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PubMed1975

Absence and retention of small bowel gas in infants with midgut volvulus: mechanisms and significance.

The radiographic pattern of high intestinal obstruction--gastric and duodenal distension with absence of small bowel gas (ASBG) or a completely gasless abdomen--may be present in infants with midgut volvulus. In most instances, ASBG is associated with viable small bowel. However, when associated with abdominal distension and tenderness ASBG usually reflects strangulated midgut volvulus and bowel necrosis. In some patients with midgut volvulus there is a radiographic pattern of low small bowel obstruction; this is generally associated with necrotic bowel. These seemingly opposite observations can be explained by reviewing the dynamics of gas absorption in normal bowel and in closed loop intestinal obstruction. Impaired blood supply can result in either gaslessness or gaseous distension under differing conditions. Key words: Infant, intestinal tract, intestinal gas, intestinal obstruction, intestinal volvulus, malrotation, gasless abdomen.

Barium Sulfate↗
PubMed1984

Colon interposition: an adjuvant operation for short-gut syndrome.

Six infants with short-gut syndrome refractory to medical management underwent isoperistaltic colon interposition (length 11.7 +/- 3.1 cm.). The abdominal catastrophes that required extensive intestinal resection were: volvulus (3), necrotizing enterocolitis (2), and gastroschisis with intestinal atresia (1). No infant had another major congenital anomaly. The average trial of attempted medical therapy prior to colon interposition was 5.5 +/- 3.6 months. There was no perioperative mortality or morbidity associated with the colon interposition. Following the colon interposition, three infants were weaned from total parenteral nutrition (TPN) in 3 +/- 1 months and all survived. In contrast, three infants could not be withdrawn from TPN and they died secondary to complications of TPN (2 from sepsis and 1 from hepatic failure). Long-term survival was associated with a greater length of small bowel remaining after the initial resection (51 +/- 12 cm v 35 +/- 24 cm), colon interposition at a younger age (3 +/- 1 months v 8 +/- 3.5 months), and a shorter duration of medical management prior to colon interposition (2.8 +/- 0.8 months v 6.7 +/- 5.0 months). All survivors are now tolerating a regular diet and having one to four formed stools per day. Normal somatic growth and developmental milestones are being achieved. The follow-up period is from 24 to 84 months. Our experience with the colon interposition in the patient with short gut syndrome has led us to conclude that when a reasonable trial of medical management has failed, a colon interposition is a safe and effective adjuvant to treatment.

Child Development↗
PubMed1980

[Strangulated retrocostoxiphoid hernia. Review of the published literature and report on two cases (author's transl)].

Two cases of strangulated retrocostoxiphoid hernia (Morgagni-Larrey hernias) are reported. This is a relatively rare complication, as only 66 cases have been reported, and it has a poor prognosis. The clinical picture includes three main symptomatological groups: occlusion of the colon, gastric volvulus, and small intestine occlusion. Radiological examination of the lungs by frontal and profile films is usually sufficient to establish the diagnosis rapidly, and whether surgery is indicated. In some cases, however, the symptoms are such that opacification with water soluble agents is required. Reduction of the visceral hernia and closure of the orifice is carried out after laparotomy, resection of viscera being rarely required.

Aged↗
PubMed2005

Recurrent sigmoid volvulus in pregnancy: report of a case and review of the literature.

Intestinal obstruction caused by sigmoid volvulus is extremely rare during pregnancy; only 73 cases have been reported worldwide. A case report of recurrent sigmoid volvulus in a 22-year-old pregnant Saudi female and a review of the literature are presented. Despite a previous sigmoidopexy in another institution, colonoscopic detortion and rectal tube decompression was successful until after delivery when sigmoid colectomy was performed. From this case, we propose a treatment option based on the absence or presence of peritonitis and gestational age is suggested. In the first trimester, nonoperative procedure using colonoscopic detorsion and rectal tube decompression is recommended until the second trimester when sigmoid colectomy is performed for recurrent cases. In the third trimester, the treatment is nonoperative until fetal maturity and delivery when sigmoid colectomy is performed. Sigmoid volvulus complicating pregnancy is an uncommon and potentially serious condition and should be recognized as a surgical emergency. Prompt surgical intervention is necessary to minimize maternal and fetal morbidity and mortality.

Diagnosis, Differential↗
PubMed2005

Postoperative short bowel syndrome.

BACKGROUND: Unanticipated massive resection after intraabdominal procedures is an increasing cause of short bowel syndrome (SBS). Our aim was to determine the frequency and potential mechanisms of postoperative SBS. STUDY DESIGN: We reviewed retrospectively the clinical course of 210 adult patients with SBS evaluated over a 20-year period. RESULTS: Fifty-two (25%) patients had postoperative SBS. The initial operations included colectomy (n=20), hysterectomy (n=8), appendectomy (n=5), gastric bypass (n=5), and other (n=14). Intestinal obstruction (n=38) was the most common reason for resection leading to SBS, either from adhesions (n=26) or volvulus (n=12). Postoperative intestinal ischemia led to resection in 14 patients. SBS occurred from 1 day postoperatively to years later, with 16 (30%) intestinal resections occurring within 1 month. Patients undergoing resection for intestinal ischemia were more likely to undergo resection during the first month than were patients with adhesions and volvulus (86% versus 4% and 25%,respectively, p < 0.05): Patients undergoing resection for ischemia and volvulus were more likely to have remnant length<60 cm compared with those with adhesions (57% and 58% versus 23%, respectively, p < 0.05). Patients undergoing resection for adhesive obstruction were more likely to undergo multiple resections. Thirty-five (67%) patients required longterm parenteral nutrition. Seven (13%) patients died, three in the early postoperative period and four from complications of SBS. CONCLUSIONS: SBS is a potential postoperative complication of intraabdominal procedures and accounts for a considerable proportion of tertiary referrals for SBS. Surgical treatment of postoperative obstruction after common surgical procedures is the most frequent cause. Preventing adhesions, avoiding technical errors, diagnosing a potentially ischemic intestine in a timely manner, and approaching the frozen abdomen cautiously are important strategies for preventing this condition.

Adolescent↗
PubMed2005

Small bowel volvulus among adults.

BACKGROUND: To elucidate clinical experience associated with rare cases of small bowel volvulus among adults, we conducted a retrospective study. METHODS: From January 1993 to March 2003 inclusively, we reviewed the presentation and management of 19 patients featuring small bowel volvulus. All study-included patients underwent surgical treatment to confirm their diagnosis. We also analyzed their signs, symptoms, radiological examination details, clinical course and surgical results. RESULTS: The mean age of the study-included 19 patients (13 males, six females) was 61.3 years (range = 16-83 years). All patients suffering from small bowel volvulus were categorized as displaying either primary (no obvious predisposing factors) or secondary volvulus (specific predisposing anatomical abnormalities present). Among them, nine patients were categorized as having primary volvulus, and the remaining 10 were patients with secondary volvulus; this comprised one pregnancy, two malignant stromal tumors of the jejunum, six jejunal diverticula, and one adhesion band. Nine examples of volvulus occurred in the jejunum, four in the ileum, and six in both jejunum and ileum. There were five examples of a counter clockwise rotation of small bowel volvulus. Two patients exhibited bowel wall gangrene, both of whom died subsequent to surgery. The overall mortality rate was 11%. CONCLUSIONS: Although small bowel volvulus is rarely seen among adults, when a patient presents with intestinal obstruction, the possibility of small bowel volvulus must be considered. Early surgical intervention should be undertaken in order to prevent vascular compromise.

Adolescent↗