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Clinical Gastroenterology and... Jul 2022
Topics: Colon, Sigmoid; Humans; Intestinal Volvulus; Sigmoid Diseases
PubMed: 35131344
DOI: 10.1016/j.cgh.2022.01.052 -
Journal of Vascular and Interventional... Feb 2022
Topics: Digestive System Abnormalities; Humans; Intestinal Volvulus; Mesenteric Arteries
PubMed: 35101225
DOI: 10.1016/j.jvir.2021.10.024 -
Journal of Medical Imaging and... Apr 2023Sigmoid volvulus is a potentially devastating and life-threatening condition associated with sigmoid colon redundancy. Many of the classical radiological signs are...
INTRODUCTION
Sigmoid volvulus is a potentially devastating and life-threatening condition associated with sigmoid colon redundancy. Many of the classical radiological signs are considered to represent the two adjacent loops of bowel in a mesentero-axial volvulus. However, limited case reports and series have reported on an organo-axial subtype of sigmoid volvulus. This clinical entity is not widely understood. In this study, we assess the radiological and clinical features of mesentero-axial and organo-axial sigmoid volvulus.
METHODS
After institutional board approval (CH62/6/2016-228), all computed tomography (CT) studies from 2011 to 2017 reported as sigmoid volvulus at a single institution were reviewed. The cases were reviewed by three radiologists retrospectively and the course of the bowel followed with a focus on assessing its rotational axis. In each case, the sigmoid volvulus was independently subclassified as mesentero-axial or organo-axial volvulus based on the axis of rotation of the volvulus. In addition, X-ray signs including disproportionate sigmoid dilatation, distended inverted 'U' in sigmoid, coffee bean sign, opposed wall sign, direction of apex of sigmoid loop, liver overlap sign, northern exposure sign and proximal colonic dilatation and CT features including whirl sign, 'X' marks the spot sign, split wall sign and number of transition points were reported for each case. The clinical management and outcomes including morbidity, mortality, endoscopic decompression and need for surgery were also evaluated. The subtype of volvulus was correlated with the above X-ray signs, CT features and clinical management and outcomes. Statistical analysis was conducted using Stata/MP, version 15 (StataCorp LP, College Station, TX, USA).
RESULTS
A total of 38 scans were reviewed. There were 19 patients identified. Of these, six (32%) were reported as mesentero-axial and 13 (68%) as organo-axial volvulus. No X-ray signs were able to distinguish the two types of volvulus. The number of transition points on CT was predictive of volvulus subtype (OR 25, 95% CI: 1.30-1295.30, P = 0.01). Within the limitations of a small cohort, there was no statistically significant difference in unsuccessful endoscopic decompression, need for colectomy, repeated admissions or mortality between the groups.
CONCLUSION
This study has demonstrated that organo-axial sigmoid volvulus may be as common as mesentero-axial volvulus. Distinguishing organo-axial from mesentero-axial volvulus can be achieved on CT, but not on abdominal X-ray. The number of transition points (two for mesentero-axial and one for organo-axial) may be used as a diagnostic feature for differentiating the two forms of volvulus.
Topics: Humans; Intestinal Volvulus; Retrospective Studies; Decompression, Surgical; Lumbar Vertebrae; Tomography, X-Ray Computed
PubMed: 35773776
DOI: 10.1111/1754-9485.13454 -
Journal of Medical Case Reports Dec 2022Fetal midgut volvulus is an uncommon yet potentially life-threatening condition. Prenatal diagnosis may pose a challenge, due to the paucity of specific signs and...
BACKGROUND
Fetal midgut volvulus is an uncommon yet potentially life-threatening condition. Prenatal diagnosis may pose a challenge, due to the paucity of specific signs and symptoms. Timely prenatal diagnosis of this condition is imperative to prevent fetal mortality and morbidity.
CASE PRESENTATION
We present a rare case report of fetal midgut volvulus, malrotation, and intestinal obstruction at 32 weeks of gestation in a 31-year-old multigravida Indian patient who presented with decreased fetal movements. Fetal ultrasound revealed midgut volvulus with proximal bowel obstruction and polyhydramnios. The patient underwent emergency surgery, which revealed intestinal malrotation and confirmed the diagnosis of midgut volvulus. Untwisting of the volvulus was done followed by Ladd's procedure. Follow-up postoperative ultrasound was unremarkable.
CONCLUSIONS
Delay in the diagnosis of fetal midgut volvulus leads to poor fetal and maternal outcomes. Hence, it is vital for radiologists, sonologists, and obstetricians to be aware of this condition while performing fetal sonography. Prompt diagnosis and surgical intervention are vital to reduce the morbidity and mortality associated with this condition.
Topics: Pregnancy; Female; Humans; Adult; Intestinal Volvulus; Prenatal Diagnosis; Intestinal Obstruction; Ultrasonography, Prenatal; Fetus
PubMed: 36575475
DOI: 10.1186/s13256-022-03720-0 -
ANZ Journal of Surgery Jul 2021
Topics: Cecal Diseases; Cholecystitis, Acute; Humans; Intestinal Obstruction; Intestinal Volvulus
PubMed: 33405363
DOI: 10.1111/ans.16550 -
Pediatric Emergency Care May 2021
Topics: Child; Colon, Sigmoid; Humans; Intestinal Volvulus
PubMed: 33587341
DOI: 10.1097/PEC.0000000000002365 -
ANZ Journal of Surgery Apr 2021
Topics: Acute Disease; Appendicitis; Digestive System Abnormalities; Humans; Intestinal Volvulus
PubMed: 32960483
DOI: 10.1111/ans.16309 -
Revista Espanola de Enfermedades... Apr 2023Intestinal obstruction due to sigmoid volvulus (SV) represents a relevant percentage of abdominal diseases presenting at the emergency department. Treatment is based on...
Intestinal obstruction due to sigmoid volvulus (SV) represents a relevant percentage of abdominal diseases presenting at the emergency department. Treatment is based on early endoscopic devolvulation (ED), followed by elective surgery as definitive treatment. A 78-year-old man institutionalized with Lewy body dementia presents with abdominal pain, distention, and absence of stool in 72 hours. Coffee bean sign was seen in abdominal x-ray. Previously, he had been admitted three times last year with recurrent SV, managed with ED succesfully. Despite the recurrence, no surgical treatment was indicated after resolution of the acute situation and recovery of intestinal transit. This time, urgent colonoscopy was performed and a 20 cm length of purplish-black (isquemic) sigmoid mucosa was observed. With these findings of stablished intestinal ischemia urgent surgical intervention was performed (sigmoidectomy and terminal "Hartmann" colostomy). Histologically, necrosis, severe ulceration and mixed inflammation was noticed in the surgical piece. The patient develops favorably during a postoperative period without incidents. Therefore, he is discharged to his center. At the moment he is asymptomatic one year after the intervention with no new episodes. Recurrency of SV after ED is up to 86% of cases. In every episode, the incidence of complications such as intestinal ischemia or perforation increases significantly, as well as urgent surgery and mortality. Definitive treatment must be surgical, sigmoidectomy and terminal anastomosis is the choice technique.
Topics: Male; Humans; Aged; Intestinal Volvulus; Sigmoid Diseases; Intestinal Obstruction; Colonoscopy; Ischemia
PubMed: 36779459
DOI: 10.17235/reed.2023.9488/2023 -
Soins. Gerontologie 2016
Topics: Aged, 80 and over; Alzheimer Disease; Humans; Intestinal Volvulus; Male; Patient Readmission; Recurrence
PubMed: 27842652
DOI: 10.1016/j.sger.2016.09.011 -
Journal of Investigative Surgery : the... Jul 2022Intestinal volvulus can cause morbidity and mortality. Surgical reduction, on the other hand, could result in ischemia-reperfusion (I/R) injury. Hydrogen rich saline...
BACKGROUND
Intestinal volvulus can cause morbidity and mortality. Surgical reduction, on the other hand, could result in ischemia-reperfusion (I/R) injury. Hydrogen rich saline solution (HRSS neutralizes free radicals in the body. This study aimed to investigate the effects of HRSS in I/R injury in experimental intestinal volvulus in rats.
METHODS
Thirty rats were randomly allocated into 5 groups. All procedures were done under general anesthesia and sterile conditions in each animal. Five ml/kg of saline and HRSS were administered intraperitoneally (ip) in Sham (Group 1) and HRSS (Group 2) groups, respectively. Groups 3, 4, and 5 constituted the study groups in which volvulus was created in a 5-cm- long ileal segment 2 cm proximal to the ileocecal valve. After 2 hours the volvuli were reduced and following 2 hours of reperfusion, these segments were removed. In volvulus-I/R group (Group 3) no additional procedure was done. HRSS was administered shortly before reperfusion (reduction of the volvulus) in Treatment I (Group 4) and 1 h before experimental volvulus in Treatment II (Group 5) groups. Blood and intestinal tissue samples were obtained from all rats at the 4th hour. Both tissue and blood total oxidant (TOS) and antioxidant status (TAS) levels were determined and tissue histomorphologies were studied. Oxidative stress indices (TOS ÷ TAS) (OSI) were calculated.
RESULTS
Tissue TOS and OSI levels and histomorphological injury scores were statistically lower in treatment groups than I/R group, whereas blood TOS and OSI levels were similar between the groups.
CONCLUSIONS
This study provides biochemical and histomorphological evidence that HRSS prevents intestinal damage in I/R injury caused by volvulus.
Topics: Animals; Antioxidants; Hydrogen; Intestinal Volvulus; Oxidative Stress; Rats; Reperfusion Injury; Saline Solution
PubMed: 35331073
DOI: 10.1080/08941939.2022.2056273