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BMJ Case Reports Aug 2023A caecal volvulus is a rare, but severe complication to a caesarean section, with serious risks of perforation, necrosis and peritonitis. We describe a case of a Middle...
A caecal volvulus is a rare, but severe complication to a caesarean section, with serious risks of perforation, necrosis and peritonitis. We describe a case of a Middle Eastern woman admitted for an elective caesarean section due to a history of three cesareans in her home country. The operation was complicated by massive adhesions and a postpartum bleed of 1750 mL. She developed severe abdominal pain refractory to strong pain medication postoperatively. She was diagnosed with a caecal volvulus without perforation on CT, which was confirmed by laparotomy. The patient was treated with a hemicolectomy and made a full recovery.
Topics: Female; Pregnancy; Humans; Cesarean Section; Intestinal Volvulus; Abdominal Pain; Colectomy; Hospitalization
PubMed: 37607760
DOI: 10.1136/bcr-2022-252757 -
International Journal of Surgery Case... Jan 2024Gastric volvulus is a rare clinical entity which occurs due to the rotation of the stomach and can have life-threatening complications. This condition can have an acute...
INTRODUCTION AND IMPORTANCE
Gastric volvulus is a rare clinical entity which occurs due to the rotation of the stomach and can have life-threatening complications. This condition can have an acute or chronic presentation and its symptoms will vary according to the degree of obstruction and rapidity of onset.
CASE PRESENTATION
We report a case of a 84-year-old male with history of frequent periods of constipation and lack of appetite who presented to the emergency room with left-sided abdominal pain and distension and persistent nausea, without the ability to vomit. Abdominal radiograph, computed tomography scan of the abdomen, contrast-enhanced examination and upper endoscopy were consistent with a gastric volvulus secondary to diaphragmatic eventration. The patient's symptoms resolved after nasogastric tube placement and fluid resuscitation. However, he was proposed to a laparoscopic anterior gastropexy to prevent symptom recurrence. He remains asymptomatic after 3 years of follow-up.
CLINICAL DISCUSSION
The diagnosis of gastric volvulus is based mainly on clinical presentation and abdominal imaging. The main principles of surgical intervention include stomach decompression with volvulus reduction, followed by gastropexy and correction of any predisposing intra-abdominal factors.
CONCLUSION
Definitive treatment of both acute and chronic gastric volvulus includes a surgical approach. Laparoscopic anterior gastropexy has been found to be a viable alternative in these patients.
PubMed: 38035865
DOI: 10.1016/j.ijscr.2023.109095 -
Journal of Gastrointestinal Surgery :... Dec 2023Acute volvulus of the gastric conduit is a rare complication after esophagectomy that warrants surgical intervention and is associated with increased morbidity and...
BACKGROUND
Acute volvulus of the gastric conduit is a rare complication after esophagectomy that warrants surgical intervention and is associated with increased morbidity and mortality. The aim of the study is to evaluate whether fixation of the gastric conduit would reduce the incidence of postoperative volvulus following esophagectomy.
METHODS
This single-center retrospective analysis of patients who underwent esophagectomy was conducted to determine the incidence of acute postoperative volvulus following a change in practice. All patients who underwent an esophagectomy from September 2013 to November 2022 were included. We compared postoperative outcomes of gastric conduit volvulus, reoperations, morbidity, and mortality among those who had fixation versus non-fixation of the conduit to the right pleural edge.
RESULTS
Two hundred and forty-two consecutive patients underwent minimally invasive esophagectomy (81% male, 41% were < 67 years old). The first 121 (50%) patients did not undergo fixation of the gastric conduit, while the subsequent 121 (50%) patients did undergo fixation. Comparing both groups, there were no significant differences in major complications, anastomotic leak, and 30-day and 90-day all-cause mortality. Four (2%) patients developed gastric conduit volvulus in the non-fixation group, requiring reoperative intervention. Following implementation of fixation, no patient experienced gastric volvulus.
CONCLUSION
Acute volvulus of the gastric conduit is a rare complication after esophagectomy. Early diagnosis and surgical intervention are critical. In this study, although not statistically significant, fixation of the gastric conduit did reduce the number of patients who experienced postoperative volvulus. Additional future studies are needed to validate this technique and the prevention of postoperative acute gastric conduit volvulus among a diverse patient population.
Topics: Humans; Male; Aged; Female; Esophagectomy; Stomach Volvulus; Retrospective Studies; Intestinal Volvulus; Incidence; Stomach; Anastomotic Leak; Anastomosis, Surgical; Esophageal Neoplasms; Postoperative Complications
PubMed: 37940809
DOI: 10.1007/s11605-023-05871-x -
Journal of Indian Association of... 2023Malrotation is a congenital anatomical anomaly that affects the normal positioning of the intestines. Traditional management of malrotation, as described by Ladd,...
INTRODUCTION
Malrotation is a congenital anatomical anomaly that affects the normal positioning of the intestines. Traditional management of malrotation, as described by Ladd, consists of detorsion of the volvulus if present, division of Ladd's bands, widening of the mesenteric root, proper positioning of the small and large bowels, and a prophylactic appendectomy. This study was done to determine whether appendectomy should be an integral part of the Ladds procedure or if it can be avoided.
MATERIALS AND METHODS
This retrospective observational study was conducted in one pediatric surgical unit in the tertiary care center of North India. All the cases of malrotation of the gut managed from January 2008 to December 2018 were reviewed. The details of the patients were recovered from the electronic data recording system of the hospital and manual operation theater records. The cases that have a follow-up of <5 years were not included in the study. The details were charted in an Excel Sheet for the analysis. No statistical test was performed because there was no event in patients in whom prophylactic appendectomy was not done.
RESULTS
The data analysis revealed that a total of 66 malrotation patients were managed during this period, those who fulfilled the inclusion criteria. Among 66 cases included in the study, in 41 cases, prophylactic appendectomy was done, whereas in the rest 25, prophylactic appendectomy was not done. During the follow-up, none of the patients in whom the appendix was preserved presented with signs or symptoms related to appendicitis or any other complications.
CONCLUSION
Ladds procedure without appendectomy can be performed in view of the potential use of the appendix in the future, and with the fact that in the current era of advanced medicine, appendicitis can be diagnosed early due to the advancement of imaging and better record keeping.
PubMed: 38173650
DOI: 10.4103/jiaps.jiaps_108_23 -
Life (Basel, Switzerland) Sep 2023Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract with a 1-3% prevalence in the general population. The surgical management...
Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract with a 1-3% prevalence in the general population. The surgical management of symptomatic MD is well described in the literature, but there is still no consensus on the indication for prophylactic resection of incidental asymptomatic MD. To address this issue, we extensively reviewed the current literature and report our experience with laparoscopic management of an unusual case of MD causing ileal volvulus and acute peritonitis two weeks after a laparoscopic appendectomy for acute gangrenous appendicitis performed in another hospital. A 50-year-old man presented to the emergency department with acute and severe abdominal pain, vomiting, and constipation. He had undergone a laparoscopic appendectomy for acute appendicitis two weeks before in another hospital. The patient was apyretic, distressed, and seeking an antalgic position. The abdomen was mildly distended and tender, and the Blumberg sign was mildly positive in the central quadrants. The clinical picture deteriorated with fever, peritonismus, and leukocytosis. A CT scan showed an ileo-ileal adhesion near the ileocolic junction and dilatation of the upstream loops with the air-fluid levels. Through an urgent laparoscopy, a necrotic mass, the MD, was wedge-resected, and the surrounding ileal volvulus derotated. The postoperative course was uneventful. There is no definitive consensus on the appropriate management of incidental asymptomatic MD, although several studies have attempted to identify guiding criteria. Features of the MD, the patient's risk factors, clinical presentation, and surgical approach need to be considered to establish definitive guidelines for the management of incidental asymptomatic MD. In the absence of definitive guidelines, personal expertise and judgement are the main resources for the surgeon approaching an incidental asymptomatic MD.
PubMed: 37895380
DOI: 10.3390/life13101996 -
Archives of Disease in Childhood Jun 2024
Topics: Humans; Intestinal Volvulus; Foreign Bodies; Magnets; Male; Female
PubMed: 38594050
DOI: 10.1136/archdischild-2024-326991 -
International Journal of Surgery Case... Oct 2023Bowel obstruction is a mechanical or functional blockade of intestinal contents from evacuation to the adjacent distal bowel or external environment. Cecal volvulus is...
INTRODUCTION AND IMPORTANCE
Bowel obstruction is a mechanical or functional blockade of intestinal contents from evacuation to the adjacent distal bowel or external environment. Cecal volvulus is the twisting of distal ileum, cecum and ascending colon on their mesentery. Transverse colon volvulus is another rare cause of large bowel obstruction even less prevalent than cecal volvulus. Colectomy with decompression stoma is the widely practice of intervention in cecal or transverse colon volvulus.
CASE PRESENTATION
A 45 years-old male patient presented to our center with failure to pass feces and flatus of 5 days duration. He also had crampy abdominal pain, abdominal distention and vomiting of ingested matter. Vital signs were normal except mild tachycardia. He had distended non-tender abdomen, hyperactive bowel sound and hyper-tympanic percussion. However, there was no sign of fluid collection of abdominal or rectal mass. Plain abdominal X-ray showed distended large bowel loops with multiple air fluid levels. Exploratory laparotomy revealed simultaneous cecal and transverse colon clockwise volvulus 270 degrees on their mesentery.
DISCUSSION
Mechanical bowel obstruction is major cause of surgical admission in both developed and developing countries. Anatomic and congenital factors play significant role in both transverse colon and cecal volvulus. Endoscopic decompression in the case of cecal and transverse colon volvulus is less probable and not recommended.
CONCLUSION
Simultaneous cecal and transverse colon volvulus is an extremely rare occasion where there is no report in the history of literatures to date. Management involves extended right hemicolectomy with proximal diversion and distal mucus fistula.
PubMed: 37769412
DOI: 10.1016/j.ijscr.2023.108725 -
Journal of Surgical Case Reports May 2024Meckel's diverticula are one of the most common gastrointestinal anomalies, yet mesodiverticular bands are rare. The treatment of these bands commonly requires surgery....
Meckel's diverticula are one of the most common gastrointestinal anomalies, yet mesodiverticular bands are rare. The treatment of these bands commonly requires surgery. A healthy patient in his 20s presented to the emergency department with a 1 day history of acute onset abdominal pain. Computed tomography imaging was consistent with volvulus of the large intestine. In the operating room, the patient was noted to have a band between the ileal mesentery and tip of a Meckel's diverticulum, consistent with a mesodivertiular band, through which cecum had volvulized. The patient underwent resection. The patient recovered without major complications. Mesodiverticular bands are rare, but may present as hemoperitoneum, small bowel obstruction, or volvulus. Pre-operative diagnosis of a mesodiverticular band is often difficult and they are most commonly diagnosed intraoperatively. Treatment should include surgery and may include simple lysis of the band, bowel resection, or more extensive resection if other pathology is present.
PubMed: 38721257
DOI: 10.1093/jscr/rjae296 -
Frontiers in Pediatrics 2024Intestinal malrotation is a rare condition, and its delayed diagnosis can lead to fatal consequences. This study aimed to investigate the identification and treatment of...
BACKGROUND
Intestinal malrotation is a rare condition, and its delayed diagnosis can lead to fatal consequences. This study aimed to investigate the identification and treatment of malrotation in children.
METHODS
Clinical data, imaging, operative findings, and early postoperative outcomes of 75 children with malrotation were retrospectively analyzed.
RESULTS
The mean age was 6.18 ± 4.93 days and 51.26 ± 70.13 months in the neonatal group (56 patients) and non-neonatal group (19 patients), respectively. Sixty-seven patients were under the age of 1 year at the time of diagnosis. The occurrence of bilious vomiting and jaundice was significantly higher in the neonatal group (89.29%) than that in the non-neonatal group (37.5%), < 0.05 and < 0.01, respectively. The incidence of abnormal ultrasound (US) findings was 97.30% and 100%, respectively, and the sensitivities of the upper gastrointestinal series were 84.21% and 87.5%, respectively. Sixty-six (88%) patients had midgut volvulus, including volvulus (two patients) and irreversible intestinal ischemia (four patients). Most neonates (89.29%) underwent open Ladd's procedure with a shorter operative time ( < 0.01). Reoperation was performed for postoperative complications (four patients) or missed comorbidities (two patients).
CONCLUSIONS
Non-bilious vomiting was the initial symptom in >10% of neonates and nearly 40% of non-neonates. This highlights the importance for emergency physicians and surgeons to be cautious about ruling out malrotation in patients with non-bilious vomiting. Utilizing US can obviate the need for contrast examinations owing to its higher diagnostic accuracy and rapid diagnosis and can be recommended as a first-line imaging technique. Additionally, open surgery is still an option for neonatal patients.
PubMed: 38803636
DOI: 10.3389/fped.2024.1390856 -
Vaccines Jul 2023Onchocerciasis remains a debilitating neglected tropical disease. Due to the many challenges of current control methods, an effective vaccine against the causative agent...
Onchocerciasis remains a debilitating neglected tropical disease. Due to the many challenges of current control methods, an effective vaccine against the causative agent is urgently needed. Mice and cynomolgus macaque non-human primates (NHPs) were immunized with a vaccine consisting of a fusion of two protein antigens, -103 and -RAL-2 (-FUS-1), and three different adjuvants: Advax-CpG, alum, and AlT4. All vaccine formulations induced high antigen-specific IgG titers in both mice and NHPs. Challenging mice with L3 contained within subcutaneous diffusion chambers demonstrated that -FUS-1/Advax-CpG-immunized animals developed protective immunity, durable for at least 11 weeks. Passive transfer of sera, collected at several time points, from both mice and NHPs immunized with -FUS-1/Advax-CpG transferred protection to naïve mice. These results demonstrate that -FUS-1 with the adjuvant Advax-CpG induces durable protective immunity against in mice and NHPs that is mediated by vaccine-induced humoral factors.
PubMed: 37515028
DOI: 10.3390/vaccines11071212