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Query: UMLS:C0019270 (hernia)
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Intestinal malrotation usually presents in the pediatric population with midgut volvulus requiring emergency Ladd's procedure. Rarely, it remains asymptomatic and is discovered incidentally only during adulthood when it seldom causes intestinal complications. The scenario of a cirrhotic adult being diagnosed with asymptomatic intestinal malrotation with subsequent intestinal complications is thus extremely rare and to our knowledge has not been previously reported. We describe a 56-year-old man with decompensated alcoholic cirrhosis (Child-Pugh class C, MELD score 22) who was initially observed after an incidental diagnosis of intestinal malrotation on computed tomography. Observation continued as his liver disease improved with alcohol cessation (Child-Pugh class A, MELD score 8). He later presented with a closed loop bowel obstruction secondary to midgut volvulus at the time of alcohol relapse and liver redecompensation (Child-Pugh class C, MELD score 22-29). He underwent emergency Ladd's procedure during which his midjejunum was volvulized into an internal hernia space created by a thick Ladd's band containing large varices. The postoperative course was complicated by ileus and loculated bacterial peritonitis. Based on our experience, we discuss special considerations with regard to the surgical technique and timing of Ladd's procedure when encountering intestinal malrotation in a cirrhotic adult with portal hypertension.
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PMID:Asymptomatic Intestinal Malrotation Progressing to Midgut Volvulus in a Decompensated Alcoholic Cirrhotic Adult: A Rare Scenario Requiring Special Considerations. 3261 64

Background. Despite the danger of infection during the outbreak of the 2019 novel coronavirus (COVID-19) in Wuhan, many patients still need surgical treatment. Most elective surgeries were delayed because of the public health emergency. However, when patients have life-threatening emergencies or illnesses, surgeries are often needed as soon as possible. Moreover, due to hospital overcrowding during the COVID-19 outbreak, healthcare professionals initially struggled to address the issue due to a lack of experience. This is especially true for day surgery centers with higher patient mobility. Methods. We remodeled pathways to separate patients and medical personnel to minimize the COVID-19 infection rate. Further, strategies for medical staff education and potential patient education, ward disinfection and maintenance, setup with 3 more screening stations, patient and companion management, medical staff management, and perioperative management were implemented before starting elective day surgery. Results. From February 11 to March 11 in 2020, 202 day surgeries were performed. These were all elective surgeries and included ultrasound-guided Mammotome biopsy, endoscopic polypectomy, hernia repair, pediatric surgeries, cholecystectomy, choledochoscopy, radical mastectomy, percutaneous transhepatic cholangial drainage, liver biopsy, video-assisted thoracoscopic surgery, laparoscopic resection of colon cancer, colostomy apotheosis, and varicose vein surgery. On days 7, 14, and 30 after discharge, no postoperative complications were reported or infection of COVID-19 cases was reported. Conclusions. Using scientific and well-designed protocols, day surgery can ensure quality surgical care with while ensuring medical safety during the COVID-19 outbreak. These protocols may also be applied to other surgical departments in China.
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PMID:Surgical Protocol in a West China Day Surgery Center During the COVID-19 Pandemic: Practice and Experience. 3279 65


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