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

We present 13 patients with 15 episodes of colonic volvulus, who underwent colonoscopy to decompress and/or devolvulate. Colonoscopic exploration demonstrated a non obstructive dilatation in three cases. In the remaining 10 patients, with 12 episodes of volvulus, decompression was obtained in 83.3% and devoluvulation in 41.6%. There were two failures, due to peritoneal metastases and adhesions which fixed the volvulus. In 40% of the cases there were mild ischemic signs. Forty per cent of the patients were submitted to elective surgery and the two failures (20%) were operated in emergency. The remaining 4 patients declined surgical treatment. At is allows differential diagnosis, we think that, for these patients, colonoscopy should be the first therapeutic approach; it also allows decompression and/or devolvulation and an early diagnosis of the associated ischemia.
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PMID:[Colonoscopic approach in the therapy of sigmoid volvulus]. 234 81

The medical records of 54 patients treated for sigmoid volvulus from 1983 to 1987 were reviewed. Patient demographics were very similar to previously published results. Four patients (7.4 percent) underwent emergency resection for gangrene with a mortality of 75 percent. Of the 50 patients who presented without ischemia, 23 (46 percent) were managed by nonoperative detorsion while 3 (6 percent) detorsed spontaneously. Fourteen of these 26 patients received no further treatment. Nonoperative mortality was 0 percent. Celiotomy was performed on 36 patients. The type of operative procedure performed had no significant bearing on outcome. Fifteen patients underwent resection and anastomosis; two of these patients died (13 percent). Fifteen patients underwent resection and colostomy with two deaths (13 percent), and six had open detorsion alone with one death (17 percent). The two factors associated with adverse outcome after surgical intervention were patient age and history of previous volvulus. All five deaths occurred in patients older than 70 years presenting with a first episode of volvulus (N = 15, mortality = 33 percent). No deaths occurred among patients younger than 70 years regardless of volvulus history or among those older than 70 years who were being treated for a recurrence (P less than or equal to 0.01). Patients older than 70 years with a first episode of volvulus represent a high risk if subjected to surgical intervention. Nonoperative detorsion alone should be considered for this subgroup of patients.
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PMID:Operative therapy for sigmoid volvulus. Identification of risk factors affecting outcome. 237 19

Operations for intestinal ischemia are frequently done by veterinarians. In equine surgery those conditions commonly producing ischemia are intussusception, volvulus, bowel obstructions, and incarcerated hernias. In an attempt to predict intraoperative bowel viability after the restoration of circulation, a variety of adjuvant methods have been investigated. There is little question that of the techniques currently available, sodium fluorescein injected intravenously approaches the ideal in predicting nonviability in humans and in most animal models. Furthermore, it is safe, takes little operating time, is inexpensive, and is ubiquitously available; in addition, the only special equipment needed is a long-wave ultraviolet lamp. Reliance on this method would seldom result in nonviable bowel being left in situ. Furthermore, the use of fluorescein would minimize the unnecessary resection of viable intestine and, thereby, minimize the postoperative nutritional problems that may occur, especially in equines. The report of Sullins et al questions the accuracy of the fluorescein technique in predicting viability and nonviability in horses and also raises the question as to whether the prediction of viability, after the restoration of intestinal blood flow, also predicts normal intestinal function. Further investigations will be needed to confirm or refute these observations.
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PMID:Determination of intestinal viability. 267 Jan 9

We report seven cases of complete volvulus of the small bowel without malrotation seen from 1973 through 1986. The clinical setting is always the same in this condition: the infant exhibits no clinical anomalies during the symptom-free interval between birth and the volvulus (4 h to 35 d, m = 7 d in our series). Onset is extremely sudden, with a complete, proximal obstruction, early and abundant passage of blood per rectum, and above all a severe shock that fails to respond to resuscitation. Roentgenograms contribute little to the diagnosis and surgery should never be delayed to perform complementary investigations of any kind. Indeed, the only effective treatment is unwinding the volvulus within the first six hours following onset, for beyond that time irreversible necrosis of the entire small bowel and occasionally colon occurs. Five infants died because they were seen too late and operated on 36 hours on average after the onset of symptoms. The two survivors had an early operation that prevented total necrosis of the small bowel. However, this pattern seems to vary according to the degree of cecum anchorage: a fixed cecum results in a very tight volvulus with complete, early ischemia and usually irreversible necrosis of the small bowel beyond the sixth hour (9/9 published cases); an even slightly mobile cecum results in a looser volvulus, with less severe ischemia, more delayed necrosis, and a possibility of complete recovery (5/6 published cases).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Primary volvulus of the small intestine without malrotation. Apropos of 7 cases]. 278 53

A single retrocardiac air-fluid level on a chest radiograph typically implies the presence of a sliding hiatal hernia. A differential retrocardiac fluid level (two air-fluid interfaces at different heights) suggests not a simple sliding hiatal hernia but rather an intrathoracic gastric volvulus. Simultaneous fluid levels above and below the diaphragm are not required to make the diagnosis. We have seen four patients with chronic gastric volvulus confirmed by upper gastrointestinal barium examination. Each case was diagnosable on the basis of the chest radiographs obtained on admission, using the radiographic sign described above. We draw attention to this sign because chronic gastric volvulus has the potential to progress to acute volvulus and gastric ischemia or infarction.
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PMID:The differential retrocardiac air-fluid level: a sign of intrathoracic gastric volvulus. 294 30

Between 1983 and 1986, four newborns who had primary closure of gastroschisis had postoperative ischemic bowel. Suspicion was raised almost immediately after closure that something was wrong inside the abdomen when there was persistent acidosis, sepsis, abdominal wall redness, and a generalized worsening condition. All four neonates were re-explored. Necrotic bowel was found, and three required silon pouch closure. The two survivors were left with a temporary short gut. Whether the cause of the bowel ischemia in the four babies was due to excessive intraabdominal pressure, volvulus, or the intestines being too vigorously manipulated, is speculative. Therefore, excessive manipulation and compression of gastroschisis contents seem unwise; if such a newborn has persistence of the above signs and symptoms, immediate reoperation and decompression are warranted.
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PMID:Ischemic bowel after primary closure for gastroschisis. 297 92

The small bowel may be subjected to transient, yet reversible ischemia in situations such as volvulus, thromboembolism, and low flow states. The surgeon is frequently faced with the necessity of intestinal resection in treating such cases. The remaining bowel, while judged viable may have been exposed to significant ischemic injury. The surgeon must decide whether such bowel will heal satisfactorily if used in an anastomosis. This study was undertaken to determine the effect of transient ischemia on intestinal anastomotic healing in the rat. Male albino rats were subjected to superior mesenteric artery occlusion for periods of 30 minutes or 45 minutes. The circulation was then re-established. The small bowel was the transected and anastomosed. Animals in each group were sacrificed at 7 and 10 days and bursting pressures performed to test the healing of the anastomosis. Results were compared with a control group having an anastomosis without precedent ischemia. There were no significant differences among the groups. The data clearly indicate that if the bowel remains viable following an ischemic insult its healing is unimpaired.
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PMID:Effects of transient ischemia on the healing small bowel anastomosis. 339 30

Antireflux operations are now commonly performed for severe gastroesophageal reflux with life-threatening presentations like recurrent aspiration pneumonia and apnea. We report a child who presented 2 years after Nissen fundoplication with jejunal volvulus resulting in massive gastric dilatation, gastric rupture, pneumoretroperitoneum, pneumomediastinum, and severely compromised circulation to the lower extremities. Because of the intense intraabdominal pressure from the gastric dilatation, there was severe ischemia of the pancreas, duodenum, small bowel, colon, and gallbladder. We suggest that gastrointestinal symptoms in a child who has had Nissen fundoplication should be promptly evaluated to avoid delay in recognition of acute gastric dilatation and to prevent a fatal outcome.
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PMID:Visceral ischemia secondary to gastric dilatation: a rare complication of Nissen fundoplication. 368 27

From June 1980 to September 1984, forty-five newborns (weight greater than or equal to 2000 g), initially presumed normal, were seen with bilious vomiting in the first 72 hours and were prospectively followed up. Nine (20%) required surgical intervention, five (11%) had nonsurgical obstruction such as meconium plug or left microcolon, and the remaining 31 (69%) had idiopathic bilious vomiting. Infants with idiopathic bilious vomiting had a benign transient course and resumed feedings by 1 week of age; 30 of the 31 had normal or nonspecific findings on initial plain abdominal roentgenogram. Specific findings on the initial plain abdominal roentgenogram were noted in five infants, and four (80%) of these had a lesion requiring surgical intervention; 56% (5/9) of neonates with surgical lesions had normal or nonspecific findings on the plain abdominal roentgenograms. None developed bowel ischemia or midgut infarction secondary to a volvulus as they were identified by contrast studies shortly after the initial episode of bilious vomiting. Although the majority of "normal" neonates with bilious vomiting do not have a surgical lesion, this study indicates that 56% of surgical cases will be missed if contrast studies are not done.
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PMID:Green vomiting in the first 72 hours in normal infants. 371 4

Situs inversus (SI) complicating neonatal bowel obstruction presents a challenging complex, and to facilitate rational decision making for treatment, we have reviewed 23 cases of abdominal SI seen in our hospital over the last 25 years. Preoperative roentgenographic studies most always predicted SI, the specific patient groups including: 12 abdominal SI with dextrocardia, 10 abdominal SI with levocardia, and 1 with partial heterotaxia. Major intraabdominal anomalies produced surgical emergencies in 7 neonates in the first year, 6 of these 7 being in the first month of life. In these 7 patients, multiple anomalies occurred including 1 child with a rotational anomaly with reversible ischemia secondary to midgut volvulus, and 4 with a rotational anomaly without volvulus, all being treated with a modified Ladd procedure. One of these children had an unrecognized intraluminal duodenal membrane, 1 an operatively diagnosed intraluminal membrane, 1 had annular pancreas, and 1 had a discontinuous jejunal atresia. A preduodenal portal vein was present in 4 of the 7 children, a branch being divided in 1 and the full vein bypassed in 2 of the other 3 patients. Two patients had biliary atresia, one of whom also had a diaphragmatic hernia. Five of the 7 neonates had associated major congenial heart disease accounting for 2 of the 3 deaths in this series. This review emphasizes the protean nature of abdominal SI, especially as it may cause or contribute to neonatal intestinal obstruction; and it is this understanding which is a prerequisite to optimal operative management.
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PMID:Situs inversus: the complex inducing neonatal intestinal obstruction. 666 1


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