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Diagnostic and Interventional Imaging Feb 2022
Topics: Colon, Sigmoid; Humans; Intestinal Obstruction; Intestinal Volvulus; Recurrence; Sigmoid Diseases; Tomography, X-Ray Computed
PubMed: 35086787
DOI: 10.1016/j.diii.2022.01.007 -
Journal of Medical Case Reports Nov 2021Sigmoid volvulus in pregnancy is a rare cause of intestinal obstruction with high maternal and fetal morbidity and mortality if not diagnosed and managed early.
INTRODUCTION
Sigmoid volvulus in pregnancy is a rare cause of intestinal obstruction with high maternal and fetal morbidity and mortality if not diagnosed and managed early.
CASE PRESENTATION
A 29-year-old female (Chagga by tribe) presented with clinical features of intestinal obstruction 24 weeks into her second pregnancy. She had symptoms for one week. An emergency laparotomy was performed whereby gangrenous sigmoid volvulus was found; thus, it was resected and Hartmann's colostomy was raised. Unfortunately, she experienced intrauterine fetal death post-operatively. She was discharged clinically stable.
CONCLUSION
Early diagnosis and management can prevent adverse effects such as bowel ischemia and preterm labor. Because classic clinical and radiological features may not be evident, high degree of suspicion is warranted.
Topics: Adult; Colostomy; Female; Gangrene; Humans; Infant, Newborn; Intestinal Obstruction; Intestinal Volvulus; Pregnancy; Sigmoid Diseases
PubMed: 34753500
DOI: 10.1186/s13256-021-03151-3 -
CMAJ : Canadian Medical Association... May 2013
Topics: Aged; Cecum; Diagnosis, Differential; Female; Humans; Intestinal Volvulus; Radiography
PubMed: 23027907
DOI: 10.1503/cmaj.120651 -
Journal of Medical Case Reports Nov 2017Sigmoid volvulus is frequently reported in the "volvulus belt" (Middle East, Africa, the Indian subcontinent, Turkey, and South America) and is the third leading cause...
BACKGROUND
Sigmoid volvulus is frequently reported in the "volvulus belt" (Middle East, Africa, the Indian subcontinent, Turkey, and South America) and is the third leading cause of large bowel obstruction in North America. It is an uncommon problem in children and adolescents, and is rarely considered a diagnosis in this group. A high index of suspicion is necessary to diagnose sigmoid volvulus in children.
CASE PRESENTATION
We present a 13-year-old Arabian girl who came with features suggestive of intestinal obstruction. Plain abdominal film revealed classic omega (coffee bean) sign of sigmoid volvulus. The volvulus was successfully decompressed by means of a rectal tube in our emergency department. The next day during the same admission the volvulus recurred and was successfully decompressed by endoscopy. She was discharged home on her parents' request; she presented again 1 month later. This time the volvulus could not be decompressed non-operatively, so she underwent sigmoidectomy with primary anastomosis. Postoperatively she developed paralytic ileus that resolved after 10 days. Following that she did well and was discharged home. She is still free of symptoms 1 year after the resection.
CONCLUSIONS
Sigmoid volvulus is an uncommon problem in children and adolescents, and is rarely considered a diagnosis in this group as a cause of intestinal obstruction. Pediatric surgeons should maintain a high index of suspicion, in order not to miss this important diagnosis, as any delay in instituting treatment has a devastating effect on morbidity as well as mortality. Early diagnosis and prompt treatment confer an excellent prognosis.
Topics: Adolescent; Anastomosis, Surgical; Colectomy; Decompression, Surgical; Emergency Service, Hospital; Female; Humans; Intestinal Volvulus; Radiography, Abdominal; Recurrence; Sigmoid Diseases; Treatment Outcome
PubMed: 29110733
DOI: 10.1186/s13256-017-1440-y -
Cirugia Y Cirujanos 2015Small bowel volvulus is a rare cause of intestinal obstruction in adult patients. This disease is more common in children and its aetiology and management is different... (Review)
Review
BACKGROUND
Small bowel volvulus is a rare cause of intestinal obstruction in adult patients. This disease is more common in children and its aetiology and management is different to that in adults.
CLINICAL CASE
A 30 year-old male with sarcoidosis presents with acute abdomen and clinical data of intestinal obstruction. Small bowel volvulus is diagnosed by a contrast abdominal tomography and an exploratory laparotomy is performed with devolvulation and no intestinal resection. In the days following surgery, he developed a recurrent small bowel volvulus, which was again managed with surgery, but without intestinal resection. Medical treatment for sarcoidosis was started, and with his clinical progress being satisfactory,he was discharged to home.
CONCLUSIONS
Making an early and correct diagnosis of small bowel volvulus prevents large intestinal resections. Many surgical procedures have been described with a high rate of complications. Therefore, conservative surgical management (no intestinal resection) is recommended as the best treatment with the lowest morbidity and mortality rate.
Topics: Adult; Humans; Ileus; Immunosuppressive Agents; Incidence; Intestinal Obstruction; Intestinal Volvulus; Intestine, Small; Laparotomy; Male; Mesentery; Postoperative Complications; Recurrence; Sarcoidosis; Tomography, Spiral Computed
PubMed: 26144269
DOI: 10.1016/j.circir.2015.05.033 -
Journal of Visceral Surgery Jun 2017
Review
Topics: Abdominal Cavity; Female; Humans; Intestinal Volvulus; Intubation, Gastrointestinal; Laparoscopy; Laparotomy; Male; Mesentery; Postoperative Care; Recovery of Function; Risk Assessment; Severity of Illness Index; Treatment Outcome
PubMed: 28522281
DOI: 10.1016/j.jviscsurg.2017.04.002 -
Langenbeck's Archives of Surgery Aug 2023Most patients with sigmoid volvulus are of old age with multiple comorbidities. So, the risk of surgery for those elderly patients is usually associated with increased... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Most patients with sigmoid volvulus are of old age with multiple comorbidities. So, the risk of surgery for those elderly patients is usually associated with increased rates of morbidity and mortality. Early intervention is required for managing sigmoid volvulus to avoid its serious complications; therefore, early endoscopic untwist of sigmoid colon can be performed followed by endoscopic fixation of sigmoid colon under sedation in this category of the patients to avoid development of high risk surgical complications following surgical fixation of sigmoid colon or sigmoidectomy after initial simple loop colostomy procedure to relieve obstruction.
METHODS
This prospective randomized controlled clinical trial included all patients who developed acute sigmoid volvulus and were referred to the Zagazig University Hospital Emergency Department between December 2020 and August 2022. The study was prospectively approved by Zagazig University Faculty of Medicine Institutional Review Board (Approval Number: 9989/23-10-2022) and was retrospectively submitted in http://clinicaltrials.gov in November 2022 ( http://clinicaltrials.gov ID: NCT05620446). Included eligible patients were simply randomized at a 1:1 ratio to "Endoscopic Group (EG)" or "Surgical Group (SG)" via drawing of sealed envelopes containing computer-generated random numbers prepared by a third party before start of intervention.
RESULTS
Sample size included 18 patients divided into 2 equal groups. (1) Endoscopic group included 9 patients who were subjected to endoscopic untwist of sigmoid colon followed by endoscopic fixation of sigmoid colon under sedation; (2) Surgical group included 9 patients who were subjected to surgical fixation of sigmoid colon or sigmoidectomy after initial simple loop colostomy under general anesthesia. In comparison between both groups, there were statistically significant differences regarding length of hospital stay and procedure time. Unfortunately, there were no statistically significant differences regarding postoperative complications and co-morbidities. Eight patients in the endoscopy group demonstrated excellent quality of life, and one demonstrated good quality of life; unlike the surgical group, there were 3 patients with excellent quality of life, 5 patients with good quality of life, and 1 patient with poor quality of life. So there was statistically significant difference regarding quality of life between both groups. During the 9-month follow-up period, both groups demonstrated no cases of recurrence post-fixation.
CONCLUSION
Endoscopic management of acute sigmoid volvulus is effective and safe in elderly high risk surgical patients (either in managing the intestinal obstruction caused by volvulus or in definitive treatment of volvulus).
Topics: Aged; Humans; Intestinal Volvulus; Quality of Life; Retrospective Studies; Endoscopy; Intestinal Obstruction
PubMed: 37635200
DOI: 10.1007/s00423-023-03071-4 -
Veterinary Surgery : VS Apr 2020To determine the prognostic value of (1) colonic venous lactate or peripheral lactate values obtained before and after manual correction of a large colon volvulus and...
OBJECTIVE
To determine the prognostic value of (1) colonic venous lactate or peripheral lactate values obtained before and after manual correction of a large colon volvulus and (2) a combination of variables including pelvic flexure biopsy.
STUDY DESIGN
Prospective clinical study.
ANIMALS
Forty adult horses in which large colon volvulus was diagnosed intraoperatively.
METHODS
Colonic venous, peripheral venous, and arterial blood samples were collected to measure lactate values before and after manual correction. Mucosal biopsy samples were obtained in cases that underwent enterotomy or colonic resection and anastomosis. Interstitium to crypt (I:C) ratio and hemorrhage scores were measured. Optimal cutoff values were determined by receiver operator curve analysis, and associations between variables and short-term outcome were determined by univariable regression. Short-term survival was defined as horses being discharged from the hospital. P ≤ .05 was considered significant.
RESULTS
No association was found between colonic venous lactate values before (P = .011) or after (P = .201) manual correction of large colon volvulus and determination of short-term outcome. Peripheral venous lactate at admission ≥3.2 mmol/L and after manual correction ≥5 mmol/L, arterial lactate postmanual correction ≥3.53 mmol/L, and histomorphometric measurements of mucosal hemorrhage ≥3 and I:C ratio > 1 were associated with poor short-term outcome.
CONCLUSION
Peripheral lactate values, histomorphometric measures of I:C ratio, and hemorrhage score provided prognostic information that could help guide recommendations made to owners.
CLINICAL SIGNIFICANCE
Peripheral lactate values after manual correction provide important intraoperative diagnostic information to assist in predicting case outcome in the operative and immediately postoperative period.
Topics: Animals; Biopsy; Blood Gas Analysis; Colon; Female; Hemorrhage; Horse Diseases; Horses; Intestinal Volvulus; Lactates; Male; Prognosis; Prospective Studies
PubMed: 31916608
DOI: 10.1111/vsu.13361 -
BMC Surgery Dec 2021Cecal volvulus, which is a torsion involving the cecum, terminal ileum, and ascending colon around its own mesentery, results in a closed-loop obstruction. It is a rare...
BACKGROUND
Cecal volvulus, which is a torsion involving the cecum, terminal ileum, and ascending colon around its own mesentery, results in a closed-loop obstruction. It is a rare reported cause of adult intestinal obstruction. This study aimed to review the clinical presentation, management, and outcomes at a rural, resource-limited referral center.
METHODS
We performed a retrospective review of all patients with a diagnosis of cecal volvulus between January 1st, 2009 and December 31st, 2019 at Tenwek Hospital in Bomet, Kenya. The outcome of survival was compared by the time to presentation. Mortality was also compared with prior reports of intestinal obstruction at our institution.
RESULTS
Thirteen patients were identified with a mean age of 52 years and a mean symptom duration of 5 days. All patients presented with abdominal pain and distension. Seven patients (54%) presented with perforation, gangrene, or gross peritoneal contamination. Identified risk factors were Ladds bands with malrotation, adhesions, and a sigmoid tumor. Procedures included primary resection and anastomosis (7), damage control (3) with anastomosis on second-look in 2 of these, simple surgical detorsion (1), and surgical detorsion and cecopexy (2). There were four mortalities (31%), of which all had delayed presentation with perforation and fecal contamination. Delays to presentation were associated with mortality (p = 0.03). Cecal volvulus resulted in increased perioperative mortality compared to all intestinal obstructions presenting to the institution (p < 0.0001).
CONCLUSIONS
Cecal volvulus carries a high risk of mortality. A high index of suspicion and early consideration in the differential diagnosis of intestinal obstruction should be considered to reduce the mortality associated with the delay in preoperative diagnosis.
Topics: Adult; Cecal Diseases; Humans; Intestinal Obstruction; Intestinal Volvulus; Kenya; Middle Aged; Retrospective Studies
PubMed: 34923984
DOI: 10.1186/s12893-021-01416-8 -
Cirugia Pediatrica : Organo Oficial de... Oct 2023Intestinal malrotation is a congenital pathology with potentially catastrophic complications, such as volvulus, whose treatment has barely not changed in nearly...
INTRODUCTION
Intestinal malrotation is a congenital pathology with potentially catastrophic complications, such as volvulus, whose treatment has barely not changed in nearly 100 years (Ladd's procedure). Dr. Abu-Elmagd recently described a new technique that was applied in one of our patients.
CLINICAL CASE
12-year-old boy who had undergone Ladd's procedure as a result of intestinal volvulus secondary to malrotation when he was 2 days old. He had subocclusion and eventually obstruction, with intestinal volvulus compatible imaging. Intraoperative findings: duodenal subocclusion, volvulus and lymphangiectasias. Kareem's procedure: bowel positioning in normal rotation, duodenopexy (duodenal C posterior to the mesenteric vessels), formation of neo-Treitz, and fixation of the cecum, the ascending colon, and the mesenteric root. The patient was discharged on postoperative day 6 and remains asymptomatic after 1 year of follow-up.
DISCUSSION
Kareem's procedure is a safe and effective malrotation repair technique. It can replace Ladd's procedure as it reduces the risk of re-volvulation and improves digestive symptoms.
Topics: Male; Humans; Child; Intestinal Volvulus; Intestines; Digestive System Surgical Procedures; Laparoscopy
PubMed: 37818902
DOI: 10.54847/cp.2023.04.16