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The Pan African Medical Journal 2021Colonic volvulus usually occurs as a single event that can affect various parts of the colon. The usual sites affected being the sigmoid colon (75%) and the caecum...
Colonic volvulus usually occurs as a single event that can affect various parts of the colon. The usual sites affected being the sigmoid colon (75%) and the caecum (22%). The phenomenon of multiple sites simultaneously undergoing volvulus is an extremely rare occurrence. We report a rare case of simultaneous sigmoid and transverse colon volvulus in a 52-year-old female. The clinical presentation and the radiological findings were that of large bowel obstruction. A subtotal colectomy and colocolic anastomosis were performed and the postoperative period was uneventful. Though rare the development of transverse and sigmoid volvulus in the same patient must always be considered in the differential diagnosis, when dealing with recurrent intermittent abdominal pain or acute intestinal obstruction.
Topics: Abdominal Pain; Anastomosis, Surgical; Colectomy; Colon, Sigmoid; Colon, Transverse; Female; Humans; Intestinal Obstruction; Intestinal Volvulus; Middle Aged
PubMed: 34046136
DOI: 10.11604/pamj.2021.38.231.27470 -
Journal of the American Veterinary... Apr 2014An 8-year-old male red kangaroo (Macropus rufus) was evaluated with a 2-week history of vomiting and anorexia. Four days prior, the patient became refractory to medical...
CASE DESCRIPTION
An 8-year-old male red kangaroo (Macropus rufus) was evaluated with a 2-week history of vomiting and anorexia. Four days prior, the patient became refractory to medical management. The kangaroo was admitted for diagnostic testing and treatment including whole body CT, blood work, and emergency laparotomy.
CLINICAL FINDINGS
CT findings of a severely enlarged stomach, splenic displacement, and a whirl sign were indicative of mesenteric volvulus with gastric dilatation-volvulus (GDV). Contrast enhancement of abdominal viscera suggested intact arterial blood supply; however, compression of the caudal vena cava and portal vein indicated venous obstruction. Results of preoperative blood work suggested biliary stasis without evidence of inflammation. Additionally, a tooth root abscess was diagnosed on the basis of results of CT.
TREATMENT AND OUTCOME
Exploratory laparotomy confirmed the diagnosis of mesenteric volvulus and GDV. The volvuli were corrected by clockwise derotation, and a gastropexy was performed. Tissue samples were obtained from the spleen and liver for evaluation. The kangaroo recovered from surgery, and the abscessed tooth was extracted 6 days later. Eight days after initial evaluation, the kangaroo was discharged.
CLINICAL RELEVANCE
In the present report, the CT whirl sign was used to diagnose volvulus of the abdominal viscera, which suggests that this diagnostic indicator has utility in veterinary patients. Mesenteric volvulus with GDV was successfully treated in a nondomestic species. The tooth root abscess, a common condition in macropods, may explain the historic episodes of anorexia reported by the owner and may have contributed to the development of mesenteric volvulus and GDV in this kangaroo.
Topics: Animals; Animals, Zoo; Gastric Dilatation; Intestinal Volvulus; Macropodidae; Male; Mesentery
PubMed: 24649996
DOI: 10.2460/javma.244.7.844 -
Radiologia 2010To determine the sensitivity of plain-film radiography and computed tomography (CT) in the diagnosis of cecal volvulus.
OBJECTIVE
To determine the sensitivity of plain-film radiography and computed tomography (CT) in the diagnosis of cecal volvulus.
MATERIAL AND METHODS
We reviewed the clinical histories of 11 patients diagnosed with cecal volvulus at endoscopy or surgery. Two radiologists working in consensus analyzed the findings at plain-film radiography and at CT and calculated the sensitivities. The plain-film and CT studies were retrospectively classified as certain, probable, or indeterminate for cecal volvulus on the basis of the presence or absence of previously reported signs. Signs of wall suffering at CT were compared to the histologic findings.
RESULTS
The most sensitive findings at plain-film radiography were the presence of a disproportionately dilated bowel loop and a pattern of distal small bowel occlusion (91%), followed by a single air-fluid level in the cecum and collapse of the distal colon (82%). At CT, the "coffee bean" sign with a single air-fluid level and collapse of the left colon had a sensitivity of 100%. The whirl sign was present in 86%. Retrospectively, 36% of the plain-film studies and 86% of the CT studies were classified as certain for cecal volvulus. Although all cases with ischemia had signs of vascular compromise on CT, no significant correlation was observed between these variables.
CONCLUSIONS
The plain-film signs reported for cecal volvulus enable a certain diagnosis in a third of all cases; the CT signs enable a certain diagnosis in most cases. The evaluation of additional findings increases the chances of reaching the correct diagnosis.
Topics: Adult; Aged; Aged, 80 and over; Cecal Diseases; Female; Humans; Intestinal Volvulus; Male; Middle Aged; Retrospective Studies; Tomography, X-Ray Computed; Young Adult
PubMed: 20546819
DOI: 10.1016/j.rx.2010.03.014 -
The Medical Journal of Malaysia Apr 2017In-utero intestinal volvulus is a rare but potential life threatening foetal complications. It is a surgical emergency and delay in diagnosis or treatment can increase...
In-utero intestinal volvulus is a rare but potential life threatening foetal complications. It is a surgical emergency and delay in diagnosis or treatment can increase the morbidity and mortality to the foetus. We report a case of mild foetal bowel dilatation diagnosed at 21 weeks of gestation. She was closely follow up and at 31 weeks of gestation, in-utero intestinal volvulus was diagnosed with the characteristic 'whirlpool' sign on ultrasound examination. This case emphasises the importance of early recognition and quick decision to delivery when intestinal volvulus is diagnosed. This enabled early surgical intervention to prevent further foetal morbidity.
Topics: Adult; Cesarean Section; Female; Humans; Intestinal Volvulus; Male; Pregnancy; Ultrasonography, Prenatal
PubMed: 28473678
DOI: No ID Found -
PloS One 2022With limited national studies available, we characterized the association of frailty with outcomes of surgical resection for colonic volvulus.
BACKGROUND
With limited national studies available, we characterized the association of frailty with outcomes of surgical resection for colonic volvulus.
METHODS
Adults with sigmoid or cecal volvulus undergoing non-elective colectomy were identified in the 2010-2019 Nationwide Readmissions Database. Frailty was identified using the Johns Hopkins indicator which utilizes administrative codes. Multivariable models were developed to examine the association of frailty with in-hospital mortality, perioperative complications, stoma use, length of stay, hospitalization costs, non-home discharge, and 30-day non-elective readmissions.
RESULTS
An estimated 66,767 patients underwent resection for colonic volvulus (Sigmoid: 39.6%; Cecal: 60.4%). Using the Johns Hopkins indicator, 30.3% of patients with sigmoid volvulus and 15.9% of those with cecal volvulus were considered frail. After adjustment, frail patients had higher risk of mortality compared to non-frail in both sigmoid (10.6% [95% CI 9.47-11.7] vs 5.7% [95% CI 5.2-6.2]) and cecal (10.4% [95% CI 9.2-11.6] vs 3.5% [95% CI 3.2-3.8]) volvulus cohorts. Frailty was associated with greater odds of acute venous thromboembolism occurrences (Sigmoid: AOR 1.50 [95% CI 1.18-1.94]; Cecal: AOR 2.0 [95% CI 1.50-2.72]), colostomy formation (Sigmoid: AOR 1.73 [95% CI 1.57-1.91]; Cecal: AOR 1.48 [95% CI 1.10-2.00]), non-home discharge (Sigmoid: AOR 1.97 [95% CI 1.77-2.20]; Cecal: AOR 2.56 [95% CI 2.27-2.89]), and 30-day readmission (Sigmoid: AOR 1.15 [95% CI 1.01-1.30]; Cecal: AOR 1.26 [95% CI 1.10-1.45]). Frailty was associated with incremental increase in length of stay (Sigmoid: +3.4 days [95% CI 2.8-3.9]; Cecal: +3.8 days [95% CI 3.3-4.4]) and costs (Sigmoid: +$7.5k [95% CI 5.9-9.1]; Cecal: +$12.1k [95% CI 10.1-14.1]).
CONCLUSION
Frailty, measured using a simplified administrative tool, is associated with significantly worse clinical and financial outcomes following non-elective resections for colonic volvulus. Standard assessment of frailty may aid risk-stratification, better inform shared-decision making, and guide healthcare teams in targeted resource allocation in this vulnerable patient population.
Topics: Adult; Humans; Intestinal Volvulus; Frailty; Treatment Outcome; Colectomy; Patient Readmission; Postoperative Complications; Retrospective Studies; Risk Factors; Length of Stay
PubMed: 36346811
DOI: 10.1371/journal.pone.0276917 -
Annals of the Royal College of Surgeons... Apr 2022Small bowel volvulus is a rare but life-threatening emergency. Volvulus of the duodenum is even rarer without the presence of predisposing factors. The clinical...
Small bowel volvulus is a rare but life-threatening emergency. Volvulus of the duodenum is even rarer without the presence of predisposing factors. The clinical presentation is vague, including abdominal pain, nausea and vomiting, prompt diagnosis of volvulus therefore relies heavily on radiographs. The treatment options lie between conservative or surgical management, where the decision is influenced by the patient and their presentation. This case is of a 100-year-old female with an extensive surgical and medical background presenting with signs of small bowel obstruction. With the help of imaging, a rare case of duodenal volvulus was diagnosed but managed conservatively due to the patient's background, age and personal wishes.
Topics: Abdominal Pain; Aged, 80 and over; Duodenal Obstruction; Duodenum; Female; Humans; Intestinal Volvulus; Intestine, Small
PubMed: 34846192
DOI: 10.1308/rcsann.2021.0242 -
Journal of Medical Case Reports Oct 2022Persistent descending mesocolon, an anomaly of fixation of the mesentery of the descending colon, can sometimes cause complications such as intestinal obstruction and...
BACKGROUND
Persistent descending mesocolon, an anomaly of fixation of the mesentery of the descending colon, can sometimes cause complications such as intestinal obstruction and intussusception. We present the first reported case of sigmoid volvulus with persistent descending mesocolon.
CASE PRESENTATION
An 82-year-old Japanese man had intermittent lower abdominal pain. Abdominal computed tomography showed dilation and a shift to the right side of the sigmoid colon, but no findings of volvulus. The next day, he presented continuous lower abdominal pain with bloody stool. A second abdominal computed tomography showed strangulation and dilation of the sigmoid colon, with shift from the right side of the abdominal cavity to the pelvic space. This suggested the descending colon was running to the medial side with sigmoid volvulus. Emergency surgery was performed for volvulus with persistent descending mesocolon. Operative findings revealed dilation of the sigmoid colon with a partial poorly colored region and strangulation that caused volvulus. After releasing the strangulation of the sigmoid colon, the descending colon was revealed to be running more to the medial side, with adherence to small intestinal mesentery. There was no Toldt's fusion fascia at the descending colon. Persistent descending mesocolon was therefore diagnosed due to abnormality of fixation of the descending colon. The sigmoid colon, including the poorly colored region, was resected and reconstructed, while the inferior mesenteric and left colonic arteries were preserved because of the complexity of the vascular system running around the descending and sigmoid colon due to the shortened mesentery. These findings were pathologically compatible with circulatory compromise and intestinal degeneration due to sigmoid volvulus. The patient had no complications after discharge, including in relation to defecation.
CONCLUSION
Persistent descending mesocolon can occasionally cause acute abdominal symptoms requiring immediate treatment. A computed tomography finding of the descending colon running more to the medial side than ordinary cases can aid diagnosis of persistent descending mesocolon.
Topics: Abdomen, Acute; Abdominal Pain; Aged, 80 and over; Colon, Sigmoid; Humans; Intestinal Volvulus; Laparoscopy; Male; Mesocolon
PubMed: 36180925
DOI: 10.1186/s13256-022-03598-y -
The Canadian Veterinary Journal = La... Aug 2023A 2-year-old, spayed female, domestic shorthair cat was presented in compensated hypovolemic shock after 24 h of anorexia, vomiting, and lethargy. An enterotomy had been...
A 2-year-old, spayed female, domestic shorthair cat was presented in compensated hypovolemic shock after 24 h of anorexia, vomiting, and lethargy. An enterotomy had been performed at 9 mo of age to remove a foreign body. Due to inconclusive findings on abdominal imaging, an exploratory laparotomy was done. An adhesion at the root of the mesentery, likely associated with the previous surgery, had resulted in partial volvulus, entrapment, and extraluminal obstruction of the jejunum. Transection of the adhesion allowed repositioning of the bowel without the need for resection. The cat was discharged from the hospital 7 d postoperatively. Adhesions have not previously been reported to cause small bowel volvulus in cats. Key clinical message: Abdominal adhesions as a cause of clinical disease in cats have apparently not been reported. This case report demonstrates how malposition of the gastrointestinal tract, secondary to adhesions, should be included as a differential diagnosis for feline patients presenting with acute abdomens. Previous abdominal surgery is a risk factor for development of adhesions. This case emphasized the importance of Halsted's principles of surgery to reduce the risk of postoperative adhesions, even in species not predisposed to forming adhesions.
Topics: Cats; Animals; Female; Intestinal Volvulus; Jejunum; Intestinal Obstruction; Tissue Adhesions; Digestive System Surgical Procedures; Cat Diseases
PubMed: 37529392
DOI: No ID Found -
Revista Espanola de Enfermedades... Jun 2024We read the paper written by Garcia-Calonge et al. presenting a patient with Lewy body dementia and recurrent sigmoid volvulus (SV) treated with emergency surgery due to...
We read the paper written by Garcia-Calonge et al. presenting a patient with Lewy body dementia and recurrent sigmoid volvulus (SV) treated with emergency surgery due to gangrenous bowel. Our clinic has 1,063-case experience with SV over 56,5-year period between June 1966 and January 2023, which data signifies the largest monocenter SV series over the world. In the light of this experience, our comments relate to neuropsychiatric diseases-SV comorbidity, endoscopic decompression, and recurrence of SV.
Topics: Intestinal Volvulus; Humans; Sigmoid Diseases; Recurrence; Decompression, Surgical
PubMed: 37350669
DOI: 10.17235/reed.2023.9751/2023 -
BMJ Case Reports Jul 2019Caecal volvulus is an uncommon cause of intestinal obstruction, with a high associated morbidity and mortality. Caecal volvulus is a very rare complication following...
Caecal volvulus is an uncommon cause of intestinal obstruction, with a high associated morbidity and mortality. Caecal volvulus is a very rare complication following retroperitoneal surgery. As such, a high degree of clinical suspicion is warranted post operatively to minimise delay in definitively investigating and managing this condition. We present a case of an 80-year-old Caucasian woman who was admitted for an elective left-sided laparoscopic retroperitoneal nephroureterectomy for transitional cell carcinoma of the left upper pole renal calyx. Postoperatively, the patient developed intestinal obstruction, secondary to caecal volvulus. The patient underwent an emergency laparotomy and limited right-sided colonic resection with primary anastomosis.
Topics: Aged, 80 and over; Cecal Diseases; Female; Humans; Intestinal Volvulus; Laparoscopy; Nephroureterectomy; Postoperative Complications
PubMed: 31278197
DOI: 10.1136/bcr-2018-228878