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PubMed2000

Neonatal intestinal obstruction with isolated levocardia.

An unusual case of isolated levocardia, duodenal obstruction, and malrotation with volvulus is reported. Three cases of situs inversus abdominus with malrotation with volvulus have been reported to date. The current case is the fourth case and only the second survivor in the series. In cases of situs inversus abdominus, because of inversion of viscera, the volvulus may occur in an anticlockwise direction and, thus, should be derotated in a clockwise direction.

Humans↗
PubMed2006

Intestinal transplantation for short bowel syndrome secondary to gastroschisis.

BACKGROUND/PURPOSE: Gastroschisis is the most frequent cause of pediatric intestinal transplantation. This study reviews our experience of intestinal transplantation secondary to gastroschisis to elucidate those factors affecting the outcome of children with short bowel syndrome. METHODS: A retrospective review was performed for children who underwent intestinal transplantation for gastroschisis at the University of Miami between June 2003 and August 1994. RESULTS: Thirty-two transplants were performed in 28 children with gastroschisis during the study period. Associated intestinal anomalies were present in 22 infants (atresia [n = 14], volvulus [n = 3], and/or ischemia [n = 16]). Spontaneous prenatal closure of gastroschisis, a rare anomaly associated with bowel atresia and ischemia because of a very small abdominal defect, was seen in 9 patients. Most of the patients had a complicated course and required multiple abdominal surgeries before transplant. Fifteen (53.6%) patients are currently alive at a median follow-up of 23.5 months. Short-term survival rate has significantly improved in recent years. CONCLUSIONS: Patients with complex gastroschisis and intestinal anomalies have a significant risk for progression to short bowel syndrome. Intestinal transplantation can be a lifesaving option and provides a satisfactory outcome for children with short bowel syndrome secondary to gastroschisis.

Child↗
PubMed1980

Mechanical bowel obstruction. Review of 316 cases in Benin City.

A retrospective study of 316 patients with a diagnosis of intestinal obstruction admitted to the University of Benin Teaching Hospital over a 5 year period is presented. The overall mortality was 10.6 percent. Attention is called to the unacceptably high morbidity and mortality associated with volvulus in this and other series. Because the most common cause of intestinal obstruction in Africa is strangulation, a preventable complication of inguinal hernia, the clinician has a unique opportunity to significantly decrease the incidence of intestinal obstruction in Africa. Finally, our study confirms that the single most important antecedent of a grave prognosis in intestinal obstruction is late presentation of the patient.

Adolescent↗
PubMed1995

Malrotation in the older child: surgical management, treatment, and outcome.

Malrotation in the neonate is an anomaly for which there are clear indications for surgery. However, the management of the older patient with this entity is not well defined. At Arkansas Children's Hospital, we reviewed our patients who were older than two years of age with malrotation. Between 1978 and 1993, 22 cases ages 2-23 years were identified. The most common presenting symptoms were vomiting 15 (68%), colicky abdominal pain 12 (55%), and diarrhea 2 (9%). Other symptoms were hematemesis 1 (5%), and constipation 1 (5%). The duration of symptoms averaged 28 months, range 2-96 months. All diagnoses were made by upper gastrointestinal (UGI) series, except for one that was recognized during an exploratory laparotomy for an intestinal duplication. A Ladd's procedure with appendectomy was performed in all cases. A significant number of patients in our series (41%) were found to have either a volvulus or internal hernia at exploration that was not clearly demonstrated by the diagnostic studies. Intestinal resection was performed in two patients for ischemic bowel. There were no perioperative deaths. Postoperative complications consisted of a wound infection in one patient. Total relief of symptoms occurred in 64% of patients. All patients with volvulus or internal hernia had resolution of symptoms, and all patients reported partial relief of their chronic symptoms. Surgical therapy eliminates the possibility of loss of bowel from volvulus or internal hernia, which is not always evident on diagnostic radiographic examination. Surgery is also highly effective in alleviating the chronic symptoms in these children. We believe, therefore, that surgical treatment is clearly indicated in the older child with proven malrotation.

Adolescent↗
PubMed1992

Volvulus of the colon in a horse associated with a mesocolic-umbilical band.

A 7-years-old Clydesdale mare was presented with severe abdominal distension and acute colic. Dilated large intestine was palpated per rectum and a ventral midline exploratory laparotomy was performed. A 180 degrees volvulus of the pelvic flexure was present, associated with an inelastic band of tissue connecting the mesocolon to the umbilicus. The band was ligated and transected, and the volvulus reduced. Postoperative complications included hyponatraemia, metabolic acidosis and laminitis. The possible aetiology of the mesocolic-umbilical band is discussed.

Animals↗
PubMed1998

[Intestinal obstruction due to Meckel's diverticulum. Description of three cases].

Among 588 small bowel mechanical obstructions operated since January 1982 until December 1996 at the Flajani Surgery Department and Emergency Department of the San Camillo Hospital in Rome, 3 male patients were operated for intestinal obstruction due to Meckel's diverticulum. In one case, obstruction was caused by a small bowel volvulus rolling on a Meckel's diverticulum, whose gangrenous extremity was "blocked" on caecum. In the other two cases, intestinal loops were incarcerated into an internal hernial ring constituted by the same diverticulum whose inflamed extremity was fixed to corresponding mesentery. We examined embryologic and clinical aspects of the pathology here considered, particularly its complications, obstruction being the most common in adult age. Diagnosis is often misunderstood, since a complicated Meckel's diverticulum simulates many other abdominal pathologies. A straight radiography and an ultrasonography of the abdomen may be useful to reach the correct diagnosis. We performed diverticulectomy, using a linear stapler and we underline the opportunity of this method. In young age laparoscopy resection is considered the gold treatment of this pathology by some authors. We didn't observe any mortality, although one of our patients was in a severe septic condition. It is necessary to examine the last ileal 100 centimetres when a suspected acute appendicitis is not initially found by operation. The opportunity of a promptly performed operation is underlined to prevent that such a benign pathology may induce also exitus.

Adult↗
PubMed1992

Neutropenic enterocolitis. Clinical diagnosis and treatment.

Review of the consultation records of the Gastrointestinal Surgical Oncology service at Roswell Park Memorial Institute from 1982 to 1987 revealed 22 patients with a clinical diagnosis of neutropenic enterocolitis. Ninety-one percent of the patients had hematologic malignancies, and 95% were receiving cytotoxic chemotherapy. Sixteen patients were treated nonsurgically; 11 died. Of those 11 cases, autopsies were performed in 9. At autopsy, the clinical diagnosis was confirmed in four cases; four cases were found to have normal intestinal tracts, and one case had a small bowel volvulus. In none of the four cases for which autopsy proved neutropenic enterocolitis was transmural bowel necrosis or perforation found. Laparotomy was performed in six patients; three survived. The clinical diagnosis was verified in four of the six patients. Neutropenic enterocolitis must be considered a diagnosis of exclusion. Care of these patients should be individualized. Nonoperative management with bowel rest, decompression, nutritional support, and broad spectrum antibiotics is recommended initially. Operative intervention is recommended for those with perforation or those whose condition deteriorates clinically during close, frequent observation.

Adolescent↗
PubMed1978

Sigmoid volvulus in two patients with progressive systemic sclerosis.

Sigmoid volvulus was diagnosed in two patients with progressive system sclerosis. In one case, this was initially confused with a high fecal impaction. Both cases responded to early surgical intervention. Sigmoid volvulus should be considered in the differential diagnosis of intestinal obstruction associated with progressive systemic sclerosis.

Adult↗
PubMed1966

Gas in the portal vein: a report of two cases.

Gas in the portal venous system was detected on plain roentgenograms of the abdomen in two women aged 61 and 72 years, respectively. Both patients had intestinal necrosis, due in one instance to a small bowel volvulus around a mesenteric band, and in the second instance to occlusion of the celiac axis, superior and inferior mesenteric arteries. In the first patient, the portal venous gas was detected before surgery, and in the second case the gas was observed at laparotomy and was visualized on radiographs of the abdomen taken shortly after death. Both patients died. Portal venous gas can be distinguished radiologically from air in the bile ducts by its characteristic slender branching gas pattern in the periphery of the liver substance. The presence of portal gas in the adult indicates intestinal necrosis in the majority of cases and should lead to early operative intervention.

Abdomen, Acute↗
PubMed2003

The impact of cystic fibrosis on neonatal intestinal obstruction: the need for prenatal/neonatal screening.

To determine the incidence of cystic fibrosis (CF) in neonates with intestinal obstruction (NIO) secondary to meconium ileus (MI), jejunoileal atresia (JA), meconium plug syndrome (MPS), volvulus (V), and meconium peritonitis (MP) and analyze the correlation of ultrasonographic (US) signs with CF in NIO with a prenatal diagnosis of intestinal anomaly, a prospective analysis of different types of NIO from 1990 to 1998 was undertaken. Immunoreactive trypsin measurement, genetic studies, and sweat tests were performed to confirm or rule out CF. Cases with prenatal diagnosis were analyzed for gestational age, dilated bowel, ascites, hyperechoic bowel, and calcifications. Of 80 neonates, 19 (24%) had CF: 2/33 (6%) JA, 6/14 (43%) MPS, 1/14 (7.1%) MP, 10/10 (100%) MI, and 0/9 V. Thirty (37.5%) had a prenatal diagnosis of an intestinal anomaly. The overall incidence of CF in NIO with a prenatal diagnosis of intestinal anomaly was 4/30 (13%), or 333 times the estimated risk of CF in the general population. A hyperechoic pattern with dilated bowel was associated with higher specificity for CF: 3/3 cases (100%), followed by hyperechoic bowel with ascites: 3/4 cases (75%). All babies with any type of NIO should thus be screened for CF. Prenatal screening for CF should be indicated in all pregnancies with US patterns of specific intestinal disorders.

Cystic Fibrosis↗
PubMed1980

Diagnostic advantages of manual compression fluoroscopy in the radiologic work-up of vomiting neonates.

This paper describes a simple and effective fluoroscopic technique that remarkably improves diagnostic accuracy when evaluating vomiting newborns. The technique also minimizes the time of the examination and the radiation dose to the patient and radiology personnel. Several examples are presented illustrating the superiority of gloved hand or nonopaque compression technique to conventional contrast radiography, emphasizing babies with pyloric stenosis and midgut malrotation. The technical limitations and diagnostic pitfalls of conventional contrast modalities are compared to the highly diagnostic images obtained with manual compression fluoroscopy. All of the classic radiographic signs of pyloric stenosis can be mimicked by antral spasm or pylorospasm. Gloved hand compression overcomes antral spasm and clearly shows the true length and diameter of the pyloric canal in these two conditions. Malposition of the duodenojejunal junction is the only consistently diagnostic sign of midgut malrotation. Nonfixation of the duodenojejunal junction can be competently assessed by compression fluoroscopy, confirming malrotation and midgut volvulus simultaneously and bringing the patient to operation much sooner than with less precise conventional techniques. Gloved hand compression technique also evaluates stenotic areas in the upper gastrointestinal tract, distinguishing spasm from organic marrowing and clearly identifying those which need surgical intervention. Facilitating intubation of the duodenum is a final contribution of compression fluoroscopy.

False Negative Reactions↗
PubMed2000

Magnetic resonance imaging of intestinal necrosis in preterm infants.

BACKGROUND AND OBJECTIVE: Noninvasive diagnosis of intestinal necrosis is important in planning surgery in preterm infants with necrotizing enterocolitis (NEC). We aimed to assess the potential of magnetic resonance imaging (MRI) for the diagnosis of intestinal necrosis. STUDY PARTICIPANTS AND METHODS: Abdominal MRI scans were performed in a group of preterm infants with suspected NEC and compared with surgical findings and to MRI results in a group of control infants. In addition, MRI was performed in 2 preterm infants with suspected NEC who did not require surgery. RESULTS: Six infants with a median birth weight of 1220 g (range, 760-1770 g) and median gestational age at birth of 30 weeks (range, 28-34 weeks) were studied at a median postnatal age of 10 days (range, 4-19 days). Four infants had a bubble-like appearance in part of the intestinal wall, intramural gas, and an abnormal fluid level within bowel lumen. At surgery, NEC was found in 5 infants and sigmoid volvulus in 1. The site of the bubble-like appearance corresponded to the site of intestinal necrosis at surgery. Four control infants with a median birth weight of 1500 g (range, 730-2130 g) and a median gestational age of 31 weeks (range, 26-36 weeks) had abdominal MRI at a median postnatal age of 8 days (range, 4-70 days). None of the above findings were seen in any control infant. The bubble-like appearance was not seen in the 2 infants with suspected NEC who did not require surgery. CONCLUSION: Abdominal MRI allows the noninvasive diagnosis of bowel necrosis. This may aid the timing of surgical intervention in preterm infants with a clinical diagnosis of NEC.gangrene, ischemia, MRI, necrotizing enterocolitis.

Birth Weight↗
PubMed1998

Two unusual cases of megacolons.

A 13-year-old boy with features of intestinal obstruction was found at laparotomy to have a sigmoid volvulus. A 7-year-old girl with a similar presentation had a tight stricture at the rectosigmoid junction causing obstruction. In both cases the proximal colon was grossly loaded with faeces. In the first child, a colostomy after resecting the sigmoid colon was considered the safer option, whereas in the second, an innovative method to decompress the proximal loaded colon using a sterilised colostomy bag was employed, enabling a primary anastomosis to be performed.

Adolescent↗
PubMed1981

[Incarcerated Chilaiditi disease. A rare indication for surgery].

Surgery was performed on a rare case of incarcerated Chilaiditi's syndrome, a syndrome that has been known for 10 years. The patient was in the state of ileus with volvulus of the stomach and hepatodiaphragmatic interposition of the stomach, transverse colon, and omentum majus. The patient was at high risk--77 years old and in bad condition due to hyperemesis and abdominal pain. Preoperative intensive care was necessary. During the operation the intestinal structures were repositioned, the diaphragmatic hernia was resected, and the muscular parts were sewn tight. The right position of the liver was reconstructed by sewing the ligaments. Colon resection was inevitable because the colon loop could not be separated and because there was lack of intraabdominal space. For indication of preventive and elective surgery, we propose that the diagnostics be enhanced when Chilaiditi's syndrome is found by chance and is still asymptomatic. These techniques may include a complete radiological examination with contrast medium, intestinal endoscopy, and computer tomography of the thoracoabdominal region.

Aged↗
PubMed2005

Surgical management of intestinal malrotation in adults: comparative results for open and laparoscopic Ladd procedures.

BACKGROUND: This study aimed to characterize the clinical features of intestinal malrotation in adults, and to compare the results for the open and laparoscopic Ladd procedures. METHODS: Between 1984 and 2003, 21 adult patients with a mean age of 36 years (range, 14-89 years) were surgically treated for intestinal malrotation. The clinical data collected included age, gender, presenting symptoms, diagnostic tests, type of operation, operative time, narcotic requirement, time to oral intake, length of hospital stay, and outcome. The groups (open vs laparoscopic) were comparatively analyzed using two-sample t-tests and Wilcoxon rank sum tests. RESULTS: The two groups were similar in terms of age, clinical presentation, and diagnostic tests performed. The most common presenting symptoms were chronic abdominal pain, nausea, and repeated vomiting. Upper gastrointestinal barium studies (UGI/SBFT) were diagnostic for all patients with malrotation as compared with computed tomography (CT) scanning, which was falsely negative in 25% of patients. A total of 21 patients underwent the Ladd procedure, either open (n = 10) or laparoscopic (n = 11). Three laparoscopic procedures were converted to open. Overall, the laparoscopic group resumed oral intake earlier than the open group (1.8 vs 2.7 days; p = 0.092), had a shorter hospital stay (4.0 vs. 6.1 days; p = 0.050), and required less intravenous narcotics on postoperative day 1 (4.9 vs 48.5 mg; p = 0.002). The laparoscopic group underwent a longer operation (194 vs 143 min; p = 0.053). Sixteen of eighteen patients available for follow-up reported complete resolution of symptoms, 2 felt greatly improved. No patient required a second operation related to volvulus or recurrent symptoms. CONCLUSIONS: The laparoscopic Ladd procedure is feasible, safe, and as effective as the standard open Ladd procedure for the treatment of adults who have intestinal malrotation without midgut volvulus. Patients also benefit from this minimally invasive approach, as manifested by an earlier oral intake, a decreased need for intravenous narcotics, and an earlier discharge from the hospital.

Adolescent↗
PubMed2002

Duodeno-jejunal atresia with volvulus, absent dorsal mesentery, and absent superior mesenteric artery: a hereditary compound structure in duodenal atresia?

Duodenal atresia predominantly represents an isolated entity, but could also be part of a complexly structured intestinal malformation. We report four children, including two from one family, with duodeno-jejunal atresia associated with malrotation, volvulus, and absent parietal attachment of the mesentery. Gross absence of the mesentery and absence of distal parts of the superior mesenteric artery were the most remarkable findings. The small intestine was supplied retrogradely from the right colic artery. Consideration of embryological theories of this malformation takes into account the important role of the duodeno-jejunal flexure during the process of entry of the small bowel loops into the abdomen. Familial occurrence suggests autosomal recessive inheritance. We propose differentiating the pathoanatomical findings in our patients from classical apple peel small bowel syndrome (APSB).

Abnormalities, Multiple↗
PubMed1985

[Pathogenesis and therapy of ileus in childhood].

Between 1975 and 1984 300 children with intestinal obstruction were treated (overall lethality 6.3%). A special problem are cases of volvulus, most on base of malrotation. In case of hermorrhagic infarction all over the small bowel the two-stage-operation has occasionally proved useful. In postoperative or recurrent obstruction a tube splinting of the intestine was used. The mortality of these patients - 106 cases since 1966 - comes to 4.7%.

Adolescent↗