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

Review of the consultation records of the Gastrointestinal Surgical Oncology service at Roswell Park Memorial Institute from 1982 to 1987 revealed 22 patients with a clinical diagnosis of neutropenic enterocolitis. Ninety-one percent of the patients had hematologic malignancies, and 95% were receiving cytotoxic chemotherapy. Sixteen patients were treated nonsurgically; 11 died. Of those 11 cases, autopsies were performed in 9. At autopsy, the clinical diagnosis was confirmed in four cases; four cases were found to have normal intestinal tracts, and one case had a small bowel volvulus. In none of the four cases for which autopsy proved neutropenic enterocolitis was transmural bowel necrosis or perforation found. Laparotomy was performed in six patients; three survived. The clinical diagnosis was verified in four of the six patients. Neutropenic enterocolitis must be considered a diagnosis of exclusion. Care of these patients should be individualized. Nonoperative management with bowel rest, decompression, nutritional support, and broad spectrum antibiotics is recommended initially. Operative intervention is recommended for those with perforation or those whose condition deteriorates clinically during close, frequent observation.
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PMID:Neutropenic enterocolitis. Clinical diagnosis and treatment. 172 60

Curative surgery of Hirschsprung's disease (HD) was performed in 32 infants younger than 3 months of age from January 1, 1977, December 31, 1986. There were 24 males, seven of whom presented with total colonic aganglionosis. Preoperative relief of obstruction was carried out by only enemas in 25 patients (81%), with addition of total parenteral nutrition of 8 to 27 days in case of severe enterocolitis. Colostomy was never performed as a routine procedure. Preoperative morbidity occurred in three cases: one enterocolitis and two sigmoid performations that were successfully treated by colostomy. Weight at operation ranged from 3.3 to 6.0 kg (mean, 4.9 kg). Swenson's (25), Duhamel's (5), and Soave's procedures (2) were performed. There was no mortality. Follow-up varied from 2 to 10 years. Postoperative morbidity occurred in five patients (one anastomotic leak, two stenosis, one volvulus, and one recurrent enterocolitis). All other patients are considered as definitively cured. Comparison with data in the literature permits one to advocate primary corrective treatment of HD without decompression in infants less than 3 months of age.
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PMID:Management of Hirschsprung's disease: curative surgery before 3 months of age. 268 54

Bowel resection during the neonatal phase of life may be associated with considerable morbidity, both short- and long-term. A retrospective evaluation is reported, concerning 74 patients who underwent bowel resection over a ten-year-period, due to necrotising enterocolitis, atresia, volvulus or Hirschsprung's disease. The cause of death of 15 non-survivors was investigated and the pattern of morbidity of 59 surviving patients was evaluated regarding growth, nutrition and defaecation. It was concluded that the ultimate prognosis for most patients is good, despite considerable morbidity during the first year of life, involving serious losses of fluids and electrolytes, cholestasis, and recurrent sepsis due to central venous catheters.
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PMID:Bowel resection in the neonatal phase of life: short-term and long-term consequences. 275 Mar 39

A case of malrotation of the mid intestine with volvulus is reported in an infant in whom the clinical and radiological appearances were unusual, and had led to a misdiagnosis of necrotising enterocolitis. If the correct diagnosis had been made earlier, operation might have saved the infant's life.
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PMID:Neonatal pneumatosis cystoides intestinalis caused by volvulus of the mid intestine. 278 37

malrotation and Hirschsprung's disease are common gastrointestinal abnormalities in neonates and infants. Four patients with the association of malrotation and Hirschsprung's disease are reported. A delay in diagnosis may be complicated by midgut volvulus or enterocolitis. The diagnostic and therapeutic implications of this important association are discussed.
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PMID:The association of malrotation and Hirschsprung's disease. 706 70

Minimal-access surgery (MAS) is rapidly becoming the surgical approach of choice for a variety of surgical disorders in adults, but its use in children remains a relative novelty. Most pediatric surgeons continue to harbor justifiable concerns about the morbidity of this modality owing to the cumbersome nature of the instruments and the technical difficulty associated with two-dimensional views. The purpose of this study was to determine the complication rate and the lessons learned from the use of MAS in performing a variety of procedures in a large series of children. To determine complications, the authors reviewed the medical records of all children (n = 636; age range, 1 month to 19 years) who underwent laparoscopy (LAP) or thoracoscopy (THO) during a 5-year period (January 1, 1990 through December 31, 1994). The follow-up ranged from 1 week to 45 months. THO was performed in 62 children. Conversion to thoracotomy occurred in eight children (13%), because of inability to localize the lesion (3), unresectibility (2), inadequate tissue sample (1), unsafe access (1), hypoxemia (1), or inadvertent esophagotomy (1). Postoperatively, two ventilator-dependent children had tension pneumothorax after lung resection and required chest tubes. LAP was performed on 574 children, with conversion to laparotomy occurring in 15 (2.6%), because of technical reasons (10) or intraoperative complications (5). The complication rate of LAP was 2% (12 of 574). Early in the experience, intraoperative complications that led to laparotomy included hemorrhage during appendectomy (2), cholecystectomy (1), and splenectomy (1); and esophagotomy during a fundoplication (1). Other technical problems in the postoperative period were a malpositioned Nissen fundoplication and a gastric volvulus after gastrostomy and Nissen fundoplication owing to improper gastrostomy tube position. In addition, two children had a hernia at the umbilical trocar site that had been used for contralateral inguinal exploration, and cellulitis developed in three patients when a gastrostomy tube was brought out through a trocar site. Other complications not specific to MAS included pelvic abscess after appendectomy (5); small bowel obstruction after jejunostomy catheter placement (1) and combined cholecystectomy/appendectomy (1); enterocolitis (1) and severe hyponatremia (1) after pull-through for Hirschsprung's disease; and pneumonia after splenectomy (1). The overall complication rate of MAS was 4% (26 of 626), and there were no deaths. The initial use of MAS was associated with technical errors, which decreased with experience. Based on this study, the authors recommend (1) routine placement of a thoracostomy tube in children after THO if they require postoperative ventilator support; (2) using the open hernia sac to place a 70 degrees telescope for contralateral inguinal exploration; and (3) not using a trocar site for gastrostomy tube placement in immune-suppressed patients. With appropriate training and experience, MAS can be used safely in children, for a wide variety of diseases, with minimal morbidity and mortality.
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PMID:Complications of minimal-access surgery in children. 886 56

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

A case of a very low birthweight premature infant with a clinical presentation of necrotising enterocolitis that was found to have malrotation and midgut volvulus at autopsy is presented.
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PMID:Intestinal malrotation in an extremely preterm very low birthweight infant. 2269 31

Lower gastro intestinal bleed (LGIB) is defined as any bleeding that occurs distal to the ligament of Treitz (situated at the duodeno jejunal junction). It constitutes the chief complaint of about 0.3 % of children presenting to the pediatric emergency department(ED). Among Indian children the most common causes are colitis and polyps. In most of the cases of LGIB the bleeding is small and self limiting, but conditions like Meckel's diverticulum often presents with life threatening bleeds. The approach in ED should include in order of priority-assessment and maintenance of hemodynamic stability, confirmation of LGIB and then to attempt for specific diagnoses and their management. This is achieved with help of rapid cardiopulmonary assessment, focused history and examination. The management of all serious hemodynamically significant bleeds includes, rapid IV access, volume replacement with normal saline 20 ml/kg, blood sampling (for cross matching, hematocrit, platelet, coagulogram and liver function tests), Inj. Vit K 5-10 mg IV, acid suppression with H2 antagonists/PPI and nasogastric lavage to rule out upper gastrointestinal bleed. Continuous ongoing monitoring of vital signs is important after stabilization. In ill looking infant, infectious colitis, Necrotizing enterocolitis (NEC), Hirschsprung enterocolitis and volvulus and in older infants and children, intussusceptions, typhoid fever, volvulus should be looked for. Proctosigmoidoscopy remains the first investigation to be done and reveals majority of etiology. Multidetector CT scan, Tc 99 m RBC scan, angiography and Push enteroscopy are the further investigation choices according to the clinical condition of the child. Intra operative enteroscopy is reserved for refractory cases with an obscure etiology.
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PMID:Emergency management of lower gastrointestinal bleed in children. 2335 12

To review the relevant literature on cytomegalovirus-(CMV-)related intestinal problems in neonates, supplemented by two own cases of volvulus, a PubMed search and separate additional searches with characterizing terms were performed. 46 hits were found, 15 of which had to be excluded because they did not report clinical cases, yielding a total of 47 infants. Symptoms in both preterm and term infants with proven postnatal infection (n=16) included abdominal distension, bloody diarrhoea, necrotising enterocolitis (NEC) with perforation and intestinal stricture, with lethal outcome in 3 patients. Manifestations in congenital or unclearly allocated CMV-infections, including volvulus, were similar. We report on 2 additional cases with volvulus in extremely low gestational age neonates (ELGANs) with proven postnatal CMV-infection and concurrent detection of CMV positive cells within the resected intestinal stroma. As a conclusion volvulus should be added to other known intestinal manifestations of breastmilk (BM) related postnatal CMV disease in extremely preterm infants.
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PMID:Intestinal manifestations of postnatal and congenital cytomegalovirus infection in term and preterm infants. 2752 9


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