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

This retrospective study evaluated predisposing factors, clinical picture and the methods of treatment related to morbidity and mortality of 19 small bowel volvulus (SBV) who underwent operation at Belen Hospital (Trujillo-Peru) during the last 26 years (1966-1992). The SBV was 1.6% of all cases of intestinal obstruction in this period and 10.8% of all intestinal volvulus. The median age was of 43 +/- 20.5 years (range, 6 to 78 years) and the majority of them were between 41 and 60 years. Sixteen cases (84.2%) were men from Indian and Spanish extraction and most of them were farmers and came from the Sierra of the Department of La Libertad. Two cases (10.5%) had non-related antecedents previous surgery. In six patients (31.6%) the volvulus was less than seven day's duration and in thirty (68.4%) it was more eight day's duration with previous attacks of obstruction (median: 19.3 days, range: 17 hours to 94 days). Pain, vomiting and distention were present in almost all of these cases. The most frequent abdominal finding was distention. The location of the volvulus was: ileum, 12 cases (63.2%), root of mesentery, 4 cases (21%) and jejunum, 3 cases (15.8%). Gangrenous bowel was present in six patients (31.5) and gangrenous intestine with perforation in two cases (10.5%) who underwent resection of the involved segment with primary anastomosis. In this group one patient (5.2%) died of sepsis and the wound infection rate was of 37.5%. There was no statistically significant correlation with the duration of illness and the presence of gangrenous loops or the mortality rate (p > 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Predisposing factors, clinical picture and mortality in volvulus of the small intestine]. 147 87

In a prospective study, 126 patients with sigmoid volvulus were treated by mesosigmoplasty during a 12-year period. Patients with sigmoid volvulus with no clinical evidence of gangrene were selected for study, and all were given a trial of non-operative reduction by proctoscopy and passage of a rectal tube. Reduction was achieved in 48 patients (38 per cent), who were subsequently treated by mesosigmoplasty as an elective procedure 1-2 weeks later. For the remaining 78 patients (62 per cent) who were not relieved by the non-operative method, emergency mesosigmoplasty was performed. There was one death in the emergency group, and two patients had a recurrence after 2 and 6 months respectively in the elective group, in whom resection was carried out. In the other 123 patients during a maximum follow-up of 12 (mean 8.2) years no recurrence was detected. Mesosigmoplasty has the advantage of low rates of mortality, morbidity and recurrence; it can be carried out as either an emergency or an elective procedure.
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PMID:Mesosigmoplasty as a definitive operation for sigmoid volvulus. 130 Oct 57

This elderly male with a long history of alcohol abuse presented with an acute pleural trauma and hemopneumothorax, which may have served as the precipitating medical illness for cecal volvulus. He subsequently developed bacterial peritonitis as a complication of his bowel obstruction. It is probable that his pleural cavity was seeded hematogenously via a bacteremia from his peritonitis, thus accounting for the empyema with species typical of bowel flora. Cecal bascule is a type of cecal volvulus that causes intestinal obstruction. Diagnosis is difficult, but a delay in recognition may result in intestinal ischemia, perforation, sepsis, and even death. Cecal ischemia or gangrene cannot always be determined based on physical examination or laboratory findings. Plain films of the abdomen may be helpful, and barium enema has been advocated by some authors. However, laparotomy is often necessary for definitive diagnosis and therapy. While cecal volvulus has not been reported to occur frequently in the elderly, the relatively common occurrence of anatomic predisposition in addition to the widespread use of respirators and the increasing age and number of medical illnesses of our population make it possible that cecal volvulus will be seen with increasing frequency in the future.
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PMID:Cecal bascule: an overlooked diagnosis in the elderly. 172 51

This report discusses 27 patients with sigmoid volvulus treated at Jordan University Hospital (JUH) during a 15-year period. These patients represented 4.7 percent of adult patients treated for intestinal obstruction in the same period. The average age was 54.5 years, and none of the patients was institutionalized. Twenty-five patients presented with acute symptoms, and two had chronic symptoms. Sigmoidoscopic detorsion was achieved in 15 patients. Emergency resection was required in two of these patients: for the development of gangrene a few hours after detorsion in one patient and for recurrence within 24 hours in the other despite the presence of a rectal tube. Early recurrence occurred in two other patients and was managed endoscopically. Emergency surgery was performed in 10 other patients: for a failed endoscopic detorsion in three patients, for ulcerated and bleeding mucosa forecasting gangrene in another, and as a primary treatment in six patients who were either misdiagnosed or suspected to have gangrenous bowel. Elective resection was performed in 13 patients. The mortality rate was 15 percent (4/27) for the whole series and 33.3 percent (1/3) for those with gangrenous bowel.
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PMID:Volvulus of the sigmoid colon in Jordan. 173 86

This report describes two cases of intrauterine volvulus without associated intestinal malrotation. Polyhydramnios was present in one neonate; the presentation was very sudden and catastrophic in the other. Neither plain films nor contrast enema indicated the correct preoperative diagnosis in these infants. A "normal" plain film or enema in a suspected case of volvulus may lead to a delay in surgical management resulting in extensive ischemic necrosis of the bowel, often with extremely high mortality. Bile emesis or aspirate in neonates demands a high index of suspicion of intestinal obstruction. Shock, bloody diarrhea, and tense and distended abdomen are ominous, indicating volvulus often with gangrene.
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PMID:Intrauterine volvulus without malrotation. 176 23

Sigmoid volvulus is an emergency which requires rapid diagnosis and immediate adequate treatment. Diagnosis is primarily radiological. Emergency laparotomy carries a high mortality and should therefore not be the immediate treatment. In our opinion, detorsion by colonoscopy under radiological control is a promising form of treatment. Selective resection of the sigmoid, thereby removing the cause of the abnormality, should not be forgotten, since this prevents recurrences. For this method, mortality after adequate gut preparation is only 5.4%. An exception to the above is gangrene of the bowel, when an emergency laparotomy cannot be avoided.
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PMID:[Sigmoid volvulus, diagnosis and feasibility of an interdisciplinary primary therapy]. 184 33

In a prospective evaluation of acute intestinal obstruction in emergency surgery, 3550 consecutive patients were studied. In the vast majority of patients (75%), obstruction was due to the external hernia, the inguinal hernia being by far the commonest type. However, the ascaris worm in children, volvulus of the sigmoid colon in adults, and intussusception in both children and adults, were significant causes of the disorder, and together accounted for 18% of the patients. Obstruction by the ascaris worm is easy to diagnose (by stool microscopy), and effective treatment (with antihelminthics) is readily available and cheap. A large number (90%) of the volvulus patients required resection for gangrene of the colon, thus arguing a strong case in support of laparotomy and inspection of the colon whenever feasible. A significant (41%) proportion of intussusception cases were adult, and in 33% of this group the lesion was associated with a tumour of the small bowel. The chief reason for death (10%) was late reporting to hospital.
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PMID:Tropical surgical abdominal emergencies: acute intestinal obstruction. 190 26

High mortality rates associated with mesenteric ischaemia are a tremendous challenge. We reviewed 43 patients admitted to Chang Gung Memorial Hospital between 1981 and 1988. A total of 24 patients (55.8%) had thrombosis or embolus of the superior mesenteric artery, five patients (11.6%) had superior mesenteric vein thrombosis, and 14 patients (32.6%) had non-occlusive infarction. Patients with mechanical obstructions (volvulus, intussusception, tumour compression, aortic dissection) causing mesenteric ischaemia were excluded. The initial symptoms were not specific before signs of peritonitis presented. The tetrad of leucocytosis (88.4%), metabolic acidosis (88.6%), hyperamylasaemia (46.9%) and elevated phosphate (33.3%) was noted to be significant. There was a high association with previous cardiovascular diseases (78.2%). The plain abdominal X-ray, which was the most frequently used investigative tool, showed suggestive but non-specific findings. A total of 38 patients (88.4%) were operated upon. In six patients (14%) the exploratory laparotomy was open and closed because the bowel gangrene was too extensive. The total mortality rate was 55.8%. To improve prognosis, clinical awareness of the problem should be raised and the use of mesenteric angiography should be encouraged in an attempt to obtain an early diagnosis.
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PMID:The spectrum of acute intestinal vascular failure: a collective review of 43 cases in Taiwan. 210 56

Extensive small bowel resection may become necessary for several reasons in children and adults. The only causal therapy of short bowel syndrome is small bowel transplantation. So far severe immunological problems have caused deleterious results despite technically successful transplantation. A clinical case of small bowel transplantation in a child is reported. The 3-year-old boy had been operated on for volvulus which had led to nearly total gangrene of the whole small bowel. Finally, only 4 cm of jejunum could be saved. Total parenteral nutrition (TPN) therefore became necessary. Small bowel transplantation was carried out with the mother as donor; transplantation technique is described in detail. Postoperative immunosuppression was performed by administration of cyclosporin A and prednisolone. Because of graft rejection, the graft had to be removed on the 12th postoperative day. At present, the child is well and on TPN again. This case shows that small bowel transplantation by living related organ donation is technically possible without impairment of the donor's quality of life. Further experimental and clinical work should be encouraged.
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PMID:Small bowel transplantation: report of a clinical case. 210 24

The diagnosis of malrotation is easily made in the neonatal period, but is often delayed in older patients. Among 82 patients treated for malrotation in this institution, 45 patients presented with symptoms related to their malrotation, seven were diagnosed at exploration for concomitant intrinsic duodenal obstruction, and 30 patients had malrotations discovered as incidental findings at laparotomy or autopsy. Among the 45 symptomatic patients, 25 (56%) underwent surgery in the first month of life, whereas 20 patients (44%) underwent surgery at an older age. In this last group, the mean age at surgery was 51.5 months (range, 2 months to 16 years), the mean age of onset of symptoms was 2 years (range, 0 to 15 years) and the mean delay in diagnosis was 1.7 years. Although bilious vomiting was the presenting symptom among all patients undergoing surgery in the neonatal period, clinical features of older patients included intestinal obstruction (7), chronic abdominal pain (4), malabsorption/diarrhea (3), peritonitis/septic shock (2), solid food intolerance (1), common bile duct obstruction (1), abdominal distention (1), and delayed transit postappendectomy (1). The frequency of midgut volvulus was equal among both groups. Unusual forms of malrotation were more frequent in patients undergoing surgery beyond the neonatal period. In this group there was evidence of chronic venous and lymphatic obstruction with one case of superior mesenteric vein thrombosis and two cases of intestinal gangrene. A Ladd's procedure was performed in all cases and the most frequent postoperative complication was adhesive intestinal obstruction. There were no deaths. Awareness of the unusual presentation in patients who present beyond the neonatal period may help reduce delays in diagnosis and surgical treatment. We believe that laparotomy is indicated in all patients with malrotation, even if they are asymptomatic.
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PMID:Malrotation presenting beyond the neonatal period. 227 27


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