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On the occasion of 2 cases, torsion of an ovarian cyst and volvulus of a cystic intestinal duplication, the authors emphasize the usual benignity of fetal intra-abdominal solitary cystic pictures, among which the most frequent are the ovarian cysts. Antenatal diagnosis allows for detection of complications, especially torsions and for early neonatal management always leading to surgical treatment.
We have encountered two patients with volvulus of the small intestine at the ileocolic anastomosis, occurring after jejunoileal bypass. This uncommon complication is generally seen many months after bypass and may be difficult to diagnose. Barium enema examination was helpful in one patient. If there are acute, severe abdominal symptoms, mechanical obstruction and early operation should be considered. Attention has been called to other intestinal syndromes with obstructive features developing after jejunoileal bypass, and these have been compared.
The article deals with experience in surgical treatment of 375 patients with various diseases of the small intestine, rare diseases (tuberculosis, enterolithiasis, tumors, etc.) among others. These diseases were usually manifested clinically in the late stages by ileus, peritonitis or bleeding into the gastrointestinal tract. Most patients with surgical diseases of the small intestine were subjected to operation for emergency indications. Such instrumental methods as laparoscopy, selective endoscopic radiocontrast study of the small intestine, angiography, etc. are important in the diagnosis of the diseases. The authors emphasize the high diagnostic efficacy of a special method of selective endoscopic radiocontrast study, especially in tumors of the small intestine. According to the authors, general mortality rate in diseases of the small intestine is high (13%) and is mainly due to such diseases as disorders of mesenteric blood circulation, incarceration of the intestine in a hernia, adhesive obstruction, volvulus, etc. The authors claim that mortality in diseases of the small intestine can be reduced if early diagnosis, early hospitalization, and adequate surgical interventions are ensured. Among the factors contributing to increase of the efficacy of surgical operations the authors indicate efficacy of surgical operations the authors indicate precision techniques of intestinal suture application with atraumatic suture material, the use of complex biological protection of the anastomosis including treatment with low-frequency ultrasound and subsequent application of collagenic films in which antibacterial agents are deposited, and measures for stimulating reparative regeneration.(ABSTRACT TRUNCATED AT 250 WORDS)
The diagnostic work up of an acute abdomen may be more difficult in pregnant than in non-pregnant women due to the normal anatomical and physiological changes that occur during pregnancy. Delayed diagnoses and treatment may have more serious consequences for pregnant women than for other patients. We report the cases of two pregnant women, one with a volvulus of the small intestine and the other with a perforated appendix. We discuss important aspects of the diagnostic work up for acute abdomen with surgical etiology in pregnant women. If a surgical etiology is suspected in a pregnant women with acute abdominal pain, the patient should be examined and followed closely both by a surgeon and a gynaecologist until a final diagnosis is reached.
A 19 year-old man had a clinical history of volvulus, ascites and abdominal pain; later, malabsorption syndrome was recognized. Jejunal biopsies obtained by endoscopic technique show changes consistent in Whipple's disease with minimal intestinal involvement and atrophy. This case report is the first in which volvulus, minimal intestinal involvement and malabsorption syndrome were recognized together. Treatment was successful with trimethoprim-sulfamethoxazole. A literature review with emphasis in recent topics, was made.
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A 31-year-old man underwent a laparotomy for acute intestinal obstruction symptoms, which he had intermittently experienced for 14 years. The cause of the obstruction was due to a volvulus of the small bowel caused by a mesenteric lipoma. This is a rare finding, which is ideally diagnosed by computed tomography, with surgery the best and most highly recommended treatment. This particular presentation, to the best of our knowledge, has not yet been previously reported in the English language.
Small intestinal diverticulosis is a rare cause of abdominal pain. We report the case of a patient whose chronic intermittent abdominal pain was due to recurrent spontaneous perforation of jejunal diverticula, and who ultimately developed an acute volvulus of the small bowel, a very rarely reported association of the disorder.
A case of distal volvulus of the stomach as a cause of acute intestinal obstruction in a paraesophageal hernia is presented. The patient, an old woman aged 82, had been suffering from abdominal pain and vomiting for about 48 hours. She successfully underwent emergency operation for the reduction of hernia and plasty of the hiatus anterior the esophagus. On the basis of personal experience and review of literature data, stress is laid on the high incidence of paraesophageal hernia complications and the importance of early diagnosis and surgical repair is underlined.
Mesenteric cystic lymphangioma is a rare pathology which is not often described in the literature. Moreover, its etiopathogenesis is still uncertain. It may remain asymptomatic or it may present aspecific painful abdominal symptoms of the sub-acute type correlated with compressive phenomena or, more rarely, with acute intestinal obstruction. Surgery is the only form of treatment for both acute and sub-acute abdominal forms. The authors report a case of two mesenteric cystic lymphangiomas of the ileum which led to the onset of intestinal obstruction caused by ileal volvulus in a 45-year-old man.
Cecal volvulus is an uncommon cause of intestinal obstruction. Operative management is the accepted form of treatment. We report a patient with cecal volvulus who was a poor surgical risk and was successfully treated by decompression and detorsion with the use of a decompression tube inserted through the colonoscope.
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Despite the recent advent of total parenteral nutrition (TPN), the long-term survival of the patients with short gut syndrome is not satisfactory with complications of catheter-related sepsis and cholestasis. The causes of short gut syndrome in pediatric surgery are multiple intestinal atresias, necrotizing enterocolitis (NEC), and midgut volvulus. For the multiple atresias, multiple anastomosis without resection has been successfully undertaken to avoid developing short gut syndrome for the last 17 years. For the massive involvement of the intestines due to NEC or volvulus, high jejunostomy and peritoneal drainage with TPN support have been tried for the last two patients and successfully weaned from the TPN within two months after closure of jejunostomy. However, in case 2 malabsorption has been persistent presumably due to a severe degree of mucosal damage occurring in the remaining intestines. Whether this eventually gets back to the normal or not is unknown. For the patients with short gut syndrome, small bowel reversal procedure was successfully done and now doing well 10 years after surgery. This paper reports details of these 3 cases.
INTRODUCTIONS: sigmoid volvulus is a relatively common cause of intestinal obstruction, particularly in the elderly and in patients with debilitating conditions. As the risks associated with surgical treatment of the sigmoid volvulus are in many cases too high, conservative (endoscopic) management is an option to be considered. MATERIAL AND METHODS: all emergency lower gastrointestinal endoscopies performed between January 1, 1996 and December 31, 2001 were review and, among these, the cases of diagnosis of sigmoid volvulus were selected. The results of the endoscopic management, percentage of recurrence, mortality rate, complications, surgical procedures etc were evaluated in the select cases. RESULTS: lower gastrointestinal endoscopy was diagnostic in all cases. Endoscopic management showed and overall efficacy of 87.5%. recurrence appeared in approximately 57% of the cases. Successful treatment was accomplished for the first episode in 25% of the cases. In case of recurrence, endoscopic management could be performed again with similar efficacy and safety. CONCLUSIONS: endoscopic reduction is a safe and successful technique for the management of emergency sigmoid volvulus, provided vascular compromise in the intestinal wall is ruled out. As recurrence is frequent, elective definitive surgery could be a treatment to consider. Endoscopic management could be the only choice treatment in the case of patients not it for surgery due to the very important risks associated with it their cases.
An anomaly of the position of the midgut in a pregnant woman predisposes to volvulus. Vascular repair, despite the abdominal catastrophe, sometimes allows parts of the intestine to be saved. A case of volvulus in a pregnant woman is described. At operation, 18 hours after onset, two anomalies were found: reverse rotation of the midgut and an anomaly of the collecting system of the superior mesenteric vein. Most of the midgut was infarcted. Thrombi were removed from the superior mesenteric vessels, and a portion of the anamalous superior mesenteric vein was reconstructed. All but 3 M. of the small bowel and the entire right colon were resected. Prolonged treatment with parenteral hyperalimentation enabled us to control the appearance of a moderate degree of malabsorption. To our knowledge, no similar case has been reported previously in the literature.
Seventy-four patients were operated on at Childrens Hospital of Los Angeles between 1951 and 1977 for abnormalities of intestinal rotation with or without volvulus. The mortality in this group of patients was 4% and represents a significant improvement from the 23% mortality previously reported from this institution between 1937 and 1951. Neonatal patients had bilious vomiting and signs of high intestinal obstruction while older children had a more chronic course characterized by intermittent episodes of abdominal pain. Evaluation with contrast studies and early celiotomy is mandatory to prevent bowel necrosis. We outline the associated gastrointestinal anomalies and management of these combined anomalies.
Glucagon Like Peptide 2 (GLP-2) has been proposed as an important regulatory hormone in nutrient absorption. The present study was conducted in human infants with intestinal dysfunction undergoing surgery, correlating postprandial GLP-2 levels with intestinal length, nutrient absorption, and patient outcome. We hypothesized that GLP-2 levels would be inversely related to nutrient absorption; we further hypothesized that post prandial GLP-2 levels would be predictive of the ability to wean patients from total parenteral nutrition (TPN), and tolerance of enteral feeding. Infants prospectively identified with nutrient malabsorption following intestinal surgery were monitored and after initiation of feeds GLP-2 levels were measured in the fed state. Intestinal length was recorded intraoperatively and nutrient absorption was quantified using both a balance study, and carbohydrate probe method. 12 infants had GLP-2 levels successfully measured; two patients had repeated studies. Average gestational age was 32.7 +/- 3.4 wk, age at testing was 1.7 +/- 1.4 mo and average weight was 3.5 +/- 1.1 kg. Causes of intestinal loss were necrotizing enterocolitis, atresia and volvulus. Five patients had severe short bowel syndrome (<50% of normal small intestinal length), 3 died. GLP-2 levels were best correlated with residual small intestinal length (r2 = 0.75). Correlations with total intestinal length including colon were less significant; residual colon appeared to not contribute to measurable GLP-2 production. GLP-2 levels were well correlated with tolerance of enteral feeds. Contradicting the initial hypothesis, GLP-2 levels were directly correlated with nutrient absorptive capacity (correlation with fat absorption: r2 = 0.72, carbohydrate = 0.50 and protein = 0.54 respectively). There were no apparent changes in GLP-2 levels with gestational or postnatal age. As a corollary to the correlation with bowel length, a postprandial level of 15 pmol/L appeared to be discriminatory; infants with postprandial GLP-2 levels of > 15 pmol/L were able to be weaned from total parenteral nutrition, while 3 of 4 infants who had GLP-2 levels less than 15 could not be weaned by one year. These results show that in infants with intestinal dysfunction, GLP-2 levels are correlated with residual small bowel length and nutrient absorption, and may be predictive of outcome. In contrast to adults with intact colon and SBS, infants with SBS and intact colon do not appear able to produce GLP-2 in response to feeding stimulation. Further studies are suggested to examine the ontogeny of the GLP-2 axis and the possible therapeutic role of GLP-2 supplementation.