Paraesophageal hernia and gastric volvulus.
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Aged↗
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Results for “Intestinal Volvulus”
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[Laparoscopic treatment of small bowel obstruction with intussusception, volvulus and appendicitis caused by an inflammatory Meckel's diverticulum].
Indications and contraindications for diagnostic laparoscopy in cases of intestinal obstructions are discussed in connection with a 16-year-old patient's case report with small bowel obstruction including intussusception, volvulus and appendicitis caused by an inflammatory Meckel's diverticulum. The use of diagnostic laparoscopy in cases of intestinal obstructions is controversial. In the described case we performed completely laparoscopically the derevolving and desusception of the volvulus and intussusception, the appendectomy and resection of the diverticulum. The procedure itself and the postoperative course were uneventful.
Adolescent↗
Fatal intestinal pseudo-obstruction in brown bowel syndrome.
A 52-year-old man, suffering for years from malabsorption due to endemic sprue, developed progressive bowel dysfunction, ie, recurrent ileus and intestinal pseudo-obstruction. Because of partial volvulus formation, ileocecal resection was performed. Histopathologic examination of the resected specimen revealed signs of advanced brown bowel syndrome, with excessive deposits of ceroid-lipofuscin in, and a considerable loss of, smooth-muscle cells and myofibrils. The patient died after surgery, and at autopsy a systemic ceroid lipofuscinosis of smooth-muscle cells was detected. Neuronal ceroid lipofuscinosis was not observed. Serious and eventually fatal bowel dysfunction is rarely seen in brown bowel syndrome, but may occur in advanced stages. Since treatment with vitamin E appears to exert a favorable effect, early diagnosis of brown bowel syndrome seems to be very important.
Ceroid↗
Intestinal carcinoid in a mare: an etiologic consideration for chronic colic in horses.
Intestinal carcinoid, or argentaffinoma, should be an etiologic consideration for horses with chronic colic. A mare was referred with a history of chronic colic. Previously, the signs of colic had subsided in response to impiric treatment, but recent episodes of colic did not. Clinical signs and results of physical examination supported the finding of strangulating obstruction of the small intestine. Exploratory celiotomy revealed internal herniation with simultaneous volvulus of the jejunum and accompanying carcinoid.
Animals↗
Is ultrasonography a good screening test for intestinal malrotation?
BACKGROUND: Early diagnosis of malrotation can prevent fatal midgut volvulus. Abnormal orientation of the superior mesenteric artery (SMA) and vein (SMV) on ultrasonography (US) has been described in malrotation. We aimed to determine the accuracy of this technique. METHODS: All children undergoing both upper gastrointestinal series (UGI) and US for possible malrotation over a 3-year period were reviewed. Patients were excluded if US did not include SMV/SMA orientation or if the duodenojejunal flexure was not visualized on UGI. RESULTS: Of 211 eligible patients, UGI and US were both normal in 62% and both abnormal in 15%. Forty-four had abnormal US and normal UGI (false positive, 21%), and 5 patients had normal US and abnormal UGI (false negative, 2%). Of these 5, none were found to have a short mesenteric base, which put them at risk for volvulus. Among abnormal ultrasounds, inversion of SMV/SMA and a "whirlpool" sign were more predictive for malrotation and volvulus than anterior/posterior orientation. CONCLUSIONS: Ultrasonography is a good screening tool that effectively rules out malrotation at risk for volvulus. Children with an abnormal ultrasound should have an UGI or go to the operating room, depending on clinical findings.
Adolescent↗
[Segmental ischemic lesions of the mesenteric small intestine].
Segmental ischemic disease consists of segmental infarctions and ischemic stenoses. Vasculitis (LES, polyarteritis nodosa, Schönlein-Henoch syndrome), thrombosis, arteriosclerotic changes, mechanical obstructions (adhesions, hernia, volvulus, traumas), hemorrhagic disorders are the most common causes of these intestinal lesions. The authors report their experience achieved during three years on 428 small bowel examinations; among these, 197 were double contrast enemas. Ten patients showed roentgenographic features referred to vascular diseases: 1 LES, 1 Schönlein-Henoch syndrome, 3 polyarteritis nodosa, 5 spontaneous hemorrhagic disorders or due to treatment with anticoagulants. The authors, after a review of the radiological findings, emphasize the high sensitivity and low specificity of double contrast small bowel enema. Furthermore they underline the usefulness of this method in demonstrating and monitoring intestinal pathologic changes.
Barium Sulfate↗
A rare case of dual obstruction of the colon.
The commonest cause of large bowel obstruction is colorectal malignancy. Volvulus of the colon is a rare cause and caecal volvulus accounts for less than 1% of all cases of intestinal obstruction. Reports of concurrent occurrence of obstructing lesions of the right and left colon are rare and anecdotal. We report a case of Caecal volvulus and carcinoma of the rectosigmoid in a 70-year-old lady.
Aged↗
Gastric and intestinal surgery.
Gastric surgery is commonly performed to remove foreign bodies and correct gastric dilatation-volvulus and is less commonly performed to treat gastric ulceration or erosion, neoplasia, and benign gastric outflow obstruction. Intestinal surgery, although commonly performed by veterinarians, should never be considered routine. The most common procedures of the small intestinal tract performed in dogs and cats include enterotomy and resection/anastomosis. Surgery of the large intestine is indicated for lesions causing obstruction, perforations, colonic inertia, or chronic inflammation.
Animals↗
Glucagonlike peptide-2 analogue enhances intestinal mucosal mass after ischemia and reperfusion.
BACKGROUND/PURPOSE: Glucagonlike peptide-2 (GLP-2), a product of the posttranslational processing of proglucagon, has been shown to enhance mucosal mass and function in both normal intestine and in the residual intestine after massive small bowel resection. This study was designed to determine if a synthetic, protease-resistant analogue of GLP-2 (GLP-2alpha) can enhance mucosal mass in small intestine after ischemia and reperfusion (I/R) injury. METHODS: Ten young adult male Sprague-Dawley rats underwent laparotomy and superior mesenteric artery occlusion for a period of 40 minutes. During this period of ischemia, each rat underwent placement of a jugular venous catheter that was connected to a subcutaneously placed osmotic pump designed to deliver its contents over 3 days. The rats were divided into 2 groups based on the contents of the pumps: group 1, saline at 1 microL/h (n = 6) and group 2, GLP-2alpha at 100 microg/kg/d (n = 4). Three days after insertion of the pumps the small intestine was harvested from the surviving rats for determination of mucosal DNA and protein content. Statistical analysis was performed using unpaired Student's t test. RESULTS: After I/R injury to the small intestine, a 3-day systemic infusion of GLP-2alpha significantly increased mucosal DNA content 41% (P<.05) and mucosal protein content 60% (P<.05) when compared with saline-treated controls. In addition, infusion of GLP-2alpha reduced mortality from 50% to 25%. CONCLUSIONS: These data show for the first time that GLP-2alpha enhances mucosal mass following I/R injury to the small intestine. GLP-2alpha may be of benefit to patients with intestinal ischemia syndromes such as necrotizing enterocolitis and midgut volvulus.
Animals↗
Sclerosing peritonitis after intestinal transplantation in children.
Long-term graft dysfunction and/or graft loss after intestinal transplantation (ITx) is a significant concern. Sclerosing peritonitis (SP) is a manifestation of chronic allograft failure and its presence may also include classic arterial obliterative arteriopathy (OA) as in chronic rejection. We describe the clinical presentation and management of SP occurring after ITx in children. Case records of 121 children undergoing ITx from 1990 to 2003 were reviewed. Three children (2.4%) presented with SP of the intestine allograft at a mean time of 6.6 yr following ITx as follows: age at Tx (yr) 8.2, and 3.7, with indication for ITx being gastroschisis in two and midgut volvulus in one patient. Type of ITx was isolated intestine in one and liver/intestine in two patients. Gross findings of SP included fibrosis/strictures; microscopically SP showed fibrosis/serositis, and fibrous adhesions; one patient had evidence of chronic allograft vasculopathy. All patients presented with clinical signs and symptoms of bowel obstruction and gastrointestinal contrast studies confirmed distal ileal obstruction (DIO). Operative findings confirmed SP and DIO in all patients; all patients were initially treated with distal segmental intestine allograft resection and lysis of the fibrous peel. All three patients recovered, although two required repeat laparotomy, there is only one long-term survival. SP after ITx may be a different manifestation of long-term intestine allograft degeneration. Surgical resection appears to offer palliation.
Child↗
Repeat laparotomy for gastrointestinal disorders in cattle: 57 cases (1968-1992).
A study was conducted to investigate indications for, typical findings during, and outcome of repeat laparotomies in 57 cattle with gastrointestinal disorders. Cattle were grouped according to the reason the initial laparotomy had been performed. Group-1 cattle (n = 46) had had left or right displacement of the abomasum (LDA or RDA) or right volvulus of the abomasum. Group-2 cattle (n = 10) had had ruminal, reticular, or abomasal obstruction or perforation. Group-3 cattle (n = 7) had had obstruction, volvulus, distention, or perforation of the small or large intestine. Median interval between laparotomies was 1 month (range, 1 day to 38 months). Intraoperative findings during repeat laparotomy in group-1 cattle included LDA (n = 18), RDA (9), right volvulus of the abdomen (5), pneumoperitoneum (1), diffuse abdominal adhesions (1), cecal adhesions (1), adhesions of the rumen to the body wall (1), abscess in the cranial portion of the abdomen (1), reticular adhesions (1), localized necrosis (1), and idiopathic rumen distention (1). Intraoperative findings during repeat laparotomy in group-2 cattle included abscess in the cranial portion of the abdomen (4), no abnormalities (1), distended rumen (1), ruptured abomasum (1), recurrent abomasal impaction (1), diffuse abdominal adhesions (1), and pyloric fat necrosis (1). Intraoperative findings during repeat laparotomy in group-3 cattle included LDA (3), RDA (1), cecal volvulus (1), anastomotic rupture (1), and impacted colocolostomy (1). Seven cows and 1 calf underwent additional repeat laparotomies. Forty-four (77%) of the 57 cattle were discharged following final laparotomy. Fourteen of the 20 group-1 cattle, 1 of the 6 group-2 cattle, and 2 of the 3 group-3 cattle for which follow-up information was available were productive after repeat laparotomy.
Abomasum↗
[Intestinal malrotation in children].
Intestinal malrotation has received, so far, little attention in the Spanish medical literature. This is probably due to the fact that is variable forms of clinical presentation may be overlooked during infancy and childhood and be present or not later in adult life. This is a report on 33 patients between 1 week and 8 years old operated upon, from 1965 to 1985, at the Clinica Infantil "La Paz", Madrid, with pre or postoperative diagnoses of intestinal malrotation (patients with Bochdalek's hernia, omphalocele and gastrosschisis are excluded). Midgut volvulus has been the most frequent preoperative complication and has occurred in 50% of patients. Intestinal obstruction was the most frequent clinical presentation, specially in patients under one week of age. There was a 30% figure of associated malformations, mostly of the duodenojejunal area (atresia, diaphragm, anular pancreas). All 5 deceased patients had other associated malformations. Long term survival was 85%.
Duodenum↗
Lethal short-bowel syndrome.
Infants with short-bowel syndrome are difficult to manage. Despite supportive measures with parenteral nutrition and surgery to lengthen remaining bowel or increase functional absorptive surface area, the outcome for many of these infants is poor. We have reviewed a series of seven infants diagnosed with severe short bowel. Causes included volvulus (3), multiple atresias (2), and total intestinal aganglionosis (2). Survival time ranged from 15 days to 8 months. During the hospital course, each infant underwent one to three operative procedures to diagnose and manage the short bowel and all received total parenteral nutrition (TPN) ranging from 10 days to 6 months. One infant died of liver failure and two others developed significant liver dysfunction secondary to TPN. Most infants remained hospitalized until their death. Death occurred at an average of 9 weeks following the diagnosis of short-bowel syndrome. This review suggests that infants with less than 6 cm of small bowel beyond the Ligament of Treitz will inevitably die of their disease or treatment complications. Until bowel transplant becomes a viable alternative, operative intervention and nutritional support may prolong survival but will not change the outcome of these infants and will only contribute to additional morbidity. A decision to withhold further therapy would be reasonable at the time the diagnosis is established.
Enteral Nutrition↗
Morbidity and mortality of colostomy and its closure in children.
BACKGROUND: This study evaluated the complications of colostomy and its closure in infants and children. METHODS: One hundred forty-six colostomies were performed in 86 neonates, 23 infants, and 37 children older than 1 year. These children underwent colostomies for anorectal malformation (84), Hirschsprung's disease (47), and other miscellaneous (15) conditions like colonic atresia, volvulus, rectal tuberculosis, traumatic rectal perforation, and intestinal obstruction caused by ascariasis. RESULTS: Of these, 17 (11.6%) had early complications, and 80 (69.8%) had stomal complications. Three patients died, but only 1 death was directly related to colostomy. Colostomy prolapse, peristomal excoriation, and malnutrition were the major complications. The complications were not dependant on the children's age or primary indication. Sigmoid colostomy had a lower malnutrition rate than transverse colostomy (34.9% v 16.9% P =.009). Among the 56 children who underwent colostomy closure, major complications include death (1.8%), anastomotic leak (7.1%), and wound infection (12.6%). CONCLUSIONS: A divided sigmoid colostomy should be performed whenever possible. Proper stomal care, regular nutritional assessment, and early closure of the colostomy would minimize morbidity and mortality of colostomy and its closure.
Abnormalities, Multiple↗
Cecal volvulus: A diagnostic and therapeutic challenge.
Cecal volvulus is a malrotational abnormality of the intestine that causes obstruction. Diagnosis is difficult and, if delayed, the results may be intestinal ischemia, perforation, sepsis, and even death. Cecal ischemia or gangrene cannot always be determined from physical and laboratory findings. Although not always conclusive, contrast radiography may be helpful; however, laparotomy is often required for definitive diagnosis and therapy. If vascular compromise of the cecum is found, right hemicolectomy is the treatment of choice. In the absence of ischemia, decompressive tube cecostomy, simple detorsion, and cecopexy have all been recommended, but the optimal treatment is a matter of controversy.
Barium Sulfate↗
The misplaced caecum and the root of the mesentery.
Five cases presenting in late infancy and childhood with symptoms and signs referable to malrotation of the midgut are described. The condition may present with jaundice, malabsorption or the signs and symptoms of intestinal obstruction due to internal hernia or volvulus. It may also result in volvulus and gangrene of the midgut. A short root of the mesentery predisposing to this event will be seen on a barium meal and follow through examination and will warn of its impending occurrence.
Cecum↗
Chilaiditi syndrome with hypertension.
Chilaiditi syndrome is interposition of the intestine between liver and diaphragm. It is often asymptomatic but there were cases presented as acute pain in the abdomen, needing corrective surgical procedure; or as mistaken renal colic, or as suspected subphrenic abscess, or as pneumoperitonium. The interposition of proximal transverse colon was found to be more common than the small intestine. Chilaiditi syndrome was associated with colonic volvulus. The colonic interposition then progressed from mild abdominal discomfort to intermittent bowel obstruction. Some patients needed surgical operation like hepatic extraperitonealization, after replacement of the dislocated gastroenteric tract, bringing the superior surface of the liver again into direct contact with the related diaphragmatic dome. A rare case of Chilaiditi syndrome incidentally associated with hypertension and ischaemic heart disease, in a male aged 50 years is reported.
Colon↗
[The abdominal complications of ventriculoperitoneal diversions].
We report several cases of abdominal complications in hydrocephalus children with ventriculoperitoneal shunts implanted by different ethnology, as well as the pathology produced. The number of children affected was 16, although some of them had suffered more than one complication, making up a total of 25 cases. The most frequent trouble was due to the intraperitoneal catheter fall, followed by intestinal perforation at different levels, allowing the catheter to get out through the anus, abdominal wall or surgical incision. Some intestinal occlusive situations was due to either volvulus or external compression caused by cerebrospinal fluid abdominal pseudocysts, secondary to ventriculoperitoneal shunt. We took different characteristics of this group of patients and studied the different complications in relation with specialized reports by international authors.
Abdomen↗