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PubMed1994

Acute and chronic presentation of intestinal nonrotation in adults.

Intestinal nonrotation has been recognized as a cause of obstruction in neonates and children and may be complicated by volvulus and intestinal necrosis. It is very rarely seen in the adult and may present acutely as a bowel obstruction and intestinal ischemia associated with midgut or ileocecal volvulus, or chronically as vague intermittent abdominal pain. The purpose of this communication is to reveal the pathogenesis and the surgical significance of intestinal nonrotation in adults and to review the English and German language literature since 1923 to establish the optimal therapeutic management. Between 1983 and 1992, we have managed and observed prospectively 10 adults with intestinal nonrotation. In four patients the nonrotation has been detected at emergency laparotomy owing to midgut or ileocecal volvulus. Four patients suffered from chronic symptoms of intermittent volvulus or small bowel obstruction and in two patients the nonrotation has been noted as an incidental finding at laparotomy for another condition. A survey of the literature from 1923 to 1992 revealed 40 adults with symptomatic intestinal nonrotation to which we contribute nine patients. We establish that in the acute symptomatic pattern, only emergency laparotomy can provide the correct diagnosis and decrease the risk of bowel disturbance. In the chronic situation, barium studies of the upper and lower gastrointestinal tract reveal varying degrees of midgut malrotation and confirm the nonrotation in each case. Also, in these forms the explorative laparotomy with a consequent staging of the abdominal situs is to be recommended. All reported cases at our institutions are without complaints after surgery. Adult patients with intestinal nonrotation and acute or chronic obstructive symptoms or those detected incidentally at laparotomy for other conditions should undergo a Ladd procedure because of the risk of midgut volvulus. In this operation, the nonrotation is left in place and the ascending colon is sutured at the colon descendens and sigmoideum. After this procedure the mesenteric pedicle is fixed and the risk of midgut torsion remains minimal.

Abdomen, Acute↗
PubMedDate not supplied

Observations on the pattern of vomiting and morbidity in patients with acute sigmoid volvulus.

BACKGROUND: Vomiting is usually a late and an infrequent symptom of colonic obstructions. Contrary to this general rule, it occurs early and more frequently in some cases of sigmoid volvulus. AIM: To study the clinical significance of vomiting in patients with sigmoid volvulus. SETTING: Teaching hospital in Western Orissa, India STUDY DESIGN: Prospective observational study MATERIAL AND METHODS: Prospectively enrolled subjects with sigmoid volvulus diagnosed on the basis of clinical, radiological and laparotomy evidence were included in the study carried out in a tertiary care centre in India. Detailed history was obtained from them, especially to elicit information about the occurrence of various symptoms. Information regarding type of vomiting was also obtained. Efforts were made to exclude other causes of vomiting. Statistical tests such as Chi-Square test, Fisher's exact test or Student's t test were used. RESULTS: Ninety-three consecutive subjects with sigmoid volvulus were enrolled. Five patients with possible other aetiologies for vomiting and seven patients with compound sigmoid volvulus were eliminated from further analysis. Two patterns of vomiting were noted in 81 evaluable patients with sigmoid volvulus. In 33 patients (Group A), vomiting preceded or coincided with the onset of other abdominal symptoms (Type 1 vomiting). In 48 patients (Group B) vomiting occurred after the onset of other abdominal symptoms (Type 2 vomiting). The period between the onset of these symptoms and that of vomiting varied from a few hours to several days. Group A patients sought medical help much earlier than those of Group B. Incidences of circulatory shock (24% vs. 8%), haemorrhagic ascites (21% vs. 6%) and colonic gangrene (64% vs. 35%) were significantly higher in Group A than in Group B. The mortality rate (15% vs. 4%) was higher in Group A as well. About 25% (n = 7) of Group A patients in contrast to 4% (n=2) of Group B required hospitalization exceeding 3 weeks. Vomitus was predominantly non-bilious (21 out of 33 patients) in Group A (64%) and bilious (10 out of 11 patients) in Group B (91%). CONCLUSION: Type 1 vomiting appears to be an indicator of more severe presentation and is associated with an increased morbidity and mortality. This study suggests that the pattern of vomiting could be a simple and useful predictor of prognosis in sigmoid volvulus.

Aged↗
PubMed1997

Recurrent colonic volvulus in children.

Recurrent intestinal obstruction caused by colonic volvulus is a rare cause of intestinal obstruction in children. Because the condition is self rectifying at times, the diagnosis can be missed or delayed. The authors present two patients, one with sigmoid volvulus and the other with sigmoid and cecal volvulus, and discuss the diagnosis and management of this condition in children. In view of the recurring nature of this condition, the authors believe that nonoperative treatment of this condition in children has no place beyond the emergency situation and that the definitive treatment should always be surgical.

Child↗