-
BMJ Case Reports Jan 2024Compound 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... (Review)
Review
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.
Topics: Humans; Colon, Sigmoid; Gangrene; Intestinal Obstruction; Intestinal Volvulus; Intestine, Small
PubMed: 38238160
DOI: 10.1136/bcr-2023-258253 -
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 -
Seizure Apr 2024This narrative review intends to inform neurologists and public health professionals about Onchocerciasis-Associated Epilepsy (OAE), a neglected public health problem in... (Review)
Review
This narrative review intends to inform neurologists and public health professionals about Onchocerciasis-Associated Epilepsy (OAE), a neglected public health problem in many remote onchocerciasis-endemic areas. For epidemiological purposes, we define OAE as sudden-onset of convulsive and non-convulsive seizure types, including head nodding seizures (nodding syndrome) in a previously healthy child aged 3 to 18 years in the absence of any other obvious cause for epilepsy, all happening within an area with high ongoing Onchocerca volvulus transmission. Several OAE pathophysiological mechanisms have been proposed, but none has been proven yet. Recent population-based studies showed that strengthening onchocerciasis elimination programs was followed by a significant reduction in the incidence of OAE and nodding syndrome. Treating epilepsy in onchocerciasis-endemic regions is challenging. More advocacy is needed to provide uninterrupted, free access to anti-seizure medication to persons with epilepsy in these remote, impoverished areas. It is crucial todevelop policies and increase funding for the prevention and treatment of OAE to reduce the associated burden of disease, notably via the establishment of morbidity management and disability prevention programs (MMDP). Moreover, effective collaboration between onchocerciasis elimination and mental health programs is imperative to alleviate the burden of OAE. This synergy promises reciprocal advantages and underscores the need for a comprehensive approach to address this multifaceted challenge.
PubMed: 38677953
DOI: 10.1016/j.seizure.2024.04.018 -
Pakistan Journal of Medical Sciences 2023Spontaneous decompression is an uncommon outcome of sigmoid volvulus (SV). The aim of this study was to evaluate the clinical presentation, diagnosis, treatment, and...
OBJECTIVES
Spontaneous decompression is an uncommon outcome of sigmoid volvulus (SV). The aim of this study was to evaluate the clinical presentation, diagnosis, treatment, and follow-up of spontaneously decompressed SV.
METHODS
We utilized the data of our 1,063 SV patients, the most comprehensive monocenter SV series in the world. To obtain the worldwide data on the spontaneous decompression of SV, we researched the last 56-years' literature in Web of Science and PubMed databases.
RESULTS
The incidence of the spontaneous decompression was 0.1% (1/1,063) in our SV series, whereas it was 1.5% (8/549) in the worldwide data (Fisher exact test, p = 0.001). By this way, cumulative spontaneous decompression rate was found as 0.6% (9/1,602). In the spontaneously decompressed cases, the main clinical features were abdominal pain/tenderness, distention, and obstipation, which were similar to management-required patients. However, the treatment and follow-up algorithm is still a relatively undefined subject.
CONCLUSION
Spontaneous decompression of SV is a very rare clinical entity. The clinical presentation and diagnosis of the spontaneously decompressed SV look alike the management-required SV. However, as seen in most management-required patients, SV tends to recur in the spontaneously decompressed cases and a recurrence-reducing procedure is required in selected patients.
PubMed: 37936730
DOI: 10.12669/pjms.39.6.8052 -
SAGE Open Medical Case Reports 2023Colonic volvulus is one of the most common causes of bowel obstruction. It could occur in different parts of the colon. The sigmoid is the most common part, but it...
Colonic volvulus is one of the most common causes of bowel obstruction. It could occur in different parts of the colon. The sigmoid is the most common part, but it rarely occurs in the transverse colon because of the colon's anatomical features. So, simultaneous sigmoid and transverse colon volvulus is a rare phenomenon that could endanger patients' lives due to its rarity, ischemia, necrosis of the colon wall, and the lack of a definite algorithm to approach this disease. So, it is essential to consider this disease as one of the most important differential diagnoses in patients with abdominal pain and distention. In this article, a 45-year-old male presented to the surgical ward with severe prolonged abdominal pain, diagnosed with simultaneous sigmoid and transverse colon volvulus during laparotomy.
PubMed: 37654550
DOI: 10.1177/2050313X231197001 -
International Journal of Surgery Case... Dec 2023Gallbladder volvulus is a rare disease whose presentation usually overlaps with that of typical calculous cholecystitis. It's diagnosis is critical as it is associated...
INTRODUCTION
Gallbladder volvulus is a rare disease whose presentation usually overlaps with that of typical calculous cholecystitis. It's diagnosis is critical as it is associated with high morbidity and mortality and therefore should be managed urgently with cholecystectomy.
CASE PRESENTATION
85-year-old female patient presented with right upper quadrant pain of one day duration that is associated with nausea and vomiting, but no fever or jaundice. She was tachycardiac and had severe abdominal right upper quadrant tenderness with positive Murphy's sign. Laboratory results showed only increase in inflammatory markers. Both ultrasound and computed tomography scan of the abdomen were done and acalculous cholecystitis was diagnosed. Open cholecystectomy was planned and performed, but gallbladder volvulus as the cause of cholecystitis was noted intraoperatively.
DISCUSSION
There is still no consensus on the exact cause of gallbladder volvulus. Even though it presents mostly in elderly patients, different ages have been already reported. It's diagnosis can be suspected based on the appearance, symptoms, and examination of the patient. Laboratory tests and imaging might provide some clues for it's diagnoses. It's ischemic process prompts urgent surgical intervention and does not improve conservatively. Our patient did not present with all of it's typical symptoms and the diagnosis was made intraoperatively.
CONCLUSION
Gallbladder volvulus could have been missed had we not opt for an urgent surgery. More studies should be done to further define its presentation, and accurately know when to consider it up in our differential diagnosis.
PubMed: 37952492
DOI: 10.1016/j.ijscr.2023.109026 -
The American Journal of Emergency... Jun 2024Pediatric digestive volvulus is a serious condition that carries with it a high rate of morbidity and mortality. (Review)
Review
INTRODUCTION
Pediatric digestive volvulus is a serious condition that carries with it a high rate of morbidity and mortality.
OBJECTIVE
This review highlights the pearls and pitfalls of pediatric digestive volvulus, including the presentation, diagnosis, and management in the emergency department (ED) based on current evidence.
DISCUSSION
Pediatric digestive volvulus is a deadly condition most commonly associated with malrotation. It occurs when the stomach or small intestine twists on itself, resulting in ischemia and potentially strangulation with necrosis and perforation. Presentation differs based on the gastrointestinal (GI) segment affected, degree of twisting, and acuity of the volvulus. Gastric volvulus most commonly presents with retching with or without nonbilious emesis and epigastric distension with pain, while midgut volvulus typically presents with bilious emesis in infants. Patients with GI necrosis and perforation may present with hemodynamic compromise and peritonitis. If suspected, emergent consultation with the pediatric surgery specialist is necessary, and if this is not available, transfer to a center with a pediatric surgeon is recommended. Imaging includes plain radiography, ultrasound, or upper GI series, while treatment includes resuscitation, administration of antibiotics, and emergent surgical decompression and detorsion of the involved segments.
CONCLUSION
An understanding of pediatric digestive volvulus and its many potential mimics can assist emergency clinicians in diagnosing and managing this deadly disease.
PubMed: 38908340
DOI: 10.1016/j.ajem.2024.06.012 -
Cureus Oct 2023Cecal volvulus, despite being the second most common type of intestinal volvulus after sigmoid volvulus, frequently gets underdiagnosed in clinical practice. Further,...
Cecal volvulus, despite being the second most common type of intestinal volvulus after sigmoid volvulus, frequently gets underdiagnosed in clinical practice. Further, management of this intestinal pathology, which requires a considerable amount of expertise, could be lacking due to the similarities in presentation with other intestinal obstructive pathologies, or the infrequency associated with the performance of required diagnostic and therapeutic procedures. We describe a case of a 47-year-old female who presented with acute cecal volvulus. In this case, prompt surgical intervention ensured the best possible outcome with preservation of the cecum via a less sophisticated surgical approach. It therefore becomes apparent that there exists other surgical options in the optimal management of cecal volvulus that ensure no part of the bowel is lost, although this is time-bound.
PubMed: 38021984
DOI: 10.7759/cureus.47343 -
Cureus Oct 2023Intrauterine volvulus is an extremely rare disorder. Its diagnosis is difficult to make antenatally, unless typical pictures are obtained. Owing to its high morbidity...
Intrauterine volvulus is an extremely rare disorder. Its diagnosis is difficult to make antenatally, unless typical pictures are obtained. Owing to its high morbidity and mortality, intensive monitoring of the fetal condition is mandatory. Here, we report a patient, gravida 4, para 1 (G4P1), who had suffered from preterm labor and diminishing fetal movement and was brought to the emergency unit after her 35th week of pregnancy. Ultrasonography was performed to reveal a fetus with a markedly distended bowel (18 mm in width). Intestinal obstruction related to intrauterine volvulus was highly suspected. The fetus was delivered via Cesarean section because of its deteriorated abdominal condition. Urgent exploratory laparotomy was done by a pediatric surgeon to relieve the bowel obstruction on the second day after birth, on the account of poor improvement of the newborn. The newborn did well after segmental resection and was subsequently followed up at the pediatric outpatient clinic. In conclusion, early detection, intensive monitoring, prompt delivery, and urgent surgical intervention are the key to save the fetal life and neonatal health.
PubMed: 38021592
DOI: 10.7759/cureus.47712 -
Pathogens (Basel, Switzerland) Mar 2024Onchocerciasis, or river blindness, has historically been one of the most important causes of blindness worldwide, and a major cause of socio-economic disruption,... (Review)
Review
Onchocerciasis, or river blindness, has historically been one of the most important causes of blindness worldwide, and a major cause of socio-economic disruption, particularly in sub-Saharan Africa. Its importance as a cause of morbidity and an impediment to economic development in some of the poorest countries in the world motivated the international community to implement several programs to control or eliminate this scourge. Initially, these involved reducing transmission of the causative agent through controlling the vector population. When ivermectin was found to be a very effective drug for treating onchocerciasis, the strategy shifted to mass drug administration (MDA) of endemic communities. In some countries, both vector control and ivermectin MDA have been used together. However, traditional vector control methods involve treating rivers in which the black fly vectors breed with insecticides, a process which is expensive, requires trained personnel to administer, and can be ecologically harmful. In this review, we discuss recent research into alternatives to riverine insecticide treatment, which are inexpensive, ecologically less harmful, and can be implemented by the affected communities themselves. These can dramatically reduce vector densities and, when combined with ivermectin MDA, can accelerate the time to elimination when compared to MDA alone.
PubMed: 38535611
DOI: 10.3390/pathogens13030268