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

During the last decade neonatal surgical results have improved considerably. Except for infants born with serious congenital heart disease, diaphragmatic hernia or exomphalos, postoperative mortality rates for infants with single anomalies have fallen to the region of 10%. This dramatic success story has been marred by a corresponding increase in the number of individuals with several anomalies entering late childhood with severe chronic handicaps. During the remainder of this century much effort will be expended in devising programmes of investigation which will attempt to predict which individuals will have a poor long-term prognosis. Such programmes will necessitate very close liaison between obstetricians, radiologists, neonatologists, local paediatricians, paediatric surgeons, general practitioners and parents. Very urgent surgery is necessary for the best results in infants with gastroschisis, intestinal volvulus and irreducible inguinal hernia, but for most other conditions there have been recent trends away from very urgent surgery to operation during daylight hours within the ensuing 24 h. Surgery within a few hours of presentation is necessary for intussusception and for early acute appendicitis, but perforated appendicitis should be treated by aggressive fluid replacement and intravenous antibiotics and surgery should be contemplated only in the rare cases of continued deterioration.
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PMID:Paediatric emergencies. 176 28

Meckel's diverticulum occurs in 2% of the population and may present at any age. Its management, when found incidentally at laparotomy, remains controversial, particularly in the pediatric population. From 1970 to 1989, a Meckel's diverticulum was discovered in 164 children at laparotomy. There were 120 boys and 44 girls with a mean age of 5.2 years (range, 0 to 18 years). Forty-seven cases were asymptomatic, representing an incidental finding at laparotomy, 25 were resected, and ectopic gastric mucosa was present in 7 specimens (28%). Three postoperative deaths (6%) that were not related to the resection and 2 complications (4%) (postoperative leak and wound infection) occurred in this group. Of the 117 symptomatic patients, 49 (42%) presented with bowel obstruction, 45 (38%) had rectal bleeding, 16 (14%) had diverticulitis, and 7 (6%) had umbilical pathology. Volvulus (20) and intussusception (19) were the most common causes of obstruction. Predisposing factors for bowel obstruction were fibrous bands to umbilicus or mesentery (37%) and ectopic mucosa (35%). Severe painless rectal bleeding occurred in 45 patients, 30 of whom (67%) required blood transfusion. A nuclear medicine Meckel scan was positive in 32 of 37 patients (85%). Contrast studies were not diagnostic; colonoscopy and gastroscopy ruled out other causes of bleeding. Patients with diverticulitis (16) presented with acute abdominal pain compatible with appendicitis. In the symptomatic group, ectopic mucosa was present in 61% of the resected specimens. Gastric (88%), pancreatic (7%), and gastric with pancreatic (3%) were the most common ectopic tissue. Postoperative morbidity and mortality for symptomatic patients was 8.5% and 0%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Meckel's diverticulum in children: a 20-year review. 181 59

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

Cattle require surgery for small-intestinal problems less frequently than they do for abomasal, forestomach, or large-intestinal problems. Close attention to local vascular anatomy is critical to success when intestinal resection is required. Cows with signs of severe abdominal pain may make rapid recoveries following prompt surgical treatment. This article discusses relevant anatomy of the small intestine and the diagnosis and treatment of intussusception, volvulus, obstruction by incarceration or entrapment, and duodenal obstruction.
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PMID:Surgery of the bovine small intestine. 220 May 75

The differential diagnosis of lower gastrointestinal bleeding in children can be reduced markedly simply by taking into account the age of the child. The clinical condition of the patient can further help narrow the diagnostic possibilities. Newborns and infants who are clinically unstable are more likely to have diseases such as necrotizing enterocolitis, volvulus, Hirschprung disease, intussusception, or Meckel diverticulum. A baby who appears healthy should be examined for swallowed blood, allergic colitis, anal fissures, or lymphonodular hyperplasia. An older child of healthy appearance with bleeding is likely to have a juvenile polyp or infectious colitis, but a child who appears sick may have hemolytic uremic syndrome, Henoch-Schoenlein purpura, or inflammatory bowel disease. This information, along with that gleaned from the physical examination, can lead the pediatrician to determine the need for specific tests, such as abdominal radiographs, stool cultures, and an endoscopic evaluation. We have come a long way in our ability to diagnose the causes of lower gastrointestinal bleeding. With the availability of newer radiographic and nuclear medicine modalities and the ability to visualize the colon endoscopically, the need for exploratory laparotomy for diagnosis is rarer. While surgery may still be the therapy of choice, new diagnostic modalities give the surgeon much more preoperative information.
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PMID:Lower gastrointestinal bleeding. 223 71

Gastrointestinal contrast studies were performed in 96 (27 percent) of 342 patients with small-bowel obstruction including 57 upper gastrointestinal and 39 barium-enema examinations. In 34 patients, upper gastrointestinal examination disclosed either obstruction or failure of contrast to reach the cecum in 24 hours; all 34 patients required surgery. The remaining 23 patients who had upper gastrointestinal studies recovered with tube decompression. Barium enema demonstrated obstruction in 13 (33 percent) of 39 cases of suspected small-bowel obstruction and localized obstruction in the colon rather than small bowel in 9 of 13 cases. Barium enema was 100 percent predictive of surgery when obstruction was shown, but was not helpful in predicting surgery when obstruction was not demonstrated. Surgery was required in 42 percent of patients whose barium enema did not show obstruction. Barium enema also was performed in 19 of 23 patients with large-bowel obstruction and showed the level of obstruction in all cases. All patients with large-bowel obstruction required surgery except for three who recovered after barium-enema reduction of intussusception or volvulus. Barium upper gastrointestinal examination is recommended in small-bowel obstruction when plain films are nondiagnostic, and in selected cases of small-bowel obstruction that do not resolve with a short trial of tube decompression. Barium enema is not recommended in suspected small-bowel obstruction but should be performed in all cases of large-bowel obstruction, except when perforation is a possibility or when the cecum measures 10 cm or larger in diameter.
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PMID:Use of gastrointestinal contrast studies in obstruction of the small and large bowel. 235 Oct 7

Following an introductory review of the literature, the symptoms, diagnostic procedures and aetiology as well as treatment, long-term results and prognosis of the individual forms of ileus are described and discussed, based on the clinical histories of 704 patients with ileus of the small intestine. Whereas ileal obstipation and other forms of obstructive ileus were revealed to have a fair prognosis, a long-term cure could be achieved in only half of the patients with either a string foreign body, intussusception or an intestinal adhesion. The prognosis in cases of malignant intestinal tumours, intestinal adhesions resulting from intra-abdominal tumours and mesenteric volvulus was hopeless.
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PMID:[Small intestinal ileus in the dog and cat--catamnestic observations of 704 patients]. 234 67

For a period of 12 years (1977-1988) 64 children with Meckel's diverticulum (32 boys and 32 girls) have been operated. In early childhood (younger than 3 years) were 14.1 per cent; most of the others (59.4 per cent) were in school age. Complicated Meckel's diverticulum had 31.2 per cent of the children, the most common complication being intestinal obstruction--65 per cent (intussusception 25 per cent, strangulation 25 per cent and volvulus 15 per cent). Acute diverticulitis was found in 25 per cent of the complicated cases. In the clinical picture of these complications lacked cause-pathognomonic symptoms. The Meckel's diverticulum was removed in 60 children (93.8 per cent) the operation was cuneiform resection of the diverticulum in 96.6 per cent of the operated children. Only one child (1.7 per cent) had postoperative complication. All others were discharged from the clinic in full surgical repair. Practical inferences were made, based on analysis of the clinical case material.
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PMID:[Meckel's diverticulum in childhood]. 239 87

The site and nature of lesions producing gastrointestinal bleeding was evaluated in pediatric patients admitted to Tokai University Hospital. The differential diagnosis was possible based upon the character of the bleeding and the age of the patient. Upper endoscopy is the diagnostic maneuver of choice in evaluating the upper gastrointestinal bleeders. Sigmoidoscopy, colonoscopy, technetium scans, tagged red cell scans and intraoperative angiography were helpful in locating bleeding sites of lower bleeders. Common causes of bleeding were as follows: Hemorrhagic disease, necrotizing enterocolitis, and midgut volvulus in neonates; intussusception and internal hernia in infants; juvenile polyp and infectious diarrhea in children; duodenal ulcer and ulcerative colitis in adolescents. Gastro-duodenal ulcers were found in all age groups. One neonate died of indomethacin induced bleeding, however, bleeding from acute ulcer was usually controlled by conservative treatments. Increasing frequency of variceal bleeding due to portal hypertension after successful Kasai procedure for congenital biliary atresia was emphasized.
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PMID:[Gastrointestinal bleeding in children]. 258 65


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