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Query: UMLS:C0042961 (volvulus)
 4,305 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In recent years patients with cystic fibrosis (CF) have experienced longterm survival and have demonstrated a number of intra-abdominal complications. This report evaluates the intra-abdominal complications seen in 69 of 189 children with cystic fibrosis from 1972 to 1983. Forty-one patients were boys and twenty-eight girls. Complications occurred in 36 neonates, with meconium ileus (MI) noted in 33 and giant cystic meconium peritonitis (GCMP) in 3. Meconium ileus equivalent occurred in seven older children presenting with bowel obstruction. In addition, rectal prolapse occurred in 12, inguinal hernia in 10, intussusception in 3, cholelithiasis in 3, GE reflux in 4, stress ulcer in 1 and appendicitis in 1. Three infants with GCMP survived resection and enterostomy. Infants with MI were divided into simple (15) or complicated (18) cases. Nonoperative therapy using gastrografin enema was successful in three of eight with simple MI. Operative enterotomy and irrigation was successful in three cases while resection and enterostomy was done in nine. MI was complicated by atresia, volvulus and/or perforation in 18 cases requiring resection and anastomosis or enterostomy. Survival for MI was 86% compared to 36% in 25 MI patients treated in the previous two decades. Meconium ileus equivalent was successfully managed using gastrografin enema in five of seven children. Only 3 of 12 children with rectal prolapse required repair. Two cases of intussusception were reduced while one required resection. Three of 10 children had hernia recurrence due to chronic pulmonary problems.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Intra-abdominal complications of cystic fibrosis. 404 71

The role of the barium enema in the evaluation of patients with acute abdominal pain is well established. It is utilized in the diagnosis and treatment of several suspected clinical entities, including appendicitis, diverticulitis, intussusception, and volvulus. There is another group of patients in whom a vague clinical presentation and an indeterminate bowel gas pattern fail to clarify the diagnosis. The role of the barium enema has been expanded as an early diagnostic aid in the evaluation of these patients. Based on abdominal film findings, three patient categories are presented, in whom the early use of a "judicious" barium enema may safely and quickly contribute to the preoperative definition of the underlying disease process, allowing for the correct mode of therapy to be undertaken.
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PMID:The expanded role of the barium enema in the evaluation of patients presenting with acute abdominal pain. 409 71

Advances in laparoscopic surgery have drastically modified not only the thinking of most general surgeons, but have also helped to change the approach to many disease processes. The tremendous success of the laparoscopic approach to biliary tract disease as well as to appendicitis, trauma, and even colonic disease led us to consideration and evaluation of laparoscopy as a tool in the management of patients with acute and chronic intestinal obstruction. Forearmed with laparoscopic skills gained performing laparoscopic cholecystectomy, common bile duct exploration, appendectomy, and laparoscopic colon resection and cognizant of the many patients with simple adhesions, internal herniae, and volvulus, we included all patients with suspected intestinal obstruction who did not have resolution of signs and symptoms with conservative treatment in this study. Patients were treated initially with intravenous fluids, nasogastric suction, and correction of electrolyte disturbances. Laparoscopy was performed on 23 patients during the period of May 1991 through April 1993 with resolution of the problem laparoscopically in 20. Details of pathological processes, operations performed, technique, and guidelines for laparoscopy are included.
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PMID:Laparoscopic surgery in acute small bowel obstruction. 795 40

Cystic fibrosis (CF), the most common lethal autosomal recessive disease in white populations, is characterized by dysfunctional chloride ion transport across epithelial surfaces. Although recurrent pulmonary infections and pulmonary insufficiency are the principal causes of morbidity and death, gastrointestinal symptoms commonly precede the pulmonary findings and may suggest the diagnosis in infants and young children. The protean gastrointestinal manifestations of CF result primarily from abnormally viscous luminal secretions within hollow viscera and the ducts of solid organs. Bowel obstruction may be present at birth due to meconium ileus or meconium plug syndrome. Complications of meconium ileus include volvulus, small bowel atresia, perforation, and meconium peritonitis with abdominal calcifications. Older children with CF may present with bowel obstruction due to distal intestinal obstruction syndrome or colonic stricture, and tenacious intestinal residue may serve as a lead point for intussusception or cause recurrent rectal prolapse. Radiologic studies often demonstrate thickened intestinal mucosal folds in older children and uncommonly show colonic pneumatosis, peptic esophageal stricture due to gastroesophageal reflux, and duodenal ulcer. Appendicitis due to inspissated secretions is uncommon. Obstruction of ducts and ductules produces exocrine pancreatic insufficiency, pancreatitis, cholestasis, cholelithiasis, and cirrhosis with portal hypertension. On imaging studies, the pancreas is commonly small and largely replaced by fat, sometimes displays calcifications, and is rarely replaced by macrocysts. Radiologic features of hepatobiliary disease include an enlarged radiolucent liver from steatosis, gallstones, a shrunken nodular liver, splenomegaly, and portosystemic collateral vessels. With the improved survival of CF patients, an increased risk for developing gastrointestinal carcinomas has been established, many occurring as early as the 3rd decade.
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PMID:Gastrointestinal manifestations of cystic fibrosis: radiologic-pathologic correlation. 883 77

CFTR, or cystic fibrosis transmembrane conductance regulator, the gene product that is defective in cystic fibrosis, is present in the apical membrane of the epithelial cells from the stomach to the colon. In the foregut, the clinical manifestations are not directly related to the primary defect of the CFTR chloride channel. The most troublesome complaints and symptoms originate from the oesophagus as peptic oesophagitis or oesophageal varices. In the small intestinal wall, the clinical expression of CF depends largely on the decreased secretion of fluid and chloride ions, the increased permeability of the paracellular space between adjacent enterocytes and the sticky mucous cover over the enterocytes. As a rule, the brush border enzyme activities are normal and there is some enhanced active transport as shown for glucose and alanine. The results of continuous enteral feeding of CF patients clearly show that the small intestinal mucosa, in the daily situation, is not functioning at maximal capacity. Although CFTR expression in the colon is lower, the large intestine may be the site of several serious complications such as rectal prolapse, meconium ileus equivalent, intussusception, volvulus and silent appendicitis. In recent years colonic strictures, after the use of high-dose pancreatic enzymes, are being increasingly reported; the condition has recently been called CF fibrosing colonopathy. The CF gastrointestinal content itself differs mainly from the normal condition by the lower acidity in the foregut and the accretion of mucins and proteins, eventually resulting in intestinal obstruction, in the ileum and colon. Better understanding of the CF gastrointestinal phenotype may contribute to improvement of the overall wellbeing of these patients.
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PMID:Gastrointestinal manifestations in cystic fibrosis. 886 67

The round worm, Ascaris lumbricoides, is one of the largest of the parasites that infest the human bowel. The worms usually develop in the jejunum and can reach several thousand in number, causing bowel obstruction, volvulus, intussusception, appendicitis and even bowel perforation with penetration into the peritoneal cavity. They tend to invade the bile and pancreatic ducts and may cause acute cholecystitis and pancreatitis. Ascaris lumbricoides can be detected by sonography. This imaging modality can be helpful in diagnosing the presence of the worms and in evaluating response to treatment. We present an 18-month-old girl in whom bowel worms were detected by sonography.
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PMID:[Sonographic imaging of Ascaris lumbricoides]. 894 May 20

Patients with intra-abdominal processes that require prompt surgical intervention, including appendicitis, perforated viscus, ischemic bowel, volvulus, and bowel obstruction, often present with signs and symptoms of an acute abdomen. Several medical problems can mimic an acute abdomen. Overwhelming postsplenectomy infection is a life-threatening condition that can present with acute abdominal symptoms. The incidence of overwhelming postsplenectomy infection ranges from 1% to 25%, and is caused by Streptococcus pneumoniae in 50% of cases. Capnocytophaga canimorsus, a bacteria commonly found in dog saliva, accounts for less than 1% of cases. Overwhelming postsplenectomy infection has a rapidly deteriorating course that progresses to respiratory and renal failure, cardiovascular collapse, and death. The mortality associated with overwhelming postsplenectomy infection is 60% to 80%. Early diagnosis and institution of appropriate antibiotic therapy and supportive care is essential to improve patient outcome. A previously healthy woman who had undergone splenectomy secondary to trauma 11 years earlier presented with symptoms of an acute abdomen. A diagnosis of overwhelming postsplenectomy infection due to C canimorsus was made based on her peripheral blood smear and blood culture findings. Early aggressive care and antibiotic treatment resulted in a successful outcome for this patient with no long-term morbidity. This patient's clinical course demonstrates the importance of early diagnosis and treatment of overwhelming postsplenectomy infection.
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PMID:Postsplenectomy Capnocytophaga canimorsus sepsis presenting as an acute abdomen. 986 57

Over the last twenty years, ultrasound has progressively become the primary modality used to assess the acute pediatric abdomen. The lack of radiation exposure and the high diagnostic efficacy of US have contributed to broaden the use of US. During his career, any radiologist may be involved in the evaluation of an acute abdomen in a child. He has to be familiar with the sonographic findings and the age-related symptoms which allow diagnosis of intussusception, hypertrophic pyloric stenosis, midgut volvulus, and appendicitis. He also has to be familiar with the findings which help to exclude these diseases. For experienced radiologists the accuracy in detecting appendicitis and intussusception are respectively close to 95% and 100%. In this chapter, we will also discuss the differential diagnoses of the most frequent causes of acute pediatric abdomen and the technical limitations of US. The learning objectives will be
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PMID:[Role of ultrasound in children with emergency gastrointestinal diseases]. 1144 95

Because young children often present to EDs with abdominal complaints, emergency physicians must have a high index of suspicion for the common abdominal emergencies that have serious sequelae. At the same time, they must realize that less serious causes of abdominal symptoms (e.g., constipation or gastroenteritis) are also seen. A gentle yet thorough and complete history and physical examination are the most important diagnostic tools for the emergency physician. Repeated examinations and observation are useful tools. Physicians should listen carefully to parents and their children, respect their concerns, and honor their complaints. Ancillary tests are inconsistent in their value in assessing these complaints. Abdominal radiographs can be normal in children with intussusception and even malrotation and early volvulus. Unlike the classic symptoms seen in adults, young children can display only lethargy or poor feeding in cases of appendicitis or can appear happy and playful between paroxysmal bouts of intussusception. The emergency physician therefore, must maintain a high index of suspicion for serious pathology in pediatric patients with abdominal complaints. Eventually, all significant abdominal emergencies reveal their true nature, and if one can be patient with the child and repeat the examinations when the child is quiet, one will be rewarded with the correct diagnosis.
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PMID:Common abdominal emergencies in children. 1182 31

In many poor countries of the world the need for surgical treatment of acute abdominal emergencies is largely unmet. In some cases this service is provided by physicians with little postgraduate surgical training, and there is a paucity of published data on the outcomes of this service. This series of sequential cases of acute abdominal surgical emergencies from a hospital in rural Sierra Leone illustrates the causes, outcomes, and challenges in this setting. All patients with an acute abdomen from September 1992 until September 1994 who required surgery were identified by review of theater records, ward books, and patients' notes. Altogether, 173 cases were identified. Operative diagnoses included ectopic pregnancy (n = 43), strangulated hernia (n = 45) 15 of which required bowel resection, appendicitis (n = 15), normal appendix (n = 4), uterine rupture (n = 9), perforated ulcer (n = 8), tubal or pelvic abscess (n = 7), volvulus (n = 6), and others. Ninety percent survived to discharge after a median postoperative stay of 9.2 days (range 7-127 days). Of the 18 deaths, 83% occurred during the first 3 days. Factors associated with poor outcome were ileal perforation due to typhoid fever and resection of bowel after a strangulated hernia. These results show that acute abdominal surgery can be done at the district level in poor countries using limited facilities by staff without extensive surgical training. The outcomes are comparable to those from larger centers.
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PMID:Case series of acute abdominal surgery in rural Sierra Leone. 1191 Apr 89


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