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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Intestinal occlusion is a rare pathologic event during pregnancy occurring mostly in the second and third trimenon when increased volume of the uterus and the consequent displacement of abdominal organs cause complications of pathologies which would otherwise escape notice, such as intestinal adhesions, to become manifest. Diagnosis is difficult for a number of reasons. Vomiting during the first trimenon and mild abdominal pain during the third are often neglected or considered to be part of the normal course of pregnancy; pain is sometimes referred to atypical sites due to the displacement of abdominal organs; in other cases, the high endorphin tonus is apt to reduce the customary defence reaction. All this should not cause time to be lost, and whenever intestinal occlusion is suspected all the necessary diagnostic procedures must at once be carried out and appropriate therapy must speedily be started so as to reduce the risk of mortality and morbidity for mother and fetus. Management of ileus in pregnancy is identical to that for the non pregnant woman, except for the need to empty the uterus in cases in which it prevents treatment or if the fetus has reached a sufficient degree of pulmonary maturity. The paper describes a case of ileal volvulus and revisits the literature analyzing the diagnostic and therapeutic options suggested.
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PMID:[Intestinal volvulus in pregnancy]. 149 64

Intestinal malrotation may be complicated by volvulus and intestinal necrosis. One hundred two children (64 male, 38 female) undergoing surgical abdominal exploration from 1977 to 1987 had malrotation. Fifty-two patients were less than 7 days of age, 13 from 8 to 30 days, 26 from 31 to 365 days, and 11 were older than 1 year of age. Of infants, 39 of 65 had 40-week gestations, 18 of 65 had 36- to 39-week gestations, and 8 of 65 had less than 36-week gestations. Chief symptomatology included: bilious emesis (47), intestinal obstruction (19), abdominal pain (11), and bloody stools (7). Seventy patients had congenital anomalies (50 single, 20 multiple). Diagnostic evaluations included 56 upper gastrointestinal series and 27 barium enemas. Each patient underwent correction of malrotation and appendectomy, and correction of congenital anomalies (omphalocele-9, gastroschisis-6, diaphragmatic hernia-7). Complications included short gut (2), sepsis (5), feeding difficulties (2), pneumonia (3), small bowel obstruction (2), and other (15). Nine patients (8.8%) died (trisomy 18-1, trisomy 13-1, intestinal necrosis-3, hepatic failure-1, prematurity-1, other sepsis-2). Two hundred sixteen children with intestinal malrotation have been treated from 1937 to 1987. Mortality rate has improved from 23% to 2.9%.
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PMID:Malrotation of the intestine in children. 154 4

The records of nine dogs with intestinal volvulus were reviewed. Most were young adult (median 2.6 years) males (6/9) of medium to large breeds. Vigorous activity, dietary indiscretion, or trauma preceded volvulus. Signs included a peracute to acute onset of vomiting, hematochezia, a moderately distended and often painful abdomen, and shock. Normal packed cell volume, altered white blood cell count, hypoproteinemia, hypoalbuminemia, hypokalemia, pathologic bowel dilatation, and serosanguineous abdominal fluid were common clinical findings. Jejunum was most often affected. One dog survived with surgical management.
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PMID:Canine intestinal volvulus. A report of nine new cases. 158 53

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

A review was performed of the 37 cases of malrotation of the intestine which occurred in previously healthy children during a 12-year period. There were 33 patients (89%) younger than eight weeks of age, with 17 patients (46%) aged less than one week. Symptoms included bilious vomiting in 36 patients (97%) and constipation in 33 patients (89%). On initial examination, 35 patients (95%) appeared to be well (including 23/25 patients [92%] with volvulus of the midgut), and 28 patients (76%) exhibited no abnormal physical findings on abdominal examination (including 15/25 patients [60%] with volvulus of the midgut). In all, 25 cases (68%) of malrotation were accompanied by volvulus of the midgut; in 21 of these cases, torsion of the bowel was greater than or equal to 360 degrees. There were four patients (11%) with gangrenous bowel requiring surgical resection. The mortality rate associated with this disorder was 5%; both patients who died were neonates with volvulus who presented in shock and had extensively gangrenous bowel. Malrotation of the intestine usually presents in the young infant, is almost always associated with bilious vomiting, and is commonly accompanied by few if any abnormal physical findings suggestive of a serious underlying intraabdominal disease process. An emergent radiographic contrast study of the upper gastrointestinal tract should be performed to delineate the anatomy of the proximal bowel in all young infants with bilious vomiting.
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PMID:The clinical features of children with malrotation of the intestine. 178 23

The intestinal post-operative bridle represents the third most important etiology of obstructions at the clinic of the University Hospital of Dakar, behind hernia strangulations and the volvulus of the digestive tube. Between 1970 and 1989, a retrospective study has led to a sample of 79 patients with post-operative bridle obstructions. The group was made of 47 women and 32 men between 17 and 84 years of age. Stomach ache was by far the most common functional symptomatology, followed by the stoppage of the transit and vomiting. In most cases palpation revealed the presence of tympanism. For almost all the patients, the abdomen without preparation revealed either a hydroaeric level or a diffuse grey area. The initial intervention concerned mainly gynecological affections or pathologies of appendicular type. The resection of the bridles was carried out in most cases. There were 10 deaths. The intestinal obstructions by post-operative bridles continue to be a surgical emergency still characterized by a high mortality rate. The late consultation of the patients, often received when presenting considerable visceral deficiency, is one of the main causes of the high rate of fatalities.
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PMID:[Intestinal obstruction caused by postoperative adhesion. 79 cases]. 180 62

Abdominal lymphangiomas are usually classified together with mesenteric cysts. However, they differ by location, histology, and potential for recurrence, and should be considered a separate clinical entity. Thirteen children, aged 2 weeks to 11 years (mean, 5.8 years), with abdominal lymphangiomas were identified over the past 16 years at this institution. Of these, 12 were symptomatic. Abdominal pain (11), vomiting (8), increased abdominal girth (8), and nausea (6) predominated. Other presentations were less frequent. Symptoms were present for an average of 2 months (7 less than 1 week) before correct diagnosis. An abdominal mass was palpable in 10 cases. Intestinal gangrene secondary to volvulus was present in 2. Although multiple imaging modalities were used ultrasonography (8/8) and computed tomography (CT; 4/4) proved most expedient and reliable. In 2 cases, the lymphangioma could not be completely resected. There was 1 recurrence. Although intraabdominal cystic lesions are described in the literature as relatively symptom-free, our experience suggests otherwise. In this series, abdominal pain and an abdominal mass were common. Catastrophic complications can occur and excision is facilitated by earlier diagnosis and the benefit of smaller size. Ultrasound and CT can accurately diagnose the lesion and should be used liberally in children with intermittent or ill-defined abdominal pain, leading to prompt recognition and definitive treatment.
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PMID:Pediatric abdominal lymphangiomas: a plea for early recognition. 181 64

Gastric volvulus is a rare disease. We recently encountered a gastric volvulus associated with Bochdalek hernia and severe hypopotassemia. A 32-year-old woman experienced epigastric pain and recurrent vomiting. The changes of the electrocardiogram in this patient (K1.8mEq/l) were inverted T wave and ST depression. She was diagnosed as having gastric volvulus associated with Bochdalek hernia by chest X-ray films, contrast radiography of the upper digestive tract and thoraco-abdominal CT scans. Symptoms did not disappear with the administration of conservative therapy. At laparotomy, the stomach was rotated around its mesenteric axis in the sagittal plane. After operative repair, symptoms disappeared, and serum potassium level returned to normal. Gastric volvulus is rather easily diagnosed if its existence is kept in mind.
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PMID:[A case of Bochdalek hernia in an adult with volvulus of the stomach and hypopotassemia]. 189 66

Two cases of gastric volvulus are reviewed. Both patients were nonverbal, mentally handicapped children, who were fed through a gastrostomy. They had intermittent intolerance to bolus feeds through the gastrostomy, accompanied by abdominal distension and vomiting of gastric contents. One had a previous partial fundoplication and gastrostomy, and the other had had two pyloroplasties and gastrostomy. The axis of torsion ran from the esophagogastric junction to the gastrostomy site. Both children were treated by detorsion and gastropexy. It is postulated that the gastrostomy served as a fixed point for the volvulus. This was facilitated by the chronically dilated stomachs induced by bolus feeds. These two cases are reported to alert the clinician to this possibility when a neurologically impaired child with a gastrostomy presents with feeding difficulties and persistent vomiting.
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PMID:Gastric volvulus--a late complication of gastrostomy. 191 95

Although it is common in the adult population, sigmoid volvulus is unusual in childhood. We report the cases of four children treated for sigmoid volvulus, and we review an additional 44 cases. The mean age of occurrence was 8 years. Predisposing factors were present in 33%. Abdominal pain (66%), vomiting (31%), and obstipation (10%) were the most common symptoms. Abdominal findings included distention (69%), tenderness (41%), and a mass (10%). The classic roentgenographic omega sign of volvulus was present on plain films in only 29% of the cases. Barium enema examination was diagnostic in 61% of the cases in which it was used. Nonoperative treatment by barium enema or proctoscopy was successful in all 17 cases in which it was attempted. The recurrence rate after nonoperative treatment was 31%. Thirty children had operation. The mortality in the group of patients having "derotation" alone was 29%. Immediate resection was associated with a 25% mortality; none of the patients who had elective resection died. Sigmoid resection is the definitive treatment for children as well as adults, but nonoperative decompression to allow for elective resection should be attempted in patients who have no evidence of peritonitis.
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PMID:Sigmoid volvulus in childhood. 219 90


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