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[Laparoscopic diverticulectomy for ileal volvulus on Meckel's diverticulum].

Laparoscopy in the emergency setting is a logical extension of this technique. Open laparoscopy is particularly useful in the management of acute abdomen. In fact, after a sequential work-out that includes physical examination, laboratory data, plain abdominal x-rays and ultrasonography, diagnostic laparoscopy is advocated. The Authors herein report a case of intestinal obstruction (volvulus due to Meckel's diverticulum) treated with laparoscopy. The efficacy and safety of the diagnostic and/or therapeutic laparoscopic procedure in the emergency setting are discussed.

Adolescent↗

Monozygotic twins with discordant intestinal rotation.

Previous case reports have suggested a strong concordance of intestinal malrotation among identical twins. This has led to the recommendation that the asymptomatic twin undergo screening when malrotation is discovered in the identical sibling. We present a case of monozygotic twins in which one twin presented with intestinal malrotation with midgut volvulus while the other twin was found to have normal gastrointestinal anatomy.

Diseases in Twins↗

Large diverticulum and volvulus of the small bowel in adults.

The purpose of this study was to evaluate the relationship of large diverticulum (>3 cm) and volvulus of the small bowel (SB) in adults. A computer search of the medical records between January 1995 and December 2002 revealed 94 surgically proved cases of small bowel volvulus in adults. We reviewed the surgical records and recorded any specific condition found during laparotomy. The control group included 107 consecutive patients receiving a laparotomy with a diagnosis other than SB volvulus. In the 94 surgically proved cases of SB volvulus, the surgical records described presence of adhesion in 47 cases, adhesions around large SB diverticulum (>3 cm) in 5 cases, coexistence of large SB diverticulum and adhesions around the narrowed mesenteric root in 4 cases, large SB diverticulum without a specific description of the presence of adhesion or narrowed mesenteric root in 24 cases, narrowed mesenteric root without large SB diverticulum in 3 cases, internal hernia in 4 cases, tumors in 3 cases, and absence of any specific lesion in 4 cases. Only one case was found to have a large SB diverticulum in the control group. The incidence of large SB diverticulum in SB volvulus of adults was 35% (33/94), significantly higher than that of the control group (1%, 1/107) (p < 0.01). Large diverticulum of the small bowel might play a contributing role in the occurrence of SB volvulus in adults.

Adult↗

Surgical management of worm volvulus.

A retrospective study of 50 consecutive patients with small-bowel volvulus complicating intestinal ascariasis is reported. The commonest presenting features were abdominal distension (44 patients) and abdominal pain (38 patients). Thirty-three patients presented with vomiting, of whom 8 vomited worms. Twenty-five patients presented with peritonitis. In 33 patients there was evidence of worm infestation on radiographs while volvulus was diagnosed radiographically in 16 patients. Thirty-two patients required emergency surgery, while 16 were observed for a mean of 2.6 days before surgery. Thirty-nine patients had gangrenous bowel that required resection. The overall mortality rate was 14.5% and all deaths were from the gangrenous group. The results show that volvulus complicating ascariasis still carries a high mortality and morbidity rate. We stress the importance of early detection and early operative intervention.

Ascariasis↗

Intestinal obstruction caused by caecal volvulus.

The case of a 6-month-pregnant woman who had an uneventful postoperative recovery and normal vaginal delivery following a right hemi-colectomy for volvulus of the caecum with gangrene is reported.

Adult↗

Minimal access surgery for sigmoid volvulus in children.

A 12-year-old boy presented with large-bowel obstruction due to sigmoid volvulus. Temporary relief was achieved with rectal tube decompression. Elective laparoscopic-assisted sigmoid colectomy was performed. Post-operative recovery was uneventful. The patient remained well with no recurrence after 4 years of follow-up. Laparoscopic-assisted sigmoid colectomy may be the procedure of choice for selected children with sigmoid volvulus.

Child↗

Small bowel volvulus after uterine artery embolization requiring bowel resection: a case report.

BACKGROUND: Previously described surgical complications following uterine artery embolization for leiomyomata include sequelae of uterine aberrant embolization (buttock and labial necrosis, vesicouterine fistula), prolapsed cervical myoma, uterine necrosis, ischemic uterine rupture and sepsis. CASE: A 43-year-old woman presented with severe abdominal pain, nausea and vomiting 7 days after bilateral uterine artery embolization for symptomatic leiomyomata. Mechanical obstruction of the distal ileum was diagnosed and did not respond to conservative measures. At laparotomy, volvulus of the distal ileum, which adhered to omental and uterine adhesions, required resection and end-to-end anastomosis. CONCLUSION: Volvulus may occur following uterine artery embolization for leiomyomata.

Adult↗