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

Laparoscopic gastrostomy (LG) and laparoscopic jejunostomy (LJ) were performed successfully on 22 consecutive patients after development of the procedure on a porcine model. Patients did not undergo percutaneous endoscopic gastrostomies (PEG) due to obstruction from head and neck, esophageal cancer, gastropexy for gastric volvulus, perforated esophagus, failed PEGs, or surgeon's preference. Operative time averaged < 20.5 min. Five patients underwent the procedure under local anesthesia with intravenous sedation and three patients were operated on in a strictly outpatient setting. There was one postoperative death. LG and LJ are safe alternatives to open enterostomy in patients who cannot undergo PEG.
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PMID:Laparoscopic gastrostomy and jejunostomy: review of 22 cases. 795 41

In some emergency situations of colo-rectal pathology, especially those characterized by hemorrhaging, the endoscopy has acquired, with the passing of years, a fundamental role both from the diagnostic and the therapeutic point of view. In no more than 25% of the lower intestinal tract hemorrhages, the clinical picture does have the signs of an emergency. The diverticula, IBD and angiodysplasias are primarily responsible for rendering these characteristics. Even when possible problems concerning an accurate intestinal cleaning can arise, a correct diagnosis is possible at least in seven cases out ten. When the colonoscopy isn't conclusive and the bleeding persists may be recommended the selective arteriography (helpful also in hemorrhages lower than 0.5 ml/min). Also in cases of acute obstructive syndrome the colonoscopy, taking advantage of the direct view of the lesion, can give a correct diagnosis, sometimes supported by the histologic examination. Regarding the operating capacity of the method, the endoscopy can resolve minute and localized bleeding lesions. The Argon or Nd:YAG laser photocoagulation is widely used. Recently BICAP and heater probe methods have been developed, which aveld the problem connected to the HF electrocoagulation. A very efficacious and simple method is that of injecting 1:10.000 adrenalin, 1% polidocanol, absolute ethanol or hypertonic solution around the lesion. The scarred strictures are those more easily and safely treated by pneumatic dilatation or (limited to the rectum-sigmoid) by Savary sounds. In the volvulus or bowel invagination, just by having the endoscope goes up in the lumen, often normal condition settles again. In the Ogilvie's syndrome you can deflate the cecum with an aspirator or more simply by positioning a tube above the hepatic flexure, with 85% success. In the malignant strictures the debulking of tumor mass by laser treatment, sometimes followed by dilatation, may be preparatory to the surgery or purely palliative. Finally the extraction of foreign bodies must be performed, in order to obtain a relaxed anal sphincter, in general anaesthesia or by a previous rigid rectoscope dilatation.
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PMID:[Emergencies in colorectal diseases: role of the endoscopist]. 892 30

Ultrasonography was used to compare adhesions induced by two different methods of gastropexy in 16 dogs. An incisional gastropexy technique was used in eight dogs (group 1) and a 'modified' gastropexy technique in the remaining eight (group 2). The length and thickness of the gastropexy and the peristaltic activity of the stomach were measured ultrasonographically and compared between groups. Measurements for the two groups were taken in the early postoperative interval (two to four days), intermediate postoperative interval (eight to 20 days) and late postoperative interval (57 to 79 days). Both techniques were equally successful in forming permanent adhesions at two months postoperatively and there was no recurrence of gastric dilatation and volvulus. The length and thickness of the gastropexy were similar for both groups at two months postoperatively and there were no surgical complications with either technique. The modified gastropexy provides a technique that can easily be performed by a single surgeon, with no increased operative time or duration of anaesthesia, and with the formation of a permanent adhesion.
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PMID:Ultrasonographic comparison of adhesions induced by two different methods of gastropexy in the dog. 979 30

From 1976 to 1995, 23 children, 4 boys and 19 girls, were treated at our department for sacrococcygeal teratomas (SCT). Their records were analyzed retrospectively, considering age at operation, histopathology, recurrences, and long-term evolution. One died on the 1st day of life following tumor rupture with hemorrhagic shock without surgical intervention. All others were operated upon at a mean age of 4.2 days for those 19 (= 82%) who were diagnosed in the neonatal period and whose histology proved benign. In the remaining 3 children, in whom tumor manifestation did not occur before 11 months, 13 months, and 10 years of age, respectively, histopathologic evaluation revealed 2 carcinomas and 1 yolk-sac tumor, and all 3 recurred. Overall, 5 patients died, the 1 mentioned above, 1 due to volvulus after laparotomy, and 1 from multiple associated congenital malformations. Two deaths were related to malignancy, whereby only 1 was a malignant teratoma diagnosed at the original operation. Eight children had recurrences, 2 were benign and 6 malignant, with 3 of the latter having been graded benign on histology of the primary tumor. Of the 18 surviving patients, 17 (93.5%) returned for clinical review following a standardized protocol. The average interval from the primary surgery was 12.3 years (range 3.5-22 years). Four had malignant tumors with a recurrence-free period of from 9 to 14 years; 5 (29.4%) had urinary or anorectal functional impairment. One child with a patulous anus presented with fecal soiling. Two reported nocturnal enuresis, 1 associated with perineal anesthesia. One had a neurogenic bladder with overflow voiding and bilateral third-degree vesicoureteral reflux. Second-degree reflux was found in the last patient. We conclude that follow-up after surgery for SCT should not only search for tumor recurrence but include the diagnosis and treatment of possible secondary urinary and/or fecal incontinence.
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PMID:Sacrococcygeal teratoma: clinical course and prognosis with a special view to long-term functional results. 1063 38

Among Gastrointestinal Duplications, colonic duplications are the less common. The case presented here consist of a duplication of the transverse colon, difficult to diagnose, which had abdominal distension as the main symptom. A 4-year-old child was referred to the Unity of Pediatric Surgery, Hospital de Base, Brasilia, DF with a history of progressive abdominal distension. Plain X-Rays of the abdomen demonstrated a large fecaloma, which demanded removal. A Barium Enema was done suggesting Congenital Megacolon. A rectal biopsy was performed under general anesthesia, demonstrating normal ganglion cells. Medical treatment was instituted for chronic constipation in the Pediatric Gastroenterology clinic. The patient returned three months later with the same complaints. A new rectal biopsy was done; normal ganglion cells were described, ruling out Hirschsprung's disease. The parents were told to insist on the medical treatment diets. Four years later the patient was seen in the Emergency Room with signs and symptoms of low intestinal obstruction. Exploratory Laparotomy was undertaken as an emergency and the findings were complete volvulus of the large bowel involving the transverse colon up to the splenic flexure, demonstrating a large duplication of the transverse colon. A resection of the duplication and end-to-end colonic anastomosis was performed with an uneventful postoperative care. Discharged on excellent conditions.
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PMID:[Tubular duplication of the colon: a case report and review of the literature]. 1468 38

Gastric dilatation-volvulus (GDV) is a disease in which there is gross distension of the stomach with fluid or gas and gastric malpositioning. It causes pathology of multiple organ systems and is rapidly fatal. It is common in large- and giant-breed dogs. The disease appears to have a familial predisposition. Thoracic depth/width ratio also appears to predispose dogs to GDV. Implicated dietary factors include dietary particle size, frequency of feeding, speed of eating, aerophagia and an elevated feed bowl. A fearful temperament and stressful events may also predispose dogs to GDV. Abdominal distension, non-productive retching, restlessness, signs of shock, tachypnoea and dyspnoea are possible clinical signs. Initial treatment includes treatment of shock and gastric decompression. Surgical treatment should be performed promptly. There are no studies comparing the use of different anaesthetic agents in the anaesthetic management of GDV. Pre-medication with an opioid/benzodiazepine combination has been recommended. Induction agents that cause minimal cardiovascular changes such as opioids, neuroactive steroidal agents and etomidate are recommended. Anaesthesia should be maintained with an inhalational agent. Surgical therapy involves decompression, correction of gastric malpositioning, debridement of necrotic tissue, and gastropexy. Options for gastropexy include incisional, tube, circumcostal, belt-loop, incorporating, and laparoscopic gastropexy. Expected mortality with surgical therapy is 15-24%. Prognostic factors include mental status on presentation, presence of gastric necrosis, presence of cardiac arrhythmia and plasma lactate levels. Prophylactic gastropexy should be considered in dogs identified as being at high risk.
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PMID:Gastric dilatation-volvulus in dogs. 1603 41

The purpose of the study was to evaluate ischaemia/reperfusion injury in simulated abomasal volvulus in sheep. Sixteen ewes were randomly allocated to three groups. The control group (n=4) served as sham-operated controls. The animals of the ischaemia group and reperfusion group (n=6, each) underwent a simulated 'abomasal volvulus'. The abomasum was exteriorized under general inhalation anesthesia and forced into a 180( composite function) anticlockwise rotation around its longitudinal axis, followed by another 270( composite function) anticlockwise rotation around its transectional axis. All ewes were monitored for 4 h. In the reperfusion group, volvulus was released after 3 h (i.e., 1 h of reperfusion). In the ischaemia group, the volvulus remained for 4 h (no reperfusion). Vital signs were monitored and some haematological and biochemical parameters were measured, without any significant differences. Full-section biopsy specimens were taken at the 3rd and 4th hours from the greater curvature of the abomasum. Histopathological lesions were scored according to the severity of mucosal oedema, submucosal oedema, haemorrhage submucosal and submuscularis layers, and polymorphonuclear infiltration on a scale of 0 to 4 (nil, mild, moderate, severe, and extreme). Another biopsy specimen was taken at the 4th hour for transmission electron microscopic examination. The scored lesions in light-microscopic examination were significantly different at the 3rd and 4th hours between the control and the experimental groups (p<0.05). There was no significant difference between the reperfusion and ischaemia groups (p>0.1). Within-group comparisons (3rd hour with 4th hour) revealed no significant differences. In transmission electron microscopic examination there were no remarkable changes in the control group, but in the ischaemia and reperfusion groups there were remarkable cellular (epithelial and goblet cells), mitochondrial and microvillous changes that strongly implied the occurrence of ischaemia (p<0.05). In transmission electron-microscopic examination of abomasal samples the lesions were more remarkable in reperfusion group than in the ischaemia group. It is concluded that ischaemia/reperfusion injury occurred in this model of simulated abomasal volvulus in sheep and that ischaemia/reperfusion injury should be considered as a potential determining factor in the outcome of cattle with abomasal volvulus.
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PMID:Ischaemia/reperfusion injury in experimentally induced abomasal volvulus in sheep. 1722 87

Sigmoid volvulus requires decompression and subsequent surgical correction, and is often seen in debilitated patients. In an effort to decrease the physiological burden of surgery in these high-risk patients, we report an innovative minimal access technique for the definitive treatment of decompressed sigmoid volvulus in patients with concomitant faecal incontinence. A retrospective chart review of a series of two consecutive patients who had undergone a minimal access Hartmann's procedure (HP) between November 2005 and October 2006 was performed. A single skin incision of < or = 4 cm at the proposed colostomy site was used to identify, exteriorize, divide, and resect the redundant mesosigmoid and sigmoid colon. The same incision was used to mature the end-colostomy. No other incisions were created, and no laparoscopy or laparoscopic instruments were used. Perioperative clinical parameters and outcomes are reported. Patient 1 was a 94-year-old male, American Society of Anesthesiologists (ASA) class 4, who underwent a HP via a 4-cm skin incision under general anaesthesia in 150 min with a length of inpatient stay of 5 days. Patient 2 was an 83-year-old female, ASA class 3, who underwent a HP via a 3-cm skin incision under conscious sedation in 83 min, with a length of inpatient stay of 4 days. Estimated blood loss was <50 cm(3) for both patients, both patients had bowel function and were tolerating oral feeds upon discharge, and there was no perioperative morbidity or mortality in either patient at 30 days. Incisionless HP appears feasible in treating sigmoid volvulus and faecal incontinence in debilitated patients.
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PMID:Incisionless Hartmann's procedure: an innovative minimal access technique for surgical treatment of sigmoid volvulus in debilitated patients with faecal incontinence. 1901 65

A Morgagni diaphragmatic hernia is a rare congenital anteromedial defect in adults (5%). Symptoms of visceral herniation are attributable to the organs involved. Imaging is the mainstay of diagnosis either in an asymptomatic person or in a person with respiratory and/or gastrointestinal symptoms, ultimately requiring surgical intervention because of the risk of incarceration. We present a rare case of 80 years old female with vague upper abdominal pain and recurrent vomiting. An anteromedial parasternal defect was established on conventional as well as on cross-sectional imaging in right hemidiaphragm through which the upper abdominal contents were protruding in the right hemithorax, all enclosed in a peritoneal sac. The herniation resulted in mesentro-axial gastric volvulus. Due to age and anaesthesia risk, patient was conservatively managed.
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PMID:Mesentro-axial gastric volvulus in a morgagni diaphragmatic hernia in an old female. 2157 40

OBJECTIVE To describe the technique, clinical findings, and short-term outcome in dogs undergoing laparoscopic-assisted incisional gastropexy with a reusable single-incision surgery port. DESIGN Retrospective case series. ANIMALS 14 client-owned dogs. PROCEDURES Medical records of dogs referred for elective laparoscopic gastropexy between June 2012 and August 2013 were reviewed. History, signalment, results of physical examination and preoperative laboratory testing, surgical procedure, duration of surgery, postoperative complications, duration of hospital stay, and short-term outcome were recorded. All patients underwent general anesthesia and were positioned in dorsal recumbency. After an initial limited laparoscopic exploration, single-incision laparoscopic-assisted gastropexy was performed extracorporeally in all dogs via a conical port placed in a right paramedian location. Concurrent procedures included laparoscopic ovariectomy (n = 4), gastric biopsy (2), and castration (7). Short-term outcome was evaluated. RESULTS Median duration of surgery was 76 minutes (range, 40 to 90 minutes). Intraoperative complications were minor and consisted of loss of pneumoperitoneum in 2 of 14 dogs. A postoperative surgical site infection occurred in 1 dog and resolved with standard treatment. Median duration of follow-up was 371 days (range, 2 weeks to 1.5 years). No dogs developed gastric dilation-volvulus during the follow-up period, and all owners were satisfied with the outcome. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that single-incision laparoscopic-assisted gastropexy with a reusable conical port was feasible and effective in appropriately selected cases. Investigation of the potential benefits of this reusable port versus single-use devices for elective gastropexy in dogs is warranted.
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PMID:Elective gastropexy with a reusable single-incision laparoscopic surgery port in dogs: 14 cases (2012-2013). 2743 47


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