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Clinics in diagnostic imaging (105): Sigmoid volvulus causing intestinal obstruction, with successful endoscopic decompression.

An 89-year-old woman was admitted for intestinal obstruction. Her abdominal radiograph showed typical features of sigmoid volvulus. Decompression was done successfully through careful flexible sigmoidoscopy with minimum air insufflation. The patient's symptoms were relieved and she was discharged two days post-procedure. No recurrence was noted at extended follow-up. Rapid diagnosis and early decompression are key to optimal management of sigmoid volvulus.

Aged, 80 and over↗

An analysis of 75 cases of intestinal obstruction caused by pedunculated lipomas.

A retrospective study of 75 cases of pedunculated lipoma obstruction (PLO) of the intestine was conducted. Age, breed and sex distributions were compared to the non-PLO colic population. Horses in the PLO group were significantly older than in the non-PLO colic group (P < 0.001). A significant increase in risk of PLO was associated with geldings (O.R. 2.32) and with ponies (O.R. 3.75). Of the 75 PLO cases analysed, 69 were strangulating, 70 involved small intestine and 5 involved small colon. Cases of strangulation obstruction tended to have lipomas originating distant to the mesenteric border of the intestine. The short-term survival rate for PLO cases was 48%. Long-term survival rate was 38%. Lipoma weight of some of the PLO group was compared with that from an asymptomatic pedunculated lipoma (APL) group. The two weight distributions were significantly different (P < 0.001).

Age Distribution↗

Congenital duodenal diaphragms in adults: a delayed cause of intestinal obstruction.

Congenital duodenal diaphragms in the adult are uncommon, unsuspected lesions that infrequently cause intestinal obstruction. The diaphragms may be single or multiple and are usually located near the ampulla of Vater. Three cases are summarized and the recent literature reviewed. At least 35 cases have been reported. Treatment most often consisted of duodenotomy,excision of the web and duodenal closure.

Aged↗

Use of gastroduodenal manometry to differentiate mechanical and functional intestinal obstruction: an analysis of clinical outcome.

OBJECTIVES: Our aim was to assess the outcome of patients whose gastrointestinal motility recording suggested intestinal mechanical obstruction. METHODS: Medical records were reviewed for operative reports and alternative diagnoses during at least 1-yr follow-up. RESULTS: During 1988-1992, 27 of 890 consecutive manometric recordings suggested mechanical obstruction: 20 with non-propagated, prolonged contractions, seven with a pattern of non-propagated clustered contractions that lasted > 30 min. Obstruction was confirmed at laparotomy in 17 (including two with progressive systemic sclerosis) and by radiology in one. In confirmed obstruction, 12 of 18 contrast radiographs performed prior to manometry were either normal or nondiagnostic. One laparotomy was negative for obstruction; nine patients who did not undergo laparotomy were classified as unobstructed. Manometric recordings showed prolonged contractions in two, clustered contractions in three, and a mixed pattern in four. Positive predictive values of these patterns for obstruction were: prolonged contractions, 82%; clustered contractions, 57%; and mixed pattern, 56%. CONCLUSIONS: Thus, non-propagated, prolonged contractions in small bowel should prompt a search for obstruction, even when this is equivocal on barium small bowel radiography.

Adolescent↗

Localized visceral invasion of peritoneal mesothelioma causing intestinal obstruction: a new clinical presentation.

Peritoneal mesothelioma is a surface malignancy involving the serous surfaces of the abdominal cavity. In the case presented here, the disease presented itself in a manner that has not been previously described. The tumor involved the full thickness of the bowel besides the familiar surface spread which is characteristic of the disease. Intestinal obstruction is a rare or late presentation of mesothelioma. It was the presenting symptom in the present case due to the full thickness infiltration of the small bowel by the tumor. The offending segment was resected and the ascites was treated with intraperitoneal chemotherapy. Though the patient at present has progression of disease he enjoys a reasonable quality of life after palliation of the ascites and obstruction.

Aged↗