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At least 235 records · Page 13Linked to original sources
PubMed1999

Intestinal obstruction from midgut volvulus after laparoscopic cholecystectomy. A report of an unusual complication.

Congenital midgut malrotation, a rare anatomic anomaly that can lead to duodenal or small bowel obstruction, rarely is recognized beyond the first year of life. We report a case of unrecognized congenital midgut malrotation that resulted in midgut volvulus, causing intestinal obstruction and requiring emergent reoperation after laparoscopic cholecystectomy. This unusual complication, first reported in 1994, involved a 56-year-old man and resulted in cecal infarction recognized and treated on the second postoperative day. This second case describes a less acute postoperative course, with multiple bouts of partial bowel obstruction leading to two readmissions and finally resulting in a reexploration and definitive treatment on the 19th postoperative day.

Adult↗
PubMed2005

Surgical treatment of malrotation after infancy: a population-based study.

PURPOSE: Because malrotation most commonly presents in infants, treatment recommendations for older children (>1 year) have been based on data obtained from small case series. The purpose of this study was to use a large national database to determine the clinical significance of older children presenting with malrotation to develop treatment recommendations for this group. METHODS: Records of children undergoing a Ladd's procedure were identified in the Kids' Inpatient Database, an administrative database that contains all pediatric discharges from 27 states during 2000. Patient characteristics, associated diagnoses, operations performed, and mortality were evaluated. Discharge weighting was used to obtain a national estimate of the number of children older than 1 year treated for malrotation. RESULTS: Two hundred nineteen older children (>1 and <18 years) undergoing a Ladd's procedure were identified in the database. One hundred sixty-four (75%) of these patients were admitted for treatment of malrotation, whereas most of the remaining 55 patients (25%) were admitted for another diagnosis and underwent a Ladd's procedure incidental to another abdominal operation. Seventy-five patients underwent a Ladd's procedure during an emergency admission. Thirty-one patients had volvulus or intestinal ischemia, 7 underwent intestinal resection, and 1 patient died. Based on case weightings, it was estimated that 362 older children underwent a Ladd's procedure for symptoms related to malrotation in 2000 in the United States (5.3 cases per million population). CONCLUSIONS: These findings provide support for performing a Ladd's procedure in older children with incidentally found malrotation to prevent the rare but potentially devastating complications of this anomaly.

Adolescent↗
PubMed2000

Pattern of acute abdomen in Yirgalem Hospital, southern Ethiopia.

A retrospective analysis was undertaken on 229 cases of acute surgical abdomen surgically managed at Yirgalem hospital from January to December 1997. Small intestinal obstruction ranked the first and it was mainly due to small intestinal volvulus. Acute appendicitis was the second in the rank. Large intestinal obstruction was the third and it was mainly due to sigmoid volvulus. Typhoid perforation, primary peritonitis, perforated gastroduodenal ulcer, abdominal tuberculosis and empyema of the gallbladder in that order were the other observed causes of acute surgical abdomen. Analysis based on the specific causes of acute abdomen is of great value for early diagnosis and prompt treatment in clinical practice.

Abdomen, Acute↗
PubMed2001

Cecal volvulus causing postoperative intestinal obstruction: report of a case.

Cecal volvulus is a rare cause of intestinal obstruction after major abdominal surgery. A case of cecal volvulus occurring in the early postoperative period after left colon resection for malignancy is presented. Clinical evaluation and plain abdominal radiographs suggesting cecal volvulus prompted laparotomy and correction. Delay in diagnosis results in high mortality, and treatment depends largely on the viability of the involved intestine. This report describes the second case of cecal volvulus complicating a left colectomy. It was treated by detorsion and reperitonealization cecopexy.

Aged↗
PubMed1993

Cecal volvulus: the CT whirl sign.

Cecal volvulus is a rare, but potentially fatal, cause of intestinal obstruction. As computed tomographic (CT) scanning is often the initial diagnostic test in patients with acute abdominal pain, we reiterate the importance of the "whirl sign" in diagnosing intestinal volvulus. We report the first description of the CT diagnosis of cecal volvulus.

Aged↗
PubMed2003

Omentum pediculed musculo-peritoneal flap (OPMP) for growing intestinal neomucosa in a rat model.

BACKGROUND/PURPOSE: To construct a musculo-peritoneal flap adequately vascularised through attached omentum and to evaluate whether this flap is functional for growing new intestinal mucosa. METHODS: 24 rats underwent two surgical procedures. 1) A musculo-peritoneal flap was prepared, omentum was fixed onto the muscular side and a silicon graft was placed on the peritoneal side. 2) After one month the so constructed OPMP flap was mobilised and attached to the jejunum. Animals were harvested at 2, 4 and 8 months for macroscopic and microscopic evaluation. RESULTS: One rat died at 7 months due to intestinal volvulus. In the remainder the circumference of the patched intestine significantly increased compared to that of normal intestine (p<0.001). The flaps were markedly contracted in the 4 month rats (p<0.01). All flaps were completely covered by neomucosa except in the 2 month rats. Crypt depth and crypt density of the neomucosa was significantly lower in 2 month rats compared to other groups (p<0.05). Similarly neomucosal villous height was markedly low in the 2 month rats (p<0.01). CONCLUSIONS: To date, we have found no reports of small bowel patching using this technique. In this context, use of OPMP flap is likely to be useful for increasing intestinal surface area.

Animals↗
PubMed1977

Congenital positional anomalies of the colon: radiographic diagnosis and clinical implications. I. Abnormalities of rotation.

Positional anomalies of the colon may be explained by an arrest in the normal development process of the distal midgut. Aberrations involving the incipient stages of rotation lead to severe malpositions, while those involving the latter stages to milder forms. The normal embryology of the distal (postarterial) segment, as well as forms of complete and partial nonrotations, are discussed and illustrated. A survey of 39 consecutive cases of rotational abnormalities of the midgut with special emphasis on the configuration of the colon is presented. There is a high incidence of associated failure of fixation resulting in mobile colons that can be demonstrated radiographically. In addition, the great majority of colonic malrotations demonstrate rotational abnormalities involving the proximal intestinal tract. Their clinical implication is related to the presence of other incidental congenital anomalies or to complications derived from faulty mesenteric fixations such as peritoneal bands, adhesions, kinking, or intestinal volvulus.

Colon↗
PubMedDate not supplied

[Volvulus of the sigmoid colon].

Sigmoid colon is the most frequent side for a volvulus. We present four cases of sigmoid volvulus admitted to our department during the period July 1994-December 1995. Intestinal volvulus, despite its benignity, has a quite high morbidity and mortality. Important factors such as the patient's features and frequent late diagnosis can influence the complicated outcome of the disease. Plane X-ray of the abdomen is helpful while barium enema can be therapeutical because of the pressure of the inflated air. Sigmoid resection is the most effective treatment for the disease.

Aged↗
PubMed1993

The short bowel syndrome: what's new and old?

Conditions which resulted in colonic preservation such as strangulated hernia, intestinal volvulus, and mesenteric infarction were once the main reasons for a major intestinal resection leading to the short bowel syndrome. Now Crohn's disease is the most common underlying diagnosis; such patients often have a jejunostomy. A measurement of the residual jejunal length from the duodenojejunal flexure makes possible predictions of patient outcome. Patients with a jejunostomy and less than 100 cm jejunum usually need long-term parenteral support, whereas 50 cm or more of jejunum usually suffices for adequate oral nutrition if the colon is preserved. While patients with and without a colon have problems with nutrient absorption, those with a jejunostomy also have problems of water, sodium and magnesium losses. Stomal losses may exceed oral intake and all such patients ('secretors') need parenteral supplements. Fluid and sodium losses can be reduced by octreotide, omeprazole or H2 blockers but not sufficiently to avoid the need for intravenous supplements. Colonic preservation increases the incidence of calcium oxalate renal stones (20%). Patients with and without a colon have a high prevalence of gallstones (40%). Clinically important intestinal adaptation occurs in those with a colon but not in those with a jejunostomy. Many surgical techniques, including small bowel transplantation, have been suggested to improve absorption, but as the quality of life of most patients with a short bowel is good with current treatments, they are not at present recommended.

Adaptation, Physiological↗
PubMedDate not supplied

Management of sigmoid colon volvulus.

BACKGROUND/AIMS: Sigmoid colon is the most frequent site for a volvulus. The condition has been a formidable one, fraught with innumerable complications responsible for many deaths. In this report, we reviewed our experience with sigmoid colon volvulus. METHODOLOGY: We present our experience of 61 cases of sigmoid volvulus admitted to our department. Twenty-four patients were subjected to non-operative decompression and the others underwent emergency operation. RESULTS: Intestinal volvulus has quite a high morbidity and mortality. Mortality rate of elective resection following sigmoidoscopy was 7.6%. Mortality rate for emergency surgical detortion, primary resection and Hartman procedure were respectively 13%, 16.6% and 37.5%. Important factors such as the patient's features and frequent late diagnosis can influence the complicated outcome of the disease. Plain X-ray of the abdomen is helpful. CONCLUSIONS: Management with the conservative method of treatment in the form of detortion by sigmoidoscopy and rectal tube application is initially effective in most cases of volvulus of the sigmoid colon. On the other hand, elective or emergency sigmoid resection is the most effective treatment for the disease.

Adult↗
PubMed1988

Isolated intestinal myopathy resembling progressive systemic sclerosis in a child.

A 15-yr-old girl had a life-threatening episode of toxic megacolon at age 6 yr and a life-long history of constipation and abdominal distention. A diagnosis of chronic intestinal pseudoobstruction was made. Her clinical course was that of repeated bouts of pseudoobstruction, multiple episodes of intestinal volvulus at different sites, and progressive cachexia. Histologic examination of specimens of jejunum, ileum, appendix, and colon revealed progressive fibrotic changes in intestinal smooth muscle. The abnormalities observed are most consistent with those described in progressive systemic sclerosis, but no cutaneous manifestations of this disorder have been noted in this child, and no abnormalities in other organs have been detected. Thus, this patient represents a childhood case of chronic intestinal pseudoobstruction caused by a disorder closely resembling progressive systemic sclerosis confined to the gastrointestinal tract.

Adolescent↗