted clockwise around the cystic bile duct.
CONCLUSIONS
While many previous cases have been reported since Wendel, further case studies are nevertheless important to help guide proper clinic evaluation and pinpoint the potential for a gallbladder volvulus.
Topics: Abdominal Pain; Aged; Aged, 80 and over; Female; Gallbladder Diseases; Humans; Intestinal Volvulus; Torsion Abnormality
PubMed: 34625099
DOI: 10.1186/s13256-021-03115-7