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Medicine Dec 2017Sigmoid volvulus (SV) is an exceptionally rare but potentially life-threatening condition in children. (Review)
Review
RATIONALE
Sigmoid volvulus (SV) is an exceptionally rare but potentially life-threatening condition in children.
CHIEF COMPLAINT
Abdominal distention for 1 week.
DIAGNOSES
Sigmoid volvulus.
PATIENT CONCERNS
We present a case of a 12-year-old boy with mechanical ileus who was finally confirmed to have SV with the combination of abdominal plain film, sonography, and computed tomography (CT) with the finding of mesenteric artery rotation.
INTERVENTIONS
Because bowel obstruction was suspected, abdominal plain film, sonography, and CT were performed. The abdominal CT demonstrated whirlpool sign with torsion of the sigmoid vessels. In addition, lower gastrointestinal filling study showed that the contrast medium could only reach the upper descending colon. Therefore, he received laparotomy with mesosigmoidoplasty for detorsion of the sigmoid.
OUTCOMES
The postoperative recovery was smooth under empirical antibiotic treatment with cefazolin. A follow-up lower gastrointestinal series on the seventh day of admission showed no obstruction compared with the previous series. He was finally discharged in a stable condition 8 days after admission.
LESSONS
SV is a congenital anomaly and an uncommon diagnosis in children. Nevertheless, case series and case reports of SV are becoming more prevalent in the literature. Failure to recognize SV may result in life-threatening complications such as sigmoid gangrene/perforation, peritonitis, sepsis, and death. Thus, if the children have persistent and recurrent abdominal distention, abdominal pain, and vomiting, physicians should consider SV as a "do not miss diagnosis" in the differential diagnosis.
Topics: Child; Humans; Intestinal Volvulus; Male; Sigmoid Diseases; Tomography, X-Ray Computed
PubMed: 29384922
DOI: 10.1097/MD.0000000000009434 -
The Israel Medical Association Journal... Oct 2022Rare incidence cases are part of the routine work of pediatric surgeons. Cecal anomalies in children are an example of such cases. Objectives: To describe the...
BACKGROUND
Rare incidence cases are part of the routine work of pediatric surgeons. Cecal anomalies in children are an example of such cases. Objectives: To describe the presentation, workup, management and outcome of rare cecal anomalies in children and to analyze the skills needed for their successful treatment.
METHODS
A retrospective chart review was conducted of all cases of cecal anomalies managed by the pediatric surgical service at a tertiary hospital from June 2017 to January 2020. Data regarding demographics, clinical presentation, radiological studies, surgical treatment, pathology, complications, and outcome were collected.
RESULTS
Five cases of cecal anomalies were encountered over a period of 32 months, including a cecal volvulus, cecal duplication, cecal intussusception, and two cecal masses (one ulcerated lipoma and one polyp). All patients, except the patient with cecal duplication, presented acutely and were managed surgically. Long-term follow-up of 17-24 months was unremarkable in all cases.
CONCLUSIONS
A wide knowledge base, careful judgment, and creativity enable pediatric surgeons to successfully treat rare conditions such as rare cecal anomalies. These skills should be part of the education of pediatric surgery trainees.
Topics: Humans; Child; Retrospective Studies; Cecal Diseases; Cecum; Intestinal Volvulus; Intussusception
PubMed: 36309857
DOI: No ID Found -
The Turkish Journal of Gastroenterology... Apr 2023Sigmoid volvulus may recur following endoscopic decompression. Flatus tubes are traditionally used to prevent an early recurrence. This study aims to evaluate the...
BACKGROUND
Sigmoid volvulus may recur following endoscopic decompression. Flatus tubes are traditionally used to prevent an early recurrence. This study aims to evaluate the recurrence-preventive role of the flatus tubes in sigmoid volvulus.
METHODS
Sigmoid volvulus recurrence was retrospectively analyzed in prospectively collected clinical data of endoscopically decompressed 60 patients, in whom no tube, rectal tube, or sigmoidal tube was used.
RESULTS
Mean pain/discomfort scores were higher in rectal and sigmoidal tube groups than that of no tube group (1.2 ± 0.4, 4.2 ± 0.9, and 3.5 ± 0.9, respectively, P < .001). The early recurrence was seen in 3 patients in the no tube group, while no early recurrence was determined during tube placement in the rectal and sigmoidal tube groups (15.0%, 0.0%, and 0.0%, respectively, P < .05, P < .05, and P > .05). The tubes were removed or spontaneously discharged in 13 (65.0%) and 12 patients (60.0%) in the rectal and sigmoidal tube groups, respectively, and sigmoid volvulus recurred in 2 patients in each group following the removal or spontaneous discharge. There was no statistically significant difference between the early recurrence rates of the no tube, rectal tube, and sigmoidal tube groups following the removal or spontaneous discharge of the tubes (15.0%, 15.4%, 16.7%, respectively, P > .05) and in total (15.0%, 10.0%, and 10.0%, respectively, P > .05).
CONCLUSION
Flatus tubes may prevent the early volvulus recurrence during their placement in sigmoid volvulus. Nevertheless, they generally cause pain and discomfort, and they are frequently removed or spontaneously discharged, which suppresses their recurrence- preventive effects.
Topics: Humans; Intestinal Volvulus; Retrospective Studies; Decompression, Surgical; Flatulence; Sigmoid Diseases; Lumbar Vertebrae; Pain; Colon, Sigmoid
PubMed: 36635912
DOI: 10.5152/tjg.2023.22201 -
BMC Pediatrics Feb 2021In neonatal intensive care unit (NICU) patients with intubation status, fluoroscopic evaluation for the bowel is limited. This study was to evaluate the utility of...
BACKGROUND
In neonatal intensive care unit (NICU) patients with intubation status, fluoroscopic evaluation for the bowel is limited. This study was to evaluate the utility of bedside upper gastrointestinal (UGI) series with delayed radiographs (DR) for assessing duodenojejunal junction (DJJ) and small bowel passage in NICU patients with nonspecific bowel ultrasonography and contrast enema findings.
METHODS
We reviewed clinical and imaging data for bedside UGI with DR of NICU patients from 2014 to 2019. Five abdominal radiographs were obtained at fixed time intervals of immediately after, 1 min, 5 min, 1 h, and 2 h following the administration of 5 cc/kg isotonic water-soluble contrast agent via the nasogastric tube.
RESULTS
Twenty bedside UGI with DR were performed in 17 patients (weight range: 520-3620 g, age range: 0-4 months). Confidence identifying the DJJ was either good (n = 7) or equivocal (n = 8) at immediate or 1 min radiographs. The DJJ could not be evaluated in five from four delayed passage (including two meconium plug syndrome and one gastric volvulus) and one inadequate timing. There was only one case of intestinal malrotation, which was not detected on ultrasonography, but detected at the first UGI examination with good DJJ confidence.
CONCLUSIONS
Bedside UGI with DR can evaluate intestinal malrotation using immediate and 1 min delay and small bowel passage using 1 and 2 h delay images in NICU patients with nonspecific ultrasonographic and contrast enema findings. The majority with delayed contrast passages can have bowel pathology. Because of a small number of patients in this study, further studies with more infants are needed.
Topics: Digestive System Abnormalities; Humans; Infant; Infant, Newborn; Intensive Care Units, Neonatal; Intestinal Volvulus; Radiography; Ultrasonography
PubMed: 33607968
DOI: 10.1186/s12887-021-02554-x -
The Canadian Veterinary Journal = La... Feb 2021An unusual condition in a 3-month-old Shire colt presented for colic unresponsive to medical therapy is documented in this report. A redundant mesocolonic mesentery...
An unusual condition in a 3-month-old Shire colt presented for colic unresponsive to medical therapy is documented in this report. A redundant mesocolonic mesentery resulting in intestinal displacement and volvulus was diagnosed during exploratory celiotomy. The finding was presumed to be congenital, resulting in a loose anatomic configuration that predisposed the intestine to displacement, torsion, volvulus, and entrapment. Key clinical message: This case demonstrates that congenial anatomical anomalies should be included in the differential of younger animals presented for recurrent conditions and highlights the use of exploratory celiotomy to reach a definitive diagnosis.
Topics: Animals; Colic; Horse Diseases; Horses; Intestinal Volvulus; Male; Mesentery
PubMed: 33542558
DOI: No ID Found -
PloS One 2017Small bowel volvulus is a rare disease, which is also challenging to diagnose. The aims of this study were to characterize the clinical and radiological features...
OBJECTIVES
Small bowel volvulus is a rare disease, which is also challenging to diagnose. The aims of this study were to characterize the clinical and radiological features associated with small bowel volvulus and treatment and to identify risk factors for associated small bowel necrosis.
METHODS
Patients with small bowel volvulus who underwent operations from January 2001 to December 2015 at the First Affiliated Hospital of China Medical University (Shenyang, China) were reviewed. Clinical, surgical and postsurgical data were registered and analyzed.
RESULTS
Thirty-one patients were included for analysis. Fifteen patients were female (48.4%), with an average age of 47.7 years (18-79 years). The clinical signs and symptoms were unspecific and resembled intestinal obstruction. Clinical examination revealed abdominal distension and/or diffuse tenderness with or without signs of peritonitis. The use of CT scans, X-rays or ultrasound did not differ significantly between patients. In 9 of 20 patients that received abdominal CT scans, "whirlpool sign" on the CT scan was present. Secondary small bowel volvulus was present in 58.1% of patients, and causes included bands (3), adhesion (7), congenital anomalies (7) and stromal tumor (1). Out of the 31 patients, 15 with gangrenous small bowel had to undergo intestinal resection. Intestinal gangrene was present with higher neutrophils count (p<0.0001) and the presence of bloody ascites (p = 0.004). Three patients died of septic shock (9.68%), and the recurrence rate was 3.23%.
CONCLUSIONS
To complete an early and accurate diagnosis, a CT scan plus physical exam seems to be the best plan. After diagnosis, an urgent laparotomy must be performed to avoid intestinal necrosis and perforation. After surgery, more than 90% of the patients can expect to have a favorable prognosis.
Topics: Adolescent; Adult; Aged; Female; Humans; Intestinal Obstruction; Intestinal Volvulus; Intestine, Small; Male; Middle Aged; Risk Factors; Young Adult
PubMed: 28426721
DOI: 10.1371/journal.pone.0175866 -
The Pan African Medical Journal 2023Caecal volvulus is a rare cause of mechanical bowel obstruction (1-1.5%) that carries a high mortality rate if diagnosis or surgical intervention is delayed. We report a...
Caecal volvulus is a rare cause of mechanical bowel obstruction (1-1.5%) that carries a high mortality rate if diagnosis or surgical intervention is delayed. We report a 35-year-old man who presented with acute colicky abdominal pain, vomiting, and constipation for the past 18 hours. A plain abdominal X-ray showed distended large bowel loops with two large well-defined air-fluid levels superimposed on each other, suggestive of caecal volvulus. The patient underwent emergency laparotomy, and the intraoperative finding confirmed the diagnosis of gangrenous extended caecal volvulus, which involves the terminal ileum, cecum, and the whole of the ascending colon. A right hemicolectomy was performed, and bowel continuity was restored by primary ileotransverse anastomosis. The patient recovered without complications and was discharged on postoperative day 6. In conclusion, caecal volvulus is a rare cause of adult intestinal obstruction. Early diagnosis and surgical intervention can prevent perforation and reduce morbidity related to volvulus perforation.
Topics: Male; Adult; Humans; Intestinal Volvulus; Cecal Diseases; Intestinal Obstruction; Cecum; Colectomy
PubMed: 37034486
DOI: 10.11604/pamj.2023.44.37.37403 -
Orphanet Journal of Rare Diseases May 2023Intestinal malrotation is a rare congenital condition with potentially devastating consequences due to potential volvulus and massive intestinal necrosis. Diagnosis is...
BACKGROUND
Intestinal malrotation is a rare congenital condition with potentially devastating consequences due to potential volvulus and massive intestinal necrosis. Diagnosis is often delayed and long-term symptoms following surgical correction are poorly characterized. We developed the Intestinal Malrotation Patient Outcomes and WEllness Registry (IMPOWER), a national patient-generated registry (PGR), to capture data related to presenting symptoms, testing, diagnosis, treatment, and follow-up of individuals diagnosed with malrotation. IMPOWER captures patient-reported information from adult patients and parents/caregivers of children diagnosed with malrotation at the time of enrollment and at ongoing 6-month intervals. We present baseline characteristics of patients enrolled during the first two months of the registry.
RESULTS
Within the first two months, 354 patients with malrotation enrolled in IMPOWER, and 191 (53.9%) completed all baseline assessments. Nearly 90% of the 119 pediatric participants and 37.7% of the 72 adult participants experienced symptoms prior to diagnosis. Vomiting was the predominant symptom for pediatric participants compared to abdominal pain in adults. Yellow bilious emesis was more commonly reported than green, and volvulus at diagnosis occurred in 70% of pediatric and 27% of adult participants. One-third of pediatric participants had a bowel resection as part of their initial surgical procedure, resulting in 23.4% with diagnosed short bowel syndrome. More than 60% of pediatric and 80% of adult registrants reported gastrointestinal symptoms that persisted throughout the first year following their initial operation. Approximately 25% of registrants reported visiting four or more gastroenterologists for management of ongoing symptoms.
CONCLUSIONS
Fewer than half of pediatric patients presented with the "classic" presentation of green bilious colored emesis. Yellow bilious emesis was more commonly reported, and chronic gastrointestinal symptoms (i.e., abdominal pain, reflux, constipation, diarrhea) and feeding intolerance were common following surgical procedures for malrotation. This novel PGR highlights the need for a multicenter prospective registry to characterize the natural history and develop consistent standards of care related to the diagnosis, treatment, and long-term care for patients with malrotation.
Topics: Adult; Child; Humans; Infant, Newborn; Intestinal Volvulus; Digestive System Surgical Procedures; Vomiting; Abdominal Pain; Treatment Outcome
PubMed: 37170358
DOI: 10.1186/s13023-023-02722-5 -
Cirugia Y Cirujanos 2023Various complications occur after a biliary-digestive reconstruction. Volvulus of a segment of the biliodigestive loop has not been described. Two patients who underwent...
Various complications occur after a biliary-digestive reconstruction. Volvulus of a segment of the biliodigestive loop has not been described. Two patients who underwent biliodigestive bypass, years later, began with sudden and intense abdominal pain, associated with a volvulus with necrosis of a segment of this biliodigestive loop. This complication occurred many years after the initial correction, and manifested with sudden abdominal pain without impaired liver function, as occurred in these patients.
Topics: Child; Humans; Intestinal Volvulus; Anastomosis, Roux-en-Y; Abdominal Pain; Postoperative Complications
PubMed: 38096865
DOI: 10.24875/CIRU.22000346 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Apr 2023Sigmoid volvulus is a pathology that can be mortal because it is frequently encountered in elderly patients. In case of bowel gangrene, mortality and morbidity increase...
BACKGROUND
Sigmoid volvulus is a pathology that can be mortal because it is frequently encountered in elderly patients. In case of bowel gangrene, mortality and morbidity increase further. We planned a retrospective study, in which the effectiveness of the model was evaluated by creating a model that aims to predict whether intestinal gangrene is present in patients with sigmoid volvulus only by blood tests and thus to quickly guide treatment methods.
METHODS
In addition to demographic data such as age and gender, laboratory values such as white blood cell, C-reactive protein (CRP), lactate dehydrogenase (LDH), potassium, and colonoscopic findings and whether there was gangrene in the colon during the operation were evaluated retrospectively. In the analysis of the data, independent risk factors were determined by univariate and multivariate logistic regression analyzes as well as Mann-Whitney U and Chi-square tests. Receiver operating characteristic (ROC) analysis was performed for statistically significant continuous numerical data, and cutoff values were determined and Malatya Volvulus Gangrene Model (MVGM) was created. The effectiveness of the created model was again evaluated by ROC analysis.
RESULTS
Of the 74 patients included in the study, 59 (79.7%) were male. The median age of the population was 74 (19-88), and gangrene was detected in 21 (28.37%) patients at surgery. In univariate analyzes, leukocytes <4000/mm3 and >12000/mm3 (OR: 10.737; CI 95%: 2.797-41.211, p=0.001), CRP ≥0.71 mg/dl (OR: 8.107 CI 95%: 2.520-26.082, p<0.0001), potassium ≥3.85 mmoL/L (OR: 3.889; 95% CI): 1.333-11.345, p=0.013), and LDH ≥288 U/L (OR: 3.889; CI 95%: 1.333-11.345, p=0.013), whereas, in multivariate analyzes, only CRP ≥0.71 mg/dL (OR: 3.965; CI 95%: 1.071-15.462, p=0.047) was found to be an independent risk factor for bowel gangrene. The strength of MVGM was AUC 0.836 (0.737-0.936). In addition, it was observed that the probability of bowel gangrene increased approximately 10 times if MVGM was ≥7 (OR: 9.846; 95% CI: 3.016-32.145, p<0.0001).
CONCLUSION
Besides being non-invasive compared to the colonoscopic procedure, MVGM is a useful method for detecting bowel gangrene. In addition, it will guide the clinician in taking the patients with intestinal loop gangrene to emergency surgery without wasting time in the treatment steps, as well as avoiding complications that may occur during colonoscopy. In this way, we think that morbidity and mortality rates can be reduced.
Topics: Humans; Male; Aged; Female; Intestinal Volvulus; Retrospective Studies; Gangrene; Colonoscopy; Colon; Mesenteric Ischemia
PubMed: 36995205
DOI: 10.14744/tjtes.2022.11893