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PubMed1978

The radiology of ileosigmoid knot.

The findings on the radiographs of 14 cases of ileosigmoid knot are presented and analysed. The clinical features and pathology of the condition are briefly described. The key radiological features consist of a dilated loop of pelvic colon, evidence of small intestinal obstruction and retention of faeces in an undistended proximal colon. The dilated loop usually lies in the right side of the abdomen and the limbs taper inferiorly into the right lower quadrant. Medial deviation of the distal descending colon is an inconsistant but highly specific finding. The radiographs readily permit distinction from primary volvulus of the small intestine and from non-obstructive surgical emergencies such as perforated viscus and ruptured ectopic pregnancy. The combination of radiographic findings may however be simulated by volvulus of the right colon, closed loop small intestinal obstruction and by volvulus of the pelvic colon complicated by peritonitis. The differential diagnosis is discussed and the value of sigmoidoscopy, rather than barium enema, emphasised.

Adolescent↗
PubMed1990

An individualized approach to the management of gastroschisis.

A 93% survival rate was achieved in 80 neonates treated for gastroschisis between 1979 and 1986. Uncomplicated gastroschisis occurred in 70 infants (88%); 51% underwent staged silo reduction and 49% had primary fascial closure. Gastroschisis associated with intestinal atresia or volvulus was present in 10 neonates (12%), half of whom had a residual jejunoileum between 10 and 55 cm. Major postoperative complications included gastrointestinal problems (infarction, obstruction, and prolonged dysfunction), wound infection, and catheter-associated difficulties (sepsis, infiltration, and malposition). Three of the six deaths were related to associated conditions (extreme prematurity, trisomy 13, and multiple anomalies) and three were caused by intraoperative hemorrhage, necrotizing enterocolitis, and extensive short-bowel syndrome. No statistical difference in morbidity, mortality, and length of hospitalization was demonstrated between infants treated by silo reduction and primary closure. Safe management of gastroschisis should include an individualized assessment of visceroabdominal disproportion and degree of intraabdominal tension. Vigilant expectation of potentially life-threatening complications is required to decrease postoperative morbidity, irrespective of the technique of abdominal wall closure.

Abdominal Muscles↗
PubMed2002

Meckel's diverticulum associated with ileal volvulus in a neonate.

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.

Humans↗
PubMed1985

Volvulus of cecum following simple nephrectomy.

We report a case of intestinal obstruction secondary to cecal volvulus following a palliative nephrectomy. Cecal volvulus and other causes of acute abdomen should be considered in postoperative patients who develop adynamic ileus undergoing retroperitoneal surgery.

Aged↗
PubMed1981

The universal, muscular chain reaction, muscle spasm, torsions, ruptures and extravasations. Chameleons of pathology and some manifestations of simple muscular disorders.

Most bodily functions require the coordinated actions of complementary and supplementary paired muscle groups. Where this essential muscular cooperation is lacking, hollow organs may burst and others become literally screwed up, giving rise to many similar spastic diseases such as Torticollis, Twisted ovarian cyst, Torsion of the Testis, Volvulus of the intestines, Varicose Veins, Megacolon, Aortamegaly, Scoliosis, Erb's Palsy, Peyronie's Disease, Main-en-Griffe, Undescended Foot (Pes Cavus), Talipes, Strabismus. Spasm is "panenepidemic" and unclassified examples of Torsion Dystonia and Dyskinesia really are as common as debt and taxes.

Female↗
PubMed1988

Ischemic bowel after primary closure for gastroschisis.

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.

Abdominal Muscles↗
PubMed1990

Colonoscopy in critically ill patients. What conditions call for it?

Indications for colonoscopy in the intensive care unit include acute lower intestinal bleeding, sigmoid volvulus, pseudo-obstruction of the colon, and suspicion of pseudomembranous colitis. Although the incidence of cardiorespiratory complications may be higher in these critically ill patients, the procedure can be done safely with proper attention to detail. Because of colonic dilatation, endoscopy can often be done without bowel preparation.

Colonic Diseases↗
PubMed2004

[Acute abdominal pain in childhood].

Acute abdominal pain in children occurs often and requires rapid clarification. Hints as to the condition are often given by the first impression and the case history of the patient. When the clinical examination and laboratory results do not lead to a clear finding, imaging methods such as a sonography can clarify the case. The most common cause for abdominal pain in infants is acute enteritis, mostly brought about by rotaviruses. Additional diagnoses are abdominal hernia, malrotation, hypertrophic pyloric stenosis, invagination or gastroesophageal reflux. In school-age children, the classic finding is "appendicitis". This should be differentiated from constipation, gastritis, pancreatitis, sigmoid volvulus, bowel and intestinal obstruction or, perhaps, gallstone trouble.

Abdomen, Acute↗
PubMedDate not supplied

Pneumatosis cystoides of the right colon: a possible source of misdiagnosis. Report of a case.

Pneumatosis cystoides intestinalis is a rare condition that can be located in any part of the gastrointestinal tract. It is usually associated with a wide variety of gastrointestinal or pulmonary diseases. The primitive form is much less frequent and usually involves the left colon. The pathogenesis of pneumatosis cystoides intestinalis is still unclear. The mechanical theory, which is the most accepted explanation, postulates that gas is forced into the bowel wall by breaks in the mucosa; this is more likely to occur when the intraluminal pressure is higher, as happens in obstructive conditions, during endoscopies, or during infections from gas-forming bacteria. Pneumatosis cystoides is often asymptomatic, representing an occasional finding during investigations for other abdominal conditions. Complications occur in about 3% of cases and include obstruction, intussusception, volvulus, haemorrhage and intestinal perforation. When presenting acutely or in association with other abdominal conditions the differential diagnosis is rarely a problem. More important is to diagnose asymptomatic primitive submucosal pneumatosis of the colon, in order to avoid unnecessary intestinal resections. The Authors present the case of a patient with pneumatosis coli who underwent laparotomy for a suspected colonic lipomatosis of the right colon.

Colon↗
PubMedDate not supplied

Clinical observation of meconium peritonitis.

Twenty cases of meconium peritonitis were found between September 1980 and March 1988 at Mackay Memorial Hospital. The male to female ratio was 1.5 to 1. Six of the 20 cases involved premature babies. The great majority presented symptoms and signs before 5 days old, but one case was not diagnosed until 13 months of age. Polyhydramnios of the mother was found in six cases (30%). Abdominal distension was the universal symptom in all 20 cases. Hydrocele was noticed in 8 of the 12 male babies. In seven cases (35%) radiological examination showed abdominal calcifications. All patients underwent surgical intervention. Peritonitis was of cystic type in seven cases (35%); fibroadhesive in nine cases (45%); generalized in four cases (20%). Evident intestinal perforation was noted in 13 patients, and a mechanical obstructive lesion was found in 9 cases (45%) including intestinal diaphragm, atresia, volvulus, and Hirschsprung's disease. In only two patients (10%) was neither evident perforation nor obstructive lesion. The overall mortality rate was 30% (6/20), with no mortality after 1986 (0/6). The mortality seemed increased in those associated with perforation (4/13) and midgut volvulus (2/2) in particular, compared with non-perforation cases (1/7). It appears that early aggressive operation, and meticulous postoperative care, have contributed to the higher survival rate in recent years.

Cysts↗
PubMed1980

[Operative procedure guidelines for the treatment of colonic volvulus].

In Western Europe volvulus of colon is a very rare disease. We observed only 15 cases within 15 years among more than 70,000 patients. In comparison with the literature we try to give some recommendations for the treatment of colonic volvulus. If the intestine is without disturbance of blood supply a two stage proceeding is proposed: first derotation of the intestinal loop and in a second step elective resection. If there is gangrene or perforation incontinuity resection without primary anastomosis is recommended.

Colonic Diseases↗
PubMed1994

The "institutional colon": a frequent colonic dysmotility in psychiatric and neurologic disease.

OBJECTIVES: The true existence of a disease entity termed "institutional colon" has remained controversial. The present study serves to test whether this entity actually exists and how frequently psychiatric and neurologic diseases are associated with colonic dysmotility. METHODS: Using the hospital discharge records of four million US military veterans, we investigated the comorbid occurrence of volvulus, impaction of intestine, constipation, and megacolon with any neurologic or psychiatric disease. RESULTS: Comorbidity of colonic and neurologic/psychiatric diseases in identical subjects occurred two to three times more often than one would expect from the overall distribution of each group of diseases alone. Presenile dementia and Alzheimer's disease, Parkinson's disease, multiple sclerosis, and quadriplegia were associated significantly with all four colonic diseases. The various forms of schizophrenia coincided mostly with megacolon and constipation. Major depressive disorder was associated only with constipation, but with none of the other colonic diseases. CONCLUSION: Psychiatric and neurologic diseases are frequently associated with colonic dysmotility. The association raises the possibility of a pathophysiologic link involving the neuronal control of colonic motility.

Colonic Diseases↗
PubMed1997

Intrauterine volvulus without malrotation in a very low-birth-weight preterm infant.

Midgut volvulus without abnormalities of intestinal rotation/fixation is an extremely rare cause of acute intestinal obstruction in the neonatal period with a high morbidity and mortality. The authors describe an intrauterine volvulus without malrotation in a 970g preterm girl born at 27 weeks' gestation. The discrepancy between minimally evocatory clinical manifestations and severity of intestinal pathology is underscored. Resection of the necrotic bowel and primary end-to-end anastomosis within 30 hours of birth was followed by a favorable outcome. A literature review indicates a significant relation of intrauterine midgut volvulus without malrotation to preterm birth with low-birth-weight, immediate postnatal presentation and favorable prognosis.

Adult↗
PubMed1988

[Long term prognosis after massive small bowel resection in children].

Eight survivors after massive small bowel resection were reviewed for a period of 2 to 19 years to assess the long term prognosis of patients. The primary diseases of short bowel syndrome were congenital intestinal atresia (6) and midgut volvulus (2). The length of the residual small intestine ranged between 27 and 75 cm and ileocecal valve was also resected in 3 cases. All cases had been already weaned from parenteral nutrition and six children tolerate normal meals and two have still enteral formula at home now. Near normal somatic growth was achieved in cases which received intensive nutritional supports after operation. The D-Xylose absorption test revealed gradual improvement except one with the shortest intestine (27 cm) and fat absorption was disturbed in patients who had less than 45 cm residual intestine. Late metabolic complications, such as renal calculus, cholelithiasis and pathologic fractures were encountered in three cases.

Child, Preschool↗
PubMed2005

Surgical treatment of the sigmoid volvulus.

Sigmoid volvulus is not an uncommon cause of intestinal obstruction. The purpose of this study is to evaluate the clinical features and surgical treatment methods in patients with sigmoid volvulus. Thirty-two patients operated on between January 1991 and October 2002 were reviewed retrospectively. The demographic data of the patients, clinical features, preoperative radiological and operative findings, type of surgical procedure performed, postoperative complications, mortality and duration of hospital stay (DHS) after surgery were reviewed. There were 21 male (66%), 11 female patients (34%) and their age ranged from 61 to 87 years with a median of 73.5 +/- 8.38 years. Most frequent clinical features were abdominal pain, distension and constipation. The correct preoperative diagnosis was made in 44% (14/32) of cases. Surgical treatment consisted of sigmoidectomy with primary anastomosis (R&A) (n = 9, 28%), sigmoidectomy with colostomy (R&C) (n = 16, 50%), and detorsion with sigmoidopexy (D&P) (n = 7, 22%). Concomittant diseases were more frequent in R&C group (n = 14, 87%) and this was statistically significant as compared to R&A (n = 4, 44%) (P = 0.03). Postoperative complication rate in R&C group was more frequent and DHS longer but the difference between treatment groups was not significant statistically. Two recurrences were observed in D&P group. Sigmoidectomy should be the basic principle in management of sigmoid volvulus and primary anastomosis can be performed safely in selected patients without increasing morbidity and DHS.

Abdominal Pain↗
PubMed1992

Synchronous cecal and sigmoid volvulus. Report of a case.

Volvulus is a rare cause of intestinal obstruction in the U.S. Sigmoid colon volvulus is the most frequent, followed by cecal volvulus. The simultaneous occurrence of cecal and sigmoid colon volvulus is extremely unusual. We are reporting what to our knowledge is the third case.

Cecal Diseases↗