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 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Caecal volvulus is an infrequently encountered clinical condition and an uncommon cause of intestinal obstruction. Patients with this condition may present with highly variable clinical presentations ranging from intermittent, self limiting abdominal pain to acute abdominal pain associated with intestinal strangulation and sepsis. Lack of familiarity with this condition is a factor contributing to diagnostic and treatment delays. The objective of this review is to promote clinicians' awareness of this disease through patient case illustration, discussion of disease pathogenesis, clinical features, and management strategies.
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PMID:Diagnosis and treatment of caecal volvulus. 1634 1

Wandering spleen, which is defined as a spleen without peritoneal attachments, is a rare disease and a delay in the clinical and/or radiological diagnosis may lead to splenic torsion, infarction, and necrosis. Owing to the physiologic importance of the spleen, especially in children, and the risk of postsplenectomy sepsis, early diagnosis and splenopexy are recommended. In the present article, we describe the results of our management of this rare problem on six patients, and we review all available literature from 1895 to 2005. Briefly, our technique includes flap creation from parietal peritoneum and settlement of spleen in the fossa splenica. Free edges of this flap are stitched to the stomach and the left end of transverse colon and the beginning of the descending colon. The body of the stomach was stitched to the abdominal wall to prevent gastric volvulus, while the fundus region was fixed to the diaphragm to support the spleen. Finally, an omental patch was stitched to the intact abdominal wall above the flap. In conclusion, the procedure of splenopexy without using mesh is considered to be a safe and curative modality for wandering spleen without imposing any undue risk of infection or foreign material reaction.
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PMID:Surgical treatment of patients with wandering spleen: report of six cases with a review of the literature. 1734 72

Primary volvulus means idiopathic volvulus without predisposing factor and is rare in children. The etiology is unknown. The incidence is relatively higher in neonates. The most common symptoms are abdominal distension and bilious vomiting. Our patient was a preterm baby at age of 89 days. Acute onset of abdominal distension and sepsis-like symptoms were noted. After operation, no anatomical anomaly was noted. Probable primary midgut volvulus was diagnosed. Early diagnosis of primary volvulus of the small intestine is difficult. Operation should be performed as soon as possible in a neonate with quick progression toward unstable hemodynamics and acidosis with ileus. Postoperative short bowel syndrome was noted. There are often sepsis, enterocolitis, and poor body weight gain noted among short bowel patients. With breast milk feeding and probiotics usage, there were few complications of short bowel syndrome noted in our patient. The duration for establishing intestinal adaptation was shorter than for other patients. The patient's body weight, body length and development caught up gradually within 18 months.
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PMID:Possible effect of probiotics and breast milk in short bowel syndrome: report of one case. 1762 9

Small-bowel volvulus around the superior mesenteric artery is a very unusual cause of small-intestinal obstruction, which may result in intestinal ischemia and necrosis. A 45-year-old woman, who had received a living-donor liver transplant with a right lobe graft for fulminant hepatic failure 5 years earlier, underwent a liver biopsy and was placed in the right decubitus position. Abdominal pain, high fever, tachycardia, and altered mental status developed quickly, suggesting abdominal sepsis. Computed tomography (CT) showed a "target sign," representing a counter-clockwise rotation of the mesenteric pedicle. However, without laparotomy, the symptoms subsided completely within 12 h by her lying strictly in the left decubitus position. A second CT scan showed an orthotopic untwisted jejunum. Although many complications associated with percutaneous liver biopsy have been described, to our knowledge this is the first report of positioning-associated intestinal volvulus after a liver biopsy.
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PMID:Small-intestinal volvulus around the superior mesenteric artery as an extremely rare positioning-associated complication after percutaneous liver biopsy. 1851 44

Short bowel syndrome (SBS) is a malabsorptive state occuring as a result of surgical resection or congenital disease of a significant portion of the small intestine . The amount of resection or remaining bowel generally dictates the degree of malabsorption and consequentely the need for specialized enteral nutrition or parenteral nutrition (PN). Intestinal failure in the context of SBS is defined as a dependence on PN to maintain minimal energy and fluid requirement for growth in children. Common causes of SBS in infants and children include necrotizing enterocolitis, midgut volvulus, intestinal atresia, and gastroschisis. Early identification of patients at risk for long-term PN dependency is the first step toward avoiding severe complications. Close monitoring of nutritional status, steady and early introduction of enteral nutrition, and aggressive prevention, diagnosis, and treatment of infections such as central venous catheter sepsis and bacterial overgrowth can significantly improve the prognosis. Intestinal transplantation is an emerging treatment that may be considered when intestinal failure is irreversible and children are experiencing serious complications related to TPN administration.
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PMID:Overview of pediatric short bowel syndrome. 1866 16

Most surgeons agree that complex neonatal ovarian cysts, regardless of size, warrant operative intervention. Management of simple cysts >4 cm is still controversial, although many favor intervention because of the increased risk of torsion. Whereas laparoscopic cyst resection is favored by some, others prefer less invasive percutaneous needle aspiration. We present a newborn infant who was admitted with sepsis and respiratory failure after home delivery. Ultrasound done on day 8 to check for umbilical venous line placement incidentally showed a simple cyst measuring 3.6 x 5.9 x 6.9 cm that was presumed to be of ovarian origin. Percutaneous needle aspiration was atraumatic and revealed serous fluid, with a high estradiol level. Four days later, surgery was indicated for clinical deterioration with suspected hemorrhage into the cyst. We found a midgut volvulus with extensive necrosis secondary to a jejunal duplication cyst. Ovaries were normal and there was no evidence of malrotation. Postoperatively, after discussion with the parents, support was withdrawn and the child died. We should not rely solely on ultrasonographic features and fluid characteristics to diagnose a large neonatal abdominal cyst, but rather confirm the diagnosis with laparoscopy.
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PMID:Lethal outcome after percutaneous aspiration of a presumed ovarian cyst in a neonate. 1934 4

Malrotation is a congenital abnormality of the gastrointestinal tract that predisposes to midgut volvulus and can lead to small bowel infarction. Midgut volvulus is rare in adulthood and even rarer during pregnancy. If not diagnosed accurately, it carries a high-mortality rate. We present a case of 27-year-old woman with 33 weeks of gestation, who presented with acute abdomen and intrauterine fetal demise. CT angiogram with multidetector row scanner showed the midgut volvulus clearly and unequivocally. Unfortunately, the patient died of septicemia and extensive bowel infarction. CT angiogram images are presented here. To our knowledge, no similar case with gestational midgut volvulus and CT angiogram has been reported previously in the literature.
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PMID:Fatal midgut volvulus: a rare cause of gestational intestinal obstruction. 1942 7

Irreversible intestinal failure in children is predominantly caused by surgical conditions such as volvulus, necrotizing enterocolitis, and gastroschisis. Functional intestinal failure from motility disorders such as intestinal pseudo-obstruction or enterocyte dysfunction with microvillus inclusion disease also may require intestine replacement. Approved indications for intestinal transplantation include liver dysfunction, loss of major venous access, frequent central line-related sepsis, and recurrent episodes of severe dehydration despite intravenous fluid management. Surgical options include transplantation of the isolated intestine, combined liver-intestine transplantation, or multivisceral transplantation of the stomach, duodenum, pancreas, and small bowel (with or without the liver). Immunosuppression for intestinal transplantation is based on tacrolimus therapy, often with induction immunosuppression using antilymphocyte antibodies (eg, antithymocyte antibody and alemtuzumab). Experience at centers of excellence demonstrates 1- and 5-year patient survival rates of 95% and 77%, respectively, with ongoing investigations focusing on lowering long-term causes of graft loss such as chronic rejection.
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PMID:Current perspectives on pediatric intestinal transplantation. 1946 23

Internal herniation, defined as a protrusion of the bowel through a peritoneal or mesenteric aperture into a compartment of the abdominal cavity, is a potentially serious complication following Roux-en-Y gastric bypass. In view of the high risk of strangulation and volvulus with possible progression to necrotic bowel, sepsis and multiple organ failure, early diagnosis and prompt surgical intervention are crucial to minimise morbidity and mortality rates. As little is known about internal herniation, pathogenesis, consequences, clinical presentation and diagnostic approach are discussed in this article. A review of the literature and the consideration of three cases make it clear that diagnosis is often delayed due to a vague, non-specific clinical presentation and the frequently negative radiological investigations. Displacement of the superior mesenteric artery (SMA) with crowding, stretching and engorgement of its visceral branches, mesenteric swirl and a clustered appearance of small bowel loops are CT findings with a high specificity but low sensitivity. A high degree of vigilance, communication between radiologists and surgeons and a low threshold for surgical exploration is therefore necessary.
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PMID:Internal herniation after Roux-en-Y gastric bypass: case reports and a review of the literature. 1994 98

3 patients, 2 women aged 41 and 47 and one man aged 75 years, presented with abdominal pain and distension. In 2 patients the diagnosis 'sigmoid volvulus' was reached following plain abdominal X-ray. Both patients underwent sigmoidal resection with primary anastomosis after endoscopic deflation. The third patient proved to have a caecal volvulus on emergency laparotomy and underwent ileocaecal resection. In 2/3 of the cases diagnosis can be made by history, physical examination and conventional X-ray. Delay in the diagnosis increases the risk of peritonitis and death due to ischaemia and perforation of the colon. In the absence of peritoneal tenderness, signs of ischaemia or sepsis, the initial treatment consists of endoscopic deflation, which is successful in 68-78% of cases. Resection of the sigmoid colon is recommended a few days after endoscopic decompression in order to prevent recurrence. Caecal volvulus is not suitable for treatment with endoscopic deflation and should be treated with ileocaecal resection.
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PMID:[Colonic obstruction due to volvulus of the sigmoid colon or caecum]. 2029 24


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