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

When to operate immediately, when to observe, and when not to operate at all represent major challenges in the management of a child with an acute abdomen. This article is an overview of the subject from symptom to diagnosis, evaluation, and preparation for the surgical intervention. Tables provide examples of conditions requiring prompt surgical intervention and relative surgical urgency; pathologies suitable for (initial) nonsurgical management; and clinical pictures where surgical intervention is not indicated. Factors that influence the timing of operation are provided, as is the differential diagnosis between intestinal strangulation and obstruction. Brief notes highlight four important causes of acute abdomen in children acute appendicitis, malrotation with volvulus, Meckel's diverticulum, and intussusception. These as well as other intraabdominal pathologies are illustrated by means of surgical photographs. The acute abdomen is a clinical diagnosis. Other diagnostic modalities have merely supporting roles. The decision to operate is based primarily on the results of a good history and thorough physical examination(s).
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PMID:Acute abdomen. When to operate immediately and when to observe. 915 57

There are few reports of the sonographic appearance of Meckel's diverticulum. We present a case of torsion of a Meckel's diverticulum that was suggested by sonography and confirmed pathologically. We discuss the sonographic differential diagnosis, which includes acute appendicitis, enteric duplication cyst and intestinal volvulus.
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PMID:Torsion of a Meckel's diverticulum: sonographic findings. 971 31

Volvulus of the small intestine is a condition of bowel obstruction due to knotting and twisting of the small intestine. Two types of volvulus are described: 1) primary small intestinal volvulus where no predisposing factors exist, and 2) secondary volvulus where congenital or acquired conditions promote twisting of the small intestine. Over a 5-year period, 18 patients (eleven men and seven women) presenting volvulus of the small intestine are operated in the Emergency Surgery Clinic of the University Hospital "Queen Giovanna", representing 8.7 per cent of the total of 206 cases of small intestinal mechanical ileus (incarcerated herniations involving the small intestine are not included in the series). Primary volvulus is found in one patient. In those presenting secondary volvulus adhesions are the commonest underlying cause of small intestinal rotation--13 cases, next ranking primary tumor of the small intestine--one case, Meckel's diverticulum--one, carcinosis of peritoneum--one, and one patient with small intestine volvulation around colostomy. The most frequently encountered symptoms and laboratory examinations performed are analyzed. Intestinal necrosis is established in four instances (22 per cent). One patient dies of peritonitis and polyorganic insufficiency. Volvulus of the small intestine should be mandatorily considered in patients presenting mechanical ileus of the small intestine. Early operative intervention is a therapeutic approach contributing to preclude intestinal necrosis.
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PMID:[Volvulus of the small intestine]. 973 71

Among 588 small bowel mechanical obstructions operated since January 1982 until December 1996 at the Flajani Surgery Department and Emergency Department of the San Camillo Hospital in Rome, 3 male patients were operated for intestinal obstruction due to Meckel's diverticulum. In one case, obstruction was caused by a small bowel volvulus rolling on a Meckel's diverticulum, whose gangrenous extremity was "blocked" on caecum. In the other two cases, intestinal loops were incarcerated into an internal hernial ring constituted by the same diverticulum whose inflamed extremity was fixed to corresponding mesentery. We examined embryologic and clinical aspects of the pathology here considered, particularly its complications, obstruction being the most common in adult age. Diagnosis is often misunderstood, since a complicated Meckel's diverticulum simulates many other abdominal pathologies. A straight radiography and an ultrasonography of the abdomen may be useful to reach the correct diagnosis. We performed diverticulectomy, using a linear stapler and we underline the opportunity of this method. In young age laparoscopy resection is considered the gold treatment of this pathology by some authors. We didn't observe any mortality, although one of our patients was in a severe septic condition. It is necessary to examine the last ileal 100 centimetres when a suspected acute appendicitis is not initially found by operation. The opportunity of a promptly performed operation is underlined to prevent that such a benign pathology may induce also exitus.
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PMID:[Intestinal obstruction due to Meckel's diverticulum. Description of three cases]. 988 69

In developed countries, intestinal volvulus in children is most frequently due to malrotation. To review the experience in Nigeria, a retrospective analysis of 28 patients managed over 25 years at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, was undertaken. There were 22 boys and 6 girls with an age range of 4 days to 14 years (median 4 years). There were equal numbers over and less than 5 years of age. Vomiting (89%) and abdominal distension (79%) were the most prominent features. Thirteen children (46%) had fever, associated with bowel gangrene in 5, while 8 (29%) presented with severe dehydration and shock. A plain abdominal radiograph was the only investigation performed, but the features were not specific for volvulus. In 11 children (39%) the volvulus was idiopathic, in 9 (32%) due to adhesions or bands, in 5 (18%) to malrotation, and in 1 each a Meckel's diverticulum, internal herniation, and ventriculoperitoneal shunt. Twenty-three patients had a small-bowel, 4 sigmoid, and 1 caecal volvulus. The bowel resection rate for gangrene was 46% (small bowel 9, sigmoid 3, caecum 1). All patients with malrotation had Ladd's procedure performed. Wound infections occurred in 10 patients (36%), complete wound dehiscence in 1, and recurrence in 1 (idiopathic terminal ileal volvulus). The mortality was 21%, mostly from overwhelming infection (2 neonates, 11-year-old, 3 >/= 5 years). Intestinal volvulus in our environment differs in aetiology from other reports. The resection rates are similar, however. This condition carries high morbidity and mortality.
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PMID:Intestinal volvulus: aetiology, morbidity, and mortality in Nigerian children. 1066 35

Meckel's diverticulum is the congenital anomaly of the gastrointestinal tract affecting about 2% of the population. It is a true diverticulum containing all layers of the ileum wall. Heterotopic tissue is frequently present (25%): gastric mucosa, duodenal mucosa, jejunal mucosa and pancreatic tissue. Meckel's diverticulum is localized about 50 cm from the ileo-colic valve on the external border of the ileum. Most of Meckel's diverticula are clinically silent; clinical symptoms (19%) are in cases of complications such as: strangulation of the bowel in a ring formed by the diverticulum, intussusception of the diverticulum into the ileum, volvulus, incarceration of the diverticulum in hernia, tumour originating in the diverticulum. The diagnosis of Meckel's diverticulum is very difficult. The most useful in the diagnosis are plain abdominal radiographs, barium studies, CT, sonography and scintigraphy Abdominal sonography shows a tubular fluid structure localized far from the coecum. The wall of the diverticulum is swollen and in the lumen are chyme or fat.
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PMID:[Ultrasonographic diagnosis of Meckel's diverticulum--case report]. 1120 10

Meckel's diverticulum is present in 2 per cent of the population with bowel obstruction as its most common complication. This case report describes an extremely rare complication of a Meckel's diverticulum, a cecal volvulus. The diagnosis of cecal volvulus was made preoperatively on abdominal X-rays; the diagnosis of a Meckel's diverticulum was made intraoperatively. The cecum was found to be twisted around a vitelline band on a broad-based Meckel's diverticulum extending to the umbilicus. The diverticulum was resected. The patient did well postoperatively and was discharged without any difficulty.
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PMID:Meckel's diverticulum causing cecal volvulus. 1120 95

The era of videoendoscopic surgery in emergency surgery practice has facilitated a wide range of endoscopic operative procedures. In our unit the diagnosis of acute abdomen is made after sequential clinical and laboratory examination, and diagnostic laparoscopy is advocated. Laparoscopy-assisted resection of complicated Meckel's diverticulum in two adult patients was performed, and the results are discussed. Between December 1996 and June 2000, 98 patients underwent diagnostic laparoscopy at the Cerrahpasa Medical Faculty Emergency Surgery Unit of Istanbul University because of signs and symptoms of acute abdomen. Among these, we have diagnosed one case of intestinal obstruction due to a volvulus around Meckel's diverticulum and one of acute abdomen masquerading as acute appendicitis but actually involving omphalomesenteric duct cyst torsion. Both of these patients underwent diagnostic laparoscopy and laparoscopy-assisted Meckel's diverticulectomy. Diagnostic laparoscopies were performed on 46 male (47%) and 52 female (53%) patients. In all cases, laparoscopy successfully confirmed the diagnosis. Although in 27 patients the interventions were converted to open procedures, the operations were completed laparoscopically in 71 patients. Two of these patients underwent laparoscopy-assisted Meckel's diverticulectomy and their postoperative periods were uneventful. Both patients were discharged from the hospital on their fourth postoperative day. Diagnostic laparoscopy is a safe and effective method for diagnosis of acute abdomen. In emergency surgery practices in developing countries, advanced laparoscopy should be performed to reduce expenses. Laparoscopy-assisted Meckel's diverticulectomy is a safe and economic procedure and can be performed in adults for treatment of complicated cases without staplers.
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PMID:Laparoscopy-assisted resection of complicated Meckel's diverticulum in adults. 1249 56

A symptomatic Meckel's diverticulum (MD) may manifest as an intestinal obstruction secondary to a volvulus. We describe a case of a meconium-impacted MD associated with inflammatory adhesions to adjacent viscera that presented as an intestinal obstruction in a 4-h-old infant secondary to an ileal volvulus with resultant infarction of the diverticulum and ileal segment.
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PMID:Meckel's diverticulum associated with ileal volvulus in a neonate. 1241 2

Indications and contraindications for diagnostic laparoscopy in cases of intestinal obstructions are discussed in connection with a 16-year-old patient's case report with small bowel obstruction including intussusception, volvulus and appendicitis caused by an inflammatory Meckel's diverticulum. The use of diagnostic laparoscopy in cases of intestinal obstructions is controversial. In the described case we performed completely laparoscopically the derevolving and desusception of the volvulus and intussusception, the appendectomy and resection of the diverticulum. The procedure itself and the postoperative course were uneventful.
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PMID:[Laparoscopic treatment of small bowel obstruction with intussusception, volvulus and appendicitis caused by an inflammatory Meckel's diverticulum]. 1263 75


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